Promoting inclusion for disabled students in healthcare education: Using research-based theatre to enhance knowledge and empathy.

AIM: This study explores and compares the impact of in-person and online versions of a Research-based Theatre production named "Alone in the Ring," aimed at increasing knowledge and fostering positive attitudes towards persons with disabilities in healthcare professions. The study examines changes in attitudes towards disabled persons in healthcare professions, levels of engagement in the play and knowledge about the experiences and challenges of disabled individuals in healthcare professions. It also investigates possible actions to increase inclusion for disabled persons in healthcare education and practice. BACKGROUND: Disabled students face numerous barriers in healthcare education and practice, many of which are rooted in stigma and negative attitudes. Research-based Theatre promotes experiential learning to address these attitudes and stereotypes. The performance "Alone in the Ring" is based on a comprehensive study of the experiences of disabled students and clinicians in health professions, aiming to promote inclusion for students with disabilities in these fields. DESIGN: This study uses a pre-test and post-test design with two comparison groups. METHOD: The study employed an explanatory sequential mixed method design to explore the impact of online versus in-person Research-based Theatre teaching in healthcare education. Participants were graduate health students (N = 198); 100 watched the in-person version and 98 watched the online version. Surveys were administered before and after the performance. Participants were also invited to share their experiences in semi-structured interviews and their responses were analyzed using thematic analysis. RESULTS: Results indicated that students generally felt more comfortable with disabled persons in healthcare professions in the post-survey compared to the pre-survey, with online participants reporting greater comfort and higher engagement than those in-person. Knowledge of disabled persons' experiences and challenges, as well as possible actions to increase belonging and inclusion, improved significantly for both groups from pre- to post-performance, with online participants showing a greater change. Qualitative data revealed that online theatre was perceived as authentic and beneficial for accessibility, engagement and emotional impact on students, though challenges included potential distractions and technological issues. Positive correlations were found between changes in knowledge, positive attitude and engagement, suggesting that increased engagement and a shift in attitudes can promote knowledge and awareness of the inclusion of disabled persons in healthcare professions. CONCLUSION: These results support the use of online theatre-based academic teaching that experientially engages students, increases empathy and can promote more inclusive healthcare educational settings for disabled persons.

TV medical dramas: assessing the portrayal of public health in primetime.

Introduction: The influence of medical dramas could extend beyond the realm of entertainment and potentially strengthen/orient the knowledge, attitudes and hopefully practice of health professionals and the public, despite often depicting unrealistic medical outcomes and scenarios. Methods: This study examined the portrayal of public health issues in two popular international medical series, "Grey's Anatomy" and "House, MD," selected for their awards and viewership ratings. Individual episodes were double-rated by clinicians for patient characteristics, public health issues, and infection risk management. Results: 94 episodes with 286 clinical cases were analyzed. A wide range of conditions and pathologies were depicted, with a focus on acute clinical events, trauma and mental disorders, which contrasts with real-life causes of hospitalization and highlight the dramatization in these series. Public health issues such as organ donation and substance abuse were frequently addressed, but prevention and health promotion received little attention. Proper use of personal protective equipment was mostly observed, although hand hygiene was underrepresented. Conclusion: The study highlights the dual role of medical dramas as an entertainment medium and a potential educational tool. While they can raise awareness and encourage healthier behavior, their portrayal of medical practices and patient care often deviates from reality and can create unrealistic expectations. The influence of these dramas also extends to viewers' perceptions of healthcare and medical professionals, underscoring the need for accurate and responsible portrayal of health issues in the media.

Workshop on hastened death as "space for an appreciative discussion": A qualitative study.

AIM: To evaluate the suitability of a drama-based workshop as a method for ethical deliberation. BACKGROUND: Nurses worldwide are inadequately prepared to care for people who desire hastened death, which can lead to ethical and moral dilemmas. To address this problem, we developed a drama-based ethical deliberation workshop to assist nurses in these situations. Senghor and Racine's three moments of ethical deliberation and their quality criteria served as basis for evaluation. DESIGN: Qualitative descriptive study design. METHODS: Non-participant observations and a survey with incomplete sentences to be completed by nursing students were used. Data analysis followed Mayring's deductive content analysis approach. RESULTS: All three moments of ethical deliberation according to Senghor and Racine were identified. Participants recognised hastened death as morally problematic, shared their experiences and gained a deeper understanding of the problem. They reported feeling better prepared for encounters with persons seeking assisted suicide. In terms of its quality, the drama-based workshop achieved good and partial ethical deliberation. CONCLUSIONS: The workshop has demonstrated its suitability as a method for ethical deliberation. The workshop should be complemented by specific modules, such as communication skills and be tailored to other professional groups. A validated instrument is needed to ensure a more comprehensive assessment of the quality.

Psychobiological responses to choir singing and creative arts activities in children and adolescents with mental disorders: results of a pilot study.

BACKGROUND: Children and adolescents living with mental health problems often experience stress and poor mood states, which may influence their quality of life and well-being. Arts interventions may improve mood and well-being and reduce physiological stress in this vulnerable population. METHODS: A cohort of patients in child and adolescent psychiatry (N = 42; age range: 12-18 years) participated in one of four arts activities including choir singing (n = 11), textile design (n = 9), drama (n = 16), and clownery (n = 6). They were led by professional artists and delivered through five consecutive 90-min daily afternoon sessions over the course of 1 week. Questionnaires of mood and saliva samples before and after each session served to assess short-term psychobiological changes. In addition, patients reported their quality of life and well-being at the beginning and at the end of the 1­week program. RESULTS: Results showed that alertness was significantly enhanced after textile design (∆post-pre = 4.08, 95% CI [0.77, 7.39]) and after singing (∆post-pre = 2.20, 95% CI [-0.55, 4.94]). Moreover, mood tended to be positively affected by textile design (∆post-pre = 2.89, 95% CI [-0.39, 6.18]). Quality of life increased significantly after singing (∆post-pre = 5.49, 95% CI [1.05, 9.92]). Arts participation except singing was associated with significant reductions in salivary cortisol (sCort) (textile design ∆post-pre = -0.81 ng/mL, 95% CI [-1.48, -0.14]; drama ∆post-pre = -0.76 ng/mL, 95% CI [-1.28, -0.24]; clownery ∆post-pre = -0.74 ng/mL, 95% CI [-1.47, -0.01]). No significant changes were observed for well-being over the whole program and salivary immunoglobulin A (sIgA) after any of the arts activities. DISCUSSION: These results suggest that arts participation can improve mood state and reduce stress in young people with mental disorders, but there is a need for further studies.

Acceptability and feasibility of a theatre-based wellness programme to support people living with long COVID: a single-arm feasibility study.

OBJECTIVES: To determine acceptability and feasibility of a theatre-based wellness programme to support the health and well-being of people with long COVID. DESIGN: Single-group, repeated-measures feasibility study. SETTING: Community centre and online. PARTICIPANTS: Adults with diagnosed long COVID experiencing breathlessness, pain and/or loneliness. INTERVENTION: Six-week participatory creative programme delivered to one online and one in-person group facilitated by movement, voice and drama consultants using breathing, visualisation, singing, poetry, storytelling and movement exercises. PRIMARY OUTCOME MEASURES: Programme acceptability and feasibility measured via uptake, reasons for non-attendance and barriers to engagement. SECONDARY OUTCOME MEASURES: Feasibility of recruitment and data collection procedures measured through proportion of missing data and follow-up rates, mechanisms of action of the programme identified through qualitative interviews, changes in mental health, well-being, quality of life, loneliness, social support, fatigue, breathlessness and post-COVID-19 functional status at 8-week follow-up. RESULTS: 21 people expressed interest in participating, 20 people took part in the programme, 19 completed baseline and 16 completed follow-up assessments. Participants attended an average of 4.8 of 6 sessions (SD=1.5, range 2-6). Exploratory analyses demonstrated significant improvements in self-rated health (t-test mean difference=0.12, 95% CI=0.00, 0.23, p=0.04) and chronic fatigue symptoms (mean difference=-3.50, 95% CI=-6.97, -0.03, p=0.05) at 8 weeks. Key mechanisms of action that supported health and well-being included: increased sense of community, illness acceptance, experiencing joy, increased confidence in managing everyday life, increased ability to relax and reconnection with previous identity. Barriers to engagement included: activities being outside of the participant's comfort zone, ongoing long COVID symptoms, emotional consequences of sharing experiences and connectivity and connecting online. CONCLUSIONS: A 6-week theatre-based programme was perceived as acceptable to most participants and resulted in some positive psychosocial impacts. The findings provide a rationale for supporting the ongoing development and scale-up of this and related arts programmes to support people living with long COVID.

Problematic series watching and alcohol consumption among global audiences of Korean Drama in Israel and Indonesia.

Korean dramas (K-dramas), with their unique characteristics, often encourage binge-watching. Moreover, the cultural norms and rituals surrounding alcohol, prevalent in South Korea, are mirrored in K-dramas that have gained global audiences in recent years. The present study aimed to examine problematic K-drama series watching, and the potential associations with alcohol consumption among global adult audiences from Israel and Indonesia. An online questionnaire was distributed to a non-probability convenience sample of 638 adult viewers of K-drama, of whom 383 (60%) were Indonesian and 255 (40%) were Israeli. Fifteen percent of the audiences were identified as displaying problematic K-drama series watching, 36% reported ever drinking Soju (the traditional unique Korean drink), 41% reported drinking alcohol in the past 3 months, and 24% reported binge drinking in the past 12 months. Participants who were higher in problematic K-drama series watching were more likely to be involved with drinking Soju, drinking alcohol in the past 3 months, and binge drinking in the last year. Indonesians and Israelis have significantly different viewing patterns and alcohol consumption. 21.2% of Israelis identified as problematic K-drama series watching compared to 10.7% of Indonesians. Greater percentage of the Israelis have reported consumption of alcohol than Indonesians. Multiple linear regression for problematic K-drama series watching revealed that Israeli audiences, younger age, being defined as a fan, being a member of a K-drama social network, higher number of weekly hours spent watching, and greater number of dramas being watched per month were associated with more problematic K-drama series watching. Series binge-watching may entail potentially negative health and social consequences and professionals should pay more attention to this type of problematic behavior. The identification of problematic K-drama series watching and its association with increased alcohol consumption, suggests the need for health policymakers to consider cultural influences on media alcohol messages consumption.

The effect of creative drama education given to nursing students on mental health literacy levels: A randomized controlled study.

AIM: The aim of the present study was to determine the effect of education provided to nursing students on MHL levels. METHODS: The study had a randomized pre-test post-test parallel control group design. Fifty-six (n = 56) first-year nursing students. In this study, CONSORT flow diagram was applied. The data collection forms consist of a personal information form and Mental Health Literacy Scale. In the statistical analysis Wilcoxon signed-rank test, and Mann-Whitney U test were used. RESULTS: Creative drama education was found to be significantly more effective than classroom education in increasing scores on the mental health literacy scale, including sub-dimensions for awareness of mental disorders, ability to access information, and stigma in nursing students (p < 0.05). CONCLUSIONS: Classroom education and creative drama are effective in changing mental health literacy scales. It is recommended to spread the use of creative drama, which is one of the artistic and interactive educational techniques in nursing education.

Marcel Réja and theatre therapy.

We report on the play entitled Le Pain quotidien (The daily bread) by Marcel Réja (1873-1957), a French alienist and historian of art in asylums. He also wrote short plays, although he is less well known as a playwright. The plays were printed just in time for the performance, which often took place on the day of the asylum fair. Here, we discuss a one-act play consisting of four scenes in which the actors are his patients.

Ventriloquist intervention prepared with drama technique in reducing pain, anxiety and fear in children during invasive procedures.

INTRODUCTION: This study aimed to investigate the effects of a ventriloquist nursing intervention, incorporating drama techniques, on pain, anxiety, and fear experienced by children aged 5 to 10 years undergoing painful medical procedures. METHODS: This study was designed as a time-series randomized controlled trial. Data were collected from the outpatient units of a Pediatric Hospital in a province in eastern Turkey between 24 May 2023 and 28 October 2023. This study involving a total of 72 children. Pain, anxiety, and fear levels were assessed before, during, and after intravenous cannula insertion. RESULTS: Randomization ensured that both groups had similar demographics, with an average age of 7.50 ± 1.73 years and an equal distribution of gender. During the painful procedure, it was observed that both groups experienced an increase in pain, anxiety, and fear, though this increase was statistically less significant in the ventriloquist group. Ultimately, in the post-procedure period, children in the ventriloquist group exhibited lower levels of pain, anxiety, and fear compared to the control group (p < 0.05). CONCLUSION: The findings of this study suggest that ventriloquist nursing interventions, utilizing drama techniques, can effectively reduce pain, anxiety, and fear in children undergoing painful medical procedures.

Theater for Healthcare Equity; A Model for Inclusion and Anti-Bias Training in Academic Medicine.

There are no standardized methods for training medical personnel in antiracist action, such as how to be an upstander or how to use micro-resistance. Roleplay and drama-based pedagogy can empower and educate healthcare professionals by providing experiential training and a safe space for antiracist practice and discussion. The Theater for Healthcare Equity (THE) is an innovative methodology that explores upstander techniques in real time with facilitated instruction. We implemented eight THE sessions at our institution and assessed participant responses via a voluntary survey. Forty-one participants completed a REDCap survey, and 32 participants completed the Continuing Medical Education survey. Participants appreciated the creation of safe spaces, the practice format, and the learning experience, which provided an honest and open environment for the sharing of experiences, addressing race-based bias, and practicing responses to real-life scenarios. Constructive feedback included changes to session duration, participant discomfort with improvisation, and lack of printed tools.

The effect of creative drama on nursing image: Randomized controlled study.

AIM: This study aimed to examine the effects of the creative drama method on first-year nursing students' perceptions of the image of nursing. BACKGROUND: Nursing students' perceptions of professional image can be affected by many processes during their transition to professional life. Therefore, supporting their development of a positive professional image at the beginning of their careers is necessary. DESIGN: This was a randomized controlled trial with a pre-test/post-test design and a control group. METHODS: The study was carried out at a nursing school located in the Eastern Black Sea region of Türkiye. The sample of this study consisted of 77 participants, with 38 in the experimental group and 39 in the control group. The subjects of professional image and the image of nursing were explained to the control group using presentations and case analysis and to the experimental group using the creative drama method. Research data were collected with the Student Information Form and Nursing Image Scale. RESULTS: The post-test scores obtained by the control group after receiving traditional education were higher than the pre-test scores. The post-test scores obtained by the experimental group after receiving education based on creative drama were higher than the pre-test scores. The scores of the experimental group were significantly higher after the educational intervention. CONCLUSION: Creative drama is far more effective in nursing image education for first-year nursing students than presentation and case analysis, which are conventional education methods. Creative drama can be used as an effective method to develop positive perceptions of nursing.

The effect of drama on psychosocial problems and emotional states of hospitalized children with cancer.

BACKGROUND AND PURPOSE: Hospitalization is a traumatic experience for children. Especially in the case of childhood cancers that require long-term hospitalization, children need psychosocial support. The study aimed to examine the effectiveness of drama in reducing psychosocial problems in hospitalized paediatric children diagnosed with cancer. METHODS: The study used a mixed method approach, combining both qualitative and quantitative methods with a single group. Drama sessions prepared according to the Tasks and Skills Model were used to support their psychosocial conditions. The Facial Expression Form, The Assessment Scale for Psychosocial Symptoms in Hospitalized Children, and the Drawing and Writing Technique were used before and after the drama sessions. RESULTS: This study differs from others in its use of drama intervention to reduce psychosocial problems in children undergoing cancer treatment. As a result of the study, it was found that there was a decrease in anxiety, hopelessness, anger-aggression and communication difficulties among psychosocial problems and a change in mood towards feeling happy. The study suggests that drama sessions were effective in relieving emotional distress in paediatric cancer patients. CONCLUSION: The study suggests that drama sessions were effective in relieving emotional distress in paediatric cancer patients. PRACTICE IMPLICATIONS: Applying drama to children undergoing long-term hospital treatment can help alleviate psychosocial problems by reducing stress, emotional suppression, and compensating for trauma.

The big heroine genre: motherhood and the maternal body in postsocialist Chinese television.

This article explores the feminist social critique in the 'big heroine' drama, a newly emerged genre of television that focuses on empowering yet dramatic stories of urban women in contemporary China. The article theorises the genre as a site of ongoing contestations to inform and critique women's maternal reality in neoliberal, pronatalist China. The big heroine genre is situated in the postsocialist structure of feeling defined by alienation and precarity, responding to China's need to stabilise the emerging population crisis and labour shortage. Using a popular instance within the genre, Left Right (2022), as a case study, the article argues that the show validates the legitimacy of women's anxieties and challenges in maternity and then invites viewers to engage in a multifaceted analysis of the intricate web of structural injustices women experience in pregnancy, childbirth, the postpartum and having a second child. By doing so, it not only resonates with viewers' yearning for recognition and empathy but also stimulates a broader discourse on new and persisting maternal challenges in pronatalist China. I conclude that the genre's contradictory and contingent nature mirrors the complexities of the Chinese party-state's attempt to navigate the ideological instability surrounding maternity and motherhood. The genre is progressive in its alternative imagination of kinship and care networks for women navigating the moral, medical, and cultural dilemmas of the maternal body and motherhood in the moment of the state's transitioning into a more aggressive form of pronatalism.

Vicarious punishment of moral violations in naturalistic drama narratives predicts cortical synchronization.

Punishment of moral norm violators is instrumental for human cooperation. Yet, social and affective neuroscience research has primarily focused on second- and third-party norm enforcement, neglecting the neural architecture underlying observed (vicarious) punishment of moral wrongdoers. We used naturalistic television drama as a sampling space for observing outcomes of morally-relevant behaviors to assess how individuals cognitively process dynamically evolving moral actions and their consequences. Drawing on Affective Disposition Theory, we derived hypotheses linking character morality with viewers' neural processing of characters' rewards and punishments. We used functional magnetic resonance imaging (fMRI) to examine neural responses of 28 female participants while free-viewing 15 short story summary video clips of episodes from a popular US television soap opera. Each summary included a complete narrative structure, fully crossing main character behaviors (moral/immoral) and the consequences (reward/punishment) characters faced for their actions. Narrative engagement was examined via intersubject correlation and representational similarity analysis. Highest cortical synchronization in 9 specifically selected regions previously implicated in processing moral information was observed when characters who act immorally are punished for their actions with participants' empathy as an important moderator. The results advance our understanding of the moral brain and the role of normative considerations and character outcomes in viewers' engagement with popular narratives.

Leadership dynamics in musical groups: Quantifying effects of musical structure on directionality of influence in concert performance videos.

Music ensemble performance provides an ecologically valid context for investigating leadership dynamics in small group interactions. Musical texture, specifically the relative salience of simultaneously sounding ensemble parts, is a feature that can potentially alter leadership dynamics by introducing hierarchical relationships between individual parts. The present study extended previous work on quantifying interpersonal coupling in musical ensembles by examining the relationship between musical texture and leader-follower relations, operationalised as directionality of influence between co-performers' body motion in concert video recordings. It was hypothesised that the directionality of influence, indexed by Granger Causality, would be greater for 'homophonic' textures with a clear distinction between melody and accompaniment parts than for 'polyphonic' textures with less distinction between melody and accompaniment. This hypothesis was tested by using pose estimation algorithms to track instrumentalists' body movements in a string quartet and a clarinet quintet, and then applying Granger Causality analysis to their head motion to estimate directional influence between instrumentalist pairs for sections of the pieces that varied in texture. It was found that Granger Causality values were generally higher (indicating greater directionality of influence) for homophonic than polyphonic textures. Furthermore, considering melody and accompaniment instrument roles revealed more evidence for the melody instrument influencing accompanying instruments than vice versa, plus a high degree of directionality among accompanying instruments, in homophonic textures. These observed patterns of directional information flow in co-performer body motion are consistent with changing leader-follower relations depending on hierarchical relations between ensemble parts in terms of the relative salience of melodic material in the musical texture. The finding that automatic pose estimation can detect modulations of leadership dynamics in standard video recordings under naturalistic performance conditions has implications for investigating interpersonal coordination in large-scale music video datasets representing different cultural traditions, and for exploring nonverbal communication in group activities more generally.

Storylines of family medicine VI: ways of being-in the office with patients.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VI: ways of being-in the office with patients', authors address the following themes: 'Patient-centred care-cultivating deep listening skills', 'Doctor as witness', 'Words matter', 'Understanding others-metaphor and its use in medicine', 'Communicating with patients-making good use of time', 'The patient-centred medical home-aspirations for the future', 'Routine, ceremony or drama?' and 'The life course'. May readers better appreciate the nuances of patient care through these essays.

Empowering students to create their dramatizations increases understanding of physiology.

Complex subjects such as physiology can be challenging for students to learn. These challenges are not uncommon in implementing the learning process in physiology and affect learning outcomes. Dramatization is an interactive and effective method to improve learning outcomes. In a project designed by senior medical students, junior medical students were guided in creating dramatizations related to three topics. Senior students were trained and assisted to prepare scenarios and make videos. The dramatizations were then carried out with junior medical students to help them better understand physiology and pathophysiology topics. A group of junior students receiving the same topics in a lecture format served as a control group. Pretest and posttest questionnaires were used to measure the improvement of learning outcomes. Assessment results showed an increase in performance in both groups. This study shows that dramatizations provide an effective alternative to lectures for instructing junior medical students.NEW & NOTEWORTHY The preparation of dramatizations involved students. The ideas, analogies, and dramatizations were originally from students. Dramatization is an alternative form of understanding learning objectives of medical physiology in an interesting way to increase motivation.