Hospitalized Children’s Responses to a Guided Viewing of a Mural

Photo of mural being painted

In October we received Institutional Review Board (IRB) approval for our arts in healthcare research project, and have begun collecting data from children hospitalized at Georgetown University Hospital.

Purpose: An elaborate underwater mural is underway in pediatrics on the 5th floor of the hospital’s Concentrated Care Center building in the hallway between the pediatric intensive care (PICU) and transplant units. This study will explore and describe the effects of a guided viewing of the mural on hospitalized children, with an emphasis on determining if such engagement can reduce children’s anxiety during hospitalization.

Investigators: Judy Rollins, PhD, RN, CEP, and Linda Jung, CCLS

Consultant: Stacey Sachs, MFA

Background: Healthcare experts have long recognized that hospitalization can be stressful for children. However, with appropriate support, children can weather and even grow from the experience. We are learning that the arts can play a significant role in this support (Rollins, 2005). Children respond to and often use artwork created by professional artists as tools for coping. Prescott and David (1976) reported that children, who live according to the information provided by their senses, remember places and sensations more than they remember people. Thus, they are likely more sensitive to their surroundings than are adults, and may be affected deeply and for a long time by details of which adults are unaware. The PI knows of only one, to date unpublished, study that has investigated the stress-reducing effects of professional artwork in pediatric settings. (The PI reviewed the manuscript as part of a blind reviewed journal process, thus the author’s name was withheld.) The researcher exposed hospitalized children to one of three situations in their hospital rooms: a representational nature image, an abstract nature image, or no art, and found no significant differences between groups regarding health outcomes. He/she suggests that this finding may be due to the passive nature of the intervention. We are unaware of any studies that have addressed the anxiety-reducing effects of an interactive intervention using professional artwork with children in hospitals.

Plan of study: Renovation of Georgetown’s inpatient pediatric units is currently underway with the goal of humanizing the hospital by creating an environment that is non-threatening and welcoming for children, their families, and staff. An integral element of this renovation is the incorporation of a large mural to be installed in the hallway between C51 and C52. The mural will incorporate three content elements of artwork that are believed to be therapeutic for children’s healthcare settings: (1) engaging, (2) endearing, and/or (3) nurturing (Hathorn, 2000).

Medical illustrator Stacey Sachs, MFA, Murals to Life, will design and produce a highly detailed, vibrantly colored, hand painted one-of-a-kind mural specifically for the pediatric hallway between C51 and C52. It will feature an underwater fantasy seascape including various sea creatures such as turtles, dolphins, and a variety of fish and invertebrates. Also included will be a sunken ship and treasure chest. Featured in this work will be a “seek and find” theme, where a variety of items will be placed throughout the artwork and children will be given a list of things to find. The mural will be placed on the main wall between C51 and C52, with additional artwork depicting above water scenes painted on the two side walls in the elevator corridor. Final size of this mural will be approximately 75 feet wide by 8 feet tall for the main hallway, and two 10 feet wide by 8 feet tall walls in the elevator corridor.

This exploratory study will address the following questions:

1.   What is the nature of children’s responses to an interactive viewing session with the mural?

2.   Can an intervention incorporating an interactive viewing of the mural reduce children’s anxiety?

The intervention will consist of one individual guided viewing session of the mural with each child, which will incorporate a formal critique method used in art education settings, drawing, and a “Seek and Find” list of items to find within the mural.

Duration of project: 18 months

Participants: 40 boys and girls, ages 5–18 years

Methods: A quasi-experimental phase lag design will be used (Cook & Campbell, 1979). Qualitative and quantitative methods will be used within a grounded theory approach (Glaser & Strauss, 1967) and will include drawing—Child Drawing: Hospital (CD:H) (Clatworthy, Simon, & Tiedeman, 1999)and an illuminative drawing—to accompany traditional grounded theory methods of interview and observation.

Procedure: There are two phases to the research project. During Phase I, the pre-mural phase, we will gather data from the comparison group. Phase II will begin when the mural is complete. During this stage we will facilitate the intervention with and gather data from the intervention group.

Phase I. After explaining the project and obtaining consent from a parent/guardian and assent from the child, we will ask the child to complete a CD:H. The following day, the child will be asked to complete a second CD:H. Children typically take no more than 5–10 minutes to complete the CD:H drawing. They will then be offered the opportunity to create a fish pop-up card. Because we believe the intervention may benefit the child, children in the comparison group will be told that if they would like, they can return to the hospital when the mural is complete and the PI will take them on a guided viewing.

Phase II. Upon completion of the mural, Phase II will begin. After explaining the project and obtaining consent from the parent and assent from the child, we will ask the child to complete a CD:H. The following day, the PI will accompany the child to view the mural and through interview, lead the child through “The Stages of the Critical Process” and ask the child to sketch and talk about his/her favorite part. Next, the child will be given the “Seek and Find” list of items to try to find within the mural. Once all of the items have been found, the child will return to his/her room with the PI to complete a second CD:H. We anticipate this process to take approximately 20–30 minutes. Afterwards, children will be offered the opportunity to create a painting of their favorite part of the mural.

References

Clatworthy, S., Simon, K., & Tiedeman, M. (1999). Child drawing: Hospital manual. Journal of Pediatric Nursing, 14 1), 10–18.

Cook, T.D., & Campbell, D.T. (1979). Quasi-experimentation: Design and analysis issues for field settings. Chicago: Rand McNally.

Glaser, B., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine De Gruyter.

Hathorn, K. (2000). The use of art in a healthcare setting. Therapeutic environments. Accessed August 10, 2007, from http://www.americanartresources.com/index.php?option=com_content&task=view&id=54

Prescott, E., & David, T. (1976). The effects of the physical environment on day care. Pasadena, CA: Pacific Oaks College.

Rollins, J. (2005). The arts in health-care settings. In J. Rollins, R. Bolig, & C. Mahan (Eds.), Meeting children’s psychosocial needs across the health-care continuum (pp. 119–174). Austin, TX: ProEd.