Support for healthcare workers impacted by COVID-19 comes from the performing arts.
In the UK, as in other countries, there is increasing concern for healthcare workers directly impacted by the coronavirus epidemic. Anger about the insufficient supplies of personal protective equipment is fueled by the growing tally of COVID-19-related deaths regularly reported in the media (https://www.bbc.com/news/health-52242856). There are worrying predictions that those working in COVID-19 wards will experience post-traumatic stress disorder (https://www.independent.co.uk/news/health/coronavirus-uk-nhs-intensive-care-nurses-doctors-ptsd-a9450731.html). Even those not on the frontline are experiencing disorientating changes to their working lives or training. If there is any consolation in this difficult situation, it lies in the outpouring of public support for a group of professionals that has tended to be overlooked and undervalued. This was amply demonstrated by the flood of donations collected for Captain John Moore’s sponsored walk (https://www.justgiving.com/fundraising/tomswalk) of his own garden; over £1.5 million was raised for National Health Service (NHS) charities. It is also apparent in the weekly rituals of applause (https://clapforourcarers.co.uk/) for health and social care workers — claps, clanging of pots and pans and spontaneous choruses of Somewhere Over the Rainbow. Now, support for healthcare workers has also come from an unexpected source — those in the performing arts.
Performing Medicine (https://performingmedicine.com/) is a charitable organization led by the theatre company Clod Ensemble. For over 20 years, it has provided arts-based training for medical students and professionals. Their pioneering work was recognized in two recent reports on arts and health — Creative Health (https://www.artshealthandwellbeing.org.uk/appg-inquiry/Publications/Creative_Health_Inquiry_Report_2017.pdf), published in 2017 by the UK’s All-Party Parliamentary Group on Arts, Health and Wellbeing, and the World Health Organization’s scoping review (https://www.euro.who.int/en/publications/abstracts/what-is-the-evidence-on-the-role-of-the-arts-in-improving-health-and-well-being-a-scoping-review-2019), published in 2019. Like other initiatives described in these reports, Performing Medicine’s work usually involves practical group-based training, something that cannot continue under social distancing measures. Their solution was to create a digital resource, shareable through WhatsApp. Drawing on the experiences of performing artists who work with restrictive costumes, it offers tips for coping with personal protective equipment (https://performingmedicine.com/blog/coping-with-ppe/), for example, how to navigate a space with a restricted field of vision and how to communicate when your face is obscured. The resource also promotes self-care, stressing the importance of hydration, rest breaks and physical comfort. Plans are in motion for a second resource that will reinforce this emphasis on self-care and encourage healthcare workers to consider their own health and wellbeing as well as that of their patients.
My own theatre company, Chimera, has been making performances about medical experiences for the past 8 years. Our first performance, Bloodlines, in 2013, was based on my experience as a hematopoietic stem cell transplant donor for my brother, who had contracted acute lymphocytic leukemia at the age of 33 (https://doi.org/10.1038/ni.2592). Although not intended as a learning resource, we were regularly invited to perform Bloodlines at medical schools and conferences to enhance understanding of cancer patients’ psychosocial experience. Our current project (https://www.theguardian.com/healthcare-network/2016/dec/14/theatre-show-teaching-student-nurses-compassion) is more deliberately designed as an educational initiative, with the aim of supporting empathy and emotional resilience in pre-registration nurses. The project is a collaboration with the nursing school at Kingston University, and it includes a performance, called Careful, about emotional labor in nursing. COVID-19 struck just as we were finalizing plans for a tour of nursing schools across the UK and preparing the workshops that we deliver to the Kingston students every summer. COVID-19 meant that these could not take place.
New directives from the Nursing and Midwifery Council (https://nmc.org.uk/news/coronavirus/information-for-students-and-educators/) mean that many nursing students have been accelerated into practice, often taking on clinical responsibilities earlier than expected. For others, the cancellation of placements and remote teaching means reduced opportunities to gain clinical experience and practical training. Encouraged by my Kingston nursing colleagues, I designed two learning resources in response to these changes. The first, Drama out of a Crisis, is a pack of tips and short videos for those going into practice. By sharing strategies that performers use to prepare for live performances, it is designed to help them deal with unfamiliar environments and unexpected situations. The second, Careful Encounters, supplements communication skills training for those students whose training no longer involves practical learning or placement opportunities. It uses a filmed version of the Careful performance to encourage emotional awareness and empathy, and it also provides distraction and entertainment for a community in lockdown. These are being disseminated in response to interest from other nursing schools.
The initiatives outlined here are attempts to continue the work of the emerging field described in the two reports cited above. Operating at the interface between the cultural and healthcare communities, this increasingly professionalized sector provides innovative and effective training for healthcare workers, while expanding career prospects for performing artists. COVID-19 puts this sector in jeopardy: the cultural industry faces economic devastation (https://www.theguardian.com/culture/2020/may/18/arts-funding-plea-as-shakespeare-globe-warns-it-may-not-survive-covid-19-crisis), and, as healthcare institutions are directing their energy to the frontline, partnerships with arts organizations are now a low priority. So, what does the future hold for the arts in healthcare education? Presenting at the Performance for Care (https://performanceforcare.com/) conference (held online just as the UK lockdown kicked in), the president of the Royal College of Nursing, Professor Anne Marie Rafferty, argued that, at this time of crisis, the arts can “...help us face the huge uncertainties we are confronting.” The arts, she says, are a route to building “a sense of resilience, a sense of solidarity, a sense of strength” within the healthcare community. Hope for the recovery of arts in healthcare education lies in extending this solidarity to the cultural sector too, so that future initiatives are grounded in a shared commitment to mutual support.
The author declares no competing interests.
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Mermikides, A. Drama out of a crisis: the cultural sector responds to healthcare professionals impacted by COVID-19. Nat Immunol 21, 817–818 (2020). https://doi.org/10.1038/s41590-020-0734-1