A thematic analysis was conducted following the six- month data collection through a series of informal patient interviews. This is conducted to study the patterns of meaning by analyzing the themes within the excerpts of qualitative data set to identify meaning. The interview was driven with the following formulated open–ended questions to identify and explore the possible themes within patient’s inputs:
1. What are these drawings, anecdotes and paintings signify?
2. How are these art works matter to you when it comes to expressing your thought s and emotions?
Based from the results of the interview the use of arts in form of expression and alleviation can be significantly summarized into four themes. 1) Strengthens patient’s positive feelings, 2.) Vent out feelings and concerns through storytelling, and narratives, 3.) Optimizes nurse-patient communication; and 4.) Activity for patient engagement
Theme #1: Strengthens Patient’s Positive Feelings
Art helps patients express experiences that are too difficult to put into words, such as a diagnosis or challenges inherent to their hospitalization. Some patients with communicable disease diagnosis explore the meanings of past, present, and future during art therapy, thereby integrating their condition into their life story and giving it meaning. The following were the patient inputs that suggest arts is an intervention to strengthen their positive feelings along their presentation of their art works.
The above artwork (Figure 2) highlighted the patient’s verbalization how he become inspired each day to comply with the treatment. “It motivates me towards my recovery as I miss my family. By sketching a picture of my home, [it] makes me inspire to get better every day.” This may appear to be a simple picture of a house, but it is a haven of comfort for her, a safe refuge where she felt her family's deepest care, and it is where she has many memories and wonderful moments. She becomes more determined to get well as she marvels at her artwork. It is an expression of gratitude that motivates her to get better.
Another artwork (Figure 3) emphasized that arts helped him magnify the pre-illness state which inspired him to get better each day. He stated, “Sleeping is one of the best minds reset, a reminder back when I was inside the plane sleeping for an hour, waking up in the sky passing through the clouds”. This piece of art reminds him of his first day in this country. He seemed to like the journey while on board the plane, as he recalls seeing the clouds and rain and wondering if he could go back to that day. He imagines himself as this youngster, sleeping soundly and worry-free, in contrast to his current circumstance, in which he has been placed in isolation far from the sky, beyond those clouds, and his mind is filled with anxieties and anxiety as a result of his medical condition. Something he never expected because his thoughts was filled with visions and dreams of providing for his family back home. He felt nostalgic and lonely at the same time, yet he never gave up hope.
The artwork “Soaring High” (Figure 4) was inspired by having its own prospective in life. That stimulates his mind by thinking of endless possibilities of many opportunities soon, just like a bird. The patient associates himself as the bird on this illustration thinking that reaching far would enable him to achieve his goals. Positive expectations essentially lead to optimism, he mentally enjoyed the desired future and starts to shape plans that motivate him to become better and recover faster.
Ultimately, artworks signified that it can be a refuge from the intense emotions associated with illness. There are no limits to the imagination in finding creative ways of expressing grief. In particular, artworks through coloring, drawing and painting can be a powerful way to help people express these feelings through tactile involvement at a somatic level, as well as to facilitate verbal communication and cathartic release and reveal unconscious materials and symbols that cannot be expressed through words. Thus, creating art strengthens patient’s positive feelings-- boosts self-esteem and provides a sense of accomplishment in isolated patients. The artwork, furthermore, affords the key to understanding that arts provides a significant leisure and breaks off patient’s daily routine inside the isolation rooms. When patients completed a creative project, it will not only give them a sense of accomplishment, but also fosters hope and motivation to outgrow from their situations.
Theme #2: Vents Out Feelings and Concerns through Storytelling and Narratives
Project Emery conforms that art making is a universal activity. It is a beneficial platform that integrates emotional information through storytelling and narratives. Sharing one’s feelings by connecting with people helps us gain insight in clarifying difficult feelings and situations of the patients. Apparently, interacting with people becomes less while in isolation that is why they are more prone to loneliness, anxiety, and depression. Therefore, by means of articulated art, nonverbal interactions become more meaningful, simple and yet straightforward. They learn to vent out their emotions by means of drawing and through narratives that offers a whole new perspective of communication by listening beyond words.
Based from the interviews, most patients believed that there is a solitude in isolation that leads them to do self-reflections. When they are confronted of loneliness the act in writing provides comfort that can be extremely therapeutic that it alleviates the tension and anxiety that they are experiencing. This anecdote talked about fear and hope that prompts the patient to incorporate her feelings through narratives. This art activity, therefore, acts as metaphor which amplifies strength and self–esteem by telling a story that contains life experiences that inspires her to verbalize her deep emotions.
Theme #3: Arts promote Patient-Nurse Communication
Stigmatization has been one of the common themes revealed in the pre-implementation data collection. It does have a negative impact as a form of exclusion or restriction to people during isolation. Evidently, lack of communication is one of the main concerns in between patient and health care provider. Hence, implementing this art activity mitigated and minimized the potential implications of isolation. Themes collected during patient interview proved that art therapy creates space expression and diversion that helps patient becomes visually engage with their own thoughts it opens up to a collaborative vision of feelings, ideas, and words that turns into images. It is a form of communication that helps one person processes his/her emotion and gain self-regulation. It builds bond by encouraging the patient expressive approach to psychological issues from therapeutic perspective.
Art bridges gaps and creates a common language. One patient, for example, is unable to fully articulate his dread of being hospitalized due to COVID infection. "COVID-19 has truly caused numerous deaths and even brought many countries to their knees," he claimed. Initially, he was cautious to express his desires and had difficulty communicating with his healthcare providers. Later, when he began to make art, nurses saw his works to communicate with patients by using them as a platform for communication.
Eventually, he expressed his gratitude by saying that his artwork portrayed how COVID -19 affected his life and how he was reminded of the pandemic every time he put on his mask and with every health care provider who came to see him every day. He communicates his gratitude by applauding the health-care team that is responsible for his care. He paints a picture of this girl as a metaphor for the current global disaster. After all, he is still hoping that this problem will be resolved shortly.
The team also concluded that art therapy provides a deeper and more comprehensive understanding of our patients' psychological situation by utilizing a variety of materials as a coping method for their stress and vulnerabilities. Despite language limitations and apprehension, the patient's artworks provided a common language. This method has been found to be successful in igniting conversation, particularly with aloof and hesitant patients. The preventive and rehabilitative nature of art activity would benefit many individuals with mental problems by addressing communication gaps.
Theme #4: Activity for Patient Engagement
Moreover, following a comprehensive qualitative analysis to prove the idea of art activity promotes and improves patient engagement. The outcome measure of each activity has been evaluated by giving corresponding feedback to each participant right after they have finished the activity. Notably, most of them verbalized that they develop a sense of accomplishment and a positive perception was associated with improved outcomes that motivates them to be more involve with the project. They devote time and effort in creating artworks that reflects their inner self for they have found a mechanism wherein they can associate their feeling to a nonverbal expression that is elicited by using the art materials. As a result, art activity is a useful way for patients to break up their daily routine. Most patients reported that being active with these artworks during arts is a process to make the hours worthwhile, as most patients can create 3-4 outputs per day.
Furthermore, the graph below shows that patient engagement is high, with 99 percent of 86 patients who voluntarily consented to participate in the arts diversion scoring their engagement at 8 or higher (scale). The engagement score is used to determine how well the arts program met its goal of providing not only diversion but also making their hospital stay valuable. The team defined high involvement as 8 and above (10 being the highest), moderate engagement as 5-7, not so engaged as 1-4, and no engagement at all as 0.
However, the W11 and W13 data points revealed that only 88 percent of patients, or 1 in 7 and 8 patients, had a high engagement score. Patients were not effectively informed on the project's procedure; hence the objectives were not well understood by the patients, resulting in their lack of participation. Ultimately, measuring the engagement score using a global rating system is challenging. The team used this scale to evaluate involvement, but I believe that interviews would be the ideal way to validate the project's data because the data is more focused on highlighting the patients' emotions and feelings.
It was not easy to put your feelings into words when you’re feeling anxious or depressed. Drawing pictures and making art, instead of using words can help patient express how they feel. More so, the simple act of taking part in a creative endeavor may also help to reduce your feelings of anxiety or depression, as results proved. Ultimately, it is the process of making art, rather than the outcome, that matters.
Generally, results of the interview suggested that art and mental health can have a positive connection— artistic activities such as writing anecdotes, painting, or drawing are known to lower stress levels and promote mental calmness. It provided healing with their inner emotions and matters that they do not talk about. This confirms that patients found opportunities for social interaction and engagement as it develops sense of accomplishment and diversion into something worthwhile.
The art therapy, moreover, significantly improved patient engagement in plan of care with their willingness to recover. It positively distracted them from overwhelming situations of illness, anxiety, loneliness, and stress. This what makes the project targeted the concept of humanizing the hospital experience. The use of arts as a diversional activity is beneficial for people of all ages. It prompts patient engagement in ways that are different from the standard. It connects them to childhood memories and creativity which, as an adult, often takes a backseat to other responsibilities and tasks. Arts reminds us that we are not alone and that we share a universal human experience. Through arts, patients can process experiences, find connections, and create an impact.
Art activity take a holistic approach and treating them with respect to its physical, psychological, mental, and emotional aspects, it was not a superficial intervention, but it touches the heart and the lives of many. Making art is helping many people express themselves, without having to use words. This concludes that art is a powerful tool in communication and patient engagement. Continuing this project will not only mend the sadness but also help them visualize their future and learn to appreciate life.