A picture of health

“The effect of beautiful objects, of variety of objects and especially of brilliance of colour is hardly at all appreciated… I have seen in fevers (and felt, when I was a fever patient myself) the most acute suffering produced from the patient not being able to see out of a window and the knots in the wood being the only view. I shall never forget the rapture of fever patients over a bunch of bright coloured flowers… People say the effect is only on the mind. It is no such thing. The effect is on the body, too. Little as we know about the way in which we are affected by form, by colour, and light, we do know this, that they have an actual physical effect. Variety of form and brilliancy of colour in the objects presented to patients are actual means of recovery.”

Florence Nightingale, Notes on Hospitals, 1859


Learning objectives

1. Understand more about the effect of art on health

2. Consider your own clinical environment and the impact on patients

3. Take the opportunity to look at some images yourself and reflect on how they make you feel


I’m going to take the opportunity to expand on one of my previous posts about the waiting room and explore the effect of visual art in the clinical environment.


Questions

What art is displayed in your clinical environment?

If you don’t have any art, how does that make you feel?


A retrospective analysis of cholecystectomy of patients in a suburban Pennsylvania hospital between 1972 and 1981 found that 23 surgical patients assigned to rooms with windows looking out on a natural scene had shorter postoperative hospital stays and took fewer potent analgesics than 23 matched patients in similar rooms with windows facing a brick building wall.


Questions

Do you have a window in your clinical room?

If yes, what can you see and how does it make you feel?

If no, what’s your vitamin D level again?


Art encompases many forms. In the clinical setting, the most common exposure to art is in the form of paintings on walls (if anything at all). If you’re lucky, you might have space for a sculpture. I’ve never encountered a video art installation unless you count the infinitely scrolling healthcare messages on the TV screens displayed in some waiting room. Come to think of it, I suppose the constant stream of clinical pop-up warning messages on my computer monitor could be considered modern art. Maybe not.


Questions

What type of art do you like?

What type of art do you want in the clinical setting?

Do you think art might help your patients?


One study set in an acute psychiatric care unit found that less pro re nata (PRN) anxiety medication was used when a realistic nature image was displayed compared to an abstract image or no image. Indeed, some patients seemed more agitated with the abstract image on display. The study authors go on to make a case for visual art interventions in terms of improvements in patient well-being as well as the financial savings via reduced medication costs and staff time. This result is echoed in another study which found postoperative cardiac patients experienced less anxiety and more likely to step down the analgesic ladder when exposed to a nature image when compared to patients exposed to no image or an abstract image. Again, patients exposed to an abstract image experienced more anxiety than those with no image. However, it has been noted there is a danger here in making hierarchical generalisations on art and what type of art might benefit a patient since art varies so much and the same work may invoke different feelings in different individuals.


Right, finally time to look at some images:

Cossacks 1910-1 by Wassily Kandinsky 1866-1944Cossacks (1910-1911)
Wassily Kandinsky

 

Piet MondrianComposition with Red Blue and Yellow (1930)
Piet Mondrian

 

Henri MatisseThe Sorrows of the King (1952)
Henri Matisse

 


Questions

What’s your favorite colour

What colour would you consider calming?

What colour would you associate with anxiety?


Exposure to the colours red and yellow are associated with an increase in anxiety compared to blue and green. Indeed, some studies have demonstrated increases in heart rate and respiratory rate with red and yellow than with blue and green. Obviously you don’t need me to tell you that blue (sea/sky) and green (foliage) are often found in many images of nature and landscapes. These colour preferences may however vary depending on age and gender. In one study based in the dental setting, children in positive emotion preferred blue and pink. Alternatively, when the children were in negative emotion, red and black were their choice. Interestingly even within this age band, younger children (6-9 yrs) preferred pink and older children (10-12 years) preferred blue significantly more than the other colours for positive emotion.


CALM? WISDOM? COLD?

NATURE? HARMONY? GROWTH?

LOVE? ENERGY? INTENSITY?

OPTIMISM? INTENSITY? ATTENTION/?


By the way, Biophilia isn’t just an album by the excellent musician Bjork, it’s also the name of a hypothesis suggesting that humans possess an innate tendency to seek connections with nature and other forms of life. So, what next? If we’re looking for some nature images, how about these:

Claude LorrainThe Roman Campagna (1639)
Claude Lorrain

 

Joseph Mallord William TurnerThe Fighting Temeraire (1839)
Joseph Mallord William Turner

 

Ansel AdamsThe Tetons and the Snake River (1942)
Ansel Adams

 

Charles O'RearBliss (1996)
Charles O’Rear

 

This desire to connect with nature may not just be aroused by visual art, but words in themselves might evoke images and thoughts of nature in the mind. How about putting up a poem on the wall?


Questions

What images might you want at work?

Are there any barriers you might face in trying to decorate your environment?

Have you ever google image searched ‘hospital art’ and what type of art did you find?


What art might work for your place of work? Please consider commenting on your thoughts below.


Summary

Health and art might be viewed as an unlikely pairing but there is evidence that utilising the clinical environment with the right art can improve not only patient experience but also clinical outcomes. Championing the legitimacy of art in healthcare systems that are under persistent and/or increasing strain won’t be seen as a priority and the very suggestion will probably be subject to ridicule. In such circumstances, you probably have to do something by yourself. A carefully selected painting placed on the wall might represent a small scale investment for what may be a potential long term effect for both patient and doctor health. Personally a link to something local would be nice. Plus I’d have to look at it almost everyday.

Thomas CreswickDistant view of Birmingham (1828)
Thomas Creswick


Further resources

View through a window may influence recovery from surgery.
https://www.ncbi.nlm.nih.gov/pubmed/6143402/

Effect of visual art on patient anxiety and agitation in a mental health facility and implications for the business case.
https://www.ncbi.nlm.nih.gov/m/pubmed/21539683/

Visual art in hospitals: case studies and review of the evidence
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996524/

Colour Preference to Emotions in Relation to the Anxiety Level among School Children in Puducherry – A Cross-Sectional Study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020302/

Report of the Review of Arts and Health Working Group
http://www.artsandhealth.ie/wp-content/uploads/2011/09/Report-of-the-review-on-the-arts-and-health-working-group-DeptofHealth.pdf

Paintings in hospital
https://www.paintingsinhospitals.org.uk/why-art-matters

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