Feeling alive! : Participatory visual arts programme and vitality in a nursing home – A Singapore case study

245 Chapter 21. Feeling alive! : Participatory visual arts programme and vitality in a nursing home – A Singapore case study Michael Koon Boon Tan School of Art, Design and Media Nanyang Technological University, Singapore [email protected].sg Abstract The priorities many nursing homes give to physical care often supersede consideration for leisure arrangement and resources for residents. Such an approach often resulted in low level of activity. Inactive lifestyle in nursing homes can diminish the quality of life of residents and elicit negative emotions such as boredom, reinforced dependency, lowered self-esteem, and diminished morale. In the light of population ageing and an increased in demand for nursing homes in Singapore, this research addressed the current lack of research on lifestyle arrangement to promote the personal well-being of nursing home residents. In doing so, it investigates the effect of a participatory visual arts programme to foster the well-being of nursing home residents. Through a novel approach that combined arts-health practice with social scientific qualitative case study, the link between participatory arts and vitality was explored. Participatory arts was found to vitalise the sensory, physical, cognitive, emotional, social dimension of residents and promote self-actualisation. Keywords: arts, vitality, eldercare, ageing. Theoretical background Singapore has one of the fastest ageing population in the Asia Pacific region (Mehta, Kalyani K & Vasoo, 2002). Although the Singapore government strongly favours a community-based long-term care delivery system that encourages the elderly to remain in the community (Mehta, Kalyani K. & Vasoo, 2000), it is inevitable thata portion of the elderly will need to engage Creative Practices for Improving Health and Social Inclusion 246 the services of nursing homes. While research in Singapore related to nursing homes is growing, there is a lack of knowledge of lifestyle arrangements and their impact on the personal well-being of residents. Objective The study examines how a participatory visual arts programme might promote the personal well-being of nursing home residents. Method / Description of the experience To facilitate evaluation and reflection, a case study was conducted as part of 12 week Participatory Visual Art programme with ten participants. The programme introduced and engaged the participants to create a variety of two-dimensional and three-dimensional art work such as paintings and small clay sculptures. The data collected are qualitative in nature. Research methods used include: Participant Observation, Semi-Structured Interviews, Focus Group and Video. The research took place over nine months starting from April 2014 to December 2014. Data collected were analysed and interpreted using grounded theory approach where the data were initially skimmed to obtain general themes followed by a more focused analysis to explore the relations between various themes. Results Invigorating the Senses and Mind In contrast to the mundane and lacklustre atmosphere of the ward, the art venue is a sensory-rich environment charged by the myriad of colours, Section 5. Art, coping with illness & aging 247 textures and sounds of chatters and banters. Sensory enriched environment and activities are known to benefit older adults as the stimulation they received help promote physical and cognitive wellness (de Macedo et al., 2015). The opportunity to learn through the art programme is found to invigorate participants; making them feels more alert. Alice, a participant revealed the heightened sense of awareness. Alice: When you teach us things to do, we are alert. It is better that someone teaches us something. Otherwise, people will keep sleeping. It is better that you are here to teach us. Our mind will be more active as we need to decide and think how to get things done. Participants of the Participatory Visual Art (PVA) programme welcomed and looked forward to the change of scene afforded by the weekly session. Besides helping to inject a new activity, the PVA programme was found to stimulate the participant‘s senses. The comment from Clare, a participant, clues us to the invigorating quality of the art programme which she feels is not commonly offered to residents in their everyday life. Clare: It‟s not the same. Your activity engages the mind and eyes. But the nurses don‟t do that. You attend to our brain and our eyes. You take care of our mental wellness, our vision acuity, and the ability to make discerning judgments. Art activities can be a mentally demanding activity that also induces a certain degree of cognitive engagement. When making their work, participants also need to, from time to time, make decisions on colour choice, the position and placement of elements on their pieces. Such cognitive engagement can be found in James‘s comment on his art making process: James: I find myself using my brain, you make a decision about choice of colour. Creative Practices for Improving Health and Social Inclusion 248 The varied themes of the creative projects that participants were introduced to weekly kept them on their feet and stirred their curiosity and anticipation. In a sense, it created a sense of futurity, giving participants a sense of going somewhere. At times, participants may also encounter circumstances where they may feel challenged by a new technique and need to problem solve. Although such encounters might be mentally demanding, their ability to overcome learning curve and solving creative challenges also fostered their sense of confidence and self-esteem. Fostering Positive Emotions The PVA programme fostered growth and development that allowed the residents to connect with their latent potential from which they were able to gain a new perspective about their own ability and kindle new ambitions. Many were surprised and expressed amazement over their accomplishments. It elicited positive emotions such as confidence, relaxation, pride and kindled new ambition - motivating them to regain pursuit in life. Betty: I feel so free…Iike…no burden at all. Making art is very relaxing. I can forget everything. The arts sessions were found to be a useful resource to promote physical wellness of residents. Staff noted that residents showed more willingness and enthusiasm to participate in the arts programme than the scheduled physical exercise.The actions and movement required from participants in the art making process were seen as a good alternative approach to stimulate and help the residents to maintain or improve their physical wellness. Clare, a resident also took notice of the physical stimulation she gained from making art. Section 5. Art, coping with illness & aging 249 Clare: It exercises our hands and our brains. Eyes, and the eyes.It very good. I like it. Although the art programme did initially raise a degree of uncertainty and self-doubt among participants who are physically impaired, it also led them to overcome their personal challenges. Clare‘s case provides an example of the invigorated sense of self-belief and identity. Int: Have you previously participated in any art program? Clare: No. This is my first time. I think to myself how am I going to do it with one arm. I doubted because I only have an arm, I doubted myself… Int: So you were previously concerned if you are able to participate with one arm? Clare: I wondered, can I work with one arm. Int: So how do you feel looking at your artwork? Clare: Very Good. Didn‟t think that I can produce such things. I didn‟t…I didn‟t dare imagine. I thought, what can this one arm of mine do other than some weird looking things. I am very happy, very excited that I can produce thing of such standard, I consider that that is not bad an achievement. For a disabled person to be doing this. Animating Sociability The participatory arts sessions are resources and opportunities for participants to connect themselves and interact with their counterparts. Unlike the clearly demarcated boundaries of bed in the ward, the art venue was set up in a manner where participants shared tables and are in closer proximity to each other. The play action involved in the art sessions and the light-hearted atmosphere had also secured a space that encouraged interpersonal communication. Creative Practices for Improving Health and Social Inclusion 250 Alice: When you come and teach us thing to do, our spirit are better. When the session is on, the others will gather around to chit-chat, that is good. Occasionally, the curiosity of staff passing by the session would draw to visit the session and spark conversations between staff and the participants. The residents‘ creation offered staff a different aspect of the residents, showing their capability and imagination. Their artwork offered staff a conversation piece for staff to initiate conversation with them. And at times, the conversation can spark a group chatter that where it will attract contribution from other participants and staff. Discussion Participatory Arts Activities and Vitality Although the animating quality and capability of participatory arts activities have been indicated in many arts, health and well-being studies, the link between participatory arts and the notion of vitality appears to be rarely considered and explored. Based on the range of positive affective influences observed in participants of the PVA programme, it appears that vitality might be a useful concept to further understanding on the benefits of arts on and well-being. As much as human existence is dependent on physiological functions and physical needs, it is also, in part, sustained and fuelled by what Bergson (1983) termed as élan vital or others have called a vital element (Stern, 2010). Vitality is a term commonly used to describe such experiences of aliveness. Vitality is understood as having and being aware of the availability of physical and mental energy to the self (Ryan & Deci, 2008). In order for Section 5. Art, coping with illness & aging 251 vitality to be experienced, our body and mind need to be subjected to a constant process of change when we are awake (Stern, 2010). ‗The experience of vitality is inherent in the act of movement. Movement, and its proprioception is the primary manifestation of being animate and provide the primary sense of aliveness‘ (Stern, 2010, p.10), in other words, ‗vitality must have a basis in physical action and traceable mental operations‘ (Stern, 2010, p.9). Vitality could be understood as an energised state and experience that is animated and thrive on the availability of movement, experience of positive affect and having ambition – a sense of pursuit in life. It is a feltawareness of the availability and presence of vigour. Animating Physical and Emotional Vitality The opportunity to move one‘s body is a quality of the PVA programme that many participants appreciate. The participants spoke about how the routine of spending too much time on their beds and the inactive lifestyle have made them feel tiresome and lethargic. The PVA programme puts the body in action by engaging participants to use their arms, hands and fingers as they paint, manipulate and shape the art material to create their artwork. The art-making sessions were found to be a useful resource to promote physical wellness of residents. Clare: Because every week, I get to go down there to move my body. It is not advisable to sit on the bed daily. Otherwise I sit here every day like a block of wood. Animating Cognitive Vitality Art activities can be mentally demanding and can also induce a certain degree of cognitive action and movement. The process of creating often would require participants to envision ideas in response to the project brief. Besides feeling alert, participants also expressed appreciation for the Creative Practices for Improving Health and Social Inclusion 252 opportunity to be exposed to something new and the intellectual gain afforded through the PVA programme. Peter‘s comment provides an example of such intellectual developing capacity he found from his participation in the PVA programme. Peter: Making art makes my mind more active. Not so...not so…inactive. At least I have something to learn from it. In a way good for me to learn something new. At least I have tried something new for myself. The cognitive engagement and action induced by PVA programme also engendered a sense of curiosity and adventure for participants. The varied themes of the creative projects that participants were introduced to weekly kept them on their feet and stirred their curiosity and anticipation. Animating Sensory Vitality The art venue is a sensory-rich and stimulating environment. Besides affording the participants a momentary respite from the routine life of their ward, the participatory arts sessions were found to refresh residents‘ senses and stimulated them. The art material also offered different visual, tactile and olfactory sensation for the participants. In creating their work, they would make contact with the coolness of the water or clay, dripping off paints, feeling a drift of breeze, captivated by particular hue. These sensations were found to be therapeutic for residents. The emotional response emerged from admiring their creation or that of others could also be interpreted as an on-flow of sensory vitality. The art activity appeared to heighten the senses of the participants while at the same time it accentuated their sense of awareness, involvement and connectedness with their surroundings. This notion of connectedness and alertness are known to be indicators of vitality. In contrast to the mundane and lacklustre atmosphere Section 5. Art, coping with illness & aging 253 of the ward, the art venue is a sensory-rich environment charged by the myriad of colours, textures and sounds of chatters and banters. Conclusion This discussion began by highlighting that although nursing homes provide care for persons, it seems that in its preoccupation with caring for residents‘ physical needs and health, to keep residents alive, nursing homes have overlooked residents‘ need to feel alive. As a result, the quality of life for residents is often compromised. The lack of attention to residents‘ quality of life has inevitably engendered a passive and inactive lifestyle and affected the prospect and security for individuals to age optimally in nursing home. Although multi-sensory stimulation is known to benefit residents‘ physical and cognitive wellness, many nursing homes continue to be impoverished environments with low physical and social activities. In exploring how a participatory visual arts programme might ameliorate the inactive lifestyle and enhance residents‘ subjective well-being, the discussion has paid attention to considering the transformation process occurring in participatory arts activities through which well-being gain might arise. I have also ventured to explore the link between vitality and participatory arts activities. I interpreted and identified several vitalising attributes of participatory arts activities that contributed to augment the subjective well-being of participants. They include sensory vitality, physical and emotional vitality, cognitive vitality. I hope this consideration on of vitalising qualities in the arts on the health and well-being of residents in nursing home can support further engagement and implementation of the