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Proceedings of Academics World 10th International Conference, Istanbul, Turkey, 11th December 2015, ISBN: 978-93-85832-62-8

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VISUAL ART AND ARTS THERAPY FOR HEALING IN HOSPITAL ENVIRONMENTS

1PATRICK UWAJEH, 2IYENDO.O.TIMOTHY

1,2Department of Architecture, Eastern Mediterranean University Famagusta,

North Cyprus via Mersin10, Turkey. E-mail Address: [email protected]

Abstract— Studies have revealed positive evidence of the use of art therapy programs and visual art works to facilitate the healing process of patients and staff in healthcare facilities. These researches have highlighted a strong link between the content of the images and their impact on the reactions of patients to pain, stress and anxiety. In this regard, hospitals are choosing artworks based on the positive evidences recorded. As a result of the contribution art has, in the provision of a better healing environment for patients, staffs and service users, this article is a literature review that highlights the results of various researches on cancer patients and a pilot study, which explores the effective use of visual arts and art therapy programs in healthcare facilities. The objective is to create a foundation for further investigations into the subject of healing with visual art and other art therapy programs in health care. Furthermore, a pilot study was conducted at the Near East hospital to evaluate the visual arts used within the hospital interior. Keywords— Art Programs, Health Care, Hospital, Patients, Visual Art. I. INTRODUCTION Research has shown that there have been a rapid awareness and global increase in the issue of healing environment in recent years (Anantha, 2008). Generally, the whole idea of the healing is centred on the fact that the quality of the hospital environment can make a great difference in the recovery of patients (Altimier, 2004). Ulrich advocated that a patient in a hospital ward with a view of trees and landscape will have a quick recovery compared to one facing a view of a plain wall (Ulrich, 1984). Similarly, artists and professionals in the healthcare sector have the perception that art may have positive benefits in the healing process and healthcare in general. There have been evidence of the increasing display of art works, with themes of natural images, which have positive effects on health outcomes. These effects ranges from decreased anxiety in patients, increased tolerance to pain and reduced periods of stay in hospitals (Staricoff & Loppert, 2003). Likewise, Florence Nightingale in 1859, affirmed the relevance of art in hospitals, which raised issues that are highly useful today. Moreover, she believes that beautiful objects of various forms and colours that are not often appreciated, sometimes have as much physical effect, as regular forms and colours have on us (Nightingale, 1859). Studies conducted in recent years, supported the notion that paintings and other forms of visual art can facilitates patients healing process. Furthermore, the result of these researches reveals that there is an association between images in a piece of art work and the positive impacts they have on patient’s response to traumatic pain, anxiety and stress (Landro, 2014; Nanda et al. 2012; Ulrich, 1999). As such, the use of artworks in hospitals has now been highly prioritized so as not to be seen as ordinary decorations for boring corridors and rooms.

The use of art interventions as a positive distraction is significantly recognised for the rehabilitation of hospital occupants. On the other hand, positive distraction has been defined as an environmental factor that promotes positive energy or feelings of individuals without exposing them to any form of stress, as such, taking the person's mind off his or her worries (Ulrich et al., 1991). To further buttress this fact, a study has shown that patients with breast cancer, testified adverse reduction in anxiety during chemotherapy sessions when exposed to a view of a virtual realistic display of underwater sights (Hickman et al., 1992). 1.1. History of Art in Healthcare Visual art as a western tradition started in ancient Greece, where architecturally-pleasing halls known as Asklepiea encouraged a sense of calmness and health for patients. The spaces were designed in a way that permits patients to participate in the treatment programs often drawn in their dreams by the god Asklepios. This treatment with dreams later became archaic with the development of modern medicine and the establishment of monolithic faiths in Europe. (Cork, 2012). However, the aesthetically pleasing traditional Athenian hospitals in the fifth century, which was forgotten for a long period was revived in the fourteenth century in Siena (Baron, 1996). Founded in the cathedral in Siena, the Spadale DI Santa Maria della Scala was a space used to accommodate traveling pilgrims to the various shrines in the city. By 1100, it had expanded from its original use and had started serving the population of Siena as a hospital for the treatment of illnesses. A frescoes, painted by Simone Martini in the fourteenth century, as shown in Fig.1, which depicted a Marriage of the Virgin and the Return of the Virgin to the house of her parents, were commissioned by city officials to be displayed in the hospital.

Visual Art and Arts Therapy for Healing in Hospital Environments


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Fig.1. Simone Martini - a Marriage of the Virgin and the

Return of the Virgin to the house of her parents. (http://www.wga.hu)

The facade of the hospital connected visually with the cathedral and the Palazzo Pubblico through artistic works was aimed at inspiring people in quest of physical, emotional and spiritual help (Norman, 1999). Giovanni DI Francesco Buzzichelli commissioned frescoes for the interior spaces in the hospital in 1441. Paintings by Domenico DI Bartolo and Lorenzo Vecchietta shown in Fig. 2, which highlighted sense memorializing the hospital’s history of charity works carried out in the spatial were displayed in the interior spaces and in the male infirmary wards (Cork, 2012). For many years, patients and art have been linked together, first with the aim of healing and more recently for aesthetic purposes (Iyendo & Alibaba, 2014).

Fig.2. Domenico DI Bartolo, Care of the sick, 1441-42, fresco in

Spedale DI Santa Maria della Scala, Siena. (http://www.poderesantapia.com).

Therefore the aim of this review paper is to highlight results of various researches in the use and application of art, focusing mainly on visual arts and art therapy programs organized in health care facilities, for healing in cancer patients.

II. METHODS Search Methods. The strategy employed was to search several search engines and electronic database which included; SUMMON and Elsevier Science Direct, from 2000 - 2014. The main key words used for the search were: “art in hospitals”; “visual art in hospitals”; “healing with art”; “healing cancer with art”; “art programs in health care”; “art and health care”. Criteria for Included Research. It was a prerequisite for the papers selected to have adequate discussions and data related to the following key words: Visual art in hospitals; Art healing for cancer patients; Public health and art programs and Art therapy. Retrieval Strategy- Data Extraction. For this study, the following features were extracted: the author and year of study, the study design adopted, the number of participants (mentioned or not) in the study, the target population for the study, study variable and the results of each study (Refer to Table 1). III. RESULTS AND DISCUSSION Six papers presented (random controlled trial with creative art): Puig et al. (2006); Rollins (2005a); Oester (2006); Virago & Dunkley (2008); Thyme (2009); Svensk (2009) and Six papers reported study with (art therapy): Deane et al. (2000); Heiney & Hope (1999a); Heiney & Darr-Hope (1999b); Goetze et al. (2007); Raynold & Lim (2007); Collie et al. (2006). (Refer to Table 1). Valuable literature was also sourced from the 2010 Journal of the royal society of medicine, on the visual art programs conducted at the new Royal Infirmary of Edinburgh (RIE); the new Stobhill Hospital; and the new Victoria Hospital. 3.1. Art Therapy The concept of art therapy is based on the theories that the experience gathered from the creative activities in which patients participate in, sparks up a great deal of energy that enable them handle and manage their medical conditions in a positive way. The objectives and results of most art therapies have often been summarised as: creating self-awareness and self-esteem in participants, a high level of acceptance about their medical conditions, ability to go cope through their bereaved state, development of interpersonal abilities (Schweizer et al., 2009; Case & Dalley, 1992). Art therapy is an approach which involves both psychological and therapeutic methods to manage various types of medical conditions. Case in point, forcancer patients, it helps them readjust to the changes and fears they are challenged with in a bid to survive (wood, Molassiotis, & Payne, 2013). Patients participation in arts and art therapy activities in healthcare, have shown to bring about positive change in patients-reported outcomes, as well as



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reduced symptoms of stress and improved quality of life for woman with cancer (Monti et al, 2006). Barsela, Atid, Danos, Gabay & Epelbaum, (2007) study results showed improvement in fatigue and depression levels during chemotherapy in cancer patients. Additionally, Deane Fitch & Carman 2000 study, participants of art therapy programs, demonstrated an increase in psychological will power, a better understanding about their cancer and strength to survive. 3.2. Impact of Art Therapy on Patient’s Family Members Evidence in several studies have indicated great positive benefits for family members of patients and health care givers who take part in art therapies. In a study to show how stress levels can be reduced among families and care providers of cancer patients, with an art session and the use of saliva samples from each participant, salivary cortisol was measured (which is an indicator of stress levels). To achieve this, they were asked to complete a (BAI) Beck Anxiety Inventory, followed by a two hour art session used for pre-test. At the end of the test, after a repeat of the (BAI) test, results showed a significant reduction in anxiety (Rollins et al., 2009; Walsh et al., 2007). 3.3. Visual Art in the New Royal Infirmary of Edinburgh (RIE) Opened in 2003, the hospital had a volunteer arts committee, which was recognized in 1997. During the art program organised then, a sequence of images depicting the memories of elderly patients at interviews were used to show several locations around Edinburgh in monochrome colour, and later reprinted in polychrome colours. These memories ranges from nature scenes, dance acts and days at the beach as shown in Fig. 3. Furthermore, the project got several ovations and support from patients and staffs (Lankston, Cusack, Fremantle, & Isles, 2010).

Fig. 3. Memories – Deirdre Neilson. (Fremantle & Sands, 2011)

3.4. Visual Art in the new Stobhill Hospital The new Stobhill hospital was opened in June 2009 and has an ambulatory care and diagnostic centre. In collaboration with the arts and environment working group, Jackie Sands, Clyde and the health co-ordinator for NHS Grate Glasgow, an art program was organised in 2005. In addition, among other arts within this hospital building, the visual arts were made up of paintings, drawings and window designs (see Fig 4a and b) (Lankston et al., 2010).

Fig.4a Window design and (b). Painting on the wall. (Source:

Fremantle, & Sands, 2011). 3.5. Visual Art in the New Victoria Hospital This centre for diagnostics and ambulating was opened in June 2009. In collaboration with the arts and environment working group, Jackie Sands, Clyde and the health co-ordinator for NHS Grate Glasgow, an art program was organised in 2005. The art project, which had a main theme called “the Hospital in the park”, featured art works consisting of a sculpture garden, murals and other art works (see Fig.6a and b) (Lankston et al., 2010).

Fig.5a Mural by Hanneline Visnes and (b). Sculpture- Garden

‘the threshold and prospect (Fremantle & Sands, 2011).



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Table 1: Review of visual art studies in cancer patients.



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IV. IMPACT OF VISUAL ARTS FOR HEALING IN CANCER PATIENTS Art serves as an easy form of expressing our innermost feelings. Individuals go through difficult experiences in life and use art to express the most difficult once in life, as in the case of cancer patients. These patients use art to explore the meaning of previous, current and imminent conditions during art therapy, as such create a new impression and attitude towards their present ill state. In addition, these help them to accept cancer as a long term illness and learn to live positively with it (Boehm et al., 2014). A research which studied the impact of art on cancer patients from a psychological point of view, found increased coping levels in patients, improved overall well- being, personal growth, reduction in depression levels and a better awareness and ability to cope with their situation (Deane et al., 2000; Puig et al., 2006; Heiney & Darr-Hope, 1999b; Nainis et al., 2006). Oester’s (2006) study on 41 cancer patients under controlled random trial reveals that patients were able to cope well with the treatment and presented overall improvement in well-being. Likewise, arrays of studies on the impact of art and its effect on pain, anxiety and depression in cancer patients during the pre-test and post-test periods of treatment, showed significant reduction in depression, pain and anxiety (Walsh et al., 2004; Nainis et al., 2006; Bar-Sela et al., 2007; Grulke et al., 2006; & Nainis et al., 2006), contradicting (Bar-Sela et al., 2007), which demonstrated no change in anxiety level. V. A PILOT STUDY ON VISUAL ART IN NEAR EAST HOSPITAL, (NEUH) NICOSIA There is a great deal of conviction among medical practitioners about the positive effect of hospital environment, properly furnished aesthetically. A remark by James Scott, an orthopaedic consultant surgeon, at the Chelsea & Westminster hospital, reveals that medical staff’s concur with his opinion that art in this hospital have changed the environment and has a positive effect on patients (Iyendo & Alibaba, 2014). Conversely, several other studies have documented confirmations about the positive environmental impact art has on the psychology of patients (Behrman, 1997, Iyendo & Alibaba, 2014). To further buttress the findings analysed in this research, a pilot study at the Near East Hospital was carried out. 5.1. Near East Hospital Description. A pilot study was conducted on a recently built Hospital in Near East University, Nicosia in North Cyprus. The NEUH Hospital has a 55,000 square-meter closed area with 209 private single patient rooms, 8 operating theatres, 30-bed Intensive Care Unit, 17-bed Neonatal Intensive Care Unit, laboratories and a cutting-edge diagnostic imaging

centre. To fulfil the diverse needs of the international patients an "International Patient Coordination Centre" has been created. This facility arranges and coordinates the transfer of international patients and their companions to and from North Cyprus (https://en.wikipedia.org). 5.2. Aims and Objectives The study aims to investigate the use of art works in the hospital and their impact on the wellbeing of patients and staffs. Due to the absence of a cancer treatment ward in the hospital, as it is still under construction, the main areas of focus included:

Admission Wards. Waiting areas. General circulation spaces (atrium). Paediatric unit.

5.3. Data collection method The method of collecting data adopted in this study is subjective. Personal on-site visits were made and photographs were used to document art works which are the variable in the research as seen in Fig.6.

Fig. 6. Research Methodology outline

5.4. Data Analysis A walkthrough within the circulation spaces, waiting areas and admission wards in NEUH revealed that the use of art was more for aesthetics than healing, except for the paediatric unit as seen in Fig. 7, where murals of the bright colours of rainbow are painted on walls, with colourful play toys which have positive effect on human emotions and kids in particular. At the paediatrics unit reception area, colourful landscape pictures and artistic crafts with playful tones gives a soothing feeling as seen in Fig.8.

Fig. 7. Rainbow mural on wall in the paediatric unit, Near East Hospital, Nicosia

(Iyendo’s achieves, 2013)



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Fig. 8. Colourful landscape pictures and artistic crafts in the

paediatric unit, Near East Hospital, Nicosia. (Iyendo’s achieves, 2013)

On the other hand, the absences of art in the general ward gave a sharp contrast psychologically and emotionally feeling when compared to the paediatric wards. However, most wards were furnished with flowery wall papers that improved the quality of the room and atmospheric feelings as shown in (Fig.9 & 10).

Fig. 9. Hospital ward devoid of art, Near East Hospital,

Nicosia. (Iyendo’s achieves, 2013)

Fig. 10. Flowery wall papers in wards, Near East Hospital,

Nicosia CONCLUSION It has been revealed that a proper visual environment can foster or enhance quick recovery in patients by as much as 10% (Dalke, et al., 2006). Furthermore, this can be tied to specific visual elements in hospital environment which include: the use of appropriate

colours in interiors, art works, paintings or murals on walls, and above all art therapy sessions organised from time to time for rehabilitating patients. It can be recommended that the use of art works at the Near East Hospital for healing purpose should be focused more in the hospital wards, as this would elevate a positive healing outcome on occupants inhabiting the hospital. Additionally, art programs should be organised for therapy purposes and for speedy recovery of patients as seen in the results of several studies documented in this research. The studies on the impact of art and art therapy in cancer patients have shown ample positive results on their healing process, which ranges from ability to cope with pain, depression and anxiety, to a general improvement in well-being. The large number of evidences explored in this paper reveals that visual art and art therapy in healthcare can have greater benefits on health and wellbeing. ACKNOWLEDGEMENTS This article has been written under the supervision of Asst. Prof. Dr. Nazife ÖZAY Special thanks to Timothy Onosahwo Iyendo for his valuable comments and guidance. REFERENCES

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