Participants
Patients receiving renal dialysis at the BBraun Wellstone Wexford Renal Care Centre, just outside Wexford town. Patients are from all over Wexford County. Approximately 14 patients took part in Making My Mark.
Aims
The overall objective of Making My Mark was to support patient wellbeing and promote quality of life through creative activity during the long hours which each patient is required to spend on dialysis.
Each patient attends renal dialysis for 3-4 hours, usually three times per week. The team in Wexford wanted to make the experience of renal dialysis better for patients by introducing softer aspects of care and providing a means for the staff and patients to see each other ‘beyond the machine’.
The aims were:
- To provide patients with the opportunity to make art with a trained, professional artist
- To develop their own artistic, creative skills
- To enhance patient quality of life
- To soften the clinical environment
- To promote patient motivation and sense of purpose
- To promote a sense of partnership between the patient and staff.
Methods
The project was delivered over 12 art-making sessions. Three sessions were allocated to each of the four dialysis shifts at the BBraun Wellstone Wexford Renal Care Centre, mornings and afternoons, on different days of the week, so that all patients could have an opportunity to take part. Each of the 12 sessions was scheduled to last 90 minutes long.
The artist’s approach was to first chat with patients about their interests, experience and abilities. At each of these first sessions, patients were invited to try a simple, enjoyable activity (in this case, using acrylic markers to paint pre-printed leaves) while the artist and patient discussed and developed a plan for the next two sessions.
The artist used the patients’ interests as a focus for their individual works and this, coupled with the patients preferences for certain materials or modes of art-making, dictated the activities and methods for each patient. For example, one patient had a passion for the Irish country music scene, so he and the artist explored related imagery. This patient had used coloured pencils before, so he preferred that medium. He had also worked on a graphic novel in the past, so he and the artist developed the idea of a poster which promoted country music with punchy, graphic imagery and lettering.
Another patient is a seamstress and had been creative in this area for years. She expressed a desire to learn how to draw realistically from life. The artist began with this patient at the very basics of drawing: hand-eye co-ordination exercises, progressing to shape creation, line, tone etc. The patient produced a number of excellent drawings and was thrilled to have a new skill to practice.
Other patients chose clay as their medium. Some had a clear idea of what they wanted to make and others enjoyed the process of experimenting with the clay tools and impression textures that were on offer. Another cohort of patients did not wish to take on a lot of new learning during their dialysis and instead they enjoyed the calming process of colouring pre-printed images.
All of the patients’ painted paper leaves were exhibited on a two-metre wall decal ‘Tree’ in the clinic reception area and their individually developed pieces were exhibited in the clinic’s new mini space, The Gallery.
Artistic Outputs
- All patients who took part in Making My Mark produced at least one artwork each. These included paintings, drawings, prints and sculpture. Many of the patients had never created any kind of artwork previously.
- The programme culminated in an exhibition of patient work, which was launched at a special celebration at the Renal Care Centre, and attended by family members, James Nolan, Chairperson of the Punchestown Kidney Research Fund, who funded the programme, and Liz Burns, Arts Officer with Wexford County Council.
- Such was the success of the programme that a small art gallery has been established at the Centre. Simply called ‘The Gallery’, it will continue to feature artworks by the patients going forward.
- A special ‘Tree’ has been installed on the wall of the reception area at the Centre, which features patient artworks as its ‘leaves’. As patients create more work, they will be added to the Tree.
Evaluation Methodology
Making My Mark has been evaluated in the following ways:
- Artist’s reflective journals.
- Regular review meetings with the artist and the programme managers.
- Feedback from the artist and participants at the completion of each phase.
- Regular feedback from the healthcare staff.
- Formal review with the Artist on completion of the pilot programme.
- Formal review with the programme managers (healthcare partners and Réalta / Waterford Healing Arts) on completion of the pilot programme.
Evaluation Outcomes
All respondents to the evaluation (patients, artist, healthcare staff, project partners) felt strongly that the aims of the programme had been met, and that it had a positive impact in many ways:
Patients had the opportunity to work with a highly skilled and experienced artist. Carolann Flynn, Interim Unit Manager, stated: ‘Artist Kate Murphy’s approach was always patient-centred, encouraging and supporting patients to make the art they were interested in.’
Claire Meaney, Director of Réalta / Waterford Healing Arts, said: ‘Kate is a highly skilled artist, but additionally, and essentially, she has the kindness, curiosity, energy, compassion and insight required to work in the dialysis setting.’
Patients used materials they had never encountered and developed new skills e.g. One patient had never used clay, but produced a wonderful piece for exhibition; another patient had never drawn before, but quickly learned and then discovered that they have a natural talent for drawing.
Patients and staff reported that making art during dialysis made the time go by more quickly and pleasantly, that it made the experience of dialysis better, lifted patients’ mood, and improved their wellbeing and self-confidence:
— ‘It passed the time away.’
— ‘It got me back into doing a bit of colouring.’
— ‘The meditative feeling’ (was the best thing about the experience).
— ‘It transformed my wellbeing and mental health for the three weeks.’
— ‘Art just calms me and relaxes me and now I do it all the time at home as well.‘
— ‘It’s all about just having a go, isn’t it. Just experimenting and seeing what happens.’
— ‘It has been a game changer.’
The art programme provided a focus for dialysis, which helped patients to feel more positive and motivated: ‘The whole thing was so uplifting and so rewarding. Initially I was a bit apprehensive, I didn’t know what to expect. But it was all just so positive. For the first time I started looking forward to going in to dialysis, instead of dreading it.‘
The celebratory event served to highlight each patient’s individuality and creativity, and their lives and skills outside of the clinical space. Some patients’ families attended the exhibition launch and expressed pride and joy at seeing what their loved one had achieved. It was also reassuring for the families to see that there was something else being provided for their loved one while they’re on dialysis.
The art making and the chats with patients greatly enhanced and softened the clinical environment. Partnerships and connections with staff increased during the project. Many staff interacted with the patients while they were making art and commented positively on what they were doing. This also gave them something new to talk about at later dialysis sessions.
For the artist, project support from the healthcare partner and the arts and health organisation was a significant benefit, being relatively new to the clinical setting and used to working entirely solo prior to this project.
The biggest challenge experienced by the artist was time: trying to see all the patients who wanted to participate within the session. Initially the artist stayed on late in order to work with all those who wanted to participate. As the project progressed, the artist learned to manage her time differently so that she could see everyone, but also realised that for a high quality experience for the patient, there is an optimum number of people who can be scheduled in each session.
Patient uptake was uneven i.e. in one block of sessions, there were more patients keen to participate than there was time to see, while in another, there were less patients interested. The artist adapted her schedule and used time left over from one block to give extra time to patients who were interested from another.
Timing within the normal routine of the unit was also a challenge initially, for example, working around patient meal times. This was resolved quickly and easily thanks to the support of the management and staff on the unit.
In some cases, it could be challenging for a patient to make art due to physical issues. For example, a hand tremor could mean a patient could not draw or paint, or a patient might not be able to use their dominant hand, depending on the location of their fistula. Again, flexibility was key, on the part of the artist and the patients. The artist found a more suitable/manageable medium for any patients with a physical challenge, while, with determination and support, some patients could learn to make art using their non-dominant hand.
The space available for the artist to work with each patient was quite limited, but the artist learned to adapt and factor the smaller space into her preparation. Similarly, the ‘art kart’ did not work as well as expected because the artist needed more storage space within the kart than it currently provides, and a kart with a table-top that the artist could work on would be more helpful than the current sloped lid. Again, the artist adapted her practice to suit the conditions, but a different type of unit will be needed for the next phase of the programme.
All respondents reported a desire to keep the programme going:
The benefits are clear and the foundation is now in place. It will grow from here. Patients were very clear in their evaluations that they would like the art programme to continue:
– ‘Keep it going. It’s something to look forward to.’
– ‘I would like to see art stay with us.’
– ‘More time.’
– ‘I would like to do more and to learn how to draw.’
– ‘I hope art is going to be in the dialysis more.’
– ‘Love to do more. Have it as a frequent opportunity.’
Documentation and Dissemination
- The programme was documented in photographs by Kate Murphy, Artist, and Maeve Butler, Assistant Director, Réalta / Waterford Healing Arts.
- The exhibition was documented in photographs by professional photographer Padraig Grant.
- Full page feature articles were published, with photos, in all the local papers in Wexford town and county: The Wexford People, The New Ross Standard, The Enniscorthy Guardian, The Gorey Guardian.
- A summary of the programme and exhibition was published online on the Réalta website, the Waterford Healing Arts website, and artandhealth.ie.
- A feature will be submitted to ‘Support’, the magazine of the Irish Kidney Association.
- A formal programme review was compiled and submitted to the project partners and a summary will be submitted to the project funder, the Punchestown Kidney Research Fund.
