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Caregiving is a high calling and an essential role in every society, and caregivers come to their work to do good, to help people. In my work over the past 30 years, I have asked hundreds of nurses, medical students, and other care providers to describe the moment when they knew they wanted to be a caregiver. Most describe intimate, generous, and meaningful moments of caring for a grandparent or of being cared for by a professional or family caregiver. The moments are soft, unrushed, deeply present, and loving. While most of these caregivers can describe specific instances of realizing their vision in their professional work, they also describe how the circumstances in which they work make these moments rare.
Today, the challenges that clinical staff face have accumulated to levels that are increasingly difficult to endure, as evidenced by higher levels of staff turnover and increasingly dire shortages.1 Typical stresses in the healthcare environment have been compounded by the COVID-19 pandemic and by increased violence against care providers.2 Higher patient/staff ratios due to staff shortages mean that care providers have less time to spend with their patients, fewer resources to offer them, and fewer opportunities to provide care in the ways they envisioned themselves doing so.3
For several years, I supervised musicians working on a research project in an emergency and trauma unit at our very busy tertiary care hospital. I received a note one day from a trauma nurse who wrote to share an experience. The unit had a patient whose life the trauma team couldn’t save. As they ceased their efforts and the patient’s family members began to arrive, the team felt an agonizing sense of failure. Just then, the nurse saw two musicians in residence walking down the hallway. With the family’s permission, the team invited the musicians into the room to play. The nurse described the beauty of the moment, how the music provided calm and helped connect the patient, family members, and care team. She shared that it had profoundly transformed the situation from a failure to a success for the care team because they were able to do something to care for everyone involved. They felt that, although they had not been able to cure, they had been able to bring a measure of healing to the moment and to the family.
Enhancing Patient-Centered Care
There is no single solution to the profound challenges our healthcare systems and providers are facing today. Amid greater complexity and hardship in the healthcare environment, caregivers must draw on more than scientific knowledge to serve patients effectively and to be well themselves. While the arts are not a panacea, the arts and artists are available resources that can help humanize and bring beauty and meaning to both the environment and practices of care. Artists are invaluable members of the interprofessional care team who can enhance the provision of patient-centered care. They can improve quality of care by providing holistic dimensions of caring, including creative, cognitive, and social engagement.4 In these ways, artists can help extend the care provided by clinicians and help make those moments of satisfying caring more common than rare.
We know that engagement in the arts and humanities can cultivate caregivers’ creativity, curiosity, empathy, critical thinking, communication, and social advocacy—all of which can bolster clinical skills.5 Medical school curricula are increasingly drawing on the arts and humanities, along with arts methods, to build these and other skills in students.6
Enhancing Caregiver Well-Being
Perhaps more importantly today, the arts can also contribute significantly to caregiver well-being and retention. Engagement in creative activities at work can increase staff well-being by reducing stress and fatigue and by positively impacting general health, mental well-being, creativity, and a sense of community at work, as one study of nurses engaged in silk painting at work found.7 A higher frequency of cultural activities in the workplace has also been positively associated with well-being at work, and studies have found that when given a choice, nurses are inclined to choose or retain employment in a modern hospital that offers the arts.8
The practice of medicine is an art. It requires creativity and presence as well as the unique skills and perspectives that each individual caregiver brings to bear. And arts engagement is a health behavior. People—including caregivers—who engage in the arts (such as going to a museum or concert) just once a month or more are less likely to be depressed or lonely and less likely to die early than whose who engage in the arts less than once a quarter.9 As of 2007, there were arts programs (ranging from music to crafts to writing poetry) in about half of the hospitals in the United States, which means that many caregivers have access to the arts for their patients and for themselves.10 These programs exist to help reduce suffering and to improve clinical outcomes. For example, music therapy reduced procedure times, staffing needs, and sedation in children undergoing tomography scans and echocardiograms;11 it also reduced medication, home health aide visits, and nursing home stays among patients with dementia.12 Arts programs also cultivate joy, connection, and meaning, which can be amazing gifts for patients and caregivers alike. They bring greater holism to the practice of medicine and can help caregivers experience the kind of deep and meaningful caring that they came to their roles to provide.
–J. S.
Endnotes
1. Healthcare Staffing Shortage Task Force Report (Washington, DC: American Federation of Teachers, November 2022), aft.org/sites/default/files/media/documents/2022/hc_StaffingTaskforceReport_Nov2022.pdf.
2. Healthcare Staffing Shortage Task Force Report; and P. Boyle, “Threats Against Health Care Workers Are Rising. Here’s How Hospitals Are Protecting Their Staffs,” AAMCNews, Association of American Medical Colleges, August 18, 2022, aamc.org/news-insights/threats-against-health-care-workers-are-rising-heres-how-hospitals-are-protecting-their-staffs.
3. S. Balasubramanian, “The Healthcare Industry Is Crumbling Due to Staffing Shortages,” Forbes, August 26, 2022, forbes.com/sites/saibala/2022/08/26/the-healthcare-industry-is-crumbling-due-to-staffing-shortages/?sh=426f1c7a7d6e.
4. J. Sonke et al., “Nurse Perceptions of Artists as Collaborators in Interprofessional Care Teams,” Healthcare 5, no. 3 (2017): 50.
5. D. Skorton and L. Howley, “Why We Need the Arts and Humanities to Get Us Through the COVID-19 Pandemic,” USA Today, January 6, 2021, usatoday.com/story/opinion/2021/01/06/why-arts-have-essentialrole-during-covid-19-pandemic-column/4138588001.
6. National Academies of Sciences, Engineering, and Medicine, “Chapter 7: Integration in Graduate and Medical Education,” in The Integration of the Humanities and Arts with Sciences, Engineering, and Medicine in Higher Education: Branches from the Same Tree (Washington, DC: National Academies Press, 2018), nap.nationalacademies.org/read/24988/chapter/9; and Y. Dalia, E. Milam, and E. Rieder, “Art in Medical Education: A Review,” Journal of Graduate Medical Education 12, no. 6 (December 2020): 686–95.
7. S. Karpavičiūtė and J. Macijauskienė, “The Impact of Arts Activity on Nursing Staff Well-Being: An Intervention in the Workplace,” International Journal of Environmental Research and Public Health 13, no. 4 (2016): 435.
8. K. Tuisku et al., “Cultural Leisure Activities and Well-Being at Work: A Study Among Health Care Professionals,” Journal of Applied Arts & Health 2, no. 3 (2012): 273–87; and R. Staricoff and S. Loppert, “Integrating the Arts into Health Care: Can We Affect Clinical Outcomes?,” in The Healing Environment Without and Within, ed. D. Kirklin and R. Richardson (London: Royal College of Physicians, 2003), 63–79.
9. D. Fancourt and A. Steptoe, “The Art of Life and Death: 14 Year Follow-Up Analyses of Association Between Arts Engagement and Mortality in the English Longitudinal Study of Ageing,” BMJ 367 (2019): l6377; D. Fancourt and U. Tymoszuk, “Cultural Engagement and Incident Depression in Older Adults: Evidence from the English Longitudinal Study of Ageing,” British Journal of Psychiatry 214, no. 4 (2019): 225–29; and U. Tymoszuk et al., “Cross-Sectional and Longitudinal Associations Between Receptive Arts Engagement and Loneliness Among Older Adults,” Social Psychiatry and Psychiatric Epidemiology 55, no. 7 (2020): 891–900.
10. J. Sonke et al., “The State of the Arts in Healthcare in the United States,” Arts & Health 1, no. 2 (2009): 107–35.
11. D. Walworth, “Procedural-Support Music Therapy in the Healthcare Setting: A Cost-Effectiveness Analysis,” Journal of Pediatric Nursing 20, no. 4 (2005): 276–84.
12. H. Trainor, “Effects of Using Music Therapy for Patients Suffering from Dementia,” Health Care Manager 38, no. 3 (2019): 206–10.
[Illustration by Jasu Hu]