Evaluation Report 2013
Art at the Heart of the RUH
Soundbite Supporting the core values of the RUH with an innovative arts programme, Art at the Heart of the RUH aims to enhance the hospital environment and experience with measurable benefits to patients, staff and visitors. Committed to excellence and innovation we provide creative opportunities for the whole community through partnerships, participation and collaboration. Under the Art at the Heart umbrella, Soundbite brings a varied programme of live music and creative activities to patients, staff and visitors at the RUH. Through our Soundbite programme we aim to increase access to musical provision across the RUH community; improve the wellbeing of patients, staff and visitors at the RUH, and to provide students and emerging musicians the opportunity to gain experience of music facilitation and performance in a health care setting.
Aims 1. 2. 3. 4.
To enhance the ward environment and patient experience, providing stimulating activities for older patients. To increase social interaction and enhance the relationship between staff, patients and their carers. To increase intergenerational work within the hospital through the use of student placements. To form strong partnerships with organisation within our immediate catchment area and regional networks
Objectives 1. 2. 3. 4.
To provide live music performances for patients, staff and visitors at the RUH; To provide music workshops and performances for older patients, specifically those with dementia; To deliver reminiscence sessions for patients with dementia or cognitive impairments; To provide placements and an internship programme for students and young musicians.
We would like to thank the following organisations for their support throughout 2013 Generously funded by the Joyce Fletcher Charitable Trust
Lunchtime Performances The performances have been generously funded by the Joyce Fletcher Charitable Trust.
The music has reached around 12,600 people in the atrium, and over 500 patients and visitors on wards and waiting areas.
Hannah Stone Royal Harpist to HRH The Prince of Wales
Over the last year we have had 21 performances by over 80 musicians including the RUH Choir. We have had 5 performances from musicians from Superact, and 6 from the Bath Folk Festival. 17.01.13 22.01.13 26.02.13 14.03.13 19.03.13 26.03.13 09.04.13 26.04.13 07.05.13 18.06.13 25.06.13
BSU Clarinet Quartet Aysu Bisgrove RUH Choir Dimitris Dekavallas Miranda Sykes Marick Baxter Jamie Smith RUH Choir Archer Pearce Duo Mamadou RUH Choir
09.07.13 Julie Payne and Claire King 15.08.13 Threepenny Bit 19.09.13 Marick Baxter and Jayne Dempsey 01.10.13 Emily Maguire 15.10.13 Galouis Brother 12.11.13 Emily Maguire 19.11.13 Mac Seka 03.12.13 RUH Choir 10.12.13 Galouis Brothers 17.12.13 Silver Ring choir
Workshops on the OPUs Over the past year we have provided over 190 music workshops, reaching over 2,300 patients. The sessions have been led by Rosie Mead (until March 2013) and Frankie Simpkins on four Older People’s Units – Combe, Midford, Pulteney and Helena. The majority of the workshops have taken place on the bays, with a small number delivered in the communal day room areas. The sessions took place at the following times: 11:00-12:00; 13:30-14:15; 14:30-15:15 and included live music, opportunities for patients to make requests, and reminiscence discussions. It has been observed that participating in musical activities can provide stimulation for older patients, and can increase social interaction and improve overall wellbeing. For patients with dementia, live music can help recall long lost memories and can reduce agitation and anxiety. Referrals In July 2013 we began working closely with the Dementia Coordinators and ward managers on developing a referral system whereby they refer patients to us that they feel would benefit from music. Using a referral system allows us to reach patients who are in need of stimulation/ interaction, and who may not normally hear the live music performances.
“As I set up in the day room there was a patient waiting to go home. He told me he loved the clarinet so I played a few pieces for him. He sang along with a couple and was still singing “Fly me to the moon” when I left the ward! A Physiotherapist said that they noticed he was really enjoying the performance.” Musician “Music remains a very important part of the care for patients with dementia. It creates an environment that is stimulating for the patient and also provides something familiar for them, in a very alien setting. However, it is not just the dementia patients that benefit. It is obvious to see from the smiles on the faces of patients, relatives and staff that it has a positive impact to all present. There is a very different atmosphere when there is live music on the ward.” Ward Manager
Bringing music to the wards and patients 3
The Referral Programme
Arts and Health Southwest Dementia and Arts Project Over the past year we have taken part in a project led by Arts and Health Southwest in collaboration with 6 other hospitals in the Southwest to share our experiences of managing and delivering arts projects for patients with dementia. The findings will be published as an online resource to allow hospitals without an arts coordinator to provide creative activities for their patients with dementia. The project aims to enable the spread of knowledge and experience about the use of creative activities with people with dementia from within community and residential care in to the acute sector, where it is less established. The project will encourage sustainability by involving the nursing and support staff at every stage, enabling them to gain understanding and knowledge and to spread this within their own teams – and through their endorsement spread through their wider peer group regionally and nationally. The action learning process will enable the participants to reflect on the issue of quality and how best to ensure excellence in their own projects and in the online resource.
Outcomes • Patients with dementia in 10 hospitals will have: • Experienced high quality arts based activities designed specifically to support their needs Received more person-centred care and been treated with greater dignity and respect • Nursing and support staff in 10 hospitals and arts coordinators in 7 hospitals will have: • Learnt how to be more imaginative and creative in the delivery of care for those with dementia • Acquired new skills in using arts based activities to support the delivery of person-centred care • Learnt how and why arts based activities can enhance patient experience and ultimately improve the efficiency of care • Understood the benefits of bringing professional artists in to support the delivery of care and how this can be managed and funded • Experienced the benefits of involving carers and volunteers in arts based activities and adapted their approach to engage carers and volunteers more pro-actively • Changed their behavior in the way they respond to patients with dementia showing greater recognition of their individual identity We contributed to this project with our findings and knowledge gained through undertaking research into the effects of live music for people with dementia, and the delivery of reminiscence workshops for patients with dementia.
Reminiscence Project In the summer our Music and Activities Facilitator, Frankie Simpkins, delivered a 12 week pilot creative reminiscence project – ‘Reflections’ – assisted by Elodie Guest (Creative Arts Therapies student, City of Bristol College) generously funded by the Quartet Community Foundation. The project was based around the book ‘a Little Aloud,’ which consists of story extracts and poetry grouped in themes. This formed the basis for the workshops, providing self-contained weekly reminiscence workshops for older patients, particularly those with dementia or cognitive impairments.
Aims and Objectives The project aimed to: • Provide stimulating activities for patients • Induce a feeling of achievement and happiness in the patients • Improve patients wellbeing and welfare • Increase patients self-esteem and confidence • Encourage and support social skills and interaction between patients • Promote positive reminiscence and memories
Objectives: • • • •
To provide weekly interactive workshops in the day rooms of both Midford and Pulteney To use set themes and stimulus that should encourage memories To use appropriate and accessible resources Incorporate both recorded and live music to enhance the sessions.
The sessions took place every Friday on Pulteney and Midford wards and involved around 4 patients in each group.The group sessions were based on a different theme each week; and within each session the patients had the opportunity to work with a variety of creative stimulus including poetry, music, photos, and reminiscence objects. The creative responses and images from the project have been collated into a reminiscence book, titled ‘Reflections’ which has been placed around the hospitals for patients, visitors and staff to enjoy. We hope for the book to be used as a tool within the RUH and other hospitals alongside reminiscence activities.
From top left: Activities Facilitator Frankie Simpkins
Active participation in creative activities can act as a form of social inclusion, therefore reducing loneliness and anxiety. As indicated in a study conducted by Hays and Minichiello 2005; â€˜The Meaning of Music in the Lives of Older Peopleâ€™ Psychology of Music.
Student Placements Over the last year we have had two students undertaking placements at the RUH from Bath Spa University and the City of Bristol College. Whilst on placement the students have received training in dementia awareness, and the use of music and creative activities in healthcare. Kristina Kennedy, a Music undergraduate from Bath Spa University, undertook a placement with us for one month in the summer. She initially shadowed Frankie Simpkins as she performed on the wards, and then was able to perform herself on the harp in the atrium and on the wards. Elodie Guest, Creative Arts Therapies student from the City of Bristol College, undertook her placement with us over 12 weeks, assisting Frankie with the reminiscence project. As an artist Elodie was able to design resources which could be used in the sessions, and engaged the participants through the use of art. Throughout the 12 week placement Elodie kept a reflective journal which was used to form the debrief after each session. Below is a selection of Elodie’s observations:
“I found out, whilst I was observing Frankie play her music that the wards are very busy! The musicians have to be flexible to make sure they work around the doctors and nursing staff who are doing their medical rounds in the morning.” “During lunch, we chatted about working with patients with dementia and what I can expect on the older people’s wards, as well as what to do in certain situations. The most important point I’ve learned is that facilitators need to be flexible; even if you’ve prepared a whole theme and lots of materials, the patients may not want to talk about that theme or may simply talk about something different, the activity has to be tailored to their particular needs.” “It appeared that the patients enjoyed sitting around the table in the bay, they all stayed at the table to eat their lunch (normally they would have lunch at their bedside). All three patients said they enjoyed having something different to talk and think about. “ “The reactions to the music were beautiful; everyone’s faces lit up, the patients and the staff, some sang out loud whilst others mimed the words and the atmosphere that was quite hectic when we arrived calmed down and simply became lighter. There was one patient who had been wandering in the corridor and with the assistance of one of the nurses, came and sat down with a cup of tea and stayed there, singing along to the songs she knew for the duration of the performance.”
“There is a sense of calm when the music is playing” Nurse “Very pleasant surprise, very enjoyable excellent performance” Patient
“The patients appear more engaged during sessions, there is a sense of community between patients” Nurse “The music has been the highlight of my day” Patient “A lady who was sleeping in the day room moved her chair and sat in the doorway listening and clapping.” Frankie
The Icaris Duo
Research An Exploration into the Effects of Live Music for Hospital Patients with Dementia In February 2013 Rosie Mead (Music Coordinator) led a 5 week pilot study as part of her Master’s Degree in Music Psychology. The specific objectives were to: 1. 2. 3. 4.
Explore the effects of musical interventions on agitated behaviours displayed by patients with dementia. Examine the effects of live music on mood and anxiety of patients with dementia. Investigate the effects that live music can have on sleep patterns of patients with dementia. Evaluate the agitation, anxiety and mood scales as an objective measure with a view to using them in a larger RCT.
Evidence was gathered through a mixed method approach: • Cohen Mansfield Agitation Inventory (CMAI) was completed by nursing staff every 48 hours to monitor the participants’ levels of agitation. • Staff completed a numeric rating scale of their opinion of the participants’ overall wellbeing after each session. • Participants completed a numeric rating scale assessing their level of anxiety and mood before and after each session. • Observations were conducted by the researcher • Semi structured interviews examining the participants’ perception of the choice of repertoire, ability to improve their mood and patient experience, and organisational factors such as the frequency of the performances.
Results • • •
Participants’ mood was significantly improved (p=0.005) Anxiety was reduced by 29% after the music On average agitation levels were lower for participants that listened to the music
Rosie is currently exploring this further as a larger study as part of her PhD in Sociology at Exeter University.
Effects of Live Music for Patients with Dementia MASTERS research
In the UK there are around 750,000 people with dementia Up to 1 in 4 beds in General Hospitals are occupied by people with dementia Rosie Mead Music Coordinator Art at the Heart of the RUH led a 5 week study exploring the effects of live music for hospital patients with dementia.
16 participants 12
Specific objectives: 1. Explore the effects of musical interventions on agitated behaviours displayed by patients with dementia. 2. Examine the effects of live music on mood and anxiety of patients with dementia. 3. Investigate the effects that live music can have on sleep patterns of patients with dementia. 4. Evaluate the agitation, anxiety and mood scales as an objective measure with a view to using them in a larger study.
THE RESULTS Participantsâ€™ mood was significantly improved (p=0.005) anxiety was reduced by 29% after the music on average agitation levels were lower for the patients that listened to the music Rosie will be exploring this area further conducting a larger study as part of her PhD research at Exeter University
Art at the Heart of the RUH Estates and Facilities Directorate Royal United Hospital NHS Trust Combe Park Bath, BA1 3NG 01225 824987 e: firstname.lastname@example.org www.ruh.uk.nhs/art Follow us on twitter: @artatruh
Art at the Heart of the RUH