Thesis on "Benefits of the Creative Process for Dementia"

Thesis 35 pages (12767 words) Sources: 10 Style: APA

[EXCERPT] . . . .

Framework and General Research Questions

The Kolb Experiential Learning Theory will represent the framework used for understanding the meaning dementia patients may be assigning to the art process. According to Kolb's (1984) theory, "Patients able to assign meaning would be transitioning through four sequential steps in learning: (1) concrete experience, (2) reflective observation, (3) abstract conceptualization, and (4) active experimentation"

(p. 21). Should a patient spend more time in one of these steps compared to the others, it may reflect a learning style preference (Turesky, 2005). The purpose of developing a theoretical framework for understanding the art process is to craft individualized art therapy approaches that are informed by learning style preferences. Communication and personal fulfillment, in particular, directly links the conceptual paradigms of Bruner's (2004) with Kolb's (1984) theories, because they both assume construction of a narrative in the mind of the patient. If communication and fulfillment become evident, this would suggest that the ability to assign meaning to events remains intact in these patients.

Given the language difficulties often experienced by dementia patients, kinesthetic and embodiment learning adds depth to the intellectual framework; therefore, these conceptual paradigms, which are associated with Bruner's (2004) and Kolb's (1984) learning theories, will be employed in this study's methodology. Kinesthetic learning depends on the physical experience of the learning process, so the senses, motor movement, and real-life application will be important dimensions for understanding the art process (Dunn, 2009). In a similar fashion, embodied learning depends on the physical experience, in addition to the cognitive, emotional, and social experience (Kerka, 2002). Mottram (2003) acknowledged the value of art activities as diversionary and calming, yet believed the term 'art therapy' has more to do with how dementia patients communicate with the world. Chancellor and colleagues (2014) conceded that the process of art therapy focuses on the remaining cognitive and psychological abilities of the patient by encouraging utilization; therefore, art therapy is patient-centered. Consequently, the terms 'art therapy' and 'art process', for the purposes of this study, will be aligned with the perspectives of Chancellor et al. (2014) and Mottram (2003).

The main research questions addressed by the proposed study are the following: (1) what are the experiences of dementia patients exposed to the art process and (2) what are the experiences of the art therapist during the provision of art therapy to dementia patients? Chancellor et al. 2014 offers a theoretical framework for providing art therapy to dementia patients, which are (1) preserved abilities, (2) vehicle for emotional expression, and (3) a process capable of creating a state of flow and thus a sense of well-being. This framework will be tested during the proposed study by looking for these themes in the data during reflexive activities.

Limitations

Although numerous theories of learning were discussed above, the proposed study, due to its qualitative nature, cannot provide support for or undermine these theories, since qualitative studies tend to be theory-generating, rather than theory confirming. Nothing will be measured or quantified, such as patient and caregiver QOL; therefore, any claims of efficacy will be based solely on subjective, rather than objective, data. In addition, the very small sample size will preclude making a claim of generalizability to dementia patients in general, as well as to settings other than the one planned for this study. Any claims of credibility, as Golafshani (2003) notes, will depend on researcher skill and effort. The variables that may limit credibility include my lack of expertise in dementia care and conducting qualitative research. This shortcoming will be addressed to some extent by establishing rapport with clinicians involved in dementia care and by examining the research literature.

Researchers Statement

I am a 55-year-young nontraditional graduate student in the Master in Education program at Westminster College and pursuing certification as an Adult Arts Educator. I am an academically trained visual artist with expertise in ceramics, sculpture, drawing, 2- and 3-dimensional multimedia, non-digital photography, and to a limited extent, graphic design. My academic preparation includes certification for primary and secondary arts education in the State of Utah. Professionally, I am engaged as a teaching artist in the field of Creative Aging and facilitate the cognitive rehabilitation of individuals suffering from dementia. Accordingly, I am both academically and professional prepared to pursue this research project. Comment by Robin: Got rid of chapter summaries, but they can easily be revised and included if you wish. The rubric did not call for a summary, except for the Data Analysis Chapter.

Chapter II: Review of the Literature

Chapter Introduction

As noted in the introductory chapter, this study is framed by the Kolb's (1984) Experiential Learning Theory and the conceptual paradigms associated with Bruner's (2004) Constructivist Theory. Accordingly, the guiding research question for this study is "what do dementia patients experience when exposed to the art therapy process?" To develop timely and informed answers to this research question, a review of recent and relevant peer-reviewed research and scholarly literature concerning dementia care quality, art interventions for dementia patients, and adult learning theories facilitating cognitive rehabilitation for dementia patients, will be presented next.

Dementia Care: Quality and Limitations

Current treatment strategies are designed to improve the QOL for dementia patients and their caregivers; however, there are systemic problems with the care patients typically receive. For example, a concerned family member revealed some of the problems associated with the quality of dementia care provided in contemporary healthcare facilities (Armstrong & Byrne, 2011, p. 13). The family's mother, who was 66-years old, was diagnosed with AD and had been managing well at home, but after being admitted to a hospital for a perforated ulcer the patient died within three months. The family became convinced that the diagnosis of AD conferred second class patient status, which gave the staff permission to wash the patient with the curtains open, leave her sitting in feces during family visits, remain indifferent to a need for feeding assistance, and keep family members in the dark about treatment plans. The family members ultimately concluded that their loved one had been starved to death.

The report by this family member seems to confirm the existence of discrimination based on a diagnosis of dementia, especially within the healthcare system. Given the widespread acknowledgement that the care provided is suboptimal, standards of dementia care were recently issued by a working group consisting of representatives from the American Academy of Neurology, American Geriatrics Society, American Medical Directors Association, American Psychiatric Association, and the American Medical Association (Odenheimer et al., 2013). Topping the list is maximal preservation of the patient's cognitive and functional abilities. The other standards include reduced symptom severity and frequency, preservation of the patient's general health, minimized threats to patient health and safety, and the provision of comprehensive support for family caregivers. Quality dementia care would therefore be expected to address the cognitive, psychological, and behavioral problems associated with dementia.

The available pharmacological interventions are extremely limited in both number and efficacy. According to the American Family Physician, all three categories of symptoms have been shown to be responsive to acetylcholinesterase inhibitors (AChEI), although the benefits appear to be marginal (Butler & Radhakrishnan, 2014). Antipsychotic medications are no longer recommended for a variety of reasons, including substantial side effects and safety concerns. Other interventions that have been tried include antidepressants, talk therapy, exercise, statins, fish oil, and cognitive stimulation activities such as music therapy, but rigorous empirical evidence supporting their use is lacking.

Societal Roles. Society plays a significant role in how dementia patients are perceived and treated, both inside and outside the healthcare system (Milne, 2010; Odenheimer et al., 2013). One solution receiving international attention is increased patient and caregiver exposure to art activities. The National Gallery of Australia in Canberra welcomes dementia sufferers and their professional and family caregivers once a week, as part of a program designed to compensate for the social isolation and stigma surrounding the disease (Dyett, 2014). Anecdotally, caregivers reported that anxiety levels caused by cognitive impairment seem to be reduced, which may explain why this program has survived for seven years (Dyett, 2014). This track record is consistent with apparent increases in well-being experienced by dementia patients and, by extension, family and professional caregivers.

More recently, a pilot program having similar goals was implemented in London, England (Gould, 2012). The London Arts Challenge organizes weekly art workshops at numerous venues around the city for patients suffering from early stages of the disease, along with their family caregivers. The goals are to reduce stress associated with memory loss and provide a fulfilling sense of connection to their communities. At the Museum of Modern Art (n.d.) in New York City, the education department created the MoMA Alzheimer's Project in 2007 to provide training resources for professionals interested in exposing dementia patients and caregivers to art and offering on-site art education programs. The MoMA's Alzheimer's Initiative has helped similar programs come to life in at least 60 other museums (Chancellor, Duncan, & Chatterjee, 2014). Many of these programs… READ MORE

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