Medical Center Uses Art to Develop Nurses' Skills
By Debra Anscombe Wood, RN
Monday November 17, 2008
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Nurse residents at The University of Chicago Medical Center are learning from the masters — expert clinicians, as well as Pablo Picasso, Claude Monet, and other artists.
"The goal of this [art] module is to improve their assessment skills through the development of visual discernment," says Rhonda Blender, RN, MSN, a program director with the Academy/Program Management Office at the University of Chicago Medical Center. "In order to assess the changing patient condition, first the clinician has to look and see."
Three years ago, Blender and Sarah Alvarez, assistant director of adult programs and museum education at the Art Institute of Chicago, developed "The Discerning Eye: Visual Observation Skills from the Art Museum to Patient Diagnosis." More than 200 nurses have participated since.
Nurses develop an ability to detect changes in patients' conditions by observing and discussing their observations about the pieces of art.
"New graduates don't trust what they know, and they don't know what they don't know," says Randy Ball, RN, MSN, nurse educator at the Center for Nursing Professional Practice and Research and program coordinator for the University of Chicago Medical Center. "This is a way to give them a safe environment. There are no right or wrong answers."Getting Started
Blender approached the Art Institute about creating the program after the hospital began offering the University HealthSystem Consortium/American Association of Colleges of Nurses residency program in 2005. She reports art has been used throughout history to teach visual acuity and discernment skills in a variety of professions, including medicine, law enforcement, and the military.
Alvarez selected most of the artwork based on the medical center's goals. Blender, a painter and art enthusiast in her free time, offered some suggestions.
"I wanted, by the choice of objects and works of art, to imply the variety that's out there in the world of art, which reflects the variety in the world of patients," Alvarez says.
The program began with a PowerPoint presentation, but now nurse residents go to the museum to view and discuss between five and six paintings or sculptures in person. The pieces of art selected change along with museum displays. The team limits attendance to 20 nurses to provide for a more intimate experience.The Artwork
Blender suggested a series of Monet's paintings called "Stacks of Wheat" that capture the various seasons and lighting at different times of day. The Art Institute features six of his 25 wheat paintings.
"The point of selecting that was to encourage a discussion about what it is like to go in and look at a patient," Blender says. "That patient goes through the course of the day, and his or her condition changes."
The nurses are asked to anonymously "diagnose" what may be wrong with people portrayed in some of the works, such as Picasso's "The Old Guitarist," painted during Picasso's blue period, and Ivan Albright's "Into the World There Came a Soul Called Ida." Then the participants discuss what they think are possible medical conditions based on visual evidence. The color and context influence how people view the person in the art. The subject's body language, coloration, and other nonverbal aspects provide clues. The nurses also learn to appreciate how easy it is to be influenced by an initial impression but then to look beyond that.
The museum X-rayed the Picasso, which allows nurses to see an earlier image of a woman, a child, and two animals that he painted over for "The Old Guitarist." When the nurses go back and look carefully at the painting, they can see the outline of the woman underneath because of the thinness of the paint.
"It's a reminder of the nuance that can be there," Ball says. "We talk about prioritizing what you see and not getting caught up in what you first see."
Another painting that reinforces that concept is Frans Snyders' "Still Life with Dead Game, Fruits, and Vegetables in a Market." People start looking at it in different places, just as nurses zero in on different things in an ED or other unit. Ball says some people get hung up on the eviscerated deer in the center of the painting and miss other important things going on, such as a little boy picking a vendor's pocket.
"It has everything to do with a busy acute-care unit," Blender says. "You come out of report, and there's an abundance of activity going on."
Ball says it reinforces the need to take information from other nurses but to always do one's own assessment. She hopes the experience makes nurses step back and think about what first catches the eye and see whether it is the most important thing or if the situation warrants a deeper look for something else. "If one resident comes out with that, we have been successful," Ball says.
Although the program is open only to new graduates participating in the residency program, Ball envisions all nurses taking part in the future. The hospital may expand and offer the artwork program to experienced nurses to help them develop new ways of looking at things.
The program also offers access to works of art and, Alvarez says, may expose nurses to the relevance of art to their jobs and in life.
"Our focus for this program had to do with assessing the changing patient condition, but we were also looking for opportunities to utilize the humanities in this curriculum," Blender says. "It's a deeper perspective. What is the personal narrative, both for the patient and the nurse, relative to their humanness? It's not only the visual discernment and the changing patient condition but also our humanity as practitioners, as human beings, and accessing that on behalf of the people in our care."
Debra Anscombe Wood, RN, is a freelance writer. To comment, e-mail editorIL@nursingspectrum.com.
