OUTward MOVES is a partnership between Dance 4 (the national dance agency in Nottingham), Queens Medical Centre (QMC) Arts in Health, The City of Nottingham Arts and Events, and QMC's Play Specialists and Children's Out-Patients department. 'The Arts In Health' is an initiative aims to integrate the arts as part of normal care, within a large acute hospital Trust, for the benefit of patients, visitors and staff. This developing arts programme of visual, performing and participatory projects, events and activities recognises that the arts can play an important role in the healing process and in creating welcoming and friendly environments within the Trust that inspire better health and well-being. The QMC is pioneering this concept regionally, currently having the only hospital arts co-ordinator within the East Midlands.
Dance 4 are recognised for instigating and facilitating a range of dance and health projects over the past five years, and have a substantial amount of development experience that places well-being at the forefront of the work. Both Dance 4 and QMC Arts in Health had been keen to collaborate for some time on a project at the Queens Medical Centre in the hope that projects could help aid patient recovery, relieve anxiety, inspire and enable children to access the arts.
The Children's Out-Patients Department was targeted for our first collaboration for several reasons: a large number of patients, siblings and families/carers would potentially benefit from the sessions (approximately 30,000 patients attend each year); a diverse range of patients attending the 18 different clinics (including Cerebral palsy, Orthopaedic, Neurosurgery, Dermatology, Gastroenterology and Cardiac); use of a large and flexible waiting area space; positive support of staff in the department though limited arts provision currently in the department; the opportunity for the project would compliment existing monthly arts workshops taking place on the wards within Children's Services.
The physical space of the department included a large waiting area with moveable seats arranged in small clusters, a 'teenage area' and consulting rooms located along a circuit of corridors off the main waiting area. The sessions took place throughout the department except private and consultation rooms, offering a unique experience for staff and patients alike. At times children stretched pieces of lycra material in many different directions, crossing and breaking up the waiting room space. It looked like a giant piece of sculpture constantly transforming, catching the attention of all who were waiting. At other times children explored shape making with others and contact work in the isolated corridors.
The simple but very effective dance/movement techniques used over the 8 sessions were flexible enough to cope with the challenges of such a busy through-fare and dynamic environment and were successful because of their readiness to respond and adapt to patients/families/carers and staff needs. It was clear through introductory meetings and observations of other workers in the department (play specialist, charity clown and balloon maker) that sensitivity and spontaneity would be crucial approaches needed to facilitate in this environment.
None of the partners really knew what to expect at first with many uncertainties needing questioning, so the creative team needed to consider issues like:
- how to get started practically? What approaches will be most appropriate? Through research into previous dance in hospital work like Green Candle's Dance Companies 'forWard motion!' and other arts in acute healthcare settings I decided that many of the tools developed for Dance 4's recent Early Years publication 'Small Steps, Big Moves' seemed relevant as a starting point, being easy to apply and dip in and out of. Also it allowed instigation of relationship to be more organic, begin through props, voice, music or the body
- how will the dance development worker, arts co-ordinator, play specialist and shadow worker function as a creative team? At first the non- dance specialists participated in the work and after a number of participation and reflection sessions were slowly encouraged to instigate movement relationships themselves
- how will we get the participants feedback? How will we get consent for documentation through photography?
It seemed that instead of a carefully planned project theme, what we really needed was an ever-ready and flexible choreographic toolkit (leading and following, reflecting, call and echo, exploring, creating journeys, shape activities, levels, size, improvisation responding to music etc) other art forms including music making and visual art and a bag of props to help open the channels of communication and interaction with those waiting. Using props in this setting was an invaluable tool to encourage the young people to engage with movement activity, providing a tactile sensory object to explore and share with others.
A wonderful moment occurred when we were leading a group of children around the department under lycra like a caterpillar, I looked out from under the material towards the reception area where a toddler had walked in with the use of her frame. Upon seeing our 'caterpillar' a smile lifted and she shrieked with excitement throwing her hands into the air. A little while later we tried to engage with her and her parents but after seeing the other children dance we were assured that their daughter could not participate in this creative physical activity. Of course we cannot convince everyone that dance can be inclusive for all, but it is wonderful when parents want to engage in the activities with their child as it offers them new ways to interact.
The structure and approaches drawn on for this project could arguably be described as 'play' and it was a joy to work with a play specialist, noting the similarities and differences in our work and attempting to marry them together. As a play specialist said: "Outward Moves has not only supplemented what we as Play Specialist's do, but actually removed the need for other activities. "It has made me think more about the use of music in the waiting room and also I now have new ideas to use as distraction methods, for instance blowing the feathers with a child having a blood test. It has helped people realise that hospital isn't so scary and has been really rewarding and useful for 1 child especially who has had confidence and anxiety issues about hospital and our department previously. She was able to express her new found confidence through the dance activities."
The implementation of choreographic devices meant that 'play' became improvised composition quite organically, which was unwittingly performed in the waiting room to those people not participating. On one occasion two young boys were playing on the toy train track and were clearly unimpressed by our dancing. Could we gently ease them into it? With a little persuasion they drew a huge train line being very thorough drawing the track, trains, people, stations, stops, houses, bridges and tunnels. Once finished we tried to embody our picture. We became the train, and the waiting room became our journey.
The very nature of working in children's outpatients means that you don't know who is going to be there, how old they are, what their illness is (although the specific clinic might indicate this), how long they are going to be present before being called to their appointment, who they will attend with, whether they have danced before or whether they are even interested in participating. A lot to think about! Additionally it is a working environment so you can never be sure how the multitude of nurses, doctors and reception staff will respond to you or your work despite the department as a whole being supportive. As ever it is important to keep the staff informed and allow for opportunity to share their thoughts. We placed a staff comments book on the nurse's station to be written in during this session. This became a crucial tool for the project, highlighting issues we could then remedy e.g. sound/music level infringing on reception staff and the need for inclusive activities for older children/teenagers.
The feedback from patients, visitors, carers and staff has been communicated by a department manager as having a "very positive impact on the department", highlighting opportunities for further projects of this kind within the department.
"Outward Moves has been an extremely successful pilot project both in terms of the delivery and the partnership, demonstrating how effective dance and movement can be. The project has shown patients and their families/carers that a visit to the hospital can be fun instead of stressful or boring and staff also enjoyed the lighter atmosphere the sessions created." (Arts Co-ordinator)
The partnership is currently delivering an intensive pilot dance and visual arts project in the department as a development of OUTward MOVES and aims to build further links with the Children's Out-Patients as well as with other sectors of the hospital. Dance 4 also hope to deliver training in movement facilitation to the play specialist team at QMC as a sustainable measure for dance to be an available resource in acute hospital settings for non-dance specialists to access.
For more information contact Dance 4 on 0115 9410773 or email info@dance4.co.uk