Branching out: mobilizing community assets to support the mental health and wellbeing of children in primary schools.

Introduction: Mobilizing existing creative, cultural and community assets is seen as a crucial pathway to improving public health. Schools have been identified as key institutional community assets and arts-in-nature practice has been shown to promote children's mental health. The 'Branching Out' research investigated how an established arts-in-nature practice called 'Artscaping' could be scaled up through the mobilization of community assets including school staff and local volunteers to reach more children in primary schools. Methods: The Branching Out model was piloted in six primary schools across Cambridgeshire with 'Community Artscapers' delivering 1.5-h Artscaping sessions with children outdoors for 8 weeks. Interviews were conducted with 11 Community Artscapers (six school staff and five volunteers) and four school leaders reflecting on their experiences of the Branching Out model and the data was subject to a reflexive thematic analysis. Results: The findings presented here discuss themes relating to mobilizing community assets, including framing the opportunity, recruiting and sustaining volunteers, training and supporting Community Artscapers, and tensions in roles and responsibilities. They also cover impacts for the children, including mental health provision, freedom in creativity and being outside, personal development, emotional impacts, and social connection, as well as impacts for the Community Artscapers, including making a difference, emotional wellbeing, personal and professional development, and connection and community. Discussion: These findings are considered in terms of their alignment with public health policy drivers and the potential for the Branching Out model to become replicable and self-sustaining across schools to promote children's mental health as a public health intervention.

Dance for Health: the impact of creative dance sessions on older people in an acute hospital setting.

Background: This service evaluation examined the impact of Dance for Health, a programme of weekly group dance sessions for older patients, which took place on wards in an acute hospital setting.Methods: Qualitative and quantitative observations using the ArtsObs scale were undertaken of 64 dance sessions over a 12-week period involving seven different hospital wards encompassing 313 patient attendances.Results: Statistically significant improvements were observed in the mood of the majority of patients taking part. People engaged mentally and physically with the activity were distracted from their medical condition and from what was happening on the ward. Patients appeared relaxed and were willing to express themselves creatively.Conclusion: The Dance for Health programme had a positive impact on group participants, promoting movement and physical activity for older patients. It is a meaningful and enjoyable activity, which encourages social interaction and provides respite from the medical environment.

Swedish primary healthcare practitioners' perspectives on the impact of arts on prescription for patients and the wider society: a qualitative interview study.

BACKGROUND: There is growing evidence that participating in arts activities are beneficial for mental health and wellbeing. Many patients attending primary care services have mental ill-health or social issues that healthcare practitioners currently do not have adequate ways of supporting. This study set out to explore the perspectives of primary healthcare practitioners on Arts on Prescription (AoP) as an additional referral pathway. METHODS: A qualitative exploratory descriptive approach within an interpretive framework using semi-structured interviews was used to explore healthcare practitioners' perspectives and experiences of AoP programmes in Sweden. Ten interviews were conducted with healthcare practitioners in primary care. Data were analysed using an inductive thematic approach. RESULTS: The healthcare practitioners interviewed, recognised the need for more holistic approaches to care for those with mental health issues. They perceived that AoP is beneficial for patients in terms of motivation, creating routines, providing social interactions, and increasing self-esteem. In addition, AoP was felt to have the potential to impact upon current service provision and wider society. However, whilst the opportunity to refer patients to AoP in conjunction with conventional treatments was valued, participants reported that time pressures on practitioners and the continuing dominance of the medical model of care were barriers to wider acceptance amongst practitioners at the present time. CONCLUSIONS: AoP enabled primary healthcare practitioners to offer an additional pathway for patients that is an adjunct to the traditional care pathway. However, the programmes tend to be project-based and often time limited. For programmes to be sustainable and be included as part of a wider range of interventions available to healthcare practitioners' suitable levels of funding would be required.

Older people's perceptions of the impact of Dance for Health sessions in an acute hospital setting: a qualitative study.

OBJECTIVES: To explore the perceptions of hospitalised older people and their relatives of the impact of taking part in group dance sessions in an acute hospital setting. DESIGN: A qualitative descriptive approach was used. SETTING: An acute hospital trust in the East of England. PARTICIPANTS: Purposive sample of dance group participants. INTERVENTION: Weekly music and movement sessions for frail older people on Department of Elderly Medicine Wards and the Stroke Rehabilitation Unit. Sessions take place in the ward and are facilitated by a dance artist supported by ward staff. RESULTS: Twenty-one semistructured interviews were conducted with older people and/or their relatives. Thematic analysis of the data identified three overarching themes: (1) dance as a physical activity, (2) dance as an opportunity for social interaction and (3) the dance group as a source of emotional support. Sessions were valued as an enjoyable way to undertake physical activity and provided an opportunity for social interaction between patients. This is important as loneliness and boredom are a common occurrence during hospitalisation and are detrimental to overall health and well-being. Patients reported an emotional impact though taking part; happiness from engaging with the group and the release of pent up emotions through the triggering of memories by the music and conversations within the group. CONCLUSION: Dance for Health provides a range of physical, social and emotional benefits for hospitalised older people. Further research is required to investigate the effectiveness of group dance sessions in increasing physical activity on an acute ward and the potential psychological benefits for hospitalised older people.

Scoping the Demand for Night Operation of Essex & Herts Air Ambulance: A Prospective Observational Study.

OBJECTIVE: Helicopter emergency medical services play an important role in the prehospital care of critically ill and injured patients, providing enhanced interventions and direct transfer to specialist centers. Essex & Herts Air Ambulance (EHAAT) delivers prehospital critical care to patients in Essex, Hertfordshire, and the surrounding areas. Historically, EHAAT's resources have not operated during the night. This study aimed to ascertain demand for prehospital critical care in Essex and Hertfordshire during night hours. METHODS: A prospective observational design was used. Data were collected by 11 critical care paramedics during night shifts on a critical care desk using an online survey. Details were recorded for incidents in Essex and Hertfordshire between 21:00 and 07:00 deemed appropriate for a prehospital critical care response. RESULTS: A total of 108 incidents were recorded across 52 nights, equating to an average of 2.08 incidents per night. For 52 incidents, there was no critical care resource available to attend. The majority of incidents fell in closer proximity to EHAAT's North Weald base than its Earls Colne base. CONCLUSION: The findings suggest a potential need for prehospital critical care during night hours in Essex and Hertfordshire and support the operation of a resource from EHAAT's North Weald base.

Consensus on research priorities for Essex & Herts Air Ambulance: a Delphi study.

BACKGROUND: Consensus methods such as the Delphi technique have been used widely for research priority setting in health care. Within pre-hospital emergency medicine, such approaches have helped to establish national and international research priorities. However, in a dynamic field such as pre-hospital critical care, it is necessary to regularly review the continued relevance of findings. Further, considering the variability between pre-hospital critical care providers, it is also important to determine priorities at the local level. Essex & Herts Air Ambulance (EHAAT) sought to develop a five-year research strategy that aligns with their clinical work streams and organisational priorities. METHODS: All staff and Trustees were invited to participate in an online Delphi study with three Rounds. The Delphi was administered via email and Online Surveys software. The first Round invited participants to submit up to five research questions that they felt were of greatest importance to EHAAT  to advance the care provided to patients. In Round 2, participants were asked to rate the importance of questions from Round 1, while Round 3 required participants to rank questions that were prioritised in Round 2 in order of importance. RESULTS: 22 participants submitted a total of 86 research questions in Round 1, which were reduced to 69 questions following deduplication and refinement. 11 participants rated the importance of the questions in Round 2, resulting in 14 questions being taken forward to Round 3. Following the ranking exercise in Round 3, completed by 12 participants, a top five research priorities were identified. The question deemed most important was "How does a pre-hospital doctor-paramedic team affect the outcome of patients with severe head injuries?". CONCLUSIONS: The top five research priorities identified through the Delphi process will inform EHAAT's research strategy. Findings suggest that there is still work to be done in addressing research priorities described in previous literature.

The role of collaborative working between the arts and care sectors in successfully delivering participatory arts activities for older people in residential care settings.

In the UK support for older people living in residential care to undertake meaningful activities is provided by Activities Co-ordinators. There is also a growing trend for care home providers to invite arts organisations into care settings to deliver a range of arts and cultural activities. These arts and cultural activities are delivered by Arts Facilitators, who are distinct from Activities Co-ordinators because their practice is specifically in an art form. This paper presents findings from the Creative Journeys research project which focused on exploring the role of participatory arts within residential care home in developing and maintaining social relationships between residents and staff. One of the objectives of the research was to identify factors which facilitated or hindered the delivery and impact of the activities. Data collection methods included observations and semi-structured interviews with residents and staff. Thematic analysis was conducted on the qualitative data. It was found that a key factor in the successful delivery of the groups was the working relationship between the Arts Facilitators and the Activities Co-ordinators. This relationship is explored and presented under three main themes: the collaborative process, practicalities and preparation and the approach of the Arts Facilitator. The Activities Co-ordinators' role is an under-researched area, but they play a central role in supporting visiting arts organisations to deliver the sessions and in enabling residents to attend and engage with meaningful activities.

Dance for Health: The perceptions of healthcare professionals of the impact of music and movement sessions for older people in acute hospital settings.

AIM AND OBJECTIVES: To explore staff perceptions of the impact of weekly music and movement sessions involving older patients and staff on the wards where 'Dance for Health' sessions take place. BACKGROUND: Dance for Health is a programme of weekly group dance sessions, which take place on wards in an acute hospital setting. Recent research demonstrates the value of creative arts activities in clinical settings across the globe. However, there is little research exploring the impact of dance programmes for frail older people in acute hospital settings, or healthcare professionals' perceptions of the impact of these sessions on patients, staff and the ward environment. METHOD: A qualitative descriptive approach was used. Twenty-one semi-structured interviews were conducted with staff who had supported patients participating in Dance for Health and the ward managers where the sessions took place. Data analysis was undertaken using a thematic analysis approach. FINDINGS: The sessions challenged staff assumptions about older patients' musical preferences and the level of physical activity patients were able to undertake. Staff felt that the shared experience and interactions within the group enhanced staff-patient relationships. Staff taking part in the sessions reported feeling pleasure seeing their patients enjoying themselves and valued being a part of delivering the sessions. CONCLUSION: The Dance for Health programme in an acute hospital setting has the potential to promote person-centred care through encouraging self-expression and individuality. It is a meaningful and enjoyable activity, which encourages physical activity and social interaction and enriches the aesthetic experience of the hospital environment. IMPLICATIONS FOR PRACTICE: This is the first study reporting on the use of dance sessions for older people in an acute hospital setting. Dance for Health had a positive impact on staff attending the sessions and enhanced staff-patient relationships. Staff support is key for effective delivery.

Participants' experiences of the benefits, barriers and facilitators of attending a community-based exercise programme for people with chronic obstructive pulmonary disease.

Community-based exercise programmes (CEPs) are aimed at sustaining benefits of pulmonary rehabilitation (PR) in people with chronic obstructive pulmonary disease (COPD). The aim of this study was to understand participants' experiences of the benefits, barriers and facilitators of adherence to a CEP. A descriptive qualitative design was applied, employing in-depth semi-structured interviews with a convenience sample of 12 participants with COPD attending a CEP in the East of England. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Four main themes were identified: perceived benefits, enablers and barriers, perception of safety and recommendations for programme improvement. Participants experienced physical, social and psychological benefits. Regular attendance is important to avoid deterioration in perceived benefits. CEPs may therefore provide a cost-effective approach to improving and sustaining initial benefits of PR. Enablers included ease of access, perceived benefits and convenient programme components, being a retiree, social support and seasons. Identified barriers to attendance were poor physical health, family commitments and transport difficulties. The findings clearly suggest that a CEP supervised by an exercise instructor motivates participants to attend and exercise regularly. Increasing adherence to an exercise programme will prevent deterioration in perceived health, in addition to the physical, psychological and social benefits to the individual.

The impact of the arts in healthcare on patients and service users: A critical review.

This review provides an updated evaluation of the emerging body of literature on the value of the arts in healthcare settings. Internationally, there is growing interest in the use of the arts in the healthcare context supported by the number of research studies reported in the nursing and medical literature. There is evidence that arts interventions have positive effects on psychological and physiological outcomes on patients in a hospital environment. A critical review of the literature between 2011 and 2016 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: cultural activities, outcomes and healthcare settings. Initial searches identified 131 potentially relevant articles. Following screening and review by the research team, a total of 69 studies were included in the final review. The majority of studies examined the effect of music listening on patients/service users (76.8%). These studies were primarily quantitative focusing on the measurable effects of music listening in a surgical context. Overall, the studies in the review support the growing evidence base on the value of the arts in a variety of healthcare settings for patients/service users. The review findings suggest that now is the time for different voices and art forms to be considered and represented in the research on arts in healthcare. Further research is also required to strengthen the existing evidence base.

The role of arts activities in developing resilience and mental wellbeing in children and young people a rapid review of the literature.

AIMS: This rapid review explores the role of arts activities in promoting the mental wellbeing and resilience of children and young people aged between 11 and 18 years. METHODS: A systematic search of the literature was undertaken across 18 databases; no date limit was set on publication. Search terms included a range of creative activities: music, dance, singing, drama and visual arts; these were combined with terms linked to aspects of mental health, emotional wellbeing and resilience. Only studies related to activities that took place within community settings and those related to extracurricular activities based within schools were included. RESULTS: Following the application of inclusion and exclusion criteria, eight papers were included in the review. The interventions used in the studies were diverse and the research was heterogeneous; therefore, narrative synthesis of the results was conducted. The findings from the studies are considered in terms of the contribution the activities make to building resilience of children and young people. It was found that participating in arts activities can have a positive effect on self-confidence, self-esteem, relationship building and a sense of belonging, qualities which have been associated with resilience and mental wellbeing. CONCLUSIONS: Although the research evidence is limited, there is some support for providing structured group arts activities to help build resilience and contribute to positive mental wellbeing of children and young people.

The relationship between physical activity and health status in patients with chronic obstructive pulmonary disease following pulmonary rehabilitation.

AIM: To investigate the relationship between physical activity (PA) and measures of health-related quality of life (HRQoL) and hospital admissions in people with chronic obstructive pulmonary disease (COPD) following pulmonary rehabilitation (PR). METHOD: CINAHL, Medline, PubMed, AMED, PsycINFO and Cochrane Library (database inception to July 2014) were searched. Relevant outcomes included relationships between PA and HRQoL, lung function (forced expiratory volume in one second, FEV1) and/or hospital admission. Six quantitative and 11 qualitative studies were included and Harden's method of data synthesis in a mixed-methods systematic review was applied. RESULTS: Six months following PR, increase activity levels was associated with improvement of 62m in 6MWD, 2.31 and 15.55 points increase in SGRQ and CRDQ total scores, respectively, 1.3% FEV1 and reduced dyspnoea. No study reported on hospital admission. Reported relationships were facilitated by healthcare professionals, social supporters, motivation and encouragement, reduced fear and seeing benefits and hindered by changing physical health, environment, lack of motivation, fear and social isolation. CONCLUSION: The associations between increased levels of PA and quality of life, respiratory function and dyspnoea are largely based on 6MWD and PA questionnaires. Objective measurement of free living activity in exercise maintenance phase is required along with participants' views. Implications for rehabilitation Pulmonary rehabilitation (PR) is a non-therapeutic intervention in which a team of multidisciplinary health care professionals use individually tailored supervised exercise training, self-management education, psychological and social support to optimize the physical and social performance and autonomy of patients with chronic respiratory impairment. Initial benefits from PR decline after program completion. Clinical guidelines advocate increase exercise and activity in sustaining initial benefits of PR. Following PR, increased levels of physical activity in people with COPD undertaking exercise maintenance programmes are positively related with improvements in exercise capacity, quality of life and dyspnoea. Barriers to activity participation in exercise maintenance programmes, which need to be overcome, are fear, lack of motivation, environmental factors, such as social isolation and changes in physical health. Rehabilitation professionals and social supporters can make rehabilitation more long-lasting and facilitate people with COPD to participate in activity by motivating and encouraging them, reducing their fears and reinforcing the benefits of activity participation.

Exploring assistant practitioners' views of their role and training.

AIM: To examine the views of assistant practitioners and trainee assistant practitioners regarding experiences of practice in relation to the autonomy of the role and level of supervision, the training involved and support experienced in undertaking the foundation degree, and the effects of the assistant practitioner role in the workplace. METHOD: A service evaluation was undertaken in which a small cross-sectional quantitative survey was distributed to trainee assistant practitioners undertaking the foundation degree, and assistant practitioners who had previously completed the foundation degree or who had qualified via another route. RESULTS: A total of 93 questionnaires were returned. The data indicate that there is some uncertainty surrounding the skills and competence of those undertaking the foundation degree, and a lack of opportunity for career progression for unregistered staff. CONCLUSION: Increased understanding of the scope and role of assistant practitioners and the academic requirements of the foundation degree is required to increase assistant practitioner numbers.

Healthcare professionals' perceptions of the value and impact of the arts in healthcare settings: A critical review of the literature.

BACKGROUND: Internationally there is growing interest in the use of the arts in the healthcare context evidenced by the number of research studies reported in the nursing and medical literature. Establishing successful projects in healthcare environments will to some extent be reliant on the cooperation of staff working in these settings: healthcare professionals and their cultural values will be the lynchpin in the relationship between the artists organising the activities and the patients. This review appraises healthcare professionals' perceptions of the value of the arts in healthcare settings, and the impact of the arts on healthcare professionals. METHODS: A critical review of the literature between 2004 and 2014 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: arts activities; healthcare settings, and healthcare providers. Studies were included if they were written in English, explored the attitudes of healthcare professionals on the use of the arts in healthcare settings or the impact of arts activities on healthcare staff. Studies conducted in community venues and/or reporting on arts therapies (art, drama or music) were excluded. An initial 52 studies were identified and following screening for relevance and quality 27 articles were reviewed. Arts interventions were diverse and included music listening, visual arts, reading and creative writing, and dance. RESULTS: Despite some methodological limitations of the reviewed studies it was found that the majority of staff believed that engaging in arts interventions has a positive impact on patients' health and well-being. The findings suggest that arts interventions are perceived to have an impact on patients' stress, mood, pain levels, and sleep. Furthermore, staff believed that the arts can enhance communication between staff and patients, helping to build rapport and strengthen interactions. The majority of reported staff outcomes were positive, with arts activities in healthcare settings found to: decrease stress, improve mood, improve job performance, reduce burnout, improve patient/staff relationships, improve the working environment and improve well-being. CONCLUSIONS: This review fills a gap in the literature, providing the first review of healthcare professional's views of the arts in healthcare settings and the impact of arts activities on healthcare staff. The largely positive perceptions of staff will aid in the implementation of arts activities in healthcare settings, which will enhance care and benefit both patients and healthcare staff.

Experiences of being a control group: lessons from a UK-based randomized controlled trial of group singing as a health promotion initiative for older people.

Existing randomized controlled trials within the health field suggest that the concept of randomization is not always well understood and that feelings of disappointment may occur when participants are not placed in their preferred arm. This may affect a study's rigour and ethical integrity if not addressed. We aimed to test whether these issues apply to a healthy volunteer sample within a health promotion trial of singing for older people. Written comments from control group participants at two points during the trial were analysed, together with individual semi-structured interviews with a small sample (n = 11) of this group. We found that motivation to participate in the trial was largely due to the appeal of singing and disappointment resulted from allocation to the control group. Understanding of randomization was generally good and feelings of disappointment lessened over time and with a post-research opportunity to sing. Findings suggest that measures should be put in place to minimize the potential negative impacts of randomized controlled trials in health promotion research.

The effects of participating in creative activities on the health and well-being of children and young people: a rapid review of the literature.

AIMS: Health-promoting strategies need to be culturally appropriate to encourage healthy behaviours and lifestyle choices in children and young people. This rapid review explores the effects of participating in creative activities on the health and well-being of children aged between 11 and 18 years. METHODS: Building on an earlier systematic review undertaken by Daykin and colleagues(1) a rapid review of the literature published between 2004 and 2011 was undertaken. The search was conducted systematically and included research on music, dance, singing, drama and visual arts, taking place in community settings or as extracurricular activities in mainstream schools. Therapies such as art, drama and music were excluded from the review. RESULTS: Following rigorous application of inclusion and exclusion criteria, 20 papers were included in the review: six quantitative, eight qualitative and six mixed-method approaches. The interventions used in the studies were diverse and the research was heterogeneous, therefore overall synthesis of the results was inappropriate. The review is therefore organised into the following headings: sexual health, obesity, mental health and emotional well-being. Despite the methodological weakness and limitations of the majority of the studies there were some consistencies in their findings. It was found that participating in creative activities can have a positive effect on behavioural changes, self-confidence, self-esteem, levels of knowledge and physical activity. CONCLUSIONS: Although the research evidence is generally weak there is some evidence that using creative activities as part of a health-promoting strategy may be a useful method of increasing knowledge and positive behaviours in children and young people.

The Silver Song Club Project: singing to promote the health of older people.

Attention has recently been drawn to the contribution of the arts, and of singing in particular, to health and wellbeing. This article describes a qualitative research project which aimed to gain participants' views of taking part in Silver Song Clubs--community-based singing groups for older people. Seventeen individuals aged 60-plus from six clubs were interviewed and a number of benefits were identified. These included: enjoyment; better mental health and wellbeing; increased social interaction; improvements in physical health; cognitive stimulation and learning; and improved memory and recall. It is suggested that such benefits sit well within a model of health relevant to older people themselves. Community nurses working with this age group might consider including an assessment for interest in musical and related activities, and also should be aware of any local initiatives into which individuals can be referred.

Arts on prescription: a review of practice in the U.K.

The current levels of psychosocial distress in society are significant, as evidenced by the number of prescribed antidepressants and the numbers of working days lost as a result of stress and anxiety. There is a growing body of evidence that active involvement in creative activities provides a wide range of benefits, including the promotion of well-being, quality of life, health and social capital. In the U.K. there are currently a number of projects operating that offer Arts on Prescription for people experiencing mental health problems and social isolation. The purpose of such schemes is not to replace conventional therapies but rather to act as an adjunct, helping people in their recovery through creativity and increasing social engagement. Although the schemes are varied in their approaches and settings, the common theme is that there is a referral process and creative activities take place in the community facilitated by artists rather than therapists. This paper explores whether such schemes can be part of the solution to the current challenge of mental ill-health, and looks at the evidence supporting the value of such schemes which may influence government, funders and healthcare professionals to implement Arts on Prescription more widely.

'As long as the doctors know what they are doing': trust or ambivalence about patient information among elderly men with prostate cancer?

In recent years prostate cancer has become a significant health problem worldwide with considerable social and economic consequences. Prostate cancer tends to affect older men, and by the time they reach the age of 80, about half of all men will have a form of prostate cancer. This study explored the information and support needs of men aged 75 and over with a diagnosis of prostate cancer. In-depth interviews were conducted with 19 men, to develop ideas and hypotheses to try to understand why older men do not seek information or use helplines to find out about their condition. From the data it appears that some older men do not understand how the treatment for prostate cancer will impact on their quality of life, and yet do not seek further information beyond that which is provided during consultations. Indeed there appears to be certain ambivalence about finding out more information about their condition - partly because of their beliefs about the normal ageing process and partly because of the trust they have in health professionals and their overall satisfaction with the care that they receive.

Magnetic resonance imaging for investigation of the knee joint: a clinical and economic evaluation.

OBJECTIVES: The aim of the study reported here was to investigate whether the use of magnetic resonance imaging (MRI) impacts on the clinical management of patients presenting with chronic knee problems, reduces costs, and improves patient outcome. METHODS: A single-center randomized controlled trial was conducted. Patients attending with knee problems in whom surgery was being considered were randomized either to investigation using an MRI scan or to investigation using arthroscopy. The study investigated benefits in terms of avoidance of surgery and patient health-related quality of life (using SF-36 and EQ-5D). Costs were assessed from the perspectives of the National Health Service and patients. All analyses were by intention to treat. RESULTS: The trial recruited 118 patients. No statistically significant differences were found between groups in terms of health outcome. However, the use of MRI was associated with a positive diagnostic/therapeutic impact: a significantly smaller proportion of patients in the MRI group underwent surgery (MRI = 0.41, No-MRI = 0.71; p value = .001). There was a similar mean overall cost for both groups. CONCLUSIONS: The use of MRI in patients with chronic knee problems, in whom surgery was being considered, did not increase costs overall, was not associated with worse outcomes, and avoided surgery in a significant proportion of patients.