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Spend a day in a hospital’s intensive care unit and you can expect to witness gruesome injuries, devastating illnesses, and too often, decline and death.
Nurses may go from talking to a patient when they first arrive in the ICU to putting that same patient on life support. “If that patient passes away, the nurse has to do the post-mortem care of the patient they were talking to three days ago,” says Dr. Marc Moss, vice chair for Clinical Research in the University of Colorado School of Medicine.
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For doctors, nurses, and other medical professionals, whose jobs are to treat and preserve the lives of their patients, the psychological toll of this environment can lead to anxiety, burnout, and even post-traumatic stress disorder (PTSD). A new federally funded research lab led by Moss at the University of Colorado Anschutz Medical Campus is gearing up to see if creative arts therapies could be harnessed to help critical care health professionals cope with the emotional and psychological demands of their work.
Creative arts therapies (CAT) use different art forms—music, dance, visual art, drama—to help patients improve communication, expression, and emotional, cognitive, or social functioning. Rather than asking patients to talk about what’s going on in their lives, CAT engages them with different mediums that they can use to explore what might be hard to put into words.
“We have these very specific psychological filters for speaking, but when we make art, when we make music, when we dance, those filters fall away,” says Katherine Reed, manager of the Ponzio Creative Arts Therapy Program at Children’s Hospital Colorado. “We call it backdoor access to emotional territory.”
Beyond improving psychological health, there’s also the potential for CAT to have positive ripple effects on hospital staff retention and turnover. According to a 2018 report from Nursing Solutions, Inc. (NSI), hospital staff turnover is on the rise in the U.S.: it reached a national average of 18.2 percent in 2017, with the South Central region averaging 19.1 percent. The highest turnover is among emergency care nurses—so high that NSI estimates that the average emergency department replaces its entire staff of registered nurses every five years.
About 15 years ago, Moss started looking into the psychological health of critical care nurses after some of his research coordinators for another project told him that the very symptoms he was researching in patients—anxiety, PTSD, etc.—were symptoms that they had experienced as health care professionals. “This is why I left nursing,” Moss remembers the coordinators telling him. Those observations spurred Moss into a new research direction that uncovered what he referred to as “an epidemic” of psychological distress and burnout syndrome among ICU nurses.
“Burnout syndrome and psychological distress in healthcare professionals is really an occupational health issue,” Moss says. “It’s not that there’s something wrong with the individual. It’s that they work in a difficult environment.”
Over the last several years, he’s investigated the effectiveness of mindfulness-based cognitive therapies for critical care nurses. In 2018, Moss saw a call from the National Endowment for the Arts (NEA) for research lab proposals involving the arts, health, and social/emotional wellbeing, and his research radar pinged.
The NEA Research Labs program is a relatively new effort to increase empirical knowledge around the arts. According to Sunil Iyengar, the NEA’s director of the Office of Research and Analysis, the lab at Anschutz is one of 12 labs that will be up and running this spring. Over the next two years, the NEA is funding $150,000 to the lab at Anschutz, with the potential to extend funding for a total of 10 years.
The lab is partnering with the Ponzio program at Children’s, as well as Lighthouse Writers Workshop, to develop its program and study protocols. According to Moss, they’re currently planning to conduct two six-month clinical trials with cohorts of 75 people for each trial, all critical care health professionals. Fifteen individuals in each cohort will serve as a control group. Participants will experience creative arts therapy 12 times (twice a month) over the six-month periods. These first rounds of studies will focus on designing the therapies to be acceptable to participants and evaluating how feasible it is for participants to complete the program, with plans for a larger study later on that will focus on the effectiveness of CAT for building resiliency and wellness. Moss and his colleagues are currently in the process of developing the study’s protocols.
“You can’t work in healthcare without experiencing trauma—it’s everywhere—but the Western medical model does not really account for what it takes to survive that,” Reed says. “When you engage your creative self, it gives you a vehicle, a way to explore all that territory and figure out … how you can maintain the sacred in your work, even when it’s painful. And to help transform that pain into something that’s really meaningful.”
At Children’s Hospital, the Ponzio Creative Arts Therapy Program is part of psychiatric patients’ daily treatment. Many of the patients are introduced to art journaling—they’re given a blank book of about 80 pages and encouraged to fill it with words and images, using whatever mediums they enjoy. Reed has countless stories of how she’s seen CAT help both her patients and Children’s Hospital personnel, some of whom now organize their work schedules so they can attend CAT sessions.
Michael Henry, executive director of Lighthouse, has seen similar effects from writing workshops with various populations, including people experiencing homelessness and those living with cancer diagnoses. “You have these experiences and they can break apart your sense of reality,” he says. “Constructing it in a narrative is a tangible way of taking that broken apart experience and putting it together—and by doing that, you gain control over it, so it ceases to have control over you.”
As the medical fields expand and staffing needs grow, burnout and consistently high turnover will be problems not just for hospital onboarding costs, but also for quality and continuity of care, and any method of preventing staff burnout could be crucial. The lab is paving the way to prove CAT’s efficacy in quantitative, measurable terms which carry greater weight in the medical community.