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health care environment, issues also highlighted in the wider literature.Further factors relating directly to aesthetic qualities of the environment canbe identified in the research, including the importance of nature; hence, theemphasis on good landscape designs with seating and garden areas as wellas access to views of outside (Douglas and Douglas, 2005).The studies also have implications for issues of patient involvement in artsand health care environment improvement programmes. Involvement ofpatients in social and community activities is an important concern (Benjaminand Spector, 1990; Timko, 1996). Patient involvement in arts activities as partof a social-recreational programme can support positive outcomes in mentalhealth care (Timko, 1996).Key questions arise from the literature about possible differences inperception between particular groups of health care service users and staff.Further research is needed in this area, although there is some evidence thatmental health patients may have stronger and more polarised reactions totheir environment than other groups (Chen and Sanoff, 1988). This furtherunderlines the importance of consultation and participation. The existence ofdiverse views and perceptions means that arts initiatives designed as part ofhealth care improvement programmes are unlikely to receive consensualsupport and may arouse strong feelings in different stakeholders. Forexample, questions of identity and pride as expressed in the façades andentrances to buildings may be a lower priority for residents than for othergroups; while day to day experiences within the building may be a strongerfocus for service users and staff than for other stakeholders. While there is noeasy way of addressing these possible tensions, the research identifies theimportance of transparent participatory processes that allow stakeholders toexplore, contribute to and understand decisions about improvement of healthcare environments (Chen and Sanoff, 1988).52
11. Summary and DiscussionThis discussion of the literature reviews highlights a number of key issues andquestions that relate to our own research exploring the impact of arts inmental health care. These include: key impacts and outcomes of arts; thecontribution of arts to health care environments; the benefits of patientparticipation in arts; appropriate and inappropriate art; tensions between ‘art’,‘participation’ and ‘health’; the importance of participatory processes; and theneed for robust research.11.1 Key impacts and outcomes of artsWhile not seeking to generate quantitative outcomes, our study does seek toexplore the impact of arts on patients and staff affected by the ‘Moving On’project. The review highlights a number of issues: Arts can affect clinical outcomes, such as anxiety, depression, stressand behaviour, as well as perceptions of well-being and satisfactionwith care. Arts can contribute to enhanced experiences of care in a number ofways, such as: creating uplifting environments; providing greaterprivacy and dignity for patients; and creating a sense of identity,welcome and reassurance. The different responses to the arts of different groups need to beexplored. Patients sometimes voice greater approval of arts than staff,although staff voice concern about their working environment.Enhancing staff morale and motivation and improved workingenvironments are identified benefits of arts in health care. Mental health patients may have stronger reactions to arts andenvironment than other groups: the extent of patient involvement andcontrol may be a key factor in mediating the impact of arts on healthand well-being. Adapting to ‘changed’ or new environments may be challenging forstaff and patients. The arts can play a role in enhancing the quality ofthe new environments, which can help facilitate adjustment to newfacilities. Issues of consultation and ownership seem important in underliningpositive adjustment experiences. Arts can provide community and public benefits by celebrating cultureand heritage, as well as creating links with local communities.11.2 The contribution of arts to health care environmentsOur research also examined the impact of the design and environment ofhealth care facilities on patients and staff. This research shows that arts cancontribute to the enhancement of health care environments in a number ofways. These include:53
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The impact of visual artsand design
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Table of ContentsExecutive Summary.
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10. Results of Non-intervention Stu
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Page 34 and 35: outcomes are also addressed, althou
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Page 39 and 40: General issuesThe research on the i
Page 41 and 42: was an opinion survey or 2200 staff
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Page 46 and 47: Another study by Duncan (2003) used
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Page 58 and 59: and Douglas, 2005). Qualitative met
Page 62 and 63: Creating uplifting environments and
Page 64 and 65: esearch. Critical appraisal of the
Page 66 and 67: Coultier, A.C. (2005) What is the e
Page 68 and 69: McAuslane, L. and Sperlinger, D. (1
Page 70 and 71: Ulrich, R. (1992) How design impact
Page 72 and 73: Appendix 2. Search terms used in th
Page 74 and 75: Appendix 4. Overview of the search
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Page 78 and 79: Staricoffand Loppert(2003)(unrepres
Page 80 and 81: Passini etal. (1998)Schofield(2003)
Page 82 and 83: Appendix 9. Overview of studies of
Page 84 and 85: BenjaminandSpector(1990)Assessment
Page 86 and 87: y Bryan Lawson and Michael Phiri, i
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