Developing a long-term relationship with dementia care within the Royal Edinburgh Hospital through exploring ways in which patients, families, nursing staff and artists can work together as a team; learning from each other in order to make positive change within a ward.
Artlink has been working at the Royal Edinburgh Hospital over several years providing a range of participative arts opportunities and artists placements. The longer-term nature of our involvement allows relationships with patients and staff to evolve over time and creates opportunities to link in with specific NHSL led quality improvement initiatives.
In partnership with Charge Nurse Frank Charleston we identified Pentland Ward at the Royal Edinburgh Hospital, a long stay ward for men with early onset dementia, as the best possible place to take a longer term learning team approach. It was also the focus of a Quality Improvement initiative led by Frank and Frances Aitken, NHSL Practice Improvement and Development and therefore had the added benefit of understanding how arts activity can contribute to creating positive ward environments which contribute positively to staff development and tackles absenteeism and high staff turnover which has a negative effect on quality improvement efforts.
It was decided that the learning team should consist out of NHSL staff, relatives, Artlink producer and artists, and patients. Pentland Ward was selected to ensure a continuity of involvement for both patient and family members. Selecting a long stay ward allowed us to take time to establish strong working relationships and follow through work with the same people from beginning to end. From the outset, we identified that it would be important to bring in other collaborators/ organisations to increase both the reach and scope of the project, as well as provide the additional resources that our collaborators would bring.
Using interactive performance to gain a better understanding of patients’ needs and staff practice at Liberton Hospital in order to address immediate issues of low motivation, social isolation and boredom; ensuring relevance and greater impact of longer-term approaches.
We had been approached to provide input to Liberton in early 2018 as a date for a move of patients form Liberton to new wards at the Royal Edinburgh Hospital had been established and need for input identified by staff. For over a year the start date for the project was put off, as Liberton closure dates appeared imminent, only to be pushed back until a later date. During this time, we were also working as part of Specialist Dementia Unit Improvement Programme in partnership with Healthcare Improvement Scotland (report attached), funded by EVOC. We were interested in taking what we had learned from this work into other spaces facing similar issues.
Liberton specialises in medicine for elderly patients (a larger
percentage of whom have cognitive issues). In collaboration with with key staff
on the wards we decided in March 2019 that we should no longer hold off putting
anything on the wards, as the need for input was now seen as critical. Patients and staff had nothing on their wards
in regard to activity: ‘When we first
went in it felt terrible in there. A low mood. Tired people. Very empty and
isolating spaces as there were just the 4 wards working in the entire hospital
(and now just down to two!)’ – Miss Annabel Sings
Activity on wards had diminished over a period of years for patients and staff, in anticipation of closure, ‘we have not had regular activity over the last 8 to 10 years’ – staff nurse who has worked on ward over the last 19 years. A charge nurse identified: ‘There wasvery little happening, music in hospitals once a month. That’s it’. Little activity and the knowledge that the wards were supposedly closing imminently, had left staff feeling like they were in limbo. The impact on staff, patients and families was tangible. ‘I’m bank, its worse for the permanent staff. It’s a nice team and it’s worrying for them. When are all the patients going to go? They worry that they won’t be with same colleagues, that a good staff team will be split up’. – Bank staff nurse working on ward for last 5 years.
It is always brilliant working with the energetic activity coordinators Kim and Carey at the integrated Stroke Unit and Medicine of the Elderly wards at the Royal Infirmary. It is a mutual learning experience and it strengthens the impact of our work. Working collaboratively, we have made impactful arts and music happen and are excited to start working with newly-appointed activity coordinator Murray Fotheringham at Ward 120.
Recently artist Laura Aldrige worked with the activity coordinators and patients on the Stroke and Dementia wards at the RIE and she picks up the story from here: “I wanted to work in a way that was accessible for all patients; that is taking something that could work in multiple ways and have tasks within it that were flexible to allow as much participation as possible. I decided to work with block printing; the activity allowed for much collaboration and conversation between staff, myself and patients. There was a freedom to it that allowed for testing out more abstract ideas alongside more realistic or recognisable motifs.
Interestingly the printing process seemed to bring about conversations about what patients ‘used to do for a living.’ There was one woman in particular that had been a printer and she just had all this muscle memory and was able to just print non-stop, making the most beautiful prints composed of other people’s printing blocks; how she lined up the different printing blocks and chose complimentary colours was fantastic to see. It’s crucial that people come away feeling positive and that the activity has enhanced their feelings about themselves rather than remind them what they can’t do.”
We look forward to building on this work with Kim, Carey and Murray and creating permanent displays at the Stroke and Medicine for the Elderly wards.
All the wards in the New Royal Edinburgh Building have had their first vitrine workshop with artist Tom Krasny. The project is supported by the Green Space Art Space PSP and the idea is to use the glass spaces in the wall that divide the communal dining and living spaces to create dioramas. Each ward will have a slightly different theme and the pieces made during the workshops will help populate and tell the story of the scene.
It is an energising process as Tom explains: “From my experience running workshops at the Royal Edinburgh Hospital, art activities allow participants to shift focus from stressful circumstances, concentrate on something external and make creative decisions which are at the same time intuitive and subjective. In workshops that take place in hospitals, making the work is often a collaborative effort – a dialogue between an artist or staff member and a patient.
Engaging in creative activities together is fun and informal. It gives participants a sense of agency in a place which often makes them feel controlled. What’s more, it lets them personalise objects in an environment that can feel very impersonal. Art activities also allow space for valuable interpersonal exchange.
I am frequently surprised by and learn from people I work with, their ingenuity, sense of humour and creative choices. The success of a collaborative artwork lies in the approach and atmosphere in which it is made, and I can personally say working with Artlink has made me, as well as many other people, very happy.”
People get so much out of involvement in the arts. Working together in workshops encourages a solidarity between patients that often follows them from hospital to community. The safe space that the workshops represents allows people to be themselves, to use their imagination and follow through on ideas away from clinical environment. This is invaluable.
The Robert Fergusson Unit is the national brain injuries unit treating patients from across Scotland who experience psychiatric or behavioural problems after a head injury. The unit has a multi-disciplinary team which includes: nursing staff; neuropsychiatrists; speech and language therapists; physiotherapists; occupational therapists; art therapists and social workers.
We have worked with this amazing unit over many years and when we were approached to explore the possiblity of creating a permanent artwork with them we were excited to get involved! Artist team leader Anne Elliot worked with patients, Lynda Girvan, art therapist and Alice Landrock, OT over a number of months to explore what might be possible to create. It always takes a while for ideas to get to a certain stage and when they did we brought in a new pair of eyes, in the form of artist Tom Krasny, to develop the project further.
Tom tried out different ways of constructing and deconstructing 3 dimensional forms over a period of 4 weeks. She found that working so closely with patients gave her a great insight into what shape an artwork could take. We have just presented the idea for a permanent sculpture in one of the court yard spaces to patients and staff, and they have given us the green light to progress to the next stage.
We would like to thank the patients and staff for all their hard work and look forward to our continuing work with them. Of course we will share the photos of the final sculpture once it is in place!
The Psychological Therapies Service at St John’s approached us last year asking if there was anything we could do to brighten up the waiting area and public corridors of their department. After a visit to the department and meeting with the team we invited artist Vanessa Lawrence to deliver a series of watercolour workshops for service users and staff to create their own works to brighten up the space.
The department staff team and participants have been brilliant. We have been really impressed and excited by the level of creativity and skill they brought to the workshops. Once the workshops and works were complete we had an afternoon with participants and staff to select works they would like to see framed and hung in the department. In total we selected 51 different sized watercolours to liven up these important patient areas.
“What a fantastic opportunity for patients and staff. The sessions that I have been involved with have felt very therapeutic and the artwork produced has been incredible. It has been really lovely to interact with patients in a different way and see the joy that taking part in such a course has created for them. I can’t wait to see the pieces framed and up in the waiting area!” Sinead Murray, Clinical Associate in Applied Psychology
It has been a real pleasure meeting up with staff past and present over the last year or so to hear more about their connection to the Western General. Artlink has been supporting the hospital to ﬁnd ways of marking 150 years of healthcare being provided on the site; from its ﬁrst incarnation as the Craigleith Hospital and Poorhouse to what it is today – a hive of ﬁrst class healthcare on a site that also supports over 80 different plant species.
Our meetings have involved copious amounts of coffee, running a half marathon, enjoying the talents of musical medics of the 1960s and meeting some of the folk who were born – and now work – at the Western. The conversations have given a real insight into the strong bonds that form when working in a hospital, and we have also found some pretty decent runners amongst you! These encounters and more can be found on the WGH150 blog.
From October to December 2018 artists Claire Barclay and Laura Spring worked with Carey Moss and Kim McGovern at the Royal Infirmary. Carey and Kim are the only two activity coordinators at the hospital and cover wards 101, 104, 201, 202 and 203; some are stroke wards and some are medicine of the elderly wards. Since the patient proﬁle on these wards varies, Claire and Laura had to come up with an activity that would work across all wards.
On the stroke wards patients may experience sensory and communication difﬁculties, problems reading, writing, and mobility issues as well as increased levels of tiredness and fatigue. On top of this hey are dealing with the emotional stress of having had a stroke. On the medicine of the elderly wards a large percentage of patients have dementia, which means we have to tailor activity to individuals who have memory loss, communication and language difﬁculties, impaired reasoning and judgment abilities as well as changes in visual perception.
Claire and Laura decided to try weaving exercises with the patients, as it was straightforward process with a high degree of repetition. This encouraged movement dexterity but also worked with dementia patients as the repetitive movements, over one, under one, became something all patients could process and understand.
We have been working with the Robert Fergusson National Brain Injury Unit for an extended period of time. This is a specialist clinic for the treatment of patients from across Scotland who have suffered psychiatric or behavioural problems after a head injury. The unit has a multi disciplinary team which includes nursing staff, neuropsychiatrists, speech and language therapy, physiotherapy, occupational therapy, art therapy and social work. No two patients’ needs are the same and the team work together to create bespoke care plans around each patient.
Artist Anne Elliot has been working with Lynda Girvan, art therapist and also the OT team, especially Alice Landrock. They have been working on generating ideas for an artwork that celebrates the patients and the work of the unit. It takes time to establish ways of working and at a certain stage we brought in a new artist, Tom Krasny, to take the project onto a new level and develop a series of workshops with patients and staff. Tom worked on four workshops to further test approaches that would have meaning to the patients. Working with a lightweight foam material, Tom constructed pieces that could be deconstructed and reconstructed by the patients – a bit like arty, colourful, oddly shaped, building bricks.
We were amazed at how well some patients took to this process, happy to take the pieces apart and reconstruct them in whatever way appealed to them. For some people reconstructing was about colour combinations; for others it was about putting different shapes together. The activity captured patients’ attention for up to an hour and a half, which is a mark of success on the Robert Fergusson Unit! We knew that we had hit on something that was of meaning to patients on the unit.
Laura Key, the clinical Associate in the Applied Psychology unit at St John’s got in touch with us asking if Artlink could help brighten up the waiting areas in their department. We had a look at the spaces and chatted to Laura and her colleagues to ﬁnd out what they were looking for. Through conversation we arrived at the idea that artist Vanessa Lawrence could work with patients and staff to produce art works to brighten the space. There is something special about artworks having a direct association with staff and patients who are either cared for, or work in the unit. We look forward to the artworks emerging over the next months!
With a passion for reminiscence and the help of a huge back catalogue of songs from every genre, Edinburgh’s premier Cabaret singer and host will be singing in the new year with songs that cheer us up and bring us together. The unifying effect of music is powerful and Annabel is delighted to be back for 2019.
Patients and staff alike have been clearly enjoying the healing power of song. New friends at the St John’s Stroke Unit proclaimed ‘You are really treating us to something very special here!’ as staff and patients danced to the music.
Annabel has had a great time connecting with patients and she looks to the coming year to build upon these positive bonds. She will be visiting the activity rooms and going bed to bed with her unique brand of entertainment and chat, inviting you to join her in singing together, sharing stories, laughing, dancing or simply sitting back and enjoying some entertainment.
Over the last months we have been working in partnership with The Scottish Book Trust and The Reading Agency to bring Reading Friends to care for the elderly wards. Reading Friends is a UK wide scheme that uses books and reading as a way of fostering friendship and creating meaningful moments that have long term effects.
We are one of just two projects in Scotland and the first to be bring this project onto hospital wards. Fifteen new volunteers with varied and interesting backgrounds are ready to deliver this brilliant programme after some first class training from our partners at Volunteer Edinburgh. More training is to come as we continue to recruit but we already have a few of our wonderful volunteers visiting Prospect Bank and St. Johns Hospital. Simon Jay, Artlink’s volunteer coordinator for Reading Friends, has been bringing an exciting energy to the scheme:
“Since our first volunteer meeting mid-January, we’ve had new volunteers join us and we’ve begun to get out onto the wards. The volunteers themselves will be able to share their personal experience at one of our regular volunteer meet ups. Personally I have observed how the act of companionship, through sitting alongside someone and reading, can make a difference in unquantifiable ways. For instance, one patient a volunteer was reading to became much more engaged during an hour together looking at photo-books of Edinburgh. Relatives who visited after a Reading Friend had been to visit mentioned that everyone found it easier to talk and engage with each other. On another occasion, visiting a particularly distressed patient in their room calmed them down immediately and they found the companionship very soothing.”Simon Jay, Reading Friends Volunteer Coordinator
We’d like to welcome back Sarudzai Mutebuka, Senior Charge Nurse at Prospect Bank, you have only been back a short period but your amazing energy and enthusiasm is already showing results!
To expand what’s available in some of the specialist dementia units we work with, we asked Dance Base, who are currently running ‘Step in Time’ across 5 elderly residential homes in Edinburgh, to set up one of their projects at Prospect Bank. ‘Step in Time’ is a creative movement programme for older people. To make sure that the project would be well supported, Emma Stewart-Jones from Dance Base led a training session for care staff. A fun and energising morning explored how dance and creative movement can be used in care environments. To maximise impact of this opportunity Artlink invited activity coordinators from other hospitals to take part too.
Dance Base has now started a set of 8 weekly workshops for residents till the end of March. Activity Coordinators have been invited to observe how the dance specialist leads these moment sessions. This way they can start to explore how they may incorporate similar ways of working into their own work. Artlink also organise a monthly coffee meet up for Activities Coordinators across hospitals to get us all talking to each other, sharing ways of working and feel more supported by each other.
‘Thank you to Miss Annabel Sings and Saro for setting up this training programme, it has been a delight to work with you all. Thanks to everyone who joined in the training programme, I really appreciate your energy and open minds’ Emma Stewart-Jones, Dance Base