As the methodology progressed into the phase of assessing the potential of this work the results proved gratifying. The testing of the ‘pod’ objects led to their use in many scenarios that demonstrated their value as therapeutic tools. Critically though, a design process model was employed whereby analysis of the feedback and reflection upon it, would bring about further modification providing improvements to the suitability of the solutions for their given context.
The potential for the development of these experimental objects into a viable product was emphasised by the staff on the ward. During our dialogue they mentioned the use of reminiscence therapy and suggested my objects would comfortably support this activity. Currently this therapy involves found objects often collected together in boxes. For example at Riverside they have gathered a wedding box, a 1950’s box, and other ephemera that relate to WWII. These objects are separated out into explicit themes to allow patients to participate in a clearly defined discourse. The staff stated many nursing homes have now started to work with reminiscence boxes, and this approach also proves popular amongst community artists who work to with found objects within their activities. This leads to a situation where the objects used are considered to be precious; valued for their rarity, and not easily found nor replaced if damaged. Conversely, my designed solution offers an improved outcome in this area, advantageous through its replicable nature and therefore its replaceability if damaged. Significantly, the scope for batch production tenders the opportunity for a standardised product and programme with the potential to be accessed by number of organisations. Furthermore, such objects enable the prospect for production in thematic series to deal with predefined areas of subject matter for reminiscence.
The one unmistakeable area for great potential development came from the insight of the staff that suggested the ‘designed objects’ ought to be brought into play with families/carers to encourage exchange and dialogue. They outlined circumstances when a patient is regularly visited by a loved-one, and of how there is often very little to talk about from one day to the next. This led to the suggestion of interaction with the ‘pods’, as a starting point for the family and patient to share some time, perhaps eliciting conversations not normally approached. As a result, the decision was to test approaches for this underdeveloped scenario.
The event of one family visit particularly highlighted the prospect for work in this area, as on previous visits the staff had noticed this was an example of where very little meaningful communication existed between the one of the patients and his wife, beyond conversations dealing with mundane issues such as ‘What did you have for dinner today?’ On the occasion of this visit, a number of ‘pods’ were employed as an intervention and displayed in the day room. Much to the great astonishment of the staff present, this patient (who is normally unresponsive to planned activities), got up from his chair, collected one of the objects from the other side of the room and began to show it to his wife. The visitor began to control the behaviour of her husband and was heard to close down the chance engagement, firmly stating ‘These are not for you’, and, ‘Put it down you will break it’.
The staff felt this situation came close to making a real breakthrough in shattering the barriers to conversation built up between the pair, and observed that the objects could provide a missing connection. Unfortunately on this occasion, care staff stated that they had felt the need to intrude in this conversation and explain why these objects were made available, and volunteer that it was ‘fine’ for them to be engaged with in this way.
In their feedback staff indicated that it may be useful if a short written explanation of the objects could be placed in their environment, to encourage interaction and to act as a reassurance that the ‘pods’ aren’t fragile. The OT illustrates the problem and the possible solution when she articulates, ‘I think that a card or something that explains and introduces the objects [is required]. I wouldn’t want something that prescribes it’s use in a way that suggests ‘you need to do this with it’, just something that would just prevent the situation that we had with patient and his wife. Maybe some of the staff would feel that something like this would be useful if they had not been introduced to the previously’.14
Hence, problem solving was distinctly necessary to deliver improved user experiences. Solutions converged upon the two scenarios;
- Opening up of opportunities for communication and engagement between families and their loved one’s experiencing dementia.
- Resolving the potential need to guide caregivers in facilitating group therapies.
This formed the final efforts of the programme to bring about a coalescence of ideas into a fully realised product acting as a mediator of relationships and memory. In researching methods to convey important information to users, I became interested in visual communication that would provide scope for creativity and imagination and not form sets of rigid instructions that limit potential outcomes. In connection with this concept, I became inspired by the work Map of an Englishman by Grayson Perry. His work uses the metaphor of the instruction manual and the map to pull apart the complex world of thoughts and feelings. ‘I was thinking of a map of the mind, almost like an exercise you could set on therapy course’15 he described.
Continuing with this theme I considered the use Mind Maps as developed by Tony Buzan as a practicable method to chart the territory of a collection of ideas, and attempted to establish a format for a series of supporting devices. A mind map, conventionally drawn in the shape and style of a brain cell is designed to encourage the brain to work at optimum efficiency by embodying radiant thinking the fundamental expression of the brain’s internal processes, and not in linear or sentential ways which forward rigid behaviours. I explored the concept of the architecture found in the structures of plants, leaves and cells from the natural world, such as the veins of a leaf or the branches of a tree as frameworks for a mind map. These natural forms echo the shapes of brain cells and reflect the way we ourselves are created and connected.
Making preliminary efforts to realise these carriers of ideas as three dimensional objects, I reflected on a comment made during one of the sessions, when one participant quietly commented to another, Don’t tell them anything. I recalled that I was shocked at what was implied as here seemingly existed a totally misplaced distrust of the professional care staff, perhaps based on fear of the consequences of the patient’s replies mitigating against them, that perhaps would lead to them being ‘put in a home’ as they saw it. Such fears are a cause for concern and throw into relief the anxieties that those experiencing dementia feel about their own situation. I was conscious when producing these supporting objects that they should promote openness, transparency and must function in ways that put emphasis on any information imparted is to be shared by all.
The proposed solutions were realised as panels containing both written and visual information, and great care was taken relate the information in a manner where no concealment could be either accidentally intended or implied. I again elected to utilise the laser cutting process to engrave transparent clear acrylic sheets in order that the drawn compositions conveyed on each panel would be plainly visible to all. Subsequently a number of panels were realised in formats intended for specified situations. The first panel configuration of postcard ‘props’, were intended to be placed in the vicinity of the ‘pod’ objects, as simple and recognisable communication to families to encourage engagement in the activity. The second and larger format panels explicitly convey a mind map of ideas that provide open ended prompts of assistance to families or patients in their exploration the ‘pods’.
The third and final panel arrangement was configured to correspond to the larger mind map mentioned previously, and provides guidance to assist the facilitator of group participation sessions. The common format signifying that all stakeholders in a session would be valued equally.
Establishing the nature of problems and reaching solutions through modification, conclusively led to a fully realised product for the Riverside Ward. This outcome comprising of a set of six ‘pods’, the facilitator, patient and family prompt panels and postcards. Their production comes to represent the cut off point for the practice-based outcomes of this programme of study. The body of work becoming entitled Fortuitous Novelties that builds reference to the early philosophical ideas within this narrative, and alludes to the optimistic and cathartic possibilities that aspire to be of real human benefit to the beholder of these innovative objects.
Worthy of small note, two sets of objects were finally realised, one becoming the basis of a presentation to Derbyshire PCT intended for future use at the Riverside Ward, the second for assessment purposes and as a personal record giving scope for possible future developments. The presentation of work to Riverside Ward in September 2010 represents a material and symbolic end to this phase of involvement with Derbyshire Primary Care Trust.
14. Critchlow, L (2010). Staff Feedback. [Interview]. Riverside Ward, Newholme Hospital with D.Browett. 20 May 2010.
15.Klein, J. Grayson Perry (2009) p 185.