RESEARCH AND EVALUATION
Our art and design programme has three main areas of work:
- Arts for All
- Design and Environment
- The Future Hospital
Underpinning all of our work is an objective to grow a robust body of evidence that clearly demonstrates the impact on patient outcomes, care delivery and cost effectiveness of these programmes and enhancements. We work with a group of academic partners on project evaluation and, through the dissemination of our findings, are now collaborating and sharing knowledge with sister organisations in Japan, Korea, Australia, Europe and the US.
The Zoo is a 90-minute-long bespoke digital artwork commission which can be played on a seamless loop, featuring moving portraits of 42 different animals, ranging from domestic to wild. The film was designed with creative filmmakers Accademia with the aim of providing a positive distraction to children waiting or being treated in the Children’s Emergency Department as Chelsea and Westminster Hospital, who can often be anxious, distressed or experiencing pain.
Since The Zoo has been installed, we have had excellent feedback from patients, families and staff. Due to its success, we have also installed The Zoo in the Paediatric Outpatients Department.
We are currently undertaking a full clinical trial to objectively assess the impact of the intervention on the distress and perceived pain of the patients. This study will be complete in 2020. A pilot of the study indicates a reduction of up to 30% in observable signs of pain and distress, and we are excited to verify this with the full study.
GREG WINDLE PHD THESIS - 'THE IMPACT OF ENGAGEMENT WITH THE ARTS ON THE HEALTH AND WELLBEING OF HOSPITAL INPATIENTS WITH DEMENTIA'
The global rise of dementia has provoked a multidimensional response from research, policy, and practice sectors. Care for dementia in hospital settings is of particular concern given the outsized lengths of stay and readmission rates. To respond to the resulting care needs, arts in health programmes are increasingly implemented in hospitals, with a central focus on supporting those with dementia. This PhD aimed to explore patterns of engagement with the arts and their psychosocial effects on hospital inpatients with dementia, with a particular focus on the differences in psychological impact between traditional and digital modes of engagement.
The study used a sequential mixed methods design organised across three inter-related studies. Study 1, a cross-sectional study of 123 inpatients, used a questionnaire battery consisting of validated measures for loneliness, quality of life, and depression alongside questions regarding current, past-year, and life course engagement with different art forms and cultural activities. High rates of loneliness and depression were measured among participants, but current individual engagement with the arts was associated with less loneliness and increased quality of life. Notably, passive and solitary activities such as reading and watching television were associated with lower levels of loneliness. Study 2, a focused ethnographic study of 43 participants, focused on digital and traditional arts and music programmes at an acute care NHS trust. This study found that the novelty of digital art led to focused individual engagement while traditional art groups were more likely to engage socially. Additionally, this study presented a model for patient experience of hospital art groups describing the discrete and interactive effects of arts engagement, social interaction, and environment. Study 3, a 3-arm controlled study with 90 participants, compared validated before and after measures of anxiety and wellbeing for traditional art, digital art, and control activities. This study found short term improvements in wellbeing in both digital and traditional art groups and lowered anxiety in the traditional art group compared with a control group.
The thesis triangulates data from the studies to explicate patterns of arts engagement and their effects. A methodological contribution is made by using both qualitative and quantitative methods to connect intra-activity data with outcome measures. Theoretical contributions include considerations of the balance between novelty and familiarity in arts engagement, the roles of the environment and social engagement in a hospital setting, and the use of art for both reminiscence and expression in dementia.
QUEEN MARY UNIVERSITY OF LONDON
‘RePlay’ - New Musical Instruments for Upper Limb Rehabilitation
CW+ is collaborating with designers at Queen Mary University of London to create a new musical instrument designed specifically for Upper Limb Rehabilitation. The instrument will support existing upper limb exercises and functional rehabilitation, but with the added expressivity and challenge of musical learning. It will be designed to be small, portable, and infection control friendly, and therefore usable from the early stages of a patient’s rehabilitation. Usage will begin with simple movements and patterns before increasing in complexity over time – just as with a traditional musical instrument. A feasibility study will begin in January 2020 to assess the design and accessibility of the instrument for patients on Chelsea and Westminster Hospital’s ‘Nell Gwynne’ ward.
Automated Music Playback Systems Driven by Live Patient Data
‘Pulse Music’ is an intelligent music listening system, designed to use live patient data to modify the listening experience to support specific clinical goals. Inspired by the new ‘sensor-rich’ Intensive Care environment at Chelsea and Westminster Hospital, and based on recent research suggesting a link between musical tempo and a listener’s pulse, the ‘Pulse Music’ system automatically adapts the tempo of a piece of music in response to changes in a listener’s heart rate. A recent pilot study, led by consultant cardiologist Dr Sadia Khan at West Middlesex University Hospital, investigated the potential effects of this system on a cohort of volunteer participants; the results of this are currently undergoing analysis.
INTENSIVE CARE UNIT PSYCHOLOGY SERVICE
We have appointed two psychologists to work with us on our plans to create a world-class Intensive Care Unit (ICU) at Chelsea and Westminster Hospital. The project includes collecting data across a patient’s experience of critical care, including prior to their stay for planned admissions, on the unit, and three months following their discharge from ICU. The project will provide rich data on the ‘before’ and ‘after’ of the redevelopment of our Intensive Care Unit and the impact of physical environment on wellbeing.
INTENSIVE CARE UNIT SLEEP STUDY - VIRTUAL REALITY
Sleep is a major contributing factor to intensive care associated illness, such as post-intensive care syndrome (PICS), and remains a prominent complaint amongst patients discharged from critical care settings. Whilst multiple pharmacological and non-pharmacological interventions have been trialled to combat this, there has been little homogeneity in the results. Virtual reality (VR) has been used successfully in multiple care settings including as an adjuvant to analgesia during painful procedures, as a relaxation and therapeutic aid in oncology and as a rehabilitation tool. As such, it is possible that VR may have a role in the critical care settings; however, this has never been explored. We are working with the ICU team at Chelsea and Westminster Hospital on a Sleep Study to review the feasibility of using VR in an ICU environment and how this can impact sleep quality and, in-turn, psychological and physical symptoms. The study will involve a patient-recruitment programme and a clinical team led investigation into the use of VR, using sleep-quality monitoring software and pre/post intervention questionnaires.
CARDIAC CATHETER LAB - VIRTUAL REALITY
The cardiac catheter lab is often a place of considerable anxiety for patients – there are worries regarding health status and the procedure itself can compound this anxiety not only in terms of the anticipation but also from the actual discomfort of the procedure itself. Anxiety levels are often at their highest just prior to the procedure, which is often painful, and staff may find it difficult to offer verbal reassurance and comfort as the procedure can be technically demanding. Furthermore, the presence of the specialist X-ray equipment needed for the procedure means that it is often difficult to stand in proximity.
Studies show that providing holistic care with attention to the environment can potentially lead to reduction in anxiety levels and hence improvement in patient experience. Recently, there has been interest in the use of virtual reality (VR) as immersive techniques to reduce pain and anxiety in hospitalised patients. We are undertaking a study exploring the feasibility of VR in the cardiac catheter lab environment, from a patient and staff perspective and to assess whether the use of VR can attenuate markers of pain and anxiety in patients undergoing elective procedures. For this project we are using digital content developed by us for the purpose of the study. The secondary objectives are to evaluate the effects of IR on heart rate, blood pressure, respiration, and markers of autonomic function.
CW+ has partnered with Virtual Reality (VR) company Rescape as part of their DR.VR programme. Both Chelsea and Westminster and West Middlesex hospital sites are taking part in various VR research studies, including a general impact study in Paediatrics ED, the ‘CLeVR Study’ and the ‘Sleep Study’. DR.VR is a state-of-the-art Virtual Reality Kit, including an app developed specifically for clinical VR studies which measures anxiety and pain levels both pre and post VR experience. The software allows for full staff control, ensuring content is always appropriate and monitored, and ensures that patients are receiving the best quality visuals. We have commissioned our own bespoke content to be created by film company FlixFilms, which has been incorporated onto the DR.VR headsets.
ROBOTIC COMPANION PETS
PARO is an advanced interactive robot seal developed by AIST, a leading Japanese industrial automation pioneer. PARO has five kinds of sensors: tactile, light, auditory, temperature and posture, allowing it to perceive people and its environment. In interacting with people, PARO responds as if it were alive, moving its head and legs, making sounds which imitate the voice of a real baby harp seal and showing your preferred behaviour.
Miro-E is a robotic pet companion that was originally developed for Residential Care Homes and education services by Consequential Robotics. We are currently trialling Miro-E in various paediatric departments across Chelsea and Westminster Hospital, including Burns, HDU and the Adolescent Room in Jupiter Ward. The aim of the trial is a feasibility study to assess the effectiveness of Miro-E as a distraction tool for children in what is normally considered a stressful environment. With internal camera lenses and built-in touch sensors, Miro-E recognises people and faces, and responds to affection. The clinical team will use questionnaires which we have developed, in order to establish the effects of Miro-E on stress, anxiety, cooperation and pain levels, as well as the impact distraction has on parents, carers and staff during waiting times and procedures.
UNIVERSITY OF WEST LONDON - SENSORY SPACES
We will be working with Prof. Victoria Tischler to conduct a mixed methods pre-post feasibility study to test a multi-sensory dining intervention to improve nutrition and hydration for inpatients with dementia.
This study will explore the use of smells, foods, textures and other ambience-enriching elements in hospital for people with dementia over the age of 65. Previous studies have shown that a multi-sensory approach is beneficial for improving the wellbeing of individuals with dementia, and we will be looking at the effects of it in improving and increasing patient hydration, nutrition, and enhancing their dining experience.
ARTS FOR ALL - P.A.R.T REPORTS
We are have developed in method of evaluation for our artists who deliver participator workshops. This method was designed by our PhD student Greg Windle, and is a reflective way for artists to feedback about their sessions which include positive and negative commentaries - such as the example below:
"One of the patients had asked the physiotherapists to work with me again. Really great experience in the second time working with one of the patients again after a month he was re-admitted and he spoke of the impact of the session on his confidence in moving again. Felt that the essence of the work is in supporting the development of a physical security." Cai Tomos, Creative Movement workshop facilitator