Compassion By Design

Why is there compassion deficit in the culture of care? How can creative design process generate sustainable empathy in care communities?

The paradox of authority is that when used to implement instructions, it generates the coercive and institutionally compliant behaviour that is the antithesis of an activated and spontaneous compassionate responsibility towards others. Nursing staff are especially vulnerable to being made institutionally compliant and deferential. Nursing, as noted by Menzies-Lyth, is frequently categorized as among the least prestigious of the occupations in care institution. Uniforms, titles, work descriptions and conditions can emphasize the impersonal status of the care nurse in the residential care home.

This may be further exacerbated by the nurses' own defences against the considerable anxieties that are activated when working with old people who suffer from degenerative illnesses such as Alzheimer's Disease, and those who will never recover independence. The emotional resources needed for end of life care, like those of palliative care, are especially demanding. This research asks if emotional resources can be sustained through a more psychologically nuanced, dialogical process of co creation workshop process as an integral part of the workplace. Alternating mechaniset with opportunities for intervals of creative spontaneity, working collaboratively with families and friends of residents as well as with residents themselves, will provide a means for assessing the beneficial effects of collaborative, co-creation design practice on the care home institution.

Obtaining qualitative, rather than metric, data about the relational quality of cultural experience is crucial. The psychological (Baron Cohen:2012) and psychoanalytical (Bollas:1989, Menzies-Lyth:1960) offer a complex, post-positivist social science. Psychodynamic processes can enable researchers to use their own subjectivity as a legitimate medium for knowledge and judgment of research into emotional experience of art and design research. As a post-modern autoethnographic method, the conscious use of the researchers' subjectivity opens new and innovative ways for approaching creative art and design practices as research processes.

This research project applies the concept of integrative co-operation as the basis of creative culture in order to suggest that there may be a way that design can provide an effective means of implementing (some of) the proposals of the Francis Report (2013) into the 'compassion deficit' in cultures of care. Implementing changes in the training of nursing care staff, may best be supported with research data showing that art and design creative processes can provide a means of developing a more sustainable culture of compassion.

The way that cooperation acts as an intra-psychic process of integration, of fragmented parts of the self, is understood as the basis for the way that culture is experienced as emotionally meaningful and as socially integrative. Emotional reciprocity actuated through creativity is offered as data.This project aims to gather, test and evaluate the emotional quality of researchers' subjective responses as legitimate and significant research data.

How is the creative process a medium for the transmission of emotional experience from one subject to another?
What are the ways that this transmission can be best understood as data for use in theorising creative art and design research?
How is the subject held, in integrity and solitude, by the 'spirit of the object' (Bollas)?

This research project aims to establish analogies between the processes of creativity and of care. It does this by tracing the empathy through which a utilitarian design task is successfully completed in the Alexandra Care Home in Harlow Essex. The case study is then offered for critical discussion with colleagues in a range of allied fields. Is it possible to create Compassion By Design?

The impacts of this research are multiple, both immediate and more long term:

Immediate impacts will be manifest in the transformations of the institutional culture of the Alexandra Care Home. The utilitarian outcome and the changes in the culture of care are equally significant. The case study work task, to complete the redecoration of the domestic interior of the Home, as required by the CQC report, will be successfully completed during the course of the workshops. However this legal requirement is, in a way, a secondary gain of the research project. The primary institutional gain is to be found in the value of the research data and methodological questions generated by the project. Other non-academic beneficiaries include the professional responsible for considering the curriculum for the education and training of nursing and care staff (across a wide range of practices such as nursing in palliative care, the disabled, children and young people, the socially vulnerable and others with dependency). Nursing trainees and their educators may be invited to consider the impact of the relationship between carer's subjective experiences, and especially their anxieties as a significant element of institutional life. The data on empathy may also lead to new practices, and even policies, of considering the agency of family and friends as proactive participants in the culture of care. It is suggested, in this research, that dissemination through experience, in a rhizomatic and dialogical process, may be as powerful as working through channels of authority. Authority may, paradoxically, eliminate the responsibility that is necessary for sustaining compassion.

A more long term impact is, potentially, present in the uses to which this research project may be put. The hypotheses may be proven or not, by the research data and outcomes, However the parameters of the debates on the agency of co-creative design as a form of generating sustainable cultures of compassion are present within the long-term view of the future uses of art and design. Therefore, the need to activate new approaches to the inclusion of art and design practices within social structures will continue to be felt, ever more urgently, in coming years. It is not enough for art to be added to social reform projects as a means of encouraging public engagement, or as a means of accessing celebrity cultures to draw attention to structural issues of institutional regeneration. The use of art and design as ornamental surfaces for issues that are seen as more serious, or underlying structures, is deeply undermining of the real agency and value of art and design. The wide dissemination of this new approach to art and design as a medium for research, and as a medium for social and institutional transformations, will aim to make a long term impact on the evaluative criteria of arts and humanities research more generally.

It is also envisaged that this research will be part of a culture which invites artists and designers to conceive of their own creative practices as a means of making active transitions between their status as privileged individuals to being concerned and indformed citizens, aware of the power that their practices may, potentially, have for the value of culture.

This longer term impact, of legitimising qualitative research data and their associated methods of collection, will be disseminated in a variety of ways, including through the formulation of further, larger research projects which strengthen connections between academic and non academic communities. If the research provides plausible accounts of the agency of empathy, compassion and relational intelligence it will have impact beyond quantification.