Feature-More than Pretty Pictures-July 2010

Photo courtesy of Children’s Hospitals and Clinics of Minnesoota

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Feature

More than Pretty Pictures

Health care organizations in Minnesota are incorporating painting, sculpture, theater, and music into care.

By Kate Ledger

When a 6-year-old girl was admitted in March to Children’s Hospitals and Clinics of Minnesota in Minneapolis with a severe case of empyema, she required a painful treatment—placing a tube in her chest to drain the pus from her lungs. Stefan Friedrichsdorf, M.D., medical director of the pain medicine and palliative care program, addressed her discomfort by prescribing morphine and by asking the girl to pretend to paint a picture in her mind. “She stopped crying within 15 seconds and said, ‘I see dirt on the ground. I see a unicorn flying around with myself and my mommy on its wings,’” he recalls.

The picture she conjured became the basis of a watercolor he encouraged her to paint; she continued to work on it in her room throughout her hospital stay. Each time Friedrichsdorf saw the girl, she’d added more details. “It was more than a distraction,” he says. “It gave her a sense of mastery and control over her situation and a way to express her feelings.”

Using painting to help patients express their feelings and give them a sense of control is part of a pain treatment protocol Friedrichsdorf is developing. Although his approach is novel, his interest in incorporating artistic expression into clinical practice is not. These days, physicians and leaders from health care organizations throughout the United States have a new appreciation for how various art forms can be used to prompt thought and discussion, reduce patients’ anxiety and fears, and ultimately promote healing.

From Clinic to Community

Incorporating the arts into hospitals and clinics isn’t just for the benefit of patients and their families. Some organizations see these efforts as a way to bond with the community as well. For example, Children’s Hospitals and Clinics of Minnesota, which recently began an ambitious effort to incorporate the visual arts, theater, and music into its expanded facilities in Minneapolis and St. Paul has plans to open up its in-house theater productions in Minneapolis to children from the surrounding Phillips neighborhood. In the early 1980s, actor Jason Robards was invited to perform at Mayo Clinic. He recruited high-profile actor friends and staged a series of free performances of plays that dealt with health issues for patients, family, staff, and the community. Since then, Mayo has created a Humanities in Medicine program, which is sponsored by benefactors and grateful patients and families. Its Monday noon concert series attracts an audience that includes Rochester-area residents. At the Mill City Clinic in Minneapolis, family physician and medical director Jon Hallberg, M.D., created Hippocrates Café, which has used actors from the Guthrie Theater to present readings of stories, essays, and plays related to health topics for patients and residents of the downtown Minneapolis neighborhood. The first event took place last fall, amid the H1N1 crisis, and featured songs and writings related to influenza.—K.L.

They are rewriting the part for art in hospitals and clinics, making it less about pretty pictures and more about works and projects that have intent and purpose. At some institutions, stock posters and pleasant paintings are coming down, making room for conversation-prompting exhibits. At others, bold, expressive pieces are being commissioned for public spaces. And more and more hospitals and clinics are using arts activities to help lessen patients’ stress and allow for creative expression.

Why the Arts? Why Now?

Although music and art therapy have long been offered in some clinics and hospitals, health care organizations are taking a closer look at how the performing and visual arts relate to health and healing. “For some institutions, the thinking is that it’s not curative necessarily, but it helps people cope with illness,” says University of Minnesota Boynton Health Service psychiatrist Gary Christenson, M.D. Christenson is co-chair of the Midwest Arts in Healthcare Network and a board member of the Washington, D.C.-based Society for the Arts in Healthcare, which held its annual conference in Minneapolis last April.

That thinking is bolstered by a growing body of evidence suggesting that art can be a powerful clinical tool. In fact, there’s a two-year-old journal devoted to the topic. Arts and Health, which is published by the Society for the Arts in Healthcare, presents peer-reviewed studies from around the world on how involvement with certain art forms may help mitigate pain, enhance patient compliance, improve outcomes, reduce stress, and shorten hospital stays. Christenson tells of one study that showed that pediatric patients who were offered the opportunity to select their own music during an MRI needed less anesthesia during the procedure, and even needed less nursing care. Choice of music, referred to as “tailored music intervention,” also has been shown to reduce stress in patients on ventilators. Another that was highlighted during the society’s conference showed how working with modeling clay reduced negative thoughts, depression, obsessive-compulsivity, and phobic anxiety in patients with Parkinson’s disease. Yet another demonstrated how participation in a weekly scrapbooking group reduced stress among parents of babies in a neonatal intensive care unit (NICU). Other research is beginning to show what happens in various parts of the brain while one is creating or enjoying art—physiological information that can be applied to treating patients with dementia.

Aware of such findings, health care organizations in Minnesota are partnering with the state’s arts organizations. In the Twin Cities, HealthEast’s Bethesda Hospital, for example, is working with the Northern Clay Center to bring classes to patients with Parkinson’s disease, and HealthEast’s St. Joseph’s Hospital works with COMPAS, an arts education organization, to bring teaching in creative writing and poetry to patients who suffer from both mental illness and addiction. Hudson Hospital and Clinics in Hudson, Wisconsin, which is affiliated with HealthPartners, has worked with the Phipps Center for the Arts in an effort to showcase the works of area artists as part of a healing arts program that caters to both patients and the public. In Rochester, Mayo Clinic’s Center for the Humanities in Medicine collaborates with the Rochester Arts Center to bring master’s-level art educators to hematology and bone marrow transplant patients. The teachers, who sometimes gown up and wear gloves and masks in order to sit with ill patients at the bedside, help them express their feelings and ideas using watercolors, pastels, and Sculpey clay.

Creative Partnerships

Perhaps the most ambitious initiative in the state is being undertaken by Children’s Hospitals and Clinics of Minnesota, which embarked on a large-scale expansion of its two campuses in 2007. Before construction began, then-board chairman and businessman Jim Ryan wondered aloud how the institution might make the most of its proximity to so many prominent arts institutions in designing the new facilities. Children’s established a committee that included integrative medicine physicians, nurses, child-life specialists, and local artists who sat down to dream up programs and figure out ways to collaborate. What they found “particularly exciting,” says CEO Alan Goldbloom, M.D., “was the enthusiasm of arts partners, who seemed truly eager to participate.” When Ryan died of melanoma in 2009, a second task force was already in place to begin raising funds from corporate and individual donors—with a goal of $2.6 million for the Minneapolis campus—for the newly created Arts and Healing Program. Of the funding, $2.35 million will be used to commission art; $250,000 will go to sponsor programs on the Minneapolis and St. Paul campuses. Since its fundraising initiative began a year ago, Children’s Foundation has raised $500,000, much of which has come from grateful families.

To create its programs, Children’s connected with five charter partners—the Minneapolis Institute of Arts (MIA), COMPAS, the Children’s Theater Company, the MacPhail Center for Music, and the Minnesota Children’s Museum. For guidance, they looked to a San Diego-based arts-and-health consulting firm to make sure each organization’s involvement would be specifically tailored to healing. “These programs are not about simply making the arts accessible,” explains Mark Heymans, senior gift officer for Children’s Foundation. “This is about applying arts to the healing process for kids and families.” One of Children’s more extensive arts undertakings is its construction of a theater space next to the main lobby and cafeteria on the Minneapolis campus. Set to open in the fall, the space has a stage and seating for about 50 people. In collaboration with Children’s Theater Company and COMPAS, Children’s will stage dramatic and interactive performances in the theater. Children and their families can attend the shows in person; the productions also will be shown on closed-circuit television so patients can watch from their rooms. In addition, the plan is for the actors, along with child-life specialists, to spend time talking to children in the hospital about aspects of the productions after the performances.

Other parts of the facility have been designed with the goal of helping children in the hospital engage with the arts. Each floor of the Minneapolis campus will have murals and displays based on a theme: The first floor centers on drama and theater, the second on painting and drawing, the third floor on music, the fourth on sculpting, and the fifth on storytelling. What’s more, in conjunction with the Minnesota Children’s Museum, known for its imaginative theme-based rooms, the hospital is designing and building educational and interactive play spaces for kids in designated playrooms, family resource centers, and waiting areas.

Clinical staff are findings ways to use art more directly to promote healing as well. In conjunction with the MacPhail Center for Music, Children’s is creating an early intervention program for premature babies that will use singing, movement, and massage to strengthen developmental skills and enhance parental bonding. Studies have shown that premature babies who hear music in their isolettes are released from the NICU 12 days earlier on average than others. For older patients, Children’s has other programs in the works. One that’s just getting underway on the Minneapolis campus is Art out of a Box. The program, which is being done through the MIA, is a spin on another MIA program that’s typically taken to public libraries. Child-life specialists deliver a pizza-sized box containing carefully selected art supplies based on a theme to the bedside. The first box—with colors and shapes inspired by a Dale Chihuly glass sculpture of a sunburst—is about to be tested in the outpatient infusion center, an inpatient med-surg floor, and in a sibling play area. The hope is that it will give children a project that will inspire them, while teaching elements of art appreciation.

Measures of Success

Children’s plans to embark on formal studies of the initiatives that are beginning on the Minneapolis campus, thus adding to the body of evidence showing the ways in which the arts can promote healing and well-being. Emergency physician Samuel Reid, M.D., of Children’s in St. Paul, who has a background in research, was recruited to head up the hospital-funded investigations. “Intuitively, it makes sense that [Art out of a Box] would be therapeutic and serve children and their families, but it’s never been shown scientifically,” he says. Reid’s initial studies aim to show that an arts program would be “more beneficial than a simple distraction such as watching a movie or looking at a Where’s Waldo? book—a strategy that’s commonly used in children’s hospitals.” Studies being conducted over the next several months will explore whether encouraging kids to create will lead to improvements in their perception of pain, body image, and mood in general. Subsequent investigations may look at anxiety levels, speed of recovery, need for pain medication, and length of hospital stay.

The need to produce more evidence will be an ongoing challenge for the field, notes Christenson, particularly when it comes to justifying the expenses associated with such initiatives. He says the most popular breakout session at the Society for the Arts in Healthcare conference was one on how to record objective and measurable benefits of art programs, and how to create studies using traditional scientific methods. “There’s not 100 percent buy-in for arts programs from CEOs of all hospitals, although certainly there are some strong advocates among them. Research is becoming more essential because there are still a lot of people, particularly in the medical field, who need to be convinced that this is useful beyond being just ‘nice’ for patients,” he says.

But patients’ comments tell another side of the story about what it means to engage with art when they are in the hospital. One volunteer at Saint Marys Hospital in Rochester conducted an impromptu survey last summer, asking inpatients what they thought of their experiences hearing musicians play for them at the bedside. Their comments were overwhelmingly positive. One patient called it “some of the best medicine I have had.” Another, who had been in the hospital many times, wrote that he had “never had such a pleasure as this.” And another, who had enjoyed the music while eating, called the experience “better than a dinner theater.”