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A RT TO HEART: THE EFFECTS OF STAFF CREATED ART ON THE ARTISTS AND NURSES OF THE CARDIOVASCULAR NURSING UNITS OF A MAJOR URBAN HOSPITAL B y MARY GWYN BOWEN A CAPSTONE PROJECT PRESENTE D TO THE COLLEGE OF FINE ARTS OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS UNIVERSITY OF FLORIDA 2012
2 Table of Contents Abstr act .. Page 3 Page 4 Chapter 1: Introduction 10 Background ..Page 9 Statement of the Problem Page 9 Significance of the Study ... .Page 9 Limitations of the Study Pag e 10 Chapter 2: Literature Review Page s 11 13 Chapter 3: Research Methods .. Page s 14 17 Design Page s15 16 Data Page s 16 Population Page 17 Symbol of the Project .. Page 17 Chapter 4: Findings ......... Page s 18 25 Chapter 5: Discussion Page s 2 6 27 Appendix A F Page s 28 40 Pages 41 4 3 Disclosures 4 Pag e 4 5
3 Summary o f Capstone Project Presented To The College o f Fine Arts Of The University Of Florida In Partial Fulfillment Of The Requirements For The Degree Of Master o f Arts ART TO HEART: A STUDY OF THE EFFECTS OF STAFF CREATED ART ON THE ARTISTS AND NURSES OF TWO CARDIOVASCULA R HOSPITAL UNITS By Mary Gwyn Bowen May 2 012 Chair: Craig Rol and Major: Art Education The staff o f the Cardio Vascular Department of a major urban hospital was asked to make art to place along the hallway s of two Post operative and Post procedure cardiovascular care unit s Interviews were conducted with the art makers and the nursing staff of the units to determine the effects of the art project on their daily work environment Participation in an art making project with a patient centered goal has had a positive impact on the artists Art has become the means to create a sense of ownership and community among the nursing staff o f the unit s where the art is displayed in their daily work environment Art make s a difference to the job satisfaction o f the staff of two high stress cardiovascular unit s of a hospital The art educator designed and implemented the program, conducting all interviews with artists and staff nurses of the unit.
4 Acknowledgements I would like to thank my supervisor y committee, Dr. Craig Roland, C ha ir and Dr. Elizabeth Delacruz, M ember of the University of Florida, f or their endless assistance and guidance. I gratefully acknowledge the help and support of Dr. Nancy Wells and Victoria Sandlin, MSN, RN of the Nursing Research Dep artment of Vanderbilt University Medical Center I thank Janice Gabbard, MSN, RN, Nurse Man a ger of the Progressive Cardiac Care Unit and the Cardiac Sh ort Stay Unit for her unfailing support And I thank Heather Campbell, MSN, RN, assistant manager of PCCU and CSSU. The support of Robin Ste a ban Chief Administrative Officer and Debra Chamberlain, Nursing Administrative Director for Inpatient Services of Vanderbilt Heart and Vascular Institute is greatly appreciated. And I am especially grateful to M arilyn Dubree Executive Chief Nursing Offic er at Vanderbilt University Medical Center. A ll gratitude and appreciation to: The nurses : Diane Adcox, Leslie Potts, Heather Hahn, Corazon Ledda, James Cobb, Terrence Hyde, Mary Beth Peach, Tara Turo n, Stephen W. Williams Sherin Tahmas bi, Tammy Long, Jamie Chapman, Lucy Hart Pam Crane, Maureen Do ne hoo and Alyssa Ramirez The artists : Dr. Andre Churchwell, Dr. David Harrison, Mary Ann Jorissen, NP, Patricia Franklin, Regina Tyree, Crystal Parsons, Leslie H ale, Bhar ati Kakkad, Sachin Par a njape Robin Waugh, Kimberly Ryder, JoAnn Gottlieb, Cindy Dorminy, Brenda Starks, Jennifer Best, Terri Hicks, Nancy Brown Jes alyn Tate Maurya Tyler Shelia Gravlee and Grace Fallin. Thank you to all the staff of the units 5 South Progressive Cardiac Care Unit and 6 South Cardiac Short Stay Unit, at Vanderbilt University Medical Center, Nashville, Tennessee.
5 Chapter 1: Introduction Chuck Stepanek (2005) As a registered nurse, artist and art e ducator, I looked for where my diverse areas of expertise intersected Working as a cardiac nurse in one of the two units taking part in this project I was aware of the difficulties faced daily by nurses and patients alike in the Progressive Cardiovascular Care Unit and its sister the Cardiac Short Stay Unit a t Vanderbilt University Medical Center in Nashville, Tenne ssee As an artist, creating art is a source of emotional sustenance in my life, therefore I sought to delve into ways art could help both patients and the nurses who care for them in the way it helps me A s an art educator, I was interested in assist ing a rtists who also work in cardiac healthcare, to develop artwork for a sp ecific pat ient centered purpose and help their co workers in the process. The nurses of the Progressive Cardiovascular Care Unit, (PCCU) and the Cardiac Short Stay Unit (CSSU) are high ly skilled and are certified by the American Heart Association in Advanced Cardiac Life Support (ACLS), which they are required to be recertified in every two years Patients in their care have undergone coronary artery bypass surgery (open heart su rgery) or other life saving cardiac and vascular surgeries and procedures such as stent placement Patients usually spend 24 hours immediately after surgery in the Cardiovascular Intensive Care Unit (CVICU) and then are moved to the Progressive Care Unit or the C ardiac Short Stay Unit to begin the di fficult task of post operative or post procedure r ehabilitation The nurses of these two cardiac care
6 units typically are responsible for the care of three to four of these patients for twelve hours of each working day In order to prevent post operative/post procedure complications and facilitate a quick return to normal life, cardiac patients must be up and walking several times a day It is the duty of the cardiac nurses to see that the patients are up and walking. C ardiac Rehabilitation Specialists are also responsible for patient ambulation The cardiac nurses must be alert to potent ial difficulties that can arise in the recovery of these pat ients Many complications are mainly prevented by early and frequent ambula tion Ambulation can be painful after surgery making motivation a prime factor in participation in early ambulation Possible complications these nurses work to hinder in cardiac patients are pulmonary embolus (blood clot in the lungs), pneumonia, deep vei n thrombosis (DVT) (blood clot in the legs) and other s (Williams, Ades, Hamm, Keteyan, LaFontane, Roitmann, & Squires 2006). Cardiac nurses work with an eye always alert to the cardiac monitor where the heart rhythm (ECG) of each patient is displayed Each patient is assisted to walk with heart monitor and oxygen tank present The cardiac nurse juggles the equipment while making sure the patient is steady on his/her feet. Cardiac patients can sometimes experience irritability of the heart during recovery, l eading to rhythm disturbances requiring certain intravenous (IV) continuous medication such as Nitroglycerine The cardiac nurse administers the medication and monitors the While the nurse is administering the medication he/she leading to a lethal arrhythmia requiring an emergency response In that event, t he
7 cardiac nurse activates the emergency response team and begins crisis man agement (Code Blue) In addition, cardiac nurs es regularly administer time sensitive medications and The nurses maintain the care of surgical wounds changing dressings daily They are responsible to ens ure the working order of the various pieces of equipment required in patient care such as IV pumps and heart monitors The cardiac nurses assist in discharge planning and instruction for patients and their families on life changes necessary after heart or vascular surgery and heart attack Perhaps one of the least acknowledged but significantly important duties of the cardiac nurses is the care and reassurance provided to stressed family members While the cardiac or vascular medical team is involved with the life saving surgery or procedure and the struggle toward recovery of the patient family members can get lost in the shuffle The cardiac nurses fill this gap by listening to and working toward meeting the need s of the scared and apprehensive family The nurses are the first line to spotting family membe rs struggling with the eminent changes to their lives brought on by the cardiac illness of their loved one Besides listening to the families voice their concern s, cardiac nurses identify and call for necessary referrals to case managers, social workers chaplai ns, and other specialists. The doctors and nurs e practitioners rely on the cardiac nurses as their eyes and ears during the twenty four hour cycle of a hos pital stay for their patients e verywhere and depend on the cardiac nurses progress or setbacks.
8 All of this the nurses do on a daily basis to the background cacophony of the sounds of heart monitors alarming, IV pumps beeping, pagers alerting and patient call lights ringing Breaks are taken only when another nurse can watch the patients of the nurse taking the break as well as, his/her own patients At the end of a twelve hour shift, feet are aching and ears are ringing But these nurses are there because they choose to be and they love their work They laugh with their patients They cry with their patients And they cheer them on. The physical and emotional stress level is high for cardiac nurses even though they love their work and choose to be there Management is ever alert in seeking means to reduce the stress level of cardiac nurses The effects of job setting and environment can be key to job and career satisfaction f or staff nurses, (Shaver& Lacey, 2003). The first part of the Art to Heart project was conceived as a tool to assist the patients in the difficult task of ambulating after heart attack or cardiovascular surgery Art became the means to facilitate motivation in post cardiac proced ure ambulation by creating an exhibit of art made by the staff of the cardiovasc ular department of the hospital to be placed along the hallways of the two nursing units where the patients are ambulating (Bowen 2011) In the process of creating the exhibit for the patients, the work environment of the nursing staff is changed P art Two of Art to Heart seeks to determine the effects of the projec t on the nurses of the two cardia c units Part two of Art to Heart also looks at the effects of the project on the artists who contributed their work to the project Art to Heart is one project with multiple facets This paper looks at
9 the facets of the project relating to the effects of the art on the daily working life of the cardiac nurses and also, of the artists employed by the cardiac department of the hospital Background As a registered nurse, art ist and art instructor, I am interested in e in healthcare The realm of possibilities for the benefits of art to nursing and patient care is immense and little studied Most art projects in hospitals are not for or about nurses and nursing care As a cardiac nurse working in Critical Care Progressive Care and Telemetry units, potential and actual issues cardiac nurses face on a daily basis were familiar to me How art can be helpful to b oth cardiac patients and cardiac nurses is a question I wanted to help answer Statement of the Problem In the post operat iv e and post procedure Cardiovascular Progressive Care Unit and Cardiac Short Stay Unit of a hospital, the staff function s in a high stress environment The purpose of this capstone project is to seek answers to the question, for patients a ffect the artists and nursing staff of the cardiac unit s It is hypothesized that art can have a positive impact on two busy cardiovascular care units in which staff members create art for a patient centered purpose and change the working environment for their co workers in the process Significance of the Study A constant issue in a busy cardiovascular care unit is the reduction of stress on the nursing staff The nurses must handle multiple tasks at once and keep that pace going for periods of twelve hours at a time The knowledge that lives are in their hands
10 is a constant thought throughout the day Walking away when things are difficult is not an option Caring for the caregivers is a n ever present issue in the mind of the managers of the cardiac units Job satisfaction and stress reduction are major factors in staff retention Limited research has been conducted into the role of art as a stress reduction and job satisfaction increasing tool to be employ ed with staff I propose in this study to test the theory of how the creation and display of art b y staff can have a positive impact on the working environment of two busy post operative and post procedure cardiovascular care un it s No studies have tested this theory. Limitations of the Study This part of the study does not address the definitions of patient centered art This study does not compare the art made by staff to other art of unknown artists The impact of art on patients is not studied in this part of the project This is a quantitative and qualitative project and is subject to the opinions and emotions of those who take part in the interviews.
11 Chapter 2: Literature Review Art as a means of improving healthcare is a growing field Wit h limited research available today, it can be argued that art in healthcare is still in its infancy The field is wide open for continuing research Much of the current literature has found art to be helpful in healthcare, (Pratt, 2 004) And as the field grows, more will be forthcoming At this point, research has revealed the effects of certain colors and styles of art in use in hospitals today Lankston (2010) has pointed out the preference for cool colors and the disdain for abs tract art expressed by patients that has l ed to more examples of realistic and nature art on display in hospitals One study addresses the effects of two styles of art on pain experienced by patients in a cardiovascular intensive care unit, (Ulrich 1993 ) Patients with nature scenes reported less pain than those with no art Patients with abstract art in their rooms reported increased pain and required more pain medication than those with no art. Many of the current studies focus on art as therapy (Goodi ll, 2010). T he process of art making as therapy appears to be making a positive imp act In one particular study by Lane ( 2005), art is seen as leading to a hol istic approach to nursing care with n urses encouraging patients to engage in art making In another study art becomes a means of conversation facilitation for the nurse with a particular patient po pulation (Wikstrom, 2003) Additionally, art in a museum setting has been used with nursi ng students as a tool for developing observational skills (In skeep, 2001). Art creation as a therapeutic modality with pati ents is growing rapidly and e xpanding with different healthcare populations Currently, it has been used with people r ecovering with anorexia nervosa (Frisch, 2006, and Craig, 2004) where it ap pear s to be
12 very e ffective According to Madden (2010), art offers a healing method with cancer patients in a number of various ways encompassing both viewing and making art The use of art as a bonding mechanism with HIV patients and others facing severe life changing illness appears to be effective therapy (Kellman, 2005), as well As patients engaged in art making as a group, they were enabled to break down barriers and gain trust with one another. Outside of the world of medicine, art has long been promoted as having value to improve s goals in art education of the early twentieth Hurl l believed that contemplating the beauty of a pain ting would encourage her students to bring more beauty into their lives, (St ankiewicz, 2001 p.117 ). Elliot Eisner, Professor Emeritus at the Stanford University School of Education of what p. 203 ) What better place to put that statement to the test that the cardiac department of a hospital? Eisner also states the f deep enrichment for all of us, (Eisner, p. 241) In a busy c ardiac unit life and death are faced on a daily basis The enrichment art provides gives the opportunity for p eople to step out of that life and death reality for a few moments and into the world of beauty provided by art, however briefly Eisner tells us, imag ination is given license to fly, (Eisner, p.198) A bit of flight into imagination may be just the ticket for a short escape from the stressful reality of a busy cardiac care unit.
13 John Dewey developed his ideas for the arts in educat ion in the early twentieth century An important reasoning fo arts education was the belief that the arts could bring a community together by fostering a connection to community as a source of pride and attachment, (Jackson, 1998) Dewey, as philosopher, was concerned with the collective and the concept of community He believed art was a means to achieve this sense of community. Art made for and by nurses and hospital staff has so far not been studied and will be addressed in this research project I hope more research will be focused on art to improve the working environment for nurses on a busy high stress unit Art as a means to assist nurses in providing patient care begs for more research.
14 Chapter 3: Research Methods It is h ypothesized that art can have a posi tive impact on two busy cardiovascular care unit s in which staff members create art for a pati ent centered purpose and change the w orking environment for their co workers in the process T he staff art makers will create a rt t o display on the units for the benefit of the patients As the art i s displayed it will c hange the environment for the nu rses whose daily work is carried out on the units in question This study s eeks to define through quantitative and qualitative da ta collection, the experience of art making by staff for patients on two car diovascular care unit s a nd will explore the impact the staff created art has on the nurses of the unit s The purpose is to uncover what benefits may have occurred in job satisfaction for the se highly skilled cardiovascular nurses where the art will be exhibited As the principal investigator, I sought answers to the question ow does art made by the staff of the cardiovascu lar department of a hospit al and exhibited in the working environment of the nurses who daily care for post surgical and post procedural patients on the Cardiovascular Care Units affect those nurses and artists ? I asked artists employed by Vanderbilt Heart and Vascular Institute to submit artwork for the project through a general email call for participation Artists were informed of the project through email notice and by placing flyers around the various cardiac areas of the hospital. Selection criteria w ere developed through review of literature relating to what was appropriate subject matter for art in a hospital setting (Ulrich 1993 & Lankston 2010) The criteria were submitted to the IRB alon g with other study documents, (A ppendix E).
15 A committee was c onvened to judge the artwork based on the selection criteria The selection committee did not judge artistic merit The committee made selections for the project solely by adherence to the designated selection criteria Members of the committee included a cardiologist, a senior hospital administrator, a senior nursing administrator, an RN working with the vascular surgeons and a professor from the school of nursing Artwork was shown to the committee by both jpeg computer image and actual artwork Sixty sev en pieces were submitted Thirty four artworks were judged to adhere to the selection criteria. Framing was done by the hospital for assurance that all art was framed according to specific safety standards for hospitals Artists were informed of framing co ncerns and asked not to submit work in frames Frames required special clamps that could be bolted to the walls Building Maintenance and Engineering fitted each artwork securely to the walls of the cardiac units The cost for framing and hanging of the artwork was considerable but necessary for patient safety in a hospital setting. All artwork required glass wit h the frames so that each piece could be regularly cleaned Oil paintings were fitted with glass cove rs in the frames. The glass caused a reflect ion from the bright hospital lights resulting in a slight visual limitation to the viewers The limitation did not appear to be significant. Design As the investigator I identified fifteen art creators who contributed art to the project and invited each to partic ipat e in a questionnaire where a series of specific que stions were asked Additionally, I invited eighteen nurses from th e two cardiovascular care units to respond to a series of questions by writing answers on a
16 questionnaire provided by the inve stigator relating to the art displayed on the walls of the units where the nurses work on a daily basi s Each artist and nurse was given an informed consent document (Appendix A) to peruse with the opportunity to ask questions Each was offered the choice to have their full name, first name only, or a culturally specific pseudonym identified within the interview process All chose the use of their full name. After demons trating consent to the questionnaire by signature, each participant was i nformed of th e time constraint of twent y minutes only to complete all questions As investigator I administered the questionnaire and noted any additional comments aside from those written All questions were administered in this method After the questio ns were answe red, each respondent w as given the opportunity to add any additional comments he/she may wish Universally, post questionnaire comments were positive Both artists and nurses expressed a positive experience. All responses were entered into a database to enable the search for reoccurring themes in the answer s (Ryan, 2003) In t he process, a narrative story has develop ed and become a valuable part of this project I seek to highlight these stories in a reasonable manner (McCormack, 2000 ) opening the p roject to inquiry and legibility De veloping themes and stories have be en followed to their conclusions and reported thusly Each has been identified, catalogued and documented appropriately. Data Analysis As questionnaires were collected, a project was created in Resea rch Electronic Data Capture (REDCap ) (Harris, Taylor, Payne, Gonzalez, Conde, 2009) and all data e ntered into the database A REDCap spreadsheet report (Appendix A, Figure 6) was
17 created to view the data and search for themes Responses from the artists and nurses were quickly scanned for reoccurring responses suggesting the possibility of certain themes Graphs and charts were not created as the responses were overwhelmingly positive making the presence of only one bar in a ch art, or in some cases a very lopsided graph. Population Fifteen of the hospital employed artists who contributed t heir art for the project we re invited to participate by myself, as investigator and provide answers to eight questions, (A ppendix B ). Eight een nurses from the two cardiovascular care units where the art is displayed we re invited to participate by myself, as investigator and provi de answers to ten questions, (A ppendix C ). Symbol of the Project As an artist, I created a painting (Figure 5 ) in line with the original goal of the Art to Heart project of motivating cardiac patients to ambulate The idea was to depict an image of a heart in motion. Though later thoughts sugge sted this was also a metaphor for the nurses of the cardiac units Card iac nurses are themselves the very image of a heart in motion To do the work they do, a big heart on the move is required And as the artists too, the image suggests the sharing of their hea rts in the sharing of their art.
18 Chapter 4: Findings Art made by staff changes the environment of a busy unit and becomes a tool for creating a sense of community among the nurses of the unit With this project, art takes a more central role in the healthcare environment As a growing body of evidence suggests, art can and does have much to contribute to healthcare Reducing stress and improving nursing work environment is one area where art can make a difference This study uncovers vital themes suggesting how and why art can improve the surroundings for those w orkers who daily keep the hospital functioning This study examined how making art f or that specific purpose affected the artists. As the questionnaires were administered and catalogued, themes and stories developed creating the result of an overall positi ve experience for artists, nurses and me, t he investigator As this project unfolded, responses to the questions provided a picture of the benefits of an art project created for a specific patient population on th e artists and nursing staff of two busy cardiovascular care hospital unit s I n the role of art educator, this project offered me the opportunity to assist artists who might not otherwise share their work into developing ideas for submission to the project The Information uncovered in this proj working environment of nurses in a high stress discipline A sense of connection to each other and their workplace develops between the nurses, artists and other staff of the cardiovascular department of the hospital. This information further sheds light on the responses of artists creating artwork with a patient centered purpose and the nurses caring for those patients
19 Dr. Andre Churchwell Cardiologist The process and purpose of art making has been and continues to be much studied Ellen Dissanyake (2003) postulates art and art making as the process of When Dr. Andre Churchwell d epicts his daily Viewers relate differently to doctor/patient interaction when observing th at relationship through the eyes of art. Patricia Franklin, RN, Charge Nurse A nurse, Patricia Franklin, walks her dog through a particularly lovely park on a regular basis and feels nourished by the surroundings of nature Trish believes bringing that pa rk to share with co workers and patients will impart some level of that nourishment she feels to these others Placing her photographs of the park at a beautiful time of year on the walls of the busy cardiac unit provides the opportunity for viewers to mom entarily remove themselves from the hospital environment and be transported to the park As Elliot Eisner (2002) informed us, the photographs of the park the park in th Jennifer Best, Medical Student Medical student, Jennifer Best, finds temporary stress relief from the rigors of medical school, through her painting In an outpouring of the emotional expression of a
20 special moment in her life, she painted a beautiful painting of a waterfall that was the sce ne of a special time for her That special moment in her life shared through her painting has become a vehicle for special moments in the lives of the nurses on the cardiac units when they can bri efly loose themselves in the beauty of the waterfall Was this what Estelle Hurll intended with Cindy Dorminy, M.Ed, LPN Children invoke memories of carefree times in the lives of most people They are transported to that time of innocence and awe Cindy Dorminy, observes her child in the expression of that time of carefree innocence and awe, capturing that child in the act of discovering the sweet scent of a newly opened flower, in a photograph The display of that photograph on the wall of the cardiac unit gives the nurses a chance to remember those light hearted days of childhood and briefly forget the stress of the busy workday. Nancy Brown, Medical Receptionist Some of the potential artist s in this project were not sure they could describe Brown, quilting is an active venture in her life outside of work Even though she must coordinate patterns and colors to make a cohesive design in a quilt, she did not see this as art With encouragement, she submitted a section of quilt she was working on Many comments from viewers have expressed their identification with the art of quilting A centuries
21 Kimberly Ryder, Administrative Assistant to the Heart Station Administrative Assistant to the Heart Station, (a position that answers the call from cardiac units to send an EK G technician to carr y out an EK G on a patient), Kimberly Ryder, spends some of her overflowing creativity in her off time doing what standard ink pen Each heart wa s a minutely detailed unique work The series of hearts was then placed into a composition on a board creating a single work of art Viewers are drawn into the work following the intricate patterns of each heart The cacophony of the unit fades into the ba ckground as the focus shifts into the individual designs of the beautifully worked hearts. Mary Ann Jorissen, Nurse Practitioner, Cardiac Surgery MaryAnn Jorissen, Nurse Practitioner with the Cardiac Surgery team, was focused on what art she wanted to sub mit to the project She worked on two oil paintings and exchanged ongoing progress communications with me as she worked exchanges MaryAnn sought to create paintings that would be inline with the purpose of the project by the staff and patients, alike. Bharati Kakkad, Research Assistant F or Bharati Kakkad, sharing her art with the cardiac nurses was an act of gratitude
22 cardiac surgery units in this project Bharati wanted to share her art as a means of expression of the gratitude she felt for the care her husband received from these nur ses. Other Findings The most rewarding aspect of the pro ject has been the excitement expressed by artists and nurses alike Several commented on the excitement and sense of Some inq uired Patient privacy issues ruled out that possibility but did not dampen enthusiasm As others in the hospital stopped by the ense of As nurse Leslie Potts The Art to Heart project coincided with a widely anticipated hospital inspection by the American Nurses Credentialing Organization, known in the nursing field as MAGNET Part of the Magnet philosophy is the empowerment of and the enabling of nurses to develop growth in th eir careers One of the Magnet visiting inspectors commented that the nurses of the two cardiac units exhibited a strong sense of The artists gave universally positive responses to the question of whether t he project was a meaningful experience All artists respond ed yes to the question In the q ualitative section of the questionnaire the artists each expounded in their answers, on how t his particular art making project was a meaningful experience Dr. An dre Churchwell C ardiologist, responded to the question with the one word, Kimberly Ryder Administrative A ssistant to the Heart Station Maurya Tyler,
23 RN, CCRN, Cardiac Nurse Specialist and Jesalyn Tate Research I ntern, all responded that the experience Regina Tyree, Exercise P hysio lo gist, 5 South Cardiac Surgery said that participating i Crystal Parsons, Exercise P hysiologist Jennifer Best, Medical S prospect of healing with painting was dear to be part of t he project The artists all felt the project made a positive difference to the hospital. Where the artists had differing opinions was in the selection c riteria Only two changed their art making process based entirely on the selection criteria Two others central themes One artist was puzzled by the restriction on red, an other on the prohibition of animals as subject matter A third artist was intrigued by the stipulation that people not be looking directly at the viewer Regardless of the reaction to the selection criteria, it did not appear to significantly disrupt anyon Jesalyn Tate, Research Intern, stated she had focused on images she felt would be cheerful for the patients Leslie Hale, Cardiac Device Technician, remarked that she had used brighter colors in her work to create positive and enco uraging feelings in patients. The nurses of the two units all stated they were aware of the newly placed art on the walls of their respective units All were either completely aware or somewhat aware
24 of who the artists were peared to be because some of the artists were not personally known to all of the nurses All felt the art made their workplace more pleasant and all would like to see more projects of this kind in their workplace The nurses all responded that the art made a positive difference to how they motivated their patients to ambulate. To the narrative questions, the nurses expounded on their previous answers Leslie Potts, RN III, PCCN Diane Adcox, RN, Pam Crane said the, beach and water reminded The themes that emerged from th e nurses were how the art helps them relax and makes their workplace more enjoyable It added warmth and made the environment more inviting and less hospital like And the art served as a focus for conversation Perhaps, the most valuable theme that emerge The nurses all described how they felt the art motivated the patients Some responses focused on the observation of patients and families t aking time to comment on the art One family member was seen using a camera phone to take a picture of Several responses stated the art gave the patients a distraction from the difficulty of
25 post operative recovery Diane Adcox, RN felt there was a difference with how frequently the patients ambulated almost immediately after the art was in place And the positive imp act of the art was also felt by other members of the staff whose daily work takes place on the units in this project Medical receptionist Edna Wilson expressed her delight with the artw ork by hugging and thanking artist, JoAnn Gottlieb E chocardiographer, whose art hangs in front of the medical reception desk Ms. Wilson stated she was present at work when the art was being hung a nd requested to ean photograph placed within her line of vision in her daily work location. Of the t hr ee male nu rses responding to the questionnaires, all three stated they related to a drawing created by Dr. Andre Churchwell illustrating the docto r/patient relationship in what can be termed as whimsical heartedness (no pun intended) t hat lifts the spirit of those viewing his work The men appeared to share a sense of comradeship in their preference rt. Several of the nurses felt some of the art was placed in corners that could not be seen as well as they would like as they went about their daily work Under the direction of Leslie Potts, RN, the maintenance engineer moved several of the artworks to locations more visible to the nursing staff and the patients The nurses wanted the art to be pl aced in the most visible locations for the staff during their daily work Leslie stated she believed the art should also, be placed in the best possible location for visibility by the patients, as well.
26 Chapter 5: Discussion The unique location of this art exhibit in two busy cardiac care units made the selection of art a key component of the project for me, as an art educator Not all art is appropriate for a hospital setting, as the work of Dr. Roger Ulrich (1993) and others has repeatedly pointed out Therefore, much of my work on the project encompassed assisting the artists with understanding the criteria and developing their work to meet it For some there was disappointment when art did not meet the necessary requirements There was no shortage of art submitted Sixty seven pieces were submitted Thirty four works of art were selected for the final exhibit. In carrying out an art project in the patient care area of a hospital, patient safety in framing had to be considered as a factor Artists cou ld not submit their work framed The hospital had to have each artwork specially framed to adhere to regulatory requirements outlined by the boards of hospital accreditation This presented a logistical issue for me, as art educator in working with a frame r who understood how to meet these requirements The necessary framing was a financial concern in the finishing of the project, as well. For artists who submitted photography, files had to be sufficiently sized for enlargement Unfortunately, some photogr aphs had to be rejected for this reason And in order to ensure uniformity in photographic quality, it was necessary to have all photographs enlarged through the framer, increasing costs of the project However, the beauty and cohesiveness of the photograp hy bore out the importance of following this guideline.
27 As principal inve stigator, the project has been a positive experience Both artists and nurses were eager to participate in the project and welcomed the opportunity to take part in the questionnaires Their sense of pride in the artwork is shared by all, whether artist or nurse When the artwork was hung, th e excitement was palpable. Several remark s to me by the nurses and t he artists It appears tha t art can be valuable in increasing job satisfaction and stress reduction for nurses, as well as, a motivational tool with their patients. And it would seem that creating art for a noble cause was an honoring and gratifying exp erience for the artists The only objections given in the project were to some of the selection criteria suggesting more research is needed into why certain features and styles of art may not be acceptable in a hospital setting It is possible more educati on is needed as explanation of why certain sel ection criteria are necessary. Overall, an art project with staff created art placed on a busy stressful nursing unit can be a positive experience for all, artists, nurses, patients and families Art provides the means for enh ancing the work environment of two busy cardiac care hospital unit s The staff artists, nurses, and ancillary personnel shared a sense of community and pride in their workplace through the vehicle of a shared art project.
28 Appendix A : Exhibit s Figure 1 : Heather Hahn, RN works at a computer station beneath a pastel painting of sunflowers by Grace Fallin, R N
29 Figure 2 : Stephen Williams, RN works at a computer desk in front of a seascape by Bhara ti Kakkad
30 Figure 3 : Photographs by Regina Tyree, Exercise P hysiologist, and Dr. David Harrison, line the hallway where the nurses are assisting their patients to ambulate daily
31 Figure 4 : James Cobb, RN stops at a supply cart in front of a painting of clouds in a summer sky by Jesalyn Tat e
32 Figure 5 : Art Heart is the symbol of the heart in motion for patients r ecovering from cardiac sur gery or procedure, of of the cardiac nurses, and of the artists sharing their hearts through their art
33 Figure 6: REDCap database partial spreadsheet Grant 1UL1RR024975 From NCRR/NIH (Harris
34 Appendix B: Informed Consent Document
36 Appendix C: Questions for Artists
37 Appendix D: Questions for Nurses
38 Appendix E: Art Selection Criteria
39 Appendix F : IRB Form
41 References Bowen, M.G. ( 2011 ). The Effects on staff created art on the post operative rehabilitation of cardiovascular surgery patients Unpublished Dissanayake, E. (2003) The core of art: Making special Journal of Canadian Association for Curriculum Studies, 1(2), 13 38. Eisner, E (2002) The Arts and the Creation of Mind Yale University Press 2002. Frisch, M. J., Franko, D.L., Herzog, D.B (2006) Arts based therapies in the Treatment of eating disorders Eating Dis orders 14(2) 131 1 42. Goodill, S.W. (201 0) The creative arts therapies: making healthcare whole Minnesota Medicine 46 9 Harris, P. A., Taylor, R.T., Payn e, J., Gonzalez, N., Conde, J.G. (2009). A metadata driven me thodology and workflow process for providing translational research informatics support, Journal of Biomedical Informatics 42(2):377 8 Inskeep SJ Lisko SA (2001) Alternative clinical nursing experience in an art gal lery Nursing Education 2.6(3),1 7 1 9 Jackson, P.W., (1998) John Dewey and the lessons of art New Haven, Yale University Press. 1998. Kellman, J. (2005) HIV, art and a journey to ward healing: one man's story. Journal of Aesthetic Educa tion 39(3), Fall 2005 Lane, M.R. (2005). Creativity and spirituality in nursing: implementing art in healing Holistic Nursing Practice 122 5 Lankston, L., Cusack, P., Fremantle, C., Isles, C. ( 2010 ) Visual art in hospitals: case studies and review of the evidence Journal of Social Medicine 103(12), 490 49 9.
42 Madden, J. R., Mowry, P., Gao, D., Cullen, P.M., For eman, N.K. ( 2010 ) Creative arts therapy improves quality of life for the pediatric brain tumor patients receiving outpatient chemotherapy Pediatric Oncology Nursing 27(3) 133 45. McCormack, C (2000) From interview transcript to interpretive story: part 2 developing an interpretive story Field Methods. 2(4) 298 315 Minino, A.M., Murphy S. L., Xu, J., Kochanek, K.D (2011) Deaths, final data for 2008 National Vital Statistics Report National Center for Health Statistics 59(10). Pratt, R.R. ( 2004 ) Art, dance and music therapy Physical Medical Rehabilitation Clinics of North America Journal (4) 827 8 41. Ryan, G.W., Bernard, H. R. (2003). Techniques to Identify themes Field Methods. 15(1) 85 10 Stankiewicz, M.A ( 2001) The Roots of Art Education Davis Publications, Inc., 2001. Stepanek, C (2005) Nursing the Corn iUniverse, Inc. 2005. Wikstrom, B. (2003) instrument: a communication strategy at a nursing home in Sweden Applied Nursing Resources 2003. Williams, M., Ades, P., Hamm,L., Keteyan,S.J., LaFontaine, T., Roitmann, J., Squires, R. (2006) Core competencies for cardiac rehabilitation/secondary prevention professi onals: update 2010: position statement of the American Association of the Cardiovascular and Pulmonary rehabilitation Journal of Cardio Pulmonary Rehabilitation Prevention 2011 Jan Feb; 31(1)2 10. Ulrich, R. S., Lunden, O., Eltinge, J.L (1993) Effects of exposure to nature and abstract pictures on patients recovering from heart surgery Presented at the Thirty Third
43 Meeting of the Society for Psychophysiological Research Rottach Egern, Germany Abstract in Psychophysiology 30(7).
44 Disclosures The principal inve stigator of this project is a registered nurse with a cardiac background, an artist and an art instructor The principal investigator formerly worked on one of the units featured in this project and has a working relationship with the managem ent and staff of both units One artist contributing to this project has, at one time, been in an art class taught by the principal investigator.
45 Biographical Sketch Mary Gwyn Bowen is a registered nurse, artist and art educator After a successful career in med ical sales, travel nursing and as a small business owner, Mary Gwyn returned to her home state of Tennessee where she is at work on an art in healthcare project utilizing art in the cardiac rehabilitation process She is a research nurse specialist at Vanderbilt University Medical Center and teaches botanical and oil painting at the Williamson County (Tennessee) Parks and Recreation Centers A major project for Mary Gwyn is the Art to Heart Project focusing on staff created art in th e work environment of a busy cardiac nursing unit She received an Associate Degree in Nursing from Excelsior College, Albany, New York in 1984 Mary Gwyn obtained a Bachelor of Fine Arts degree with Honors from the Corcoran College of Art and Design, Wash ington, D.C. in 2002 After graduation in May 2012 from the University of Florida with a Master of Arts in Art Education, Mary Gwyn is looking forward to delving more into the role of art education in the healthcare environment Mary Gwyn is an active memb er of the Society of Clinical Research Associates (SoCRA), the American Nurses Association (ANA), and the American Society of Botanical Artists (ASBA) She is a past recipient of the Cecil Wallace Fordham Award for the Arts, Dallas, Texas Mary Gwyn recent ly completed the Evidenced Based Nursing Practice Fellowship at Vanderbilt University Medical Center. http://www.marygwynbowen.com marygwynbowen201 2