Personal Effects


Based on principles of Victorian social engineering and the workhouse ethos, hospitals, like prisons and schools, have a robust institutional symbolism and iconography. Their daunting edifices and regimented profiles offer deep rooted associations. Largely run on well grounded principles of hierarchy the style of delivery is cornrnand driven and paternalistic. A global demand for less hostile and more patient orientated hospitals has stimulated considerable debate on which kind of environment is appropriate for healing. This fresh demandled approach with its exciting possibilities offers a direct challenge to established orthodox hospitalisation.

Over the last 20 years a healing art dimension has been introduced across a wide range of health facilities. To date most emphasis has been placed on advocacy, rather than on the benefits of hospital art programmes which remain largely anecdotal and are accepted as an act of faith. However value for money doctrines and bottom line attitudes means the quality of hospital design is constantly undermined. The latest PFI initiatives have long-term financial prerogatives where profits rule over the interest of staff and the comfort of the patients. Changes under these circumstances will be resisted and those concerned with innovation and improving design standards will need all the encouragement they can rnuster.

Research Scientific research has determined that improvements in hospital accommodation will bring benefits and likely improvements in the rates of recovery. It is realised the physical surroundings are important to the morale and spiritual wellbeing of the users. The health managers and caring professionals should he made aware of the accumulating evidence. The master of medical measurement Roger Ulrich believes health outcomes analysis is important, because as he says, if sound research demonstrates that appropriate art beneficially affects the health of patients, "you have a powerful new kind of argument, a mainstream medical argument for having art in healthcare facilities."

What is significant is that existing clinical areas, according to the Centre for Healing Environments in Tokyo, have been proved to have a detrimental effect on the health of the inpatient. The chair of the centre (Dr Kazue Takayanagi, a leading paediatrician from the Nippon Medical School) was a key speaker at last years CHARTS conference in Manchester, organised by Arts for Health. Uniquely comprising of medical consultants, the centre presented a report 'The Psychological and Physiological Effects of an ICU environment on Healthy Individuals'. An abstract suggests the ideal environment would be one in which patient stress and anxiety is alleviated. They hypothesise that even normal healthy individuals might experience psychological stress and rises in hormone levels known to be associated with mood and stress, when exposed to an inpatient hospital environment. Ten healthy volunteers were admitted to an intensive care unit (ICU) for four days and their mental state of mind and physical condition before and after admission were examined. Results affirm almost all individuals developed feelings of depression, as measured by the profile of mood states ('POMS') and the Zung Self-Rating Depression Scale ('SDS'). Fatigue and confusion increased and vigour decreased. The qualitative assessment Q&A confirmed that healthy subjects often engaged in introspection during hospitalisation and often had a negative attitude towards the unit's environment. The findings of increased feelings of depression attributed solely to being in ICU are anathema to the type of critical care setting generally considered necessary to alleviate patient anxiety and tension. The 'negative' perception of this environment found by the Q&A strongly suggests room for improvement. It was concluded efforts should focus on nourishing the five senses; particularly sight, sound and taste within the ICU environment. Dr Takayanagi believes it is important for medical consultants like herself to engage in this type of enquiry and she would like to encourage an international network of such centres.

Promoting the effect of art on healing, the UK National Coordinating Council is the nearest equivalent to her activities here in the UK. This organisation, supported by the Nuffield Foundation was recently set up under the chairmanship of Prof Michael Baurn, professor of surgery at University College London. It is described as a 'virtual' resource centre which will be commissioned to build up a body of knowledge, and collate evidence on the importance of the arts and design in the field of humanities and medicine.

This initiative has three main strands: to provide a philosophical base for the undergraduate curriculum in order to train clinicians to be better scientists. There is also to be a round up of current art therapy practice, and the third strand concentrates on the arts and healthy lifestyles. The brief is to gather coherent studies into perception and the arts as intervention. They propose to analyse research methodology, performance indicators and outcomes. The Nuffield virtual resource for healthy arts will be a network of the great, the good, and most importantly the influential, in the spheres of medicine. The question of whether introducing the humanities into education of the caring professionals will lead to a more humanistic approach to healthcare will be addressed at the forthcoming Healing Arts Conference' at the Royal Society of Art in London.

Funded by the NHS, one live project: 'The Architectural Health Care Environment and its effects on Patient Health Outcomes' is currently underway. The study, which involves universities in Sheffield and Trondheim is chaired by the architect John Wells-Thorpe. He is to make a presentation of their findings at the midsummer conference 'Integrating Design and Care in Hospital Planning for the New Millennium" in Stockholm. In order to make strict clinical comparisons the research programme deals with measurable and quantifiable results. Understanding ways our senses are affected by sight, sound, smells and texture will provide the basis for designers to create healthy environments in a variety of settings. The study will include mental healtheare facilities and analyses the problems experienced by patients suffering 'from dementia. By measuring physiological responses and recovery times the study will provide evidence of whether creative design interventions can achieve beneficial results for patients. An example is The Woodlands Nursing Home', which was completed in 1994 by Lambeth Community Health to decant forty elderly confused patients from the old Tooting Bee Hospital. It was designed by Penoyre & Prasad Architects to appeal to all of the bodily senses and to high quality specification throughout. Flooded with natural daylight it provides a range of sensory devises as circulation and orientation clues. For patients who are inclined to wander it features a safe walkway loop through the building and outside to the four strolling path gardens.

With a 'study of the effects of the performing and visual arts in healthcare', Chelsea & Westminster Hospital Arts is test- ing its own activities. The aim is a qualitative analysis and a critical evaluation of the effects of the arts on patients, staff and visitors to the hospital. According to Dr Rosalia Staricoff, the chief investigator, the methodology for this research will include interviews, and an unambiguous questionnaire covering all of the hospital arts activities. 'The Hospital Anxiety and Depression Scale' by Zigmond & Snaith will be distributed in selected parts of the hospital. A number of controlled experiments and objective measurements such as blood pressure and pulse rates in relation to the presence of visual arts and music will be conducted. Due to extra demand, trials will, depending on availability of funds, be extended. The Exeter Evaluation, a National Lottery-funded Arts for Health project undertaken by Peter Scher and Peter Senior, is a substantial documentation of a two-year study on ways to alleviate negative aspects of being in hospital. The study is to be published in May when all will be revealed at its launch conference on 6 May.

Appropriateness The notion that certain environments can enhance health and healing has inspired other international research programmes in sensory perception and therapeutic benefits. Most widely known are those undertaken by Professor Roger Ulrich at the Centre for Health Systems and Design, within the College of Architecture at Texas A&M University. Famous for his findings on improved recovery rates for patients with a view of a tree, his observations would appear to have influenced the Federal Government "to make views of nature mandatory within five years." Making an appearance at last year's CHARTS conference, he stated the most stress-reducing phenornena in universal terms are caring, smiling faces, comedy and laughter, music in certain keys, nature, trees, plants and water. The research indicates psychologically appropriate art can substantially affect anxiety and medicine dosage. Art which is beneficial to patients with acceptably low undesirable effects he defines as 'Good Art'. This according to Ulrich is the criteria for determining the value of piece of art in healtheare. He claims some styles have negative effects on patients and they are inappropriate in clinical care settings. Describing the effect certain types of paintings had on patients, he jested; "Jackson Pollock could kill in heart surgery."

Research Ulrich undertook on 160 elderly heart procedure patients in Uppsala, Sweden, revealed a poor response to his sample of abstract art. The image of a jagged edge, located at the foot of the bed, made people more sick than those with no art, and seven out of a group of 26 requested for the picture to be removed. In psychiatric wards in Uppsala, some abstracts were physically attacked by patients. Good art such as lake and tree landscapes he claims reduced the intake of medicine. Floral garden scenes with a sense of pictorial depth but without garish colour are acceptable. Despite an audible scepticism within the audience he prescribed 'bedscapes' with natural idyllic rural scenes and the sound of water. Although results are sketchy Ulrich listed the following guidelines for choosing appropriate art to serve a therapeutic purpose: * a clearly positive; * recognisable; * can be impressionistic; * sunny nature scenes, with green, not brown, vegetation; *avoidance of chaotic/ abstract art. * people should have pleasing facial expressions and gestures that are caring and nurturing.

Clearly a wide range of claims have been made, the validity of which remain contentious. Pictorial content and style should not be prejudged; a sublime or serene abstract for instance may induce contemplation and encourage meditation. Many cultures positively discourage the use of figurative art, preferring, often due to religious belief, schematic rendition to high illusion.

The debate over which means of representation are suitable will hopefully arouse passions and stimulate debate for generations to come. Art which is dedicated to the clinical spaces or intervenes in the private space of the patient has to be approached with caution. Rather than prescribing form why not from the outset offer a choice of imagery from the art collection. What is appropriate in the evaluation dialogue is the integration of the artist's skills with the demands of the users and clinicians. It is after all the artistic process or creative phenomenon, not the artefact itself, which is our main resource. The most serious implication however is the increasing lack of confidence in the very fabric of the institutions in which the patients are treated. Claims of a universal image for a soothing environment nevertheless remain locally and culturally challenged.

There is little agreement on which bespoken characteristics are right for the patient. However it is rather the very process of designing hospital accommodation itself which is in question. Currently based on two dimensional planning principles and economical equipping, it is the arrangement of new forms such as the remodelling of space to borrow or engage with nature which is favoured. Focusing on patients' and users' needs is more important than building procurement, control and profits. The evaluations may be diverse but the innuendos scatter far beyond patient orientated bealthcare facilities to the very foundations of art and architecture practice as we know it. graham cooper. March2000 


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