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The Room by Tom Meskell

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Songwritng with older people in care settings

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Klawitter Theatre Group delivered songwriting projects with older people who visit the day care facilities at Henrietta Older Peoples Service and with residents in Belmont House Nursing Home, both based in Dublin, from June 2018 until December 2019.

Participants

Older people who visit the day care facilities in Henrietta Older Peoples Service; residents in Belmont House Nursing Home; the care assistant and activities co-ordinator, staff and managers in Henrietta Street; volunteers in Henrietta Street; activities manager and activity service provider in Belmont House.

Aims

To write songs with older people in care settings

To encourage older people to tell their stories

To engage volunteers and staff at Henrietta Street

To engage participants in singing and music making

To provide a model for contemporary creative practice

To test a different service provider approach

Methods

Klawitter Theatre Group, in collaboration with Henrietta Street and Belmont House, explored the suitability of songwriting in a day care facility and in nursing home setting respectively. In Belmont House, the project took place in collaboration with their activities leader.

The project was based on Turtle Song by Turtle Key Arts, UK. The songwriting was informed by their workshops and a method that was developed by Dr. Rod Paton of LifeMusic UK to unlock the musical potential in participants.

We followed these principles:
Everyone is musical. Making music is an act of trust.
There are no wrong notes in music.
Every contribution has a meaning.

Our criteria were as follows:
Participation was in agreement with the managers of Henrietta Street and Belmont House.
Contact with residents was non-intrusive, voluntary and monitored.
Conversations were informal and grew spontaneously out of chatting and after singing some well-known songs.
Lyrics were collected using a given theme, written down and it was agreed collectively which lyrics would be turned into verses.
Melodies for the songs were agreed upon collectively.
Everyone was involved and had a say.

The participants met once a week and there was a staff member at each session. With the help of professional musicians and volunteers, participants wrote the lyrics and composed the music for their own song cycle, ending in a live performance for friends and family which was filmed for DVD. For the last performance at Belmont House, one of the activity providers, who runs a choir there, led the show.

The project was led by Hedda Kaphengst, Director of Klawitter Theatre Group. The project was supported by Dr. Rod Paton who acted as a musician, composer and adviser for four days. Sean Meyler, care assistant and activities co-ordinator at Henrietta Street, was another musician and co-facilitator.

Artistic Outputs

Five songs were written with older people from Henrietta Street and three with residents in Belmont House during 2019. A final performance took place in Belmont House to an audience of staff and relatives in December 2019 as part of the Christmas activities. In Henrietta Street, there were two final sing-along performance of all the songs before the Christmas break.

Evaluation Methodology

Journaling after the sessions

Recorded interviews with participants

Evaluation meetings with Sean Meyler and Rebecca Mullen of Henrietta Older Peoples Service

Critical reflection with Sean Meyler and participants

Creative reflection with Sean Meyler

Recordings

Feedback from audiences

Evaluation Outcomes
Notes from our Journal:
5 JULY 2019
Facilitators: Hedda and Sean
Volunteers: Sebastian, Darius, Georgie

We sang: You Are My Sunshine and In Dublin's Fair City. We have a chorus and found a melody. Key of C. Darius played the drums. Participation was lively and good singing along.

Sean's notes: Great interest from seniors in attending workshop prior to afternoon. Delighted to hear Hedda returning for another session. I feel the group were enthusiastic especially when we found the melody and they didn't mind repeating this melody reinforcing the tale of the old grey bus. All the group took part vouching ideas and comments. The addition of Darius on the drum filled in the song thus far giving a steady but unobtrusive pace to the lyrics. The seniors readily accept this is a work in progress and changes of mind are acceptable and indeed encouraged.

Perhaps introducing some of the instruments to give greater participation? As with W and his spoons?

15 NOVEMBER 2019
Facilitator: Hedda
Volunteers: Darius and Frances

We had sad news. D, one of our most engaged and regular participants, died suddenly two nights previous. Hedda receives a call from Rebecca on her way in. It was agreed that she should go in anyway.

The group sang some gospel songs and Hedda suggested to write a little song in memory of D. We had lively participation and JK was very engaged and talked and sang along. *Sadly JK also passed away a week later.

Reflection by Sean Meyler, care assistant and activities co-ordinator
Well, what can I say? A very successful project with good results does not adequately describe the impact the songwriting activity has had on the seniors in the day centre service. As is quite normal, introducing a completely new activity to the seniors can be difficult and greeted with some scepticism but from the start the seniors group took to the idea of creating their own songs with a bit of assistance. Thinking outside the box, they wove their ideas [into] lyrics from their varied lives and experience leading to many discussions on their past and their hopes for the future. They freely shared their thoughts and offered constructive criticism throughout.

It was a delight to see their response to their songs as we added melody and asked them to take part in spontaneous music making using the instruments. Our thoughts are of course with the few seniors who passed away this year who were remembered in a song created by the group.

Personally, it has been an education. It has further shown me the creative, joyful nature of our participants who, with a little guidance, will share and bring their desires to be heard in song and music.

My sincerest thanks to all involved and especially Hedda, that blond girl as she is known to some of the seniors. Thank you for your infectious enthusiasm, your caring inclusive workshops that have brought joy and laughter to all those who took part.

Documentation & Dissemination

A journal was kept throughout the project.

Two video recordings were made in Henrietta Street and participants will receive a DVD in 2020. (This process was delayed due to the Covid-19 pandemic.)

A video snippet of the Bus song (work in progress) can be viewed here: https://vimeo.com/407597576

Documentation (images and videos) can be found on the Klawitter website and Facebook page.

A report was written for the manager of Henrietta Older Peoples Service.

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Songwriting with older people in care settings

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Klawitter Theatre Group delivered songwriting projects with older people who visit the day care facilities at Henrietta Older Peoples Service and with residents in Belmont House Nursing Home, both based in Dublin, from June 2018 until December 2019.

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The Creative Arts Service is a fully integrated ongoing core service at the Prince & Princess of Wales Hospice, Glasgow. It currently runs four days per week and is delivered by three graduate artists and a creative writer, all experienced in arts and health practice. The programme comprises visual art and creative writing workshops that are open to all patients, family members and carers accessing hospice services.

The Creative Arts Service has developed from a two year project in 2002, managed by Art in Hospital (2002 - 2014) and led by Marielle MacLeman as Artist Coordinator (2004 - 2011), into the service managed by the Prince & Princess of Wales Hospice today.

Participants

Participants of the service are patients who are registered with a Clinical Lead at The Prince & Princess of Wales Hospice, their family and carers. Patients are referred to the hospice with life-limiting or terminal illness.

The Creative Arts Service accepts referrals from Day Services, Out Patients, IPU Ward, Community Team, Family Support and hospice Outreach Clinics. Most people who access art and creative writing at the hospice have had no previous experience, or have been forced to give up creative pastimes through ill health or caring responsibilities. Attendance might offer respite for the patient, family member or carer, and a therapeutic and focused activity with peers. It isn't always easy for people to articulate why they might want to attend, however, especially if it is an activity they haven't done before. It is important that the Arts Service is able to respond to these requests to ensure individuals are given the opportunity to try something new and to make their own choice whether to take this forward or not.

In 2015, we had 1137 patient contacts for visual art, 53 patient contacts for creative writing, 35 family contacts and 14 carer contacts.

Aims

The Creative Arts Service compliments the holistic and multi-disciplinary approach to care common within a palliative care setting. This approach treats the whole person and not just the illness, so each individual can live as well as they possibly can do. Creativity is recognised as a fundamental aspect of living a 'good' life and the Creative Arts Service offers and supports high quality, patient-led engagement with creative practices that enhance a sense of wellbeing.

The central aim of the service is to offer people the opportunity to develop their own creativity as a means of personal expression. The service aims to give people back some of the control they have lost through illness, disability and caring responsibilities. It also offers people the chance to try something new and to develop new skills, whilst engaging in a relaxing and meaningful activity during a difficult time in life.

The Creative Arts Service is currently developing an arts strategy which will sit within the hospice's Vision and Values five year strategy for Clinical Day and Outpatient Services. The arts strategy will outline a commitment to maintaining high quality arts provision and ongoing critical engagement with wider arts and health practice as key to underpinning meaningful engagement for participants in a palliative care setting. In addition, the arts strategy will address the hospice's strategic aims to increase wider access to services, in particular for young adults, those that are disadvantaged, people with learning disabilities, people from different ethnic minorities, and for people who are homeless.

Methods

Art staff work with individuals to tailor activities to each person's interests and abilities to ensure the best possible outcome from each session. A process-led approach results in absorbing and rewarding experiences that help alleviate anxiety and provide relaxation.

Rather than structured group tuition, all sessions are practical, patient-led and supported by the artists and creative writer. Interventions with patients, families and carers promote independence and exceed expectations using a range of art materials, techniques or creative writing genres. The Creative Arts Service is motivated by therapeutic benefits centered round developing creativity as a route to a sense of wellbeing, rather than exploring or analysing issues raised in the creation of art work or art work itself, as would be the case in Art Therapy.

In the visual art sessions this approach can best be described as supporting participants to develop their own creative practice as artists in their own right, where ideas and skills can grow over time. It is important that all staff have an ongoing arts or creative writing practice of their own as this enables them to recognise the difficulties that can arise when making work, and to offer solutions as to how to move forward.

Good quality art materials play an important part in mediating the participant's experience. For example, enjoying the sensation of a brush moving across the paper and its resulting mark can engage a person to move onto the next mark and so on. Over time people build skills in composition, colour and mark-making. This emphasis on practice is welcomed by participants as the outcome is immediate and focuses on creative expression and what is still possible, an important approach within palliative care.

Creative writing sessions allow patients the opportunity to explore autobiographical work, fictional writing or poetry during one-to-one private sessions. Others find comfort in knowing that someone can help them write a significant letter to a loved one. The creative writer works with each participant to help them to define his/her aims and the scope of their written project to ensure that the outcome is achievable within a given timescale. The ideas, words and content all originate with the patient, with the creative writer there as creative support and to scribe when appropriate.

As an integrated service, each patient, family and carer contact is recorded on Crosscare, with consideration to reviewing progress, care planning and any actions required. An artist also represents the Creative Arts Service at weekly Multi-disciplinary Team (MDT) meetings to discuss new referrals and to raise any causes for concern with current patients. This is important as the artists will often spend two to three hours with a patient on any given day and an MDT meeting provides an opportunity to make sure the patient, their families and carers are fully supported clinically, socially, spiritually and psychologically. The MDT meeting ensures the artist can refer a patient on to the appropriate member of staff for additional support if necessary.

An artist also attends regular Clinical Service Meetings where practical and strategic hospice wide developments are shared and where departments can ask for input, feedback or advice from the wider team. The service also offers biannual Staff Art Workshops and an annual Continuing Professional Development session on the aims and benefits of the arts programme for service users. This offers non-art staff the opportunity to experience first hand what the arts service has to offer patients, families and carers.

Artistic Outputs

Every word and mark created by participants is determined and made by them with support from the art team.

The majority of the visual art work produced by patients explores mark-making in its many forms but is in no way restricted to this. People have worked with photography, text, print-making, paper-making, book making and performance, alongside more traditional media such as drawing and painting, using a broad range of quality materials. There are plans to introduce animation, video and sound in the future to compliment more traditional media.

Written work takes the form of printed and bound documents, often combined with personal photographs or images of the patient's visual art work. One example comprised a 'photographic essay' as a structure for a patient to write about her recollections of the moments surrounding a number of photographs she had taken of people and places important to her.

Evaluation Methodology

It is difficult to measure the impact of the Creative Arts Service using a formal test and evaluate model. Instead, regular feedback is sought through semi-structured interviews with patients, families and carers in which participants are asked to reflect on their experience and invited for comments on how we could improve the service in any way.

Across the hospice new services are developed in co-production with clients, and the arts service has been able to respond to identified demand to establish two new services over the last five years.

The Pattern of a Bird (2008) by Marielle MacLeman and Jeni Pearson documents and reflects on the artistic approach, visual art and creative writing made by participants during the first two years of the project (available from www.ppwh.org.uk). Marielle MacLeman also reflects on this pivotal period in the service's history in 'Arts in palliative care: the Prince & Princess of Wales Hospice' (In Jarrett, L. [Ed.] Creative Engagement in Palliative Care, 2007, Radcliffe Publishing, pp.33-40).

The art team make workshop notes after each session and use a structure of assess, plan and review to reflect on and record sessions on a patient's records in Crosscare. These are visible to all the clinical team as part of the chronological journey of the patient, family member or carer.

Evaluation Outcomes

The positive impact and benefits of the service are evident in the feedback from patient and families:

' Developing my own art practice has opened up a whole new world for me. It is something for me to look forward to. Before coming I felt trapped; it is hard staring at four walls day in, day out. It means so much just to be able to do something normal and it has really helped me to build up confidence.' - Out Patient

' For me the art service is my time, something to look forward to. I look at my surroundings differently now, I look at the detail rather than just skimming over.' - Day Services Patient

' I worked with the Creative Writer on six photographic essays. At the beginning I did not know if I would manage it but the Creative Writer worked with me to help me draw it out. Sometimes I don't know how I managed to do it all. I have achieved so much here and it has made me feel part of something again.' - Out Patient

In co-production with patients and families, two new strands to the art service have been developed: Family Workshops and a monthly Carer Drop-in workshop.

' I have always thought the arts service is a necessity and not a luxury. The benefit to the patients and families is immeasurable. As we've developed the service further we have involved families and carers. I think it has taken the fear out of what a hospice is and what a palliative care unit is, especially when you have three small children who are at school and they need to know where mummy is. They can come to a family workshop with their mum and it takes the fear out of coming here. That was one piece of feedback I remember from a patient.' - Rhona Baillie, Chief Executive

' Seeing dad being able to switch off and relaxed makes me happy. I enjoy seeing him totally involve himself in something and not to be in pain, and to be creative rather than thinking about everything else that is going on.' - Family member

As a service we continue to invest time to educate staff about the benefits for patients of attending our service and to raise our profile within the hospice itself, specifically within IPU and Community Teams, with a view to increasing referrals from these clinical teams. We contribute professional development for staff in the form of biannual Staff Art Workshops with the aim of giving staff the opportunity to try first hand what patient's experience, so they feel more comfortable making patient referrals themselves or in presenting the hospice's work to potential funders and stakeholders. This also involves ongoing education that the therapeutic aims and benefits of the Creative Arts Service differ from those of counselling using Art Therapy.

' Participating in the staff art workshop means I can better understand what patients' experience, as I felt a calmness and unexpectedly a control over my session. I can imagine that for many patients, this allows them to feel in control over an aspect of their life.' - Hospice Social Worker

' I would absolutely recommend other staff to attend staff art workshops in the future. It widens your experience and better prepares you for client contact.' - Hospice Social Worker

The art staff regularly meet the challenges involved in maintaining a balance between developing the creative practice itself, through strategy and creative interventions with participants, and the associated administration of being an integrated member of the multi-disciplinary team. This is addressed by safeguarding regular development time within the working week and meeting regularly as a department.

Often in palliative care there is a small window in which to respond to a patient and their family's needs, and a fully integrated Creative Arts Service means we can respond to that need as and when it arises. The service's foundation of high quality arts provision, accompanied by its ability to respond to patients' and families' needs, ensures a robust model for arts engagement within a palliative care setting, that can continue to grow and develop in line with the needs of those we work with.

' It's a core service and it has been from the minute I saw the benefits for patients myself. I think it offers a whole new arm to palliative care. It's a place where the patients feel they can really express themselves. It offers relaxation and a totally different environment, one they wouldn't find elsewhere in the hospice. I'm absolutely passionate about it and we would never let it go. It makes a considerable difference to people. We can look for all the outcomes we like, but I think art is hard to measure. It is when you speak to people that have never painted or drawn before that you see it gives them a great sense of pride. It's also such a positive legacy for families.' - Rhona Baillie, Chief Executive

Documentation & Dissemination

Current participants' art work is professionally framed and displayed within the dedicated art room, and also around the day services lounge and the public areas of the hospice. Professionally framing and exhibiting patients' art work is an important part of what the art service offers. The benefits of this extends to families, staff and visitors who see the work as an enhancement of the hospice interior.

At least once a year patients' art work is exhibited in a public venue within the City of Glasgow or further afield. Previous exhibiting venues have included House for an Art Lover, Tramway, Kelvingrove Art Gallery and Museum, Scotland Street Museum, the Scottish Parliament and Aberdeen Royal Infirmary, in addition to national conferences on palliative care.

A collection of creative writing by patients has been documented in Foraging (2012), available from www.ppwh.org.uk.

Participants accessing the Creative Arts Service benefit from a sense of achievement and increased self-esteem seeing their work framed, published and publicly displayed. This reflects the commitment and value given to the work created by patients by the hospice as a whole.

'The patients and their families are passionate about the service, and I think that says it all for me. It's what they think, not what we think that matters.' - Rhona Baillie, Chief Executive

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An Integrated Creative Arts Service at The Prince & Princess of Wales Hospice

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The Creative Arts Service is a fully integrated ongoing core service at the Prince & Princess of Wales Hospice, Glasgow. It currently runs four days per week and is delivered by three graduate artists and a creative writer, all experienced in arts and health practice.

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Tracing Autonomy explores autonomy, creativity and end of life. The project is a collaboration between two artists who work at The Prince & Princess of Wales Hospice (PPWH) in Glasgow, Jeni Pearson and Kirsty Stansfield, in consultation with philosopher Prof. Ben Colburn from the University of Glasgow.

Participants

For the purposes of this case study, Jeni and Kirsty are the key participants as mentees of Ben Colburn. In addition, the work was developed in close consultation with clinical palliative care staff (NHS band 7 and above) and arts and health practitioners. Working groups were also held with Enable and Sense Scotland, key organisations supporting people with learning disabilities and autism. Four patients accessing the Art Room at PPWH took part in a service evaluation of the Creative Arts Service using the Tracing Autonomy Framework.

Aims

The project has grown out of a reflection on small everyday gestures and conversations involved in creative mark making. What does it mean to make a creative mark, particularly at a time in life when a person's independence and sense of control is diminishing due to deteriorating health and disability? And, as creative practitioners asking, how does the invitation to make a mark influence the mark that is made?

Aims:

to develop a framework for reflecting on arts, health and clinical practice that foregrounds the concept of autonomy to ensure that the participant is author of their own creative experience.

to offer arts and health practitioners a structured method to support new creative approaches and to challenge habitual modes of working by using autonomy as a guiding principle.

Methods

Tracing Autonomy emerged out of a process-based arts and health practice working with people living with a life-limiting illness and a series of reflective philosophical conversations on the subject of autonomy with Prof. Ben Colburn. Very practical concerns of what takes place in the art room were related to key philosophical ideas that underpin autonomy.

During this time we covered several related philosophical themes: autonomy at end of life, threats and ideals to autonomy, voluntary and involuntary choices, conflict, authorship, responsibility and the distinction between limitations and parameters, particularly in relation to disability. This provided us with a deeper understanding of what we practice on a day-to-day basis and the transformative potential of a process-based approach.

In addition to this, the holistic assessment used within palliative care that considers the physical, psychological, social and spiritual aspects of a person's life offered us a framework to expand upon and tailor in relation to our creative practice. We did this by incorporating factors we considered to be important during the art sessions with patients and families, namely dialogue, environment and sensory factors. By considering these factors we were able to ascertain whether the creative approaches we offered in the art room were truly in support of a person's autonomy or not. We referred to this expanded holistic tool as the 'Holistic Terrain' we and others were working within.

Creatively the artists see their role as being similar to that of supporting an individual's self-directed studio practice. It is important for us to be able to adjust practice in relation to the person that sits in front of us. To be able to move into and out of a sphere of influence recognises that some may need more creative support, or a different kind of creative support, than others and that this may change day to day, moment by moment, as a person becomes less well. Central to this approach is supporting a person to direct and to be author of their own practice. The quality of dialogue that takes place around this process with a person shapes that experience. Our work with Ben provided us with a language and practical tools to ensure that a person's autonomy was at the fore of this process. We asked what supported or undermined a person's autonomy by considering four characteristics of autonomy: choice, value and relationships; and when these are supported well, the fourth characteristic of autonomy - authorship, when the person is author of their own experience.

A public exhibition of patients' art work at The Studio Pavilion at House for An Art Lover enabled us to apply and review the effectiveness of this approach to supporting autonomy.

Artistic Outputs

'all threads lead back to here' was an exhibition of art work made by people who attend the Art Room, PPWH, held at the Studio Pavilion at House for An Art Lover, Glasgow, in October 2018. The making of this exhibition directly applied some of the key ideas around autonomy by considering how to bring a person on board with us as a colleague. In other words, as long as that individual can trace a thread back through the journey of making as one that they recognise as their own, you can ensure that this process has been in support of their autonomy.

Two Tracing Autonomy workshops were held at PPWH with invited practitioners and academics from a range of fields: Alzheimer's support, palliative care (adult and paediatric), pre- and post-bereavement support for young people, young people's oncology, anthropology, philosophy, social work, creative writing, visual art and performance.

A Tracing Autonomy workshop was held at Check In Check Up, Crawford Art Gallery, Cork in 2018 with arts, health and clinical practitioners from across Ireland.

Transferable resources: Tracing Autonomy Reflective Framework and Tracing Autonomy Workshop are available to download from www.tracingautonomy.net

Evaluation Methodology

Throughout the research process we reflected on our practice as artists working in a palliative care context using the concept of autonomy as a reflective methodology. Autonomy provided us with guiding principles to help ascertain to what degree our creative practice was in support of the autonomy of others.

Throughout the project we were keen to learn from the people we are working with, the patients themselves first and foremost, but also from clinical staff and other professionals working in the fields of palliative care, learning disability and autism. This involved a process of synthesising and editing written material to present appropriate information to a range of audiences, including a poster presentation at the 2019 Scottish Partnership for Palliative Care annual conference 'Provocation, Innovation and Eternal Truths' in the Royal College of Physicians, Edinburgh.

Evaluation Outcomes

As artists working in a palliative care setting, the opportunity to be mentored by a philosopher has been hugely beneficial, particularly in gaining a very practical understanding and application of philosophical ideas in relation to creativity and the context of working with vulnerable people.

The project offered the opportunity to gain insight into our own working practices and to see how these cusped the experiences and practices of clinical practitioners working with people at the end of their lives. We found many areas in common with clinical colleagues, and by highlighting dialogue, environment and sensory factors we were able to offer a deeper understanding of autonomy and an awareness of the wider context of the person being supported.

In addition, Tracing Autonomy helped to inform the development of PPWH's new clinical assessment tools to include GIRFEC / SHENNARI indicators and a new sensory communication tool. A mandatory staff training session on autonomy was attended by 70% of clinical staff at the hospice.

' Any discussion around autonomy is very important and key to best practice. It enhances the quality of interaction between people.'

- Comment made by clinical practitioner, PPWH.

' It goes beyond art. Because all those words in the holistic terrain are important and that is what takes you beyond art, it is expansive. There is the creative focus on what you are making, but these words relate to the person as a whole.'

- Comment made by patient during Tracing Autonomy Service Evaluation.

It was an opportunity for us to critically reflect on our practice. How do we ensure choice and control when people face serious emotional, physical, cognitive and communication difficulties? Autonomy has the ability to shape the context of these choices so that they are in line with what matters to you as a person. It is important we consider the reasons people act or make decisions. For example, is someone doing something because they're grateful, or they don't want to offend you? As artists, these are important questions when embarking on a participatory exchange.

' A meaningful small gesture is only meaningful if it allows itself to be seen as a self-critical, self-reflective process. The moment it starts to take its aims, acts and habits for granted, it slips quickly further away from being a meaningful act.'

- Mika Hannula, The Politics of Small Gestures: Chances & Challenges for Contemporary Art (2006)

Documentation & Dissemination
www.tracingautonomy.net
Instagram, Twitter, Facebook: @tracingautonomy

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Tracing Autonomy: a reflective approach in support of a person's autonomy in life

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Tracing Autonomy explores autonomy, creativity and end of life. The project is a collaboration between two artists who work at The Prince & Princess of Wales Hospice (PPWH) in Glasgow, Jeni Pearson and Kirsty Stansfield, in consultation with philosopher Prof. Ben Colburn from the University of Glasgow.

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Colette Kelly case study analysis 'The Room by Tom Meskell'

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Colette Kelly case study analysis 'The Room by Tom Meskell'

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The Creative Arts Service is a fully integrated ongoing core service at the Prince & Princess of Wales Hospice, Glasgow. It currently runs four days per week and is delivered by three graduate artists and a creative writer, all experienced in arts and health practice. The programme comprises visual art and creative writing workshops that are open to all patients, family members and carers accessing hospice services.

The Creative Arts Service has developed from a two year project in 2002, managed by Art in Hospital (2002 - 2014) and led by Marielle MacLeman as Artist Coordinator (2004 - 2011), into the service managed by the Prince & Princess of Wales Hospice today.

Participants

Participants of the service are patients who are registered with a Clinical Lead at The Prince & Princess of Wales Hospice, their family and carers. Patients are referred to the hospice with life-limiting or terminal illness.

The Creative Arts Service accepts referrals from Day Services, Out Patients, IPU Ward, Community Team, Family Support and hospice Outreach Clinics. Most people who access art and creative writing at the hospice have had no previous experience, or have been forced to give up creative pastimes through ill health or caring responsibilities. Attendance might offer respite for the patient, family member or carer, and a therapeutic and focused activity with peers. It isn't always easy for people to articulate why they might want to attend, however, especially if it is an activity they haven't done before. It is important that the Arts Service is able to respond to these requests to ensure individuals are given the opportunity to try something new and to make their own choice whether to take this forward or not.

In 2015, we had 1137 patient contacts for visual art, 53 patient contacts for creative writing, 35 family contacts and 14 carer contacts.

Aims

The Creative Arts Service compliments the holistic and multi-disciplinary approach to care common within a palliative care setting. This approach treats the whole person and not just the illness, so each individual can live as well as they possibly can do. Creativity is recognised as a fundamental aspect of living a 'good' life and the Creative Arts Service offers and supports high quality, patient-led engagement with creative practices that enhance a sense of wellbeing.

The central aim of the service is to offer people the opportunity to develop their own creativity as a means of personal expression. The service aims to give people back some of the control they have lost through illness, disability and caring responsibilities. It also offers people the chance to try something new and to develop new skills, whilst engaging in a relaxing and meaningful activity during a difficult time in life.

The Creative Arts Service is currently developing an arts strategy which will sit within the hospice's Vision and Values five year strategy for Clinical Day and Outpatient Services. The arts strategy will outline a commitment to maintaining high quality arts provision and ongoing critical engagement with wider arts and health practice as key to underpinning meaningful engagement for participants in a palliative care setting. In addition, the arts strategy will address the hospice's strategic aims to increase wider access to services, in particular for young adults, those that are disadvantaged, people with learning disabilities, people from different ethnic minorities, and for people who are homeless.

Methods

Art staff work with individuals to tailor activities to each person's interests and abilities to ensure the best possible outcome from each session. A process-led approach results in absorbing and rewarding experiences that help alleviate anxiety and provide relaxation.

Rather than structured group tuition, all sessions are practical, patient-led and supported by the artists and creative writer. Interventions with patients, families and carers promote independence and exceed expectations using a range of art materials, techniques or creative writing genres. The Creative Arts Service is motivated by therapeutic benefits centered round developing creativity as a route to a sense of wellbeing, rather than exploring or analysing issues raised in the creation of art work or art work itself, as would be the case in Art Therapy.

In the visual art sessions this approach can best be described as supporting participants to develop their own creative practice as artists in their own right, where ideas and skills can grow over time. It is important that all staff have an ongoing arts or creative writing practice of their own as this enables them to recognise the difficulties that can arise when making work, and to offer solutions as to how to move forward.

Good quality art materials play an important part in mediating the participant's experience. For example, enjoying the sensation of a brush moving across the paper and its resulting mark can engage a person to move onto the next mark and so on. Over time people build skills in composition, colour and mark-making. This emphasis on practice is welcomed by participants as the outcome is immediate and focuses on creative expression and what is still possible, an important approach within palliative care.

Creative writing sessions allow patients the opportunity to explore autobiographical work, fictional writing or poetry during one-to-one private sessions. Others find comfort in knowing that someone can help them write a significant letter to a loved one. The creative writer works with each participant to help them to define his/her aims and the scope of their written project to ensure that the outcome is achievable within a given timescale. The ideas, words and content all originate with the patient, with the creative writer there as creative support and to scribe when appropriate.

As an integrated service, each patient, family and carer contact is recorded on Crosscare, with consideration to reviewing progress, care planning and any actions required. An artist also represents the Creative Arts Service at weekly Multi-disciplinary Team (MDT) meetings to discuss new referrals and to raise any causes for concern with current patients. This is important as the artists will often spend two to three hours with a patient on any given day and an MDT meeting provides an opportunity to make sure the patient, their families and carers are fully supported clinically, socially, spiritually and psychologically. The MDT meeting ensures the artist can refer a patient on to the appropriate member of staff for additional support if necessary.

An artist also attends regular Clinical Service Meetings where practical and strategic hospice wide developments are shared and where departments can ask for input, feedback or advice from the wider team. The service also offers biannual Staff Art Workshops and an annual Continuing Professional Development session on the aims and benefits of the arts programme for service users. This offers non-art staff the opportunity to experience first hand what the arts service has to offer patients, families and carers.

Artistic Outputs

Every word and mark created by participants is determined and made by them with support from the art team.

The majority of the visual art work produced by patients explores mark-making in its many forms but is in no way restricted to this. People have worked with photography, text, print-making, paper-making, book making and performance, alongside more traditional media such as drawing and painting, using a broad range of quality materials. There are plans to introduce animation, video and sound in the future to compliment more traditional media.

Written work takes the form of printed and bound documents, often combined with personal photographs or images of the patient's visual art work. One example comprised a 'photographic essay' as a structure for a patient to write about her recollections of the moments surrounding a number of photographs she had taken of people and places important to her.

Evaluation Methodology

It is difficult to measure the impact of the Creative Arts Service using a formal test and evaluate model. Instead, regular feedback is sought through semi-structured interviews with patients, families and carers in which participants are asked to reflect on their experience and invited for comments on how we could improve the service in any way.

Across the hospice new services are developed in co-production with clients, and the arts service has been able to respond to identified demand to establish two new services over the last five years.

The Pattern of a Bird (2008) by Marielle MacLeman and Jeni Pearson documents and reflects on the artistic approach, visual art and creative writing made by participants during the first two years of the project (available from www.ppwh.org.uk). Marielle MacLeman also reflects on this pivotal period in the service's history in 'Arts in palliative care: the Prince & Princess of Wales Hospice' (In Jarrett, L. [Ed.] Creative Engagement in Palliative Care, 2007, Radcliffe Publishing, pp.33-40).

The art team make workshop notes after each session and use a structure of assess, plan and review to reflect on and record sessions on a patient's records in Crosscare. These are visible to all the clinical team as part of the chronological journey of the patient, family member or carer.

Evaluation Outcomes

The positive impact and benefits of the service are evident in the feedback from patient and families:

' Developing my own art practice has opened up a whole new world for me. It is something for me to look forward to. Before coming I felt trapped; it is hard staring at four walls day in, day out. It means so much just to be able to do something normal and it has really helped me to build up confidence.' - Out Patient

' For me the art service is my time, something to look forward to. I look at my surroundings differently now, I look at the detail rather than just skimming over.' - Day Services Patient

' I worked with the Creative Writer on six photographic essays. At the beginning I did not know if I would manage it but the Creative Writer worked with me to help me draw it out. Sometimes I don't know how I managed to do it all. I have achieved so much here and it has made me feel part of something again.' - Out Patient

In co-production with patients and families, two new strands to the art service have been developed: Family Workshops and a monthly Carer Drop-in workshop.

' I have always thought the arts service is a necessity and not a luxury. The benefit to the patients and families is immeasurable. As we've developed the service further we have involved families and carers. I think it has taken the fear out of what a hospice is and what a palliative care unit is, especially when you have three small children who are at school and they need to know where mummy is. They can come to a family workshop with their mum and it takes the fear out of coming here. That was one piece of feedback I remember from a patient.' - Rhona Baillie, Chief Executive

' Seeing dad being able to switch off and relaxed makes me happy. I enjoy seeing him totally involve himself in something and not to be in pain, and to be creative rather than thinking about everything else that is going on.' - Family member

As a service we continue to invest time to educate staff about the benefits for patients of attending our service and to raise our profile within the hospice itself, specifically within IPU and Community Teams, with a view to increasing referrals from these clinical teams. We contribute professional development for staff in the form of biannual Staff Art Workshops with the aim of giving staff the opportunity to try first hand what patient's experience, so they feel more comfortable making patient referrals themselves or in presenting the hospice's work to potential funders and stakeholders. This also involves ongoing education that the therapeutic aims and benefits of the Creative Arts Service differ from those of counselling using Art Therapy.

' Participating in the staff art workshop means I can better understand what patients' experience, as I felt a calmness and unexpectedly a control over my session. I can imagine that for many patients, this allows them to feel in control over an aspect of their life.' - Hospice Social Worker

' I would absolutely recommend other staff to attend staff art workshops in the future. It widens your experience and better prepares you for client contact.' - Hospice Social Worker

The art staff regularly meet the challenges involved in maintaining a balance between developing the creative practice itself, through strategy and creative interventions with participants, and the associated administration of being an integrated member of the multi-disciplinary team. This is addressed by safeguarding regular development time within the working week and meeting regularly as a department.

Often in palliative care there is a small window in which to respond to a patient and their family's needs, and a fully integrated Creative Arts Service means we can respond to that need as and when it arises. The service's foundation of high quality arts provision, accompanied by its ability to respond to patients' and families' needs, ensures a robust model for arts engagement within a palliative care setting, that can continue to grow and develop in line with the needs of those we work with.

' It's a core service and it has been from the minute I saw the benefits for patients myself. I think it offers a whole new arm to palliative care. It's a place where the patients feel they can really express themselves. It offers relaxation and a totally different environment, one they wouldn't find elsewhere in the hospice. I'm absolutely passionate about it and we would never let it go. It makes a considerable difference to people. We can look for all the outcomes we like, but I think art is hard to measure. It is when you speak to people that have never painted or drawn before that you see it gives them a great sense of pride. It's also such a positive legacy for families.' - Rhona Baillie, Chief Executive

Documentation & Dissemination

Current participants' art work is professionally framed and displayed within the dedicated art room, and also around the day services lounge and the public areas of the hospice. Professionally framing and exhibiting patients' art work is an important part of what the art service offers. The benefits of this extends to families, staff and visitors who see the work as an enhancement of the hospice interior.

At least once a year patients' art work is exhibited in a public venue within the City of Glasgow or further afield. Previous exhibiting venues have included House for an Art Lover, Tramway, Kelvingrove Art Gallery and Museum, Scotland Street Museum, the Scottish Parliament and Aberdeen Royal Infirmary, in addition to national conferences on palliative care.

A collection of creative writing by patients has been documented in Foraging (2012), available from www.ppwh.org.uk.

Participants accessing the Creative Arts Service benefit from a sense of achievement and increased self-esteem seeing their work framed, published and publicly displayed. This reflects the commitment and value given to the work created by patients by the hospice as a whole.

'The patients and their families are passionate about the service, and I think that says it all for me. It's what they think, not what we think that matters.' - Rhona Baillie, Chief Executive

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An Integrated Creative Arts Service at The Prince & Princess of Wales Hospice

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The Creative Arts Service is a fully integrated ongoing core service at the Prince & Princess of Wales Hospice, Glasgow. It currently runs four days per week and is delivered by three graduate artists and a creative writer, all experienced in arts and health practice.

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Swan Song Project- Niamh Sammon Assignment 1

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Swan Song Project- Niamh Sammon Assignment 1

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The Swan Song-Creative Arts in Palliative Care- Assignment 1

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The successful creative arts service at The Prince & Princess of Wales Hospice at Carlton Place, Glasgow is opening its doors to figures from the world of arts and healthcare. To celebrate Creativity and Wellbeing Week, from June 13 to 19, the relevance of creative activity to palliative care will be explored by invited guests including artists working within healthcare and palliative care professionals.

The idea is that the workshops, on June 14, will offer guests the chance to explore different art materials and mark-making techniques will open conversations between professionals with an interest in palliative care, arts and health. The hospice's creative arts service is recognised as an exemplar model in its field.

John Jones, 54, from Govan, Glasgow, has been a day services patient at Glasgow's Hospice since early 2015 and rediscovered a long-forgotten love for art. "I always enjoyed art at school and my teachers wanted me to take it further but I left school and started work," he said. "I went on to work at the Rogano restaurant, I started off as a page boy, and was then a waiter and went on to do bar work." He works with watercolour crayons to create bright, lively pieces of artwork, two of which hang on the walls of the hospice's art room. "I enjoy the peace and quiet to work in the art room, it takes your mind off other things that are going on in your life," he added. "I look forward to going to the art room, it give you a different interest. You try not to think about what's going on in your life and carry on as normal. The art room takes your mind off things.
The artists are excellent, they give you help and advice. I've got a few pieces at home now and some on the walls of the art room. It is uplifting, I'd definitely recommend it. A lot of people come into the hospice and it's not for them but many find they're good at it and you'd think they had been drawing and painting all their lives. It just seems to come naturally."

John Kelly, 77, from Govanhill, Glasgow enjoys painting landscapes.
"I've been coming to day services at the hospice every week for about six months. Staff asked me if I wanted to go to the art class and I thought I'd give it a try," he said. "I like painting landscapes and architectural pieces. One of the first ones I did was of the monastery on the isle of Mull, it had a lot of intricate work.
"I enjoy the company in the class. I don't get out much at home, there are things I used to do that I can't now. The class is relaxing."
Initially set up in 2003 to address the absence of art in palliative care in Scotland, the artists who staff the project worked from a table in the corner of day services. It has grown and thrived to become a fully integrated key service with its own art room.
The creative arts service includes visual art and creative writing workshops and is open to all patients, family members and carers registered at the hospice. There are patient art workshops, in which individual projects are undertaken within a group, as well as private family art workshops for adults and children, a carer's drop-in workshop, and individual patient creative writing workshops.

The service aims to give people the opportunity to develop their creativity, express themselves and try something new while engaging in a relaxing and meaningful activity during a difficult time in their life.
It gives people back some of the control they have lost through illness, disability and caring responsibilities. Unlike art therapy the intention is never to analyse or explore issues raised by the creative process.
Most people who access the creative arts service at the hospice have had no previous experience, or have been forced to give up creative pastimes through ill health. Their attendance might offer respite for the patient, family member of carer, a therapeutic activity or a focused activity with their peers.

All sessions are patient-led and supported by qualified practicing artists who have extensive experience in the arts and health, specifically in palliative care, and have ongoing art practices of their own.

"When we meet people they have often lost a lot of confidence and are going through a very difficult time. In the art room they are in charge of every mark they make. We are there to encourage and support participants to develop their own creative practice as artists in their own right, where ideas and skills can grow over time," said artist Jeni Pearson. "It can offer those involved an increased sense of wellbeing. Art has the ability to help us view the world through new eyes. I have heard so many of our participants say that they look at things differently now and for many it can be a life-enriching experience, and this has to be of great importance within the context of palliative care."

The hospice is currently fundraising to build a new hospice in Glasgow's Bellahouston Park that will offer the very latest techniques in palliative care. Art will be an integral part, with gallery space for patients' work.

For more information, contact Angela McManus, Communications manager on 0044141 429 9812 / 00447803 970312

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Exploring the importance of creative activity to palliative care, Glasgow

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The successful creative arts service at The Prince & Princess of Wales Hospice at Carlton Place, Glasgow is opening its doors to figures from the world of arts and healthcare. To celebrate Creativity and Wellbeing Week, from June 13 to 19, the relevance of creative activity to palliative care will be explored by invited guests including artists working within healthcare and palliative care professionals.

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Catherine Flynn communicating using music therapy

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The mission of The Swan Song Project is to give anyone facing the end of life the opportunity, support and inspiration to write their Swan Song.
https://swansongproject.co.uk/why-you-can-and-should-write-your-first-song/

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Walter Schels and Beate Lakotta video and review https://www.theguardian.com/society/gallery/2008/mar/31/lifebeforedeath

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Life Before Death: Walter Schels & Beate Lakotta

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http://www.tommeskell.com/

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Jump to content

Here to support and inspire the Arts & Health
arts & health sectors through Covid-19

by Róisín Loughrey

This short documentary film entitled The Room is the result of the inaugural documentation bursary from artsandhealth.ie. Artist Tom Meskell and filmmaker Róisín Loughrey received this award in 2013 to document the arts programme at Sacred Heart Hospital in Castlebar, Co. Mayo which is facilitated by Tom.

The Room sets out to explore the small moments of magic that happen in the course the arts programme, moments that allow for growth for both participants and the artist. Using a fly-on-the-wall approach, this film is a powerful and moving portrayal of the creative experience of long-stay hospital residents who have an acquired brain injury as a result of stroke, accident or conditions such as dementia or Alzheimer's and reveals the profound impact of the arts programme on their lives.

The artsandhealth.ie documentation bursary was funded by the Arts Council and the Cork Arts and Health Programme, HSE South.

Design by New Graphic

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Jump to content Here to support and inspire the Arts & Health arts & health sectors through Covid-19 by Róisín Loughrey This short documentary film entitled The Room is the result of the inaugural documentation bursary from artsandhealth.ie. Artist Tom Meskell and filmmaker Róisín Loughrey received this award in 2013 to document the arts programme at Sacred Heart Hospital in Castlebar, Co.

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Poetry by Ronna Bloom
https://ronnabloom.com/poetry-in-healthcare

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Grief Without Fantasy | Toronto Urban Film Festival

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By: Midi Onodera (Artist) (Toronto, Canada) - A visualization of a poem by Toronto poet, Ronna Bloom from her collection, "Cloudy with a Fire in the Basement".

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https://lucikershawbacap4.weebly.com/community-project.html

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For my community development project I have been adapting my main film and project in order to take the concept into Palliative care within a Hospice setting. This would involve visiting the Hospice and presenting my idea to a group of patients and then inviting them to answer the questions, "Is there anything you ever wanted to say to someone but never had the chance to?" or I would then return to visit participants and record their responses. These questions could be answered by one of three creative methods - video, audio or written Word. The recordings/writings would then be used exactly as the participant requests. They could wish to keep them entirely for themselves or choose to share with certain people at a time that they decide for themselves. The project could also be open to friends and family of the participant under the same guidelines.
"Is there anything you want to say about your life but never have?"
or this project to be approved and go ahead, I had to produce an ethical approval application, a project proposal, patient information sheet and consent forms..

​In order f

To promote my project I made a short version of my video, edited to portray the elements of it that I wished to bring to the Hospice

With the Ethical Approval in place and interest from Galway Hospice, the Covid 19 pandemic arrived and it was no longer possible to visit the Hospice so I am currently adapting the project again in order to present it virtually. At this time when there would be less activity and less visitors, it could be even more relevant to present an opportunity for people to say things they wanted to, especially as they may not be able to see them at this time. By making a video presentation for the residents of the hospice, talk about the project, show them the quick video example I have been using and simplify the ways in which they could contribute, maybe concentrating on writing it down. I could encourage feedback via email or again writing or even video or voice recordings on a smart phone.

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For my community development project I have been adapting my main film and project in order to take the concept into Palliative care within a Hospice setting. This would involve visiting the Hospice and presenting my idea to a group of patients and then inviting them to answer the questions, "Is there anything you ever wanted to say to someone but never had the chance to?"