The “Unfold the Untold” Project
Freeman, N., Snell, L. & Grimwood, T. (2025) An evaluation of Unfold the Untold. Commissioned by Healing Arts Cumbria.
Executive Summary
Designed and led by the Healing Art’s artists, the Unfold the Untold project aimed to enhance wellbeing by bringing together patients and staff at Cumberland Infirmary as well as children from a local primary school, through shared storytelling and creativity. The project delivered weekly sessions of “creative conversations” woven in with puppetry, poetry and crafts, and culminated with tea parties, handmade board games, a book that captured participants’ stories called The Major and the Puzzle of the Broken Universe, and shadow puppetry performances of the book.
During the creative conversations, practitioners would respond to topics that interested the patients through a range of media such as poetry, drawing and craft. For example, a poem or a drawing would be created in response to a patient’s story about a loved one or a pet and would then be given to the patient as a keepsake. Conversations did not lead to any creative output when the practitioners sensed it wasn’t appropriate. Conversations were also initiated by sending messages between patients and school children on heart-shaped cards that were wound with wool. Others were about writing “recipes for a good life”, or they naturally progressed by the presence of a puppet called “The Major”.
Findings
Findings are grouped into two sections to respond to the aims of the Unfold the Untold service evaluation, which were to understand how activities may work:
1) to contribute to improved patient wellbeing
2) with ward staff and within the ward environment
Unfold the Untold Activities
An overarching perception that all of the creative practitioners had about their work with the patients was they were facilitating “creative conversations”. Any participation in creative activities or production of creative outputs were perceived to be a means by which the interaction itself could be established, enhanced, or continued. To better understand how the creative practitioners’ approaches to these creative conversations may contribute to improved outcomes for patients, the interview data have been explored and summarised through the three key elements of the World Health Organization’s (2022, p.3) Guide to evaluating behaviourally and culturally informed health interventions in complex settings, which are: wellbeing, trust, and social cohesion.
Each of the three key elements are outlined separately in order to explain what is at work, however in practice the creative practitioners apply these skills seamlessly throughout their interactions with patients.
Working Within the Wards
Ward staff reported the most valuable aspect of the project was that the creative conversations provided an “access point” where the patients were more likely to talk about their lives and experiences. Staff reported that they were able to better understand and connect with their patients following the sessions, whether they were present or not.
“Initially, staff were terrified of The Major because they didn’t understand what he was. But over time The Major came in and started discussions with our patients that they wouldn’t have had with us. The Major was a very relatable character, and I think they could recognise parts of themselves within it.”
“They do a lot of reminiscence work, and it gives our patients a space to express their emotions. It helps them to develop a sense of identity as well. Within hospital what commonly happens is you become a patient and nothing else. The Healing Arts programme really helps us to delve into who these people are; better understand them, better prescribe care. It can make a massive difference to how they feel on a day-to-day basis without us having to go down the route of looking into medication for treatment of things like depression.”
Holly Curruthers – Elm C Ward Manager
“There was one particular gentleman who we thought was confused, turns out to be a mental health issue. He was quite challenging one-to-one, but I spent a really happy time drawing… So it’s the little things like that and I like to think it kept him settled for the rest of quite a busy weekend. But it was a very good reminder for everyone that actually he’s just struggling. And if we find a way to connect, it’s all going to be a lot more peaceful.”
Freya Laverick – Healthcare Assistant
Addressing Challenges
The two greatest challenges reported by ward staff were: reservations about anything creative and understanding the benefits. As part of the project, ward staff were offered dedicated workshops so that they could experience working with creative practitioners for themselves, as well as focusing on their own wellbeing and connecting as a team.
“It helps with better patient management, especially when a patient is in distress. You know, like it is really hard to manage someone with distress in that acute setting, especially with dementia. We’ve seen that it really benefits them.”
Meena Sarangapani – Admiral Nurse Elm C
“It was really good fun actually. And it was nice working with the people from the other wards, like Elm C and seeing what they are doing. I was the only one who could make it from here. So it was nice to have that sort of little community.”
Freya Laverick – Healthcare Assistant
“The Healing Arts team started to work with a number of our healthcare assistants and our nurses on how to deliver this programme to better integrate that project within our ward. It’s been very beneficial, not just to give our patients better experiences, it’s also empowered our staff. And through that training we have actually accessed creative reflection and wellbeing support for all of our staff. We had away days and everyone had really low morale before that, and then we did some really good creative impact stuff and afterwards everyone’s morale has improved.”
Holly Curruthers – Elm C Ward Manager
Discussion and Recommendations
While the benefits of arts in health activities, such as those provided by the Unfold the Untold project, have been evidenced to make a valuable contribution to improved outcomes for patients, this evaluation demonstrates that they can only be realised through good working relationships with ward staff. This includes:
- developing trust
- demonstrating respect for the day-to-day ward environment
- working collaboratively to understand the needs of individual patients
- maintaining continuous dialogue as to how activities are provided on the wards
- responding to staff wellbeing needs
Buy-in from ward staff was reported to take a few months at least, and this is to be acknowledged and respected. Offering one off sessions on the ward and inviting ward staff to join dedicated staff wellbeing sessions have been successful to date in supporting engagement and understanding of the Healing Arts activities.
Future staff wellbeing sessions should be developed in line with feedback from staff surveys and direct discussions with ward staff. Promotion of Healing Arts activities throughout the Trust’s hospitals should also include opportunities for all staff to feedback with comments and suggestions for future activities.
References