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Concrete curing

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A practising nurse argues that the environment is not of equal importance to clinical care in helping patients recover

Entering a hospital these days can be a surprisingly pleasant experience. Great efforts have been made to make them less forbidding, institutional and clinical. Many will exhibit art and photographs.While this is a positive development, some promoters go as far as to suggest that the environment is equally important as clinical care in helping patients recover. I disagree.

Architecture has been accepted as a provider of aesthetic value in healthcare for some time, and art has been used for hundreds of years. Take St Bartholomew's in London, which commissioned William Hogarth to paint two works of art more than 250 years ago. The Chelsea & Westminster (C&W) Hospital is a leader in the field of integrating the visual and performing arts into healthcare. It, and St Mary's Hospital on the Isle of Wight, are the first in Britain to have commissioned works of art at drawing-board stage to complement innovative architectural design.

Wards in the C&W surround nine atrium spaces beneath a large canopy. The worlds largest indoor sculpture - an 18m-high, sixtonne steel figure called Acrobatic Dancer by Allen Jones (cost £100,000) - is exhibited in the reception area. 'I liked the idea of people in a ward seeing a piece of colour outside their window and then forgetting their aches and pains, ' said Jones. Falling Leaves is a 25m plus mobile by Sian Tucker suspended in one atrium.

1Works of art by students and established artists adorn hospital walls.The chapel has a painting by the 16th century Italian master Veronese. Live music, ranging from chamber to traditional jazz, can be heard.The London Concert Choir has performed here and its 'uplifting sound reverberated through the wards to the farthest corners of the building'.

2Taking part in music and art classes is a well established form of therapy for some C&W patients. Susan Loppert, the director of C&W Hospital Arts, believes that the hospital arts play a therapeutic role of equal importance to other forms of healthcare.

3She also believes that there is physical and biological evidence for their use.Music releases endorphins, leading to less need for painkillers.Blood pressure and the need for drugs can be reduced in the presence of visual and performing arts. So convinced is she, that she and her colleagues have managed to get £70K from the prestigious King's Fund (an independent British 'think tank'and healthcare charity) to pioneer 'a study of the effects of the visual and performing arts in healthcare.'

Common sense you might say. A pleasant environment is conducive to feeling good - and if patients feel good, recovery will be quicker.Music, art and song can give patients an emotional, and psychological, lift and distract them from dwelling on their illness. I certainly remember as a midwife encouraging women, averse to the use of pain relief in labour, to bring in favourite pieces of art or music that they could focus on as the contractions strengthened.

But is it as simple as that? Is the environment really of equal importance to clinical care in helping patients recover? Neither I nor the women I cared for believed that the piece of art/music was as important as my professional expertise. It was a prop. Florence Nightingale, in her Notes on Nursing, wrote: 'The variety of form and brilliancy of colour in the objects presented to the patients are actual means of recovery.'

Even Theophrastus - Aristotle's favourite pupil, writing in the 4th century BC - said: 'The sound of the flute will cure epilepsy and sciatic gout.'

However, because there wasn't much real medicine to cure people in the old days, the environment assumed some significance.

What's the excuse today? It seems likely that complementary and alternative (CAM) practitioners are taking advantage of, and benefiting from, the public's scepticism about scientifically based health care and health professionals'own decreasing confidence in what they offer.

Additionally, society's current elevation of the subjective over the social has led to a demand for more emotional and psychological support in general and in healthcare specifically. The promotion of instinct over reason, irrationality over science and anecdote over evidence is also part of this orientation. Scientific medicine has adapted to this, feeling guilty that it didn't take enough interest in the emotional and psychological aspects of patient care in its heyday (1940-60).

CAM practitioners, desperate to be recognised as equal to health professionals, have opportunistically taken advantage of this loss of confidence and public demand.Their prevalence in healthcare, however, furthers the notion in the public mind that there is something wrong with scientific medicine.The current MMR debacle is a good example of this.

Despite a total lack of evidence connecting MMR to autism, many parents insist on single vaccines for their children or avoid vaccinating them altogether, because they, and many health professionals, do not trust the government, scientists or even each other. They instead turn to and rely on the perpetrators and promoters of junk science. Homeopaths promote homeopathic alternatives to MMR, even though there's no such thing. Cranio-sacral therapists suggest that conditions such as autism have their roots in birth trauma which, of course, they can help with.They prey on the public's susceptibility and make believe they have the answers.

Scientific medicine's deficiencies will not be addressed by accepting these practitioners as equal partners in healthcare. Architecture, art and music all have a role to play in distracting patients and giving them a boost, but they are not equal to scientific medicine.

Bríd Hehir is a nurse and the public & patient involvement leader for Camden Primary Care Trust 1 www. mmu. ac. uk/artsforhealth/ projects/chelsea&westminster/ 2 www. london-concert-choir. org. uk/cwh. php 3 Michael Wright, 'The best medicine, ' the Sunday Times.19 April 1998

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