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Running head: CHANGE IN ACTION 1

Change in Action: Art Therapy and Florida Hospital of Tampa
Michelle Bittenbender
University of South Florida

Change in Action: Art Therapy and Florida Hospital of Tampa
Art Therapy has proven to be successful in coping with pain management, stress
reduction and other significant improvements in quality of life for patients diagnosed
with Cancer. Currently Florida Hospital of Tampa has no such resources available for it’s
clients. Using their current infrastructure for change, the Model for Evidence-Based
Practice Change, Florida Hospital of Tampa could model itself after it’s sister, Florida
Hospital for Children in Orlando FL, which does offer an Arts in Motion Program.
Personal involved in such a change would include nurses, physicians, educators,
clinicians, volunteers and an art therapist to oversee bedside interaction. Is there
evidence-based research to support an integrative approach to cancer treatment? Can art
therapy alleviate common cancer symptoms?
PICOT Question
In patients diagnosed with cancer, who participate in Art Therapy compared to
traditional Chemo/Radiation Therapy experience less pain & overall improved quality of
life through the duration of their cancer treatment?
Synthesized Literature Review
Search engines used to gather supporting research articles include PubMed and
the University of South Florida’s Library Database. Key words included art therapy* and
cancer*. Publication dates were limited to 2007 to present.
Current research clearly supports the benefit of adjunct use of art therapy in
relation to traditional cancer treatment. Documentation of positive gains in psychological,
spiritual and physical cancer symptoms has proven its relevance to be included in the
clinical setting (Nainis & Paice, 2007). There is no evidence that it causes any harm. A
significant decrease in pain and subsequent increase in quality of life was seen in patients
who participated in art therapy sessions (Svensk, 2009). Art therapy fostered a sense of
solidarity amongst its participants while instilling a new sense of creativity and
‘conscious living.’ These benefits may contribute to overall sense of health and potentiate
the success of traditional chemo and radiation therapy (Visser, & Op’Thoog, 2008).
Art therapy is an intervention that can elicit an advantageous response at all
phases of cancer treatment and may continue to be a solution that is accessible to patients
beyond the scope of their inpatient experience. Patients who are exposed to art therapies
are better empowered, are able to care for themselves and can define themselves outside
the limitations of their diagnosis. Art therapy reinforces positive coping behavior,
increases self-esteem and encourages a sense of control. All of these aspects significantly
contribute to increased cancer survivorship. It is important to be aware of non-
pharmaceutical interventions to be used in conjunction with traditional cancer treatment
to facilitate healing on multiple platforms. Art therapy supports patients in a holistic way,
by encouraging strength of character while simultaneously alleviating detrimental effects
such as pain and fatigue. It serves as a complimentary approach to cancer treatment,
which may increase the effectiveness of traditional chemo/radiation therapy. To consider
the innate connection between the health of one’s physical, emotional and spiritual body
in relation to the stressors of cancer diagnosis, art therapy offers a calming and
humanizing antidote to the stressful environment of oncology care.
Proposed Practice Change
At this time Florida Hospital of Tampa does not implement any type of art
therapy. It’s sister hospital, Florida Hospital for Children in Orlando FL, does offer an
Arts in Motion Program which could serve as a model. Florida Hospital of Tampa could
initiate a smaller scale bedside art therapy program to serve its patients. Initially, patients
diagnosed with cancer will be offered a session of art therapy to determine if Florida
Hospital’s results meet or exceed the results of current research. If proven successful, the
art therapy program can branch out and be offered to all in-patients of Florida Hospital of
Tampa. Patients will be advised to complete an initial and post therapy questionnaire to
determine results. Overhead costs would remain low while increased healing time and
decreased length of stay would facilitate customer satisfaction and continuity of care.
Change Strategy
The utilization of the Model for Evidence-Based Practice Change is necessary to
effectively implement organized and succinct change (Melnyk & Fineout-Overholt,
2011). Assessing the need for change, locating the best evidence and critically analyze
the evidence are the first three steps and have already been completed. Designing a
practice plan is the forth step and includes details regarding defining proposed change,
identifying required resources, designing evaluation of a pilot program and
implementation of the plan. A strategy to promote staff and team engagement, registered
nurses from both Florida Hospital of Tampa and Florida Hospital for Children will
participate in focus groups to collaborate on the planning of the practice change. During
these groups, members will be offered the same questionnaire that patients complete and
will be offered an art therapy session to familiarize them with the process and outcome of
the proposed intervention.
Implementing and evaluating change is the fifth step of the Model for Evidence-
Based Practice Change. This step will begin in January of 2014 and will continue for a
six month time period until June 2014. Finally in July of 2014, change will be
implemented and maintained in practice.
Roll Out Plan
Implementation of this plan will last the duration of a ten month time frame. Steps
1 through 3 have been completed with step 4 on schedule for December 2013. This time
frame is desirable as it marks the beginning of the year (2014) and it’s measurable
quarters. As outlined by Melnyk & Fineout-Overholt , the steps for the rollout process are
as follows:
1. Assess the need for change. Include stakeholders, collect and compare
internal and current data regarding current practice. Identify the solution
to the problem based on interventions and outcomes.
Completed September 2013.
2. Locate the best evidence. Identify types and sources. Review research
concepts. Plan and conduct search.
Completed October 2013.
3. Critically analyze the evidence. Appraise and weigh and synthesize the
evidence. Assess feasibility, benefits and risks of new improved
Completed November of 2013.
4. Design practice plan. Define proposed change, identify required
resources. Design evaluation of pilot program and implementation of
the plan.
To be completed December 2013.
5. Implement and evaluate change in practice. Implement the pilot study.
Evaluate processes, outcomes and costs. Develop conclusions and
Implementation begins January - June 2014.
6. Integrate and maintain change in practice. Communicate recommended
change to stakeholders. Integrate practice into standards of practice.
Monitor process and outcomes periodically. Celebrate and disseminate
project results.
Implementation of this step begins July 2014 and ongoing every quarter
(Model of evidence-based practice change, Melnyk & Fineout-Overholt, 2011, p. 255).
Project Evaluation
Beginning in January patients at Florida Hospital of Tampa will be offered the use
and benefits of the art therapy program. To request an art therapist visit a patient will
complete an initial online questionnaire to assess their needs and current physical,
emotional and spiritual interpretation of their symptoms. The questionnaire will rate their
experience on a scale of 0-10. Upon completion of the art therapy session the same online
questionnaire will be presented to assess change. Successful intervention will be reflected
in a score change that indicates a positive change in mind body and health.
Dissemination of EBP
Dissemination of the change can be made through the pre-existing infrastructure
within Florida Hospital. Clinic directors will use the online intra-net to announce the
change and links to further educational instruction will be placed on the homepage. A
link to the Children’s Hospital in Orlando can also be established this way to further
initiate solidarity amongst the Florida Hospital umbrella of organizations.

American Cancer Society. Cancer Facts & Figures 2013. Atlanta: American Cancer
Society; 2013.
Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in
nursing & healthcare: A guide to best practice. Philadelphia: Lippincott Williams
& Wilkins.
Nainis, N. & Paice, J. (2007). Relieving symptoms in Cancer: Innovative use of art
therapy. Journal of Pain and Symptom Management, 31(2), 162-169.
Svensk. A. (2009). Art therapy improves experienced quality of life among women
undergoing treatment for breast cancer: A randomized controlled study. European
Journal of Cancer Care. 18, 69–77. doi: 10.1111/j.1365-2354.2008.00952.x.
Visser, A. & Op’Thoog, M. (2008). Education of creative art therapy to Cancer
patients: Evaluation and effects. Journal of Cancer Education, 23, 80-84. doi:
Wood, M., Molassiotis, & A., Payne, S. (2011). What research evidence is there for the
use of art therapy in the management of symptoms in adults with cancer? A
systematic review. Psycho-Oncology. 20, 134-145. doi: 10.1002/pon.1722.