Post-registration Certificate Course in Psychogeriatric Nursing 2022-2023

Project Outline

Group G
Role Participant no. Name Hospital

Leader 47 Yau Sau Ling TPH

Member 35 Lee Ching Yiu SH

Member 36 Sin Cho Kwan SH

Member 39 Lam Yan Yan TPH

Member 44 Sze Ying Ying TPH

Project title:
A pilot study: the effects of the Expressive Arts (EAs) on the hospitalized psychogeriatric
patients’ quality of life (QoL)

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Content

Introduction and background…………………………………………………..P. 3

What is Expressive Arts (EAs).............................................................................P. 3
The effects of EAs on psychogeriatric patients………………………………...P. 3
Aims………………………………………………………………………………P. 3
Objectives………………………………………………………………………...P. 3
Significances of this project……………………………………………………..P. 3
Current Practice…………………………………………………………………P. 3
Project design…………………………………………………………………….P. 4
a) Target participants……………………………………………………P. 4
b) Venue…………………………………………………………………..P. 4
c) Duration……………………………………………………………….P. 4
d) Methodology…………………………………………………………..P. 4
e) Assessment tools………………………………………………………P. 4
f) Intervention……………………………………………………………P. 5
g) Promotion……………………………………………………………..P. 6
Timeline…………………………………………………………………………..P. 6
Budgets…………………………………………………………………………...P. 6
Resources…………………………………………………………………………P. 6
Infection Control…………………………………………………………………P. 7
Possible problems………………………………………………………………..P. 7
Contingency plans……………………………………………………………….P. 7
Reference…………………………………………………………………………P. 8-9
Appendix 1. The Chinese version of the World of Health Quality of life
instrument-Older Adults Module (WHOQOL-OLD)..................P. 10-11
Appendix 2. Details about each session of visual arts…………………………P. 12-14

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Introduction & background:
Increased aging population and more psychogeriatric patients admitted to psychiatric
hospitals. Despite the mental health condition, they still needed to stay in hospitals due to
family preparation and decision making on patients’ discharge plans as well as placements of
old age homes. During hospitalization, their quality of life (QoL) was found to deteriorate.
Among the literature search, it discovered that older adults comparatively experienced loss
than other ages. The losses affected their QoL. Hospitalization was revealed to reduce their
abilities to attain their interests.

What is Expressive Arts

Expressive Arts (EAs) was defined as involving more than one type of arts in creative ways
based on intermodal approach in individuals or groups for the sake of promoting self growth
and healing by using human inner resources (Atkins, 2003; Expressive Arts Therapy
Association of Hong Kong, 2019; International Expressive Arts Therapy Association, 2017).
The forms of arts involved in EAs included “imagery, storytelling, dance, music, drama,
poetry, movement, dreamwork, and visual art” (Atkins, 2003, p. 3). Although EAs did not
need to use a particular mode or skill, it operated and based on three common basic concepts
which were sensory-based expression, aesthetics and creativity (Malchiodi, 2012).

The effects of EAs on psychogeriatrics

Some of the studies (Chan et al., 2015; Majesk & Stover, 2019; Meira et al., 2015) revealed
that expressive arts (EAs) could improve the QoL of geriatrics with and without mental
illnesses. Moreover, limited study was conducted to examine the effects of EAs on
hospitalized psychogeriatric patients.

Aims:
To explore the effectiveness of EAs programme on hospitalized psychogeriatric patients’
quality of life (QoL)

Objectives:
1) To assess the effects of EAs
2) To assess the effectiveness of EAs programme to promote QoL for hospitalized
psychogeriatric patients

Significances of this project:

1) EAs can act as an non-pharmacological approach to improve and maintain the QoL of
hospitalized psychogeriatric patients
2) EAs combine different therapeutic interventions which can advantage hospitalized
psychogeriatric patients

Current practice:
1) New to recent services

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Project design:
a) Target participants
Target sample size: 10 participants
Inclusion criteria:
1. Aged 65 or above
2. Admitted in psychiatric unit
3. Cognitive level: Montreal Cognitive Assessment (MoCA): > 18
Reasons:
-Distinction between dementia and normal: 18/19 (Yeung et al., 2014)
-Able to express feelings and experience
4. Having steady or slightly limited movement of upper limbs
5. Able to speak in Cantonese

Exclusion criteria:
1. Clients who are incommunicable
2. Poor vision
3. Clients who are under suicidal observation or close observation

b) Venue:
Psychogeriatric wards in TPH Ward 1AL (Sub-nursing station) and SH Ward 3A
(Meeting room)

c) Duration:
- 4 sessions in 4 weeks
- 1 session per week
- 60 minutes per session
Most studies (Lin et al., 2021; Yan et al, 2021) organized activities of EAs
were ~ 60 minutes for each session

d) Methodolgy
It would be a pre- and post-intervention study using convenience sampling of
hospitalized psychogeriatric inpatients in Tai Po Hospital and Shatin Hospital.

e) Assessment tools
Objective:
The Chinese version of the World of Health Quality of life instrument-Older Adults
Module (WHOQOL-OLD)
(Appendix 1) (Hsieh, 2016)

Evaluation:
Satisfactory survey after attending EAs sessions

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f) Interventions

Session 1 Session 2 Session 3 Session 4

Duration 60 minutes

Mode of each Group

session

Time Beginning 5 minutes: Participants will introduce themselves to

Schedule each other

Next 5 minutes: Doing relaxation exercise

Next 5 minutes: Introducing the activity

Next 20 minutes: Conducting the activity

-Playing the -Playing the -Playing the -Playing the

music music music music
(https://youtu. (https://youtu. (https://youtu. (https://youtu.
be/MgphHyGg be/MgphHyGg be/1wGepZcw be/2J4-XpFBe
eQU, Relaxing eQU, Relaxing 0XA, 500 N0,
Relax Music, Relax Music, chinese CRYSTAL
Study music) Study music) children's MUSIC
-Body -Mask making songs) RELAX
mapping (visual arts) -Childhood MUSIC )
(visual arts) (Appendix 2) (visual arts) -Self as
(Appendix 2) (Heath & (Appendix 2) landscape
(Heath & Darley, 2021, (Heath & (visual arts)
Darley, 2021, P. 172) Darley, 2021, (Appendix 2)
P. 123) P. 136) (Heath &
Darley, 2021,
P.195)

Next 20 minutes: Inviting participants to share their works, feeling

and experience (storytelling)

Last 5 minutes: Conclusion

Materials -Papers -Markers -Papers -Papers

preparations -Magazines/ -Watercolour/ -Colour magazines/
newspapers/ colour pens pencils newspapers/
stickers stickers
-Colour -Colour
pencils pencils

Manpower 1 nursing staff 1 nursing staff 1 nursing staff 1 nursing staff

+ 1 assisted + 1 assisted + 1 assisted + 1 assisted
staff (e.g staff (e.g staff (e.g staff (e.g

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 supporting supporting supporting supporting
staff/TUNS/St staff/TUNS/St staff/TUNS/St staff/TUNS/St
udent nurse) udent nurse) udent nurse) udent nurse)

No. of 2-5 2-5 2-5 2-5

participants

g) Promotion
-TPH Ward 1A: Poster and pamphlet
-SH Ward 3A: Temi robot

Timeline:
Period Events

1-7/5/2023 ● Introduce the study by using poster and Temi robot as well
(1st week) as providing pamphlet
● Recruit possible participants
● Get approval from possible participants AND assess
cognitive function by MoCA
● Screen for eligibility and final decide the total number of
participants
● Conduct pre-intervention QoL assessment

8/5/2023 - 4/6/2023 Conduct session 1- 4 on the basis of one session per week
(2nd - 5th week)

5-11/6/2023 ● Conduct post-study QoL assessment

(6th week) ● Compare pre- and post-intervention QoL assessment result
● Conduct satisfactory survey about attending EAs sessions
● Evaluation and discussion

Budget:
- Mask (~$50)? from petty cash asked WM??

Resources:
Materials from ward:
- Papers/magazines/ newspapers/ stickers
- Colour pencils/watercolour/colour pens
- Glue
- Mask
- Hearing amplifier
- Tablet

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Infection control:
- Disinfect the environment and encourage pre and post hand hygiene, maintain
appropriate social distance among participants are required.
- Sharing and interaction required during the activity
- Disinfected used materials by UV disinfectant machine

Possible problems:
Process
- Participants:
a) unwilling to share their related experience and feelings
b) unpredictable emotional outburst
Measures
- COVID related policy: quarantine and lock down policies might affect the progress of
the project

Contingency plans:
Process
- Participants:
a) - respect the participant, who is unwilling to share her experience and feelings
b) - let the participant, who has emotional outburst, end the participation first
- providing reassurance and let her calm down
- explore the reason of emotional outburst after end of the activity
Measures
- COVID related policy: the form of activity can be flexibly modified

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References
Atkins, S. S. (2003). Expressive arts therapy creative process in art and life. Parkway
Publishers.

Expressive Arts Therapy Association of Hong Kong. (2019). What is Expressive Arts
Therapy?. https://www.eatahk.org/what-is--expressivearttherapy

Heath, W., & Darley, S. (2021). The expressive arts activity book : a resource for
professionals (Second edition). Jessica Kingsley Publishers.

Hsieh, P. Y. (2016). Psychometric Study on the WHOQOL Questionnaires in Elders of

Taiwan [Master Thesis: National Taiwan University].

https://tdr.lib.ntu.edu.tw/jspui/bitstream/123456789/3895/1/ntu-105-1.pdf

International Expressive Arts Therapy Association. (2017). WHAT IS REAT?.

https://www.ieata.org/what-is-reat

Kucuk adamlar. (2017, November 10). Relaxing Relax Music, Study music [Video]. YouTube.

https://youtu.be/MgphHyGgeQU

Kylan Buch. (2021, August 11). CRYSTAL MUSIC RELAX MUSIC [Video]. YouTube.

https://www.youtube.com/watch?v=2J4-XpFBeN0

Lin, D. R., Wang, Y. Y. & Chen, W. (2021). Research on Improving the Emotion and Social

Relationship with Elderly with Dementia in Expressive Arts Therapy. Turkish Journal

of Computer and Mathematics Education, 12(11), 4055-4075.

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 https://turcomat.org/index.php/turkbilmat/article/view/6532/5389

Lisa L, King. (2018, August 22). 500 chinese children's songs [Video]. YouTube.

https://youtu.be/1wGepZcw0XA

Malchiodi, C. A. (2012). Handbook of art therapy (2nd ed.).

Guilford Press.

Meira, D., Lavoura, P., Ferreira, D., Antonio Curiati, J., Lichtenstein, A., Carvalho, C.

& Tanaka, C. (2015). Impact of hospitalization in the functionality and quality of

life of adults and elderlies. European Respiratory Society, 46(59), 1399-3033.

https://doi.org/10.1183/13993003.congress-2015.PA3547

Yeung, P. Y., Wong, L. L., Chan, C. C., Leung, J. L. M., & Yung, C. Y. (2014). A validation

study of the Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) in

Chinese older adults in Hong Kong. Hong Kong Medical Journal = Xianggang Yi Xue

Za Zhi, 20(6), 504–510. https://doi.org/10.12809/hkmj144219

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Appendix 1. The Chinese version of the World of Health Quality of life
instrument-Older Adults Module (WHOQOL-OLD)

下面的問題詢問您在最近兩個星期內經歷某些事情的多寡。
1 您的感官損傷對您的日常生活有影響嗎?
□完全沒有影響 □有一點影響 □中等程度影響 □很有影響 □極有影響

2 感官喪失對您參與活動有影響嗎?
□完全沒有影響 □有一點影響 □中等程度影響 □很有影響 □極有影響

3 您有自己做決定的自由嗎?
□完全沒有 □有一點有 □中等程度有 □很有 □極有

4 您覺得能夠控制自己的未來嗎?
□完全不能夠 □有一點能夠 □中等程度能夠 □很能夠 □極能夠

5 您覺得周圍的人尊重您的自由嗎?
□完全不尊重 □有一點尊重 □中等程度尊重 □很尊重 □極尊重

6 您擔心您未來死亡的方式嗎?
□完全不擔心 □有一點擔心 □中等程度擔心 □很擔心 □極擔心

7 您害怕不能掌控自己的死亡嗎?
□完全不害怕 □有一點害怕 □中等程度害怕 □很害怕 □極害怕

8 您恐懼死亡嗎?
□完全不恐懼 □有一點恐懼 □中等程度恐懼 □很恐懼 □極恐懼

9 您害怕死之前的疼痛嗎?
□完全不害怕 □有一點害怕 □中等程度害怕 □很害怕 □極害怕

下面的問題詢問您在最近兩星期內經歷或能夠做某些事情的完整度。
10 你在感官功能上的問題會影響您和別人互動的能力嗎?
□完全沒有影響 □少許影響 □中等程度影響 □很影響 □完全影響

11 您能做您想做的事情嗎?
□完全不能夠 □少許能夠 □中等程度能夠 □很能夠 □完全能夠

12 您滿意在您生活中有繼續達成目標的機會嗎?
□完全不滿意 □少許滿意 □中等程度滿意 □很滿意 □完全滿意

13 您覺得您得到了生活中應得的肯定了嗎?
□完全沒有 □少許有 □中等程度有 □很有 □完全有

14 您覺得每天都有足夠的事情做嗎?
□完全不足夠 □少許足夠 □中等程度足夠 □很足夠 □完全足夠

下面的問題詢問您在最近兩星期內感覺到您生活各個方面的滿意、快樂或好的程度。
15 您滿意在您生命中已有的成就嗎?

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□極不滿意 □不滿意 □中等程度滿意 □滿意 □極滿意

16 您滿意您利用時間的方式嗎?
□極不滿意 □不滿意 □中等程度滿意 □滿意 □極滿意

17 您滿意您的活動程度嗎?
□極不滿意 □不滿意 □中等程度滿意 □滿意 □極滿意

18 您滿意您參與社區活動的機會嗎?
□極不滿意 □不滿意 □中等程度滿意 □滿意 □極滿意

19 對於您所能夠期待的事情感到多高興?
□極不高興 □不高興 □中等程度高興 □高興 □極高興

20 您如何評價您的感官功能?
□極不好 □不好 □中等程度好 □好 □極好

下面的問題是關於您可能擁有的任何親密關係。
21 在您的生命中有感受到有人陪伴嗎?
□完全沒有 □有一點有 □中等程度有 □很有 □極有

22 在您的生命中有經驗過愛嗎?
□完全沒有 □有一點有 □中等程度有 □很有 □極有

23 您有機會去愛人嗎?
□完全沒有 □少許有 □中等程度有 □很有 □完全有

24 您有機會被愛嗎?
□完全沒有 □少許有 □中等程度有 □很有 □完全有

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Appendix 2. Details about each session of visual arts
Body Mapping
-Ask the patients to visualize the physical, emotional, mental and spiritual layers of the body
part. Ask the following questions: “How does the head (or hands, feet, etc.) connect us to the
world? Is the head sensate? Does the head think? Does the head feel emotions, imagine,
create or hold memories? How does the head present itself to the world?”

-Patients can draw any parts of the body

-Patients would be reminded that it is not meant to be a realistic portrait of the person at all,
but a reflection of their inner life.

Mask Making
-Ask patients to design masks as they like.

-The designs are not limited to human faces, but also other kinds of masks, e.g. animals and
story related.

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Childhood
-Ask the patients to consider the following: “Think of yourself at age 12. Try to remember
how you felt when you were young. What was life like at the time? Think of what you did
and what was fun for you”

Self as Landscape
-Ask the patients to imagine themselves as a landscape.

-Can launch right in or lead them in a guided imagery that allows them to walk through their
own landscape.

-Allow them to pay attention to oceans and mountains, streams, rivers and valleys, plains,
desert and forest.

-Patients can then create their landscape in either two or three dimensions.

-Be as creative as allowing them to feel the landscape around them; “Is there a body of water
nearby? Is it a pond? Lake? Ocean? There they will meet all sorts of wildlife and experience
waves, dark depths and shallows. When they follow the course of a stream it takes them to

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many places. What is the source like? Does it join other streams? Does it go through a city?
End in a lake?”.

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