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The art of feeling connected: Interactive art as emotion-oriented care technology in nursing homes
In the Netherlands, when you are no longer able to live by yourself due to psychogeriatric problems, chronic physical conditions caused by old age or a combination of both, you are likely to move to a nursing home. For over 10 years now, emotion-oriented care is the guiding philosophy in most Dutch nursing homes. Although challenges remain, elderly care in the Netherlands is very good when compared to the rest of the world (J. Schols & Swelsen, 2019; J. M. Schols, 2008). In spite of all the benefits of emotion-oriented care, there’s still inactivity and boredom among nursing home residents during time in between activities (den Ouden et al., 2015) and a general lack of cultural activities within nursing homes. Most leisure technology in the nursing home is therapy: goal or activity-oriented and game-like. Although these games and activities are beneficial and fun for residents, they need intensive guidance from professionals and are planned on a fixed moment of the day. Open-ended interactive digital artworks might provide an addition to the spectrum of emotion-oriented care technology that creates the needed conditions for a personal experience to take place. Specifically, interactive artworks that are accessible at all times that can be enjoyed by residents on their own or together with somebody else, without the help of a professional caregiver are desired. It was therefore the main aim of this thesis to explore the potential of interactive art as experience-oriented care technology in elderly care, specifically in the nursing home environment. This aim was researched in several studies and distinguishes four phases. The first phase, Phase 1 (chapters 1 and 2), of this dissertation provides insight in the larger scope of interactive art and how people respond to interactive artworks in general. The second phase, Phase 2 (chapter 3), describes the co-creation process that has taken place to develop the interactive artworks created and studied in this PhD-project. Phase 3 (chapters 4 to 6), consists of three pilot studies that describe the responses of nursing home residents in relation to three different interactive artworks. In the fourth phase, Phase 4 (chapter 7), the results are synthesized and discussed. In chapter 1 the main problem is introduced. Interactive artworks are suggested as potential solutions to increase personal experiences for nursing home residents without professional supervision. The chapter ends with the main aim, three formulated sub-questions and an overview of the studies and four phases of the dissertation. Although most of the interactive art installations created today are not formally studied, the systematic review in chapter 2 identified 22 open-ended interactive digital artworks of which the participants’ responses were studied. Both human-to-artwork and human-to-human responses were noted for all identified artworks. The results indicate that interactive artworks can evoke a variety of verbal, physical, and cognitive/emotional responses within and between visitors, making these artworks powerful instruments. Results imply there is no straightforward relationship between the features of the artwork and the kind of response. However, two factors seemed to influence the participants’ responses: ‘the content’ (concrete or abstract) of the artwork, and ‘the presence of others’. Chapter 3 illustrates the co-creation process of interactive artworks by the design of the interface of VENSTER as a case. Results imply that although co-creation adds complexity to the design process, involving stakeholders seemed to be a crucial element in the success of the creation of the interface for VENSTER. Participants hardly paid attention to the installation and interface. There, however, seemed to be an untapped potential for creating an immersive experience by focusing more on the content itself as an interface (e.g. creating specific scenes with cues for interaction, scenes based on existing knowledge or prior experiences). “Fifteen lessons learned” which can potentially assist the design of an interactive artwork for nursing home residents suffering from dementia were derived from the design process. This description provides tools and best practices for stakeholders to make (better) informed choices during the development of interactive artworks. It also illustrates how co-design can make the difference between designing a pleasurable experience and a meaningful one. VENSTER (chapter 4) is an interactive artwork that brings the outside world into the nursing home and vice versa through an interactive physical window. Physically, VENSTER consists of two large (touch) screens, vertically mounted in a fake wall. A string attached to the roller blind in front of the screens serves as a switch to change what is seen. When the installation detects the presence of a person, music starts playing. The installation can show pre-recorded “calming” (e.g. a lake) or “activating content” (e.g. children playing), and is also able to present “interactive content” which can be manipulated in real time (e.g. manipulate the direction of falling snow). The goal of this study was (1) to determine whether and how nursing home residents with dementia respond to the interactive art installation in general and (2) to identify whether responses change when the content type and, therefore, the nature of the interaction with the artwork changes. The research protocol was set up as an observational explorative study. Six to eight residents of the closed ward and 1–2 care providers were invited to attend a session with VENSTER in a semi-public square of the nursing home. All responses carried out by nursing home residents and the caregivers present were recorded on video, coded and placed in the aforementioned framework. Results show that the interactive art installation ‘VENSTER’ evokes responses in nursing home residents with dementia, illustrating the potential of interactive artworks in the nursing home environment. Frequently observed responses were naming, recognizing or asking questions about depicted content and how the installation worked, physically gesturing towards or tapping on the screen and tapping or singing along to the music. It seemed content matters a lot. When VENSTER is to be used in routine care, the choice of a type of content is critical to the intended experience/usage in practice. Recognition seemed to trigger memory and (in most cases) a verbal reaction, while indistinctness led to asking for more information. When (initially) coached by a care provider, residents actively engaged physically with the screen. Responses however differed between content types, which makes it important to further explore different types of content and content as an interface to provide meaningful experiences for nursing home residents. The results in chapter 5 show that use of the CRDL (pronounced: ‘the cradle’) in a group setting creates opportunities for expressive and therapeutic touch. The CRDL got its name due to its shape, size and weight, which refer to a baby or a crib. Physically the CRDL has an abstract, rounded form. On opposite sides of the device, there is a grey felt inlay shaped like a larger-than-life fingerprint. Two participants have to place one hand on such a felt “pad” and simultaneously touch the other person’s skin (e.g. hand, arm or shoulder). If more people are interacting, they all have to touch each other. This way they close an electric circuit and the speaker, located in the centre of the CRDL, produces a sound, influenced by the type of touch and the selected soundscape (e.g. nature, town, instrumental, animals and house–garden–kitchen sounds). This study was designed and carried out as an observational explorative study. Three to four residents and one to two caregivers tried out the new device in an activity room. All responses carried out by nursing home residents and the caregivers present were recorded on video, coded and placed in the aforementioned framework. In a group setting the CRDL creates an atmosphere of curiosity, a playful context and can function as an intermediary between people. This lowers the threshold to touch, provides an incentive to touch and encourages experimentation with different types of touches on the arms and hands because the produced sound changes accordingly. Additionally, the sounds that the CRDL produces sometimes trigger memories and provide themes to start and support conversation. The large amount of discussion about the controls, functioning and purpose of the CRDL can be attributed to the novelty of the device and will probably diminish over time. To involve a large group is challenging. Caregivers and activity supervisors often had a hard time making multiple residents close a circle of hands and make them understand the outer edges should touch the CRDL pads. All caregivers and activity supervisors eventually switched to several small groups (three people) or individual interactions with the residents (two people) while the other participants watched. Chapter 6 describes that Morgendauw seems able to evoke responses in both the residents and their caregivers. Morgendauw is a black, table-like installation, shaped like the silhouette of a larger-than-life oak leaf. The surface of the leaf consists of touch-reactive LED panels. Morgendauw shows a constant stream of coloured particles, which resemble a stream of water flowing downhill. The colour, direction and velocity of the particles are influenced by the current weather conditions in one of five pre-programmed cities (Eindhoven, Quebec, Spitsbergen, Tokyo and Kaapstad). Every five minutes a different city is automatically selected. When the surface of Morgendauw is touched or an object (e.g. stone) is placed on it, the stream of particles will react and find a way around the hand or object. This results in a change of composition and a distortion in the particle system that will try to find a new balance. This choreography of light is augmented with an ambient soundtrack and subtle nature sounds. This study was set up and carried out as an explorative observational study. The installation was observed for two days, from 10 AM to 5 PM in a semi-public square at an indoor public square, where an open and a closed ward intersect. All responses carried out by nursing home residents, caregivers or anyone else who interacted with the installation were recorded on video, coded and placed in the aforementioned framework. Overall, residents did not seem to notice Morgendauw. The location in which Morgendauw was placed during the study and/or the characteristics of the installation seemed to create a threshold. When prompted and/or directed, the initial threshold of noticing and approaching the installation was quickly overcome and residents in general needed little explanation of the interface to interact with it. The visuals seemed mesmerizing and resulted in a concentrated gaze upon the installation. The physical rocks placed in the abstract water were moved around and the effects it had on the particle system were observed. In chapter 7, the main aim and formulated sub-questions are answered. The main findings and methodological considerations for all four phases are synthesized and discussed. Subsequently, the implications for (creative) practice and research are reported and can be clustered in three main themes: ‘developing interactive art with special attention to the interface’, ‘the involvement of all stakeholders as requirement for successful implementation of interactive art in nursing homes, and on ‘continuous improvement of the interactive artwork’. Finally, future directions are outlined (Where to go from here?). The first topic discusses how to increase the chance of change towards an art-included life in care facilities. More initiatives with changing interactive art collections in health care is the second subject discussed. The chapter concludes with the wish of the other to organize a (travelling) exhibition inside the nursing home, but open to all. The exhibition should present interactive art in such a way that it is interesting and intuitive for all to visit and enjoy, and creates connections between the nursing homes and the rest of society, residents and staff or visitors, the (interactive) art world and the field of (elderly) care. These exhibitions can advance our knowledge on how build and set the stage together with nursing home residents for personal, meaningful and cultural experiences to take place.