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Artists in Residence Jeremy Weller and Hans K Clausen have been exploring the relationships and experiences of hospital staff and patients, and the impact and dynamics of hospital communities moving and evolving, in their residencies: ‘Where it Hurts & Where it Heals’.

Writer and film and theatre director Jeremy Weller has created ‘Where it Hurts’; an hour long performance involving members of different communities from across Edinburgh and some former staff of the NHS and those currently training to work in the NHS. The current ambition is to stage the performance in a decommissioned ward space later in March or early April.

The participants, all of whom have had life changing experiences from the NHS, have come together in a workshop setting to share their experiences of engaging with NHS services whilst exploring how those experiences of care have affected their health and wellbeing. The performance explores these people’s experiences of accessing help at the NHS.

Scenes include real life examples of mental ill health, suicide, addiction, domestic violence, neglect, family breakdown, childhood trauma, isolation, illness, self harm and of often having no one to turn to accept the staff of the NHS. The performance explores why individuals chose to spend their lives caring for others. A common theme that emerged from this process is the fact that some of the people who came to the NHS seeking help actually returned to train as NHS staff, with the hope of somehow repaying the care and support they received in their time of need.

The performances are deeply personal and extremely moving, questioning the idea of what ‘care’ is whilst exploring how those who most need it live complex lives and are often not able to say what it is that really affects them. The other major theme that is explored in the work is the incredible dedication and sacrifices that are made by NHS staff to help those in the community who are most in need of support.

 

So inspired by staff, archives, histories, stories, identities, technology and learning about different professions, artist Kate Ive found it difficult to settle on only a few ideas to pursue. With 19 separate pieces in development, Kate is producing a suite of work that will be displayed throughout the new building to act as wayfinding and pieces of re-imagined histories linked directly to units. Kate is using a variety of materials in her work: copper plated plant roots will go to form a torso like form of arteries and veins; images of bandaging techniques from old nursing manuals and Golgi apparatus are re-created in ceramic; an old fashioned radiology vest is being re-designed with pliable lead just to name a few.

After spending time with staff, Kate came to understand that hospital environments can feel overwhelming with the amount of information being displayed. ‘One of the things that has fed into my work is staff saying hospitals are so full of things, there is stuff everywhere. That when you work there you quickly stop seeing things and they just become the fabric of the building as opposed to things to enjoy and look at. I’m really aware staff will be there long hours, some patients and families are there long term and that’s why in all of the works I have tried to incorporate something that requires you look a bit harder or try to engage with it in a different way.’

 

 

An example of historic illustrations of hand bandaging instructions (above) and Kate’s early porcelain work re-creating the bandage knots. Eventually the porcelain pieces will be mounted into a cabinet and labelled in an old style as seen in the illustration.

 

 

Below Kate is holding an image of the Golgi apparatus which inspired her to create the forms in porcelain enhancing them using the mocha diffusion technique to mimic the Golgi staining technique used to visualise nervous tissue under microscope.

 

Image of Susana Leret

Exploring ways in which smells encode memories, Susana Cámara Leret’s focus during her DCN fellowship is on experimenting with organoleptics: the involvement of the sense organs in medical settings and considering ‘health ecologies’ through stories of aspirations. Susana started her work by spending time with neuroscientist Norman Dott’s case notes in the Lothian Health Services Archives. There she uncovered stories from DCN in the 1920s and 1930s, when smell was referred to as a symptom, for instance olfactory hallucinations or varying smell abilities between right and left nostrils.

Susana has also spent time with Consultant Neuroradiologist Dr Pete Keston who told her about a medical intervention, embolotherapy, which is the intentional blockage of an artery to control or prevent hemorrhaging. A liquid agent called Onyx can be used in embolotherapy and when it is, the patient will have breath with a very distinct smell which can last up to a week. On investigation, Susana discovered that as the body breaks down the carrier substance used to carry Onyx to the brain, it produces a molecule that is expelled through breath. This same molecule has a natural occurrence: the key signalling cue of the Dead Horse Arum Lily, a giant flower that smells like rotting flesh.

Susana is now exploring molecular landscapes- invisible elements we sense through smell- and the associations we might apply to them to ask: How might experiences from medical settings extend beyond hospital walls into people’s homes and vice versa?

Other articulations in matters of care

Susana recently carried out a series of smell-memory sessions with doctors, nurses and hospital staff using cards that had been impregnated with the smell of Onyx. Doctors mentioned having a garlicky taste in their mouths after handling Onyx and nurses talked about knowing an Onyx patient had arrived in the ward because the smellscape had been changed so much by the agent. One nurse said the smell of Onyx reminded her of playing by the sea as a child while another said she could no longer cook asparagus because the smell reminded her of unpleasant experiences on the ward with Onyx patients.  

The molecule found in the smell of Onyx is produced by some sea algae and also when certain vegetables like asparagus are cooked. Illustrating the hyperlinked nature of smell, these stories bring into question how we think about and address medical environments.

You can see Susana’s work as part of the Thought Collider collaboration exploring substances, spaces and processes of affect at Alt-w LAB, City Art Centre, 2 Market Street, Edinburgh until August 27th.

Language and Cognition fellow Gavin Inglis

 

We recently spent some time catching up with Department of Clinical Neuroscience (DCN) Language and Cognition fellow, Gavin Inglis. The DCN fellowship project aims to promote and showcase the working activity and research interests currently in DCN through a programme of three arts/science fellowships curated by Mark Daniels. The Language and Cognition fellowship’s aim is to work with people with neurological conditions to explore areas of growing understanding and connectivity between the patient experience and scientific research practice. The resulting work will reveal some of the complex narratives found in the DCN and its partner organisations.

Gavin has a technical background and has a history of studying artificial intelligence and its possibilities in creating interactive fiction. A keen fiction writer, Gavin eventually came to realise he’s more of an author than a technologist and started thinking about creating interactive fiction that has a chance to make a difference. One such project is an online interactive fiction called Hana Feels. Hana Feels allows readers to navigate through interactions between Hana, a young woman who self-harms, and various people around her. The main purpose is to help readers consider how they might have a conversation with someone they suspect is feeling vulnerable. In creating the story pathways for Hana Feels Gavin says, ‘I thought about how awkward people feel when they have conversations outside their comfort zone. And talking to a friend or family member about their self-harm certainly falls outside the comfort zone for most people.’

‘I want to make something useful.’

Gavin brings this same care, consideration and empathy to the Language and Cognition Fellowship. After spending time in the Lothian Health Services Archive, Gavin has been studying old building plans, records and stories to help him understand the history of the Department of Clinical Neurosciences and one its pioneer founders, Professor Norman Dott.

Thinking about bringing cognition into his work with language, he is currently considering some interesting areas for development like:

 

  • Drawing from stories of patients with Functional and Dissociative Neurological Disorders (FND). After connecting with Consultant Neurologist Dr Jon Stone, Gavin has become fascinated with FND, a neurological movement disorder that means the brain doesn’t send and receive messages accurately and which is not fully understood. Symptoms of FND can present as a range of motor or sensory symptoms in the body such as weakness, movement disorders or blackouts but it’s difficult to diagnose and some patients have experienced accusations of malingering before a diagnosis has been made.
  • Creating from the writings and stories of Professor Norman Dott, whose 40 years of neurological case study notes (around 26,650 notes) have been recently archived and catalogued. Gavin has been especially taken with stories of Professor Dott himself, by all accounts a unique man who, in the early days of his career, recklessly sped around Edinburgh in his car to attend to accidents…caused by cars.
  • Explore ideas around spatial relationships, how the hospital building plans might reveal spatial relationships and help him to imagine telling stories about how a place may have felt in the past.

‘The incredible amount of thought going into the hospital is exciting.’

After spending so much time in archives and by starting to forge relationships with medical practitioners like Dr Jon Stone, Gavin feels more confident now in speaking to staff and specialists. The next phase of Gavin’s work will see him spending more time with people (staff, patients, families) and settling into a new studio and collaboration lab in Edinburgh’s City Art Centre. Inspired by his fellowship research, Gavin has been creating additional pieces of work like an upcoming Unbound event at the Edinburgh International Book Festival and mapping ideas for further exploration like a game that can help neurology patients in recovery.

To keep up with Gavin’s progress and all news from Beyond Walls, subscribe to our email newsletter which is delivered every week.

 

 

 

 

 

 

 

DCN research fellows listening to staff describing the history of the Dott Theatre. Photo by Chris Scott.

DCN research fellows listening to staff describing the history of the Dott Theatre. Photo by Chris Scott.

The DCN Creative Research Artist Fellows recently were given a unique opportunity to visit the Dott Theatres which are incredible historic surgical theatres currently still in operation at the DCN. The hope is to utilize the spaces as inspiration for a future installation currently under development.

DCN Research Fellow line up, from left to right: Gavin Inglis (Language and Cognition Fellow), Susana Camara Leret (Design Fellow), Mark Daniels (Curator), Alex Menzies (Music Fellow), Florence To (Installation Artist, collaborating with Alex Menzies). Photo by Chris Scott.

DCN Research Fellow line up, from left to right: Gavin Inglis (Language and Cognition Fellow), Susana Camara Leret (Design Fellow), Mark Daniels (Curator), Alex Menzies (Music Fellow), Florence To (Installation Artist, collaborating with Alex Menzies). Photo by Chris Scott.

 

Fellows exploring the former viewing gallery above the Dott Theatre. Photo by Chris Scott.

Fellows exploring the former viewing gallery above the Dott Theatre. Photo by Chris Scott.

 

Staff member guiding Fellows through the existing functionality of the Dott Theatres. Photo by Chris Scott.

Staff member guiding Fellows through the existing functionality of the Dott Theatres. Photo by Chris Scott.

Visualisation of the new building that will provide a new home to the Royal Hospital for Children and Young People, Department of Clinical Neuroscience and Child and Adolescent Mental Health Services. Image by HLM Architects.
Visualisation of the new building that will provide a new home to the Royal Hospital for Children and Young People, Department of Clinical Neuroscience and Child and Adolescent Mental Health Services. Image by HLM Architects.

Currently under construction at Little France on the outskirts of the city of Edinburgh, this major new hospital building will be shared by two distinct acute services, the Department of Clinical Neuroscience (DCN) and the Royal Hospital for Children and Young People (RHCYP). In addition, it will also include a Child and Adolescent Mental Health Service (CAMHS) Department with its own unique needs.

All three services have strong identities and proud histories. Maintaining the sense of individuality whilst ensuring efficient use of shared services is central to the design of the building. 

There are common themes relevant to the building for both groups of patients:

  • each will have its own identity within an integrated clinical facility, providing appropriate, discrete environments for all patients, both children & young people and adult patients, each with their own clear visual, and spatial identity.
  • 60% of the 233 beds are ensuite rooms so providing privacy and supporting infection control.
  • the building will be spacious, light, colourful and comforting and not feel like an institution
  • patients will be at the centre of the new hospital and all processes within it
  • the building design supports families as they care for their children/young people and adults in their healing process
  • patient pathways for both patient groups are separate wherever possible
  • physical and mental health facilities are on the same site

 

The building designers HLM Architects are working closely with Ginkgo and the projects teams to explore ways of enriching the patient experience which will be explored in future posts. 

For more information on the new hospital building, please click here.

David Galletly developing wall graphic illustrations at National Museum Scotland. Photo by Ginkgo

David Galletly developing wall graphic illustrations at National Museum Scotland. Photo by Ginkgo

 

There is a growing recognition of the value of an enriched environment helping to reduce stress and anxiety and this is placed at the heart of our programme.

Significant national and international research began with Roger Ulrich and his study in the 1970s, View Through a Window May Influence Recovery from Surgery, demonstrating the positive impact of a considered hospital environment where art and design are integral to the building and to the experiences and health outcomes on staff, patients and families/carers.

Below is a sample of extracts from published academic papers and government guidelines providing some overview.

Scottish policy concerning healthcare environments:

“Health buildings can often be the places in which we may feel at our most vulnerable, whether as a patient, relative or friend. The quality of the building environment that we experience can provide us with calming reassurance or, conversely, it can accentuate our feeling of stress and unease.

Many factors can contribute to engendering a sense of ease, for instance: the first impression of the facility from the public realm, the entrance experience, the degree of natural light, brightness and airiness, colour and texture, an easily understood layout with clearly defined focal points, uncluttered signage and a clear distinction between the realms of public and private space, maintaining patient dignity.

The quality of healthcare facilities along with other public buildings and places can be a significant factor in making communities successful.”

From A Policy on Design Quality for NHS Scotland, 2010

Qualitative research: End of life environments

All quotations are from (Kennedy 1999; Forte et al 2004; NHS Estates 2005).

“The environment should actively demonstrate respect for the bereaved and enable an ethos of support.”…… “It has been suggested that these dimensions of care [attention to the feel of spaces through designs and artwork and a reduction in the clinical] not only have an immediate impact but can also influence the subsequent bereavement process”

Family experience: “We remember so clearly those last things… it makes a huge impact those last impressions they feature in your dreams….. It’s not just the parents but the brothers and sisters too. It has to be nice, not frightening”.

Staff experience: “…. if you go down corridors and taking a family down to a viewing room, you would hurry them, you’d be embarrassed about where you are taking them to… whereas if it is pleasant you will relax a bit because you’re proud of what you are going down to, it will be a comfort and care continued from the wards. That makes a difference.”

Quantitative Research:

Rosalia Staricoff’s groundbreaking research “A Study of the Effects of Visual and Performing Arts in Health Care, Chelsea and Westminster Hospital” (2003) carried out at the Chelsea and Westminster Hospital, London, measured the effect of visual arts and music on patients and staff between 1999 and 2002. One set of findings recorded that the levels of cortisol a neuroendocrine hormone, used as an indicator of stress in patients waiting for their operation in Day Surgery were lower in the presence of visual arts throughout the day compared to the levels found in patients in the control group.

“A statistical test was applied to establish a comparison between the responses of clinicians and nurses. The particular environment of this hospital eased their stress levels: clinicians 75%, nurses 60%, and contributed greatly towards a positive change in mood, in 88% of clinicians and 82% of nursing staff. For 96% of clinicians and 91% of nurses the integration of the arts into health care results in a very pleasant environment.”

Over the next twelve months we will explore some of the areas of this research and how the commissioned Arts and Therapeutic Design programme can help contribute to reduced stress and an enhanced experience for patient users.