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Aging Perceived through Visual Art Observations
A
Aging Perceived through Visual Art Observations Britt-Maj Wikström, PhD
Abstract A reproduction of a work of art by the Swedish artist Lena Cronquist was introduced into clinical practice in student nurse education. Student nurses (n = 366) in a first semester course served as the study population, and the study was undertaken at two university colleges of health sciences in Sweden. The students studied the painting from the point of view of a situation that depicted an elderly woman in a sickbed. The study findings implied a valuable learning situation in which the students perceived aging in a sensitive and nuanced manner. (Geriatr Nurs 2000;21:300-2)
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he main function of art, as stated by the American philosopher Khatchadourian,1 is that it can help a person maintain or restore his humanity. It can restore wholeness to a man’s soul. Art can keep alive the inborn human capacity to feel for another fellow being and remain sensitive to beauty in the human world. It brings order into human experience. He also says that art preserves the Mamma, Lena Cronquist, 1986, © 2000 Artists Rights Society (ARS), New York/BUS, Stockholm. Reprinted with permission. capacity to form human relations and bring humans together. “We may become more senEDUCATION THROUGH AESTHETICS sitive to ourselves and others and so, perhaps, better Alfred Lichtwark3 acknowledged that humanities equipped to exist on deeper human levels.”1 Using works of art to communicate with patients has proven fruitful. are important in education. He used art as a pedagogiThe ideas generated in works of art indicate ways to cal tool to teach children to “see” through careful obbridge objective reality.2 servation. This approach promoted the ability to
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observe things more closely and in greater detail. Furthermore, he expected students to describe the feelings depicted in and evoked by the art, maintaing that oneself and one’s own feelings are seen in the work.3 Carper4 identified four fundamental patterns of knowing in nursing, one of which is aesthetics. She argues that nursing care is aesthetic if it consists of balance and unity. Today, research into the area of different aesthetical expressions like music, poetry, and literature suggests that these expressions can be used to develop and increase student nurses’ effectiveness.5-7 The integration of aesthetics into the teaching of nursing can enhance representing, interpreting, and envisioning the caring presence in nursing practice.8 The purpose of this study was to develop a visual art program for clinical practice and nurse education. A reproduction of a painting was used for observation and interpretation of aging aspects. The research question posed was, “What do students perceive about aging from careful observations of Mother, a reproduction of a work of art?”
1. Students worked alone for 45 minutes on a written response to a reproduction of Mother, a well-known painting by the Swedish artist Lena Cronqvist. The painting was studied as a hypothetical situation of an elderly woman in a sickbed. The students were asked to take a close look at the painting, and some questions were posed to help them analyze the painting in a fruitful manner. These questions helped the students bring forward their own meaning of the message sent by the painter: • What caring issues do you think of? • How does she feel? • What feelings does the painting evoke in you? 2. Students discussed in pairs and in fours for 45 minutes and made a written report. During the pair discussions, the students were asked to tell one another what they had written when they worked alone, stimulating debate on a variety of aspects of being elderly. Then the students formed a group of four with another pair; each group elected a chairperson who noted the main themes that appeared during the discussions.
RESULTS THEORETICAL FRAME Van Manen9 believes that each artistic medium has its own language of expression to be used in education. A work of art helps the individual see more sharply and reflect more deeply, creating a process of exploration and discovery that results in new ways to perceive that which is reflected on.
METHOD Sample The sample selected for the study came from two university colleges of health sciences in Sweden. Data were collected during a period of 2 years (1996 to 1998). Student nurses (n = 366) in the undergraduate program served as the study population. In the 3-year undergraduate program that led to professional nurse registration and a degree in nursing, this study was conducted during the first academic year. Information was collected about the students’ previous art experiences and art education. If any of the students had taken an art history course at the university level or visited art museums regularly, their tests were analyzed separately. The aim of the first phase of this study was to look for a work of art showing a situation that, with some effort and imagination, the student nurses could interpret as a caring view of aging at a hospital. Students’ written responses to six paintings were collected to select one in which the students could perceive aspects of aging. A painting by Lena Cronquist, Mother, suggested a wide variety of interpretations concerning aging and dependency on another person. Data Collection Data collection for the visual art program consisted of two parts:
Geriatric Nursing 2000 • Volume 21 • Number 6
When asked “What caring issues do you think of?” and “How does she feel?” the students reported that: It was an old woman who was sleeping. She had an expressive face showing sadness, suffering, and anguish. She had pain. You could see it in her facial expression and the wrinkles on her forehead. She needed alleviation of her pain. For the physical pain, she needed an ataractic drug, and for her psychological pain someone at her side who could comfort her and stroke her cheek gently. It was a tragedy that the woman was alone and forlorn. They felt sorry for her. The woman was dehydrated and badly nourished. You could see that her lips were dry and chapped. She needed someone who could give her something to drink and moisten her lips. The woman was a bother to the personnel because they were pressed for time and because it was difficult to approach her. She could not respond verbally. She lived in her own world. She was not attainable. From the perspective of the observers—what feelings do the picture of work of art evoke in you?—the students reported that: They felt sympathy for the woman because she was abandoned by her relatives and the personnel on the ward. They felt heavy at heart knowing that many elderly persons at nursing homes die alone without a caring staff or a relative at their side. When they put themselves in the old woman’s place, they felt anxiety and uneasiness. They thought of aging, pain, and decay and running the risk of getting into a similar situation as the woman. When the students thought of themselves as registered nurses, they considered themselves able to support the needs of elderly people. The interpretations indicate conflicting emotions toward elderly patients. The students may have devel-
301
oped a negative attitude toward aging after experiencing some of the discomfort generated by the work of art, but they conclude with an enhanced sense of personal capacity through having engaged in a process of exploration and discovery from observing a work of art. The experience of aging brings with it an awareness by the students about their ability to give good nursing care to elderly patients when they are registered nurses.
DISCUSSION The visual art program is interpreted in the light of Van Manen’s9 pedagogic model that stresses that learning is about discovery and reflection. In the present study, the process of learning through a work of art forms an ideal opportunity in which to practice learning based on these aspects. In this type of teaching/learning, the students are encouraged to use reflection and discovery when they study and interpret the reproduction. From their interpretations, it becomes clear that the visual art program may have heightened the student nurses’ sensitivity, shown in the way they put themselves in the place of the depicted person’s situation. The students brought a variety of interpretative and sensitive approaches to bear on the painting and the relationship of caring for elders. The painting seems to have opened up an alternative possibility for the students to express, in a sensitive way, their perception of aging—to be alone and without relatives. They find the situation tragic—an elderly woman without anyone to comfort her. It may be argued that the students either become more sensitive or the dynamic quality of sensitivity inherent in the student is lifted from their conscience. This connection underscores Henderson’s10 nursing theory in which she emphasizes the importance of a true understanding of patients in order to be sensitive to their needs. A wide variety of art sources, such as films, plays, novels, short stories, paintings, and photographs, have been used in nurse education. These aesthetic expressions sensitize student nurses to the patients’ situations.11,12 These study findings imply that the chosen art represents a distressing issue that awakened feelings of anxiety and uneasiness. The way a person perceives a work of art depends on the particulars of the viewer.2 Depending on the circumstances and the intentions, the teacher needs to work with the students’ emotional responses. Positive responses can be enhanced; responses that form barriers need to be recognized before the interpretation proceeds. In the present study, the negative feelings do not seem to form a barrier in the interpretation process. On the contrary, describing aging seems to give the students an awareness of the feelings that were present during the observation process.9 The fact that the students became aware of their own feelings could arguably lead
302
to insights into the patients’ feelings. To become aware of one’s own feelings may help understand another human being.13,14 The importance of emotional presence in order to put oneself into the situation of the patient also was seen as important by staff nurses.15 An ethical issue arising from student nurses participation in the current study is that students are in a state of dependence on a teacher. However, the written reports do not necessarily constitute a basis for forming judgments regarding the students’ ability to enter into or understand the experience lived by elderly patients at hospitals. A weakness of the method is that the students participated in the program voluntarily, which might indicate an overrepresentation of students with a special interest in visual art and thus bias the result, although the variables of art education and art experience were controlled.
CONCLUSION The debate on aging, stimulated by the work of art, could be regarded as a valuable learning experience. It might be one way to express original ideas and personal perspectives on aging. REFERENCES 1. Khatchadourian H. Humanistic functions of the arts today. J Aesthetic Ed 1980;14(2):11-21. 2. Wikström B-M, Ekvall G, Sandström S. Stimulating creativity through works of art. A controlled intervention study on creative ability in elderly women. J Creativity 1994;7:171-82. 3. Lichtwark A. Die Kunst in der Schule [The art in school]. Berlin; 1902. 4. Carper BA. Fundamental patterns of knowing in nursing. Adv Nurs Science 1978;1:13-23. 5. Oiler C. Nursing reality as reflected in nurses’ poetry, perspectives in psychiatric care. Am J Nurs 1983;21:81-90. 6. Wolf S. Aesthetics and humanities as vitamins in medical education. The Pharos 1984 Winter. 7. Darbyshire P. Understanding caring through arts and humanities: a medical/nursing humanities approach to promoting alternative experiences of thinking and learning. J Adv Nurs 1994;19:856-63. 8. Smith MJ. Enhancing aesthetic knowledge: a teaching strategy. Adv Nurs Sci 1992;14:52-9. 9. van Manen M. Researching lived experience: human science for an action sensitive pedagogy. London: The University of Western Ontario; 1990. 10. Henderson V. The nature of nursing. Am J Nurs 1964;64:62-8. 11. Calman KC, Downie RS, Duthie M, Sweeney BS. Literature and medicine: a short course for medical students. Med Ed 1988;22:265-9. 12. Bartol GM. Using the humanities in nursing education. Nurse Ed 1986;11:21-3. 13. Denzin NK. On understanding emotion. London: Jossey-Bass Publishers; 1984. 14. Abbs P. Towards a coherent arts aesthetic. In: Abbs P, editor. Living powers: the arts in education. London: The Falmer Press; 1987. p. 9-65. 15. Forrest D. The experience of caring. J Adv Nurs 1989;14:815-23.
BRITT-MAJ WIKSTRÖM, PhD, is an assistant professor at the Karolinska Institute in Stockholm, Sweden, and Jönko ping University College of Health Sciences. Acknowledgment: Financial support from the Council of Health Care Sciences, The Karolinska Institute, Stockholm Sweden, is gratefully acknowledged. Copyright © 2000 by Mosby, Inc. 0197-4572/2000/$8.00 + 0 34/1/112145 doi:10.1067/mgn.2000.112145
Geriatric Nursing 2000 • Volume 21 • Number 6
Aging Perceived through Visual Art Observations Britt-Maj Wikström, PhD
Abstract A reproduction of a work of art by the Swedish artist Lena Cronquist was introduced into clinical practice in student nurse education. Student nurses (n = 366) in a first semester course served as the study population, and the study was undertaken at two university colleges of health sciences in Sweden. The students studied the painting from the point of view of a situation that depicted an elderly woman in a sickbed. The study findings implied a valuable learning situation in which the students perceived aging in a sensitive and nuanced manner. (Geriatr Nurs 2000;21:300-2)
T
he main function of art, as stated by the American philosopher Khatchadourian,1 is that it can help a person maintain or restore his humanity. It can restore wholeness to a man’s soul. Art can keep alive the inborn human capacity to feel for another fellow being and remain sensitive to beauty in the human world. It brings order into human experience. He also says that art preserves the Mamma, Lena Cronquist, 1986, © 2000 Artists Rights Society (ARS), New York/BUS, Stockholm. Reprinted with permission. capacity to form human relations and bring humans together. “We may become more senEDUCATION THROUGH AESTHETICS sitive to ourselves and others and so, perhaps, better Alfred Lichtwark3 acknowledged that humanities equipped to exist on deeper human levels.”1 Using works of art to communicate with patients has proven fruitful. are important in education. He used art as a pedagogiThe ideas generated in works of art indicate ways to cal tool to teach children to “see” through careful obbridge objective reality.2 servation. This approach promoted the ability to
300
Geriatric Nursing 2000 • Volume 21 • Number 6
observe things more closely and in greater detail. Furthermore, he expected students to describe the feelings depicted in and evoked by the art, maintaing that oneself and one’s own feelings are seen in the work.3 Carper4 identified four fundamental patterns of knowing in nursing, one of which is aesthetics. She argues that nursing care is aesthetic if it consists of balance and unity. Today, research into the area of different aesthetical expressions like music, poetry, and literature suggests that these expressions can be used to develop and increase student nurses’ effectiveness.5-7 The integration of aesthetics into the teaching of nursing can enhance representing, interpreting, and envisioning the caring presence in nursing practice.8 The purpose of this study was to develop a visual art program for clinical practice and nurse education. A reproduction of a painting was used for observation and interpretation of aging aspects. The research question posed was, “What do students perceive about aging from careful observations of Mother, a reproduction of a work of art?”
1. Students worked alone for 45 minutes on a written response to a reproduction of Mother, a well-known painting by the Swedish artist Lena Cronqvist. The painting was studied as a hypothetical situation of an elderly woman in a sickbed. The students were asked to take a close look at the painting, and some questions were posed to help them analyze the painting in a fruitful manner. These questions helped the students bring forward their own meaning of the message sent by the painter: • What caring issues do you think of? • How does she feel? • What feelings does the painting evoke in you? 2. Students discussed in pairs and in fours for 45 minutes and made a written report. During the pair discussions, the students were asked to tell one another what they had written when they worked alone, stimulating debate on a variety of aspects of being elderly. Then the students formed a group of four with another pair; each group elected a chairperson who noted the main themes that appeared during the discussions.
RESULTS THEORETICAL FRAME Van Manen9 believes that each artistic medium has its own language of expression to be used in education. A work of art helps the individual see more sharply and reflect more deeply, creating a process of exploration and discovery that results in new ways to perceive that which is reflected on.
METHOD Sample The sample selected for the study came from two university colleges of health sciences in Sweden. Data were collected during a period of 2 years (1996 to 1998). Student nurses (n = 366) in the undergraduate program served as the study population. In the 3-year undergraduate program that led to professional nurse registration and a degree in nursing, this study was conducted during the first academic year. Information was collected about the students’ previous art experiences and art education. If any of the students had taken an art history course at the university level or visited art museums regularly, their tests were analyzed separately. The aim of the first phase of this study was to look for a work of art showing a situation that, with some effort and imagination, the student nurses could interpret as a caring view of aging at a hospital. Students’ written responses to six paintings were collected to select one in which the students could perceive aspects of aging. A painting by Lena Cronquist, Mother, suggested a wide variety of interpretations concerning aging and dependency on another person. Data Collection Data collection for the visual art program consisted of two parts:
Geriatric Nursing 2000 • Volume 21 • Number 6
When asked “What caring issues do you think of?” and “How does she feel?” the students reported that: It was an old woman who was sleeping. She had an expressive face showing sadness, suffering, and anguish. She had pain. You could see it in her facial expression and the wrinkles on her forehead. She needed alleviation of her pain. For the physical pain, she needed an ataractic drug, and for her psychological pain someone at her side who could comfort her and stroke her cheek gently. It was a tragedy that the woman was alone and forlorn. They felt sorry for her. The woman was dehydrated and badly nourished. You could see that her lips were dry and chapped. She needed someone who could give her something to drink and moisten her lips. The woman was a bother to the personnel because they were pressed for time and because it was difficult to approach her. She could not respond verbally. She lived in her own world. She was not attainable. From the perspective of the observers—what feelings do the picture of work of art evoke in you?—the students reported that: They felt sympathy for the woman because she was abandoned by her relatives and the personnel on the ward. They felt heavy at heart knowing that many elderly persons at nursing homes die alone without a caring staff or a relative at their side. When they put themselves in the old woman’s place, they felt anxiety and uneasiness. They thought of aging, pain, and decay and running the risk of getting into a similar situation as the woman. When the students thought of themselves as registered nurses, they considered themselves able to support the needs of elderly people. The interpretations indicate conflicting emotions toward elderly patients. The students may have devel-
301
oped a negative attitude toward aging after experiencing some of the discomfort generated by the work of art, but they conclude with an enhanced sense of personal capacity through having engaged in a process of exploration and discovery from observing a work of art. The experience of aging brings with it an awareness by the students about their ability to give good nursing care to elderly patients when they are registered nurses.
DISCUSSION The visual art program is interpreted in the light of Van Manen’s9 pedagogic model that stresses that learning is about discovery and reflection. In the present study, the process of learning through a work of art forms an ideal opportunity in which to practice learning based on these aspects. In this type of teaching/learning, the students are encouraged to use reflection and discovery when they study and interpret the reproduction. From their interpretations, it becomes clear that the visual art program may have heightened the student nurses’ sensitivity, shown in the way they put themselves in the place of the depicted person’s situation. The students brought a variety of interpretative and sensitive approaches to bear on the painting and the relationship of caring for elders. The painting seems to have opened up an alternative possibility for the students to express, in a sensitive way, their perception of aging—to be alone and without relatives. They find the situation tragic—an elderly woman without anyone to comfort her. It may be argued that the students either become more sensitive or the dynamic quality of sensitivity inherent in the student is lifted from their conscience. This connection underscores Henderson’s10 nursing theory in which she emphasizes the importance of a true understanding of patients in order to be sensitive to their needs. A wide variety of art sources, such as films, plays, novels, short stories, paintings, and photographs, have been used in nurse education. These aesthetic expressions sensitize student nurses to the patients’ situations.11,12 These study findings imply that the chosen art represents a distressing issue that awakened feelings of anxiety and uneasiness. The way a person perceives a work of art depends on the particulars of the viewer.2 Depending on the circumstances and the intentions, the teacher needs to work with the students’ emotional responses. Positive responses can be enhanced; responses that form barriers need to be recognized before the interpretation proceeds. In the present study, the negative feelings do not seem to form a barrier in the interpretation process. On the contrary, describing aging seems to give the students an awareness of the feelings that were present during the observation process.9 The fact that the students became aware of their own feelings could arguably lead
302
to insights into the patients’ feelings. To become aware of one’s own feelings may help understand another human being.13,14 The importance of emotional presence in order to put oneself into the situation of the patient also was seen as important by staff nurses.15 An ethical issue arising from student nurses participation in the current study is that students are in a state of dependence on a teacher. However, the written reports do not necessarily constitute a basis for forming judgments regarding the students’ ability to enter into or understand the experience lived by elderly patients at hospitals. A weakness of the method is that the students participated in the program voluntarily, which might indicate an overrepresentation of students with a special interest in visual art and thus bias the result, although the variables of art education and art experience were controlled.
CONCLUSION The debate on aging, stimulated by the work of art, could be regarded as a valuable learning experience. It might be one way to express original ideas and personal perspectives on aging. REFERENCES 1. Khatchadourian H. Humanistic functions of the arts today. J Aesthetic Ed 1980;14(2):11-21. 2. Wikström B-M, Ekvall G, Sandström S. Stimulating creativity through works of art. A controlled intervention study on creative ability in elderly women. J Creativity 1994;7:171-82. 3. Lichtwark A. Die Kunst in der Schule [The art in school]. Berlin; 1902. 4. Carper BA. Fundamental patterns of knowing in nursing. Adv Nurs Science 1978;1:13-23. 5. Oiler C. Nursing reality as reflected in nurses’ poetry, perspectives in psychiatric care. Am J Nurs 1983;21:81-90. 6. Wolf S. Aesthetics and humanities as vitamins in medical education. The Pharos 1984 Winter. 7. Darbyshire P. Understanding caring through arts and humanities: a medical/nursing humanities approach to promoting alternative experiences of thinking and learning. J Adv Nurs 1994;19:856-63. 8. Smith MJ. Enhancing aesthetic knowledge: a teaching strategy. Adv Nurs Sci 1992;14:52-9. 9. van Manen M. Researching lived experience: human science for an action sensitive pedagogy. London: The University of Western Ontario; 1990. 10. Henderson V. The nature of nursing. Am J Nurs 1964;64:62-8. 11. Calman KC, Downie RS, Duthie M, Sweeney BS. Literature and medicine: a short course for medical students. Med Ed 1988;22:265-9. 12. Bartol GM. Using the humanities in nursing education. Nurse Ed 1986;11:21-3. 13. Denzin NK. On understanding emotion. London: Jossey-Bass Publishers; 1984. 14. Abbs P. Towards a coherent arts aesthetic. In: Abbs P, editor. Living powers: the arts in education. London: The Falmer Press; 1987. p. 9-65. 15. Forrest D. The experience of caring. J Adv Nurs 1989;14:815-23.
BRITT-MAJ WIKSTRÖM, PhD, is an assistant professor at the Karolinska Institute in Stockholm, Sweden, and Jönko ping University College of Health Sciences. Acknowledgment: Financial support from the Council of Health Care Sciences, The Karolinska Institute, Stockholm Sweden, is gratefully acknowledged. Copyright © 2000 by Mosby, Inc. 0197-4572/2000/$8.00 + 0 34/1/112145 doi:10.1067/mgn.2000.112145
Geriatric Nursing 2000 • Volume 21 • Number 6