Abstract
Family care is essential to pediatric nursing practice, as the entire family is affected by childhood illness. However, little is known about art making for therapeutic purposes and how art is used to better understand families’ experiences. Our purpose was to examine the nature of arts-based interventions and research methods used with, and the experiences of families of children facing life-limiting and life-threatening illnesses, and those families who are bereaved. Academic peer-reviewed sources published between January 1999 and May 2022 were retrieved via four databases using key search terms. Twenty-five articles were analyzed, resulting in three multifaceted categories including Social, Emotional, and Family Health. Critical strengths and limitations were also identified. Art making has been incorporated into interventions and research studies due to its benefits for family well-being. Understanding the potential of art making can inspire nurses to implement such activities to enhance family nursing practice and research.
Keywords
Many infants, children, and adolescents live with incurable childhood illnesses and disabilities, placing significant care responsibilities on the family (Allshouse et al., 2018; Bally et al., 2021; Whiting, 2014). Life-limiting and life-threatening illnesses (LLIs and LTIs) such as progressive metabolic, neurological, cancer, or chromosomal conditions pose many challenges for children and their families, requiring them to navigate new environments, relationships, fluctuating symptoms, unknown illness trajectories and lifespans, and unpredictable emotional crises (Boss et al., 2020; Chan et al., 2019). Children with LLIs and LTIs and their families benefit from psychosocial support including art making which can improve quality of life (QoL) by supporting adaptation to stressful, traumatic health experiences (Bally et al., 2021; Burles et al., 2022; Derman & Deatrick, 2016; Doherty et al., 2009; Jithoo, 2010; Smith et al., 2018).
Art has been used as both an intervention in health care settings and a research method in data collection and analysis for those wishing to explore complex questions and topics with children and families (Bryan et al., 2019; Cho et al., 2022; Driessnack & Furukawa, 2012; Hyslop et al., 2018). A variety of techniques have been used by art therapists, nurses, and allied health care professionals with a variety of populations impacted by LLIs and LTIs including digital storytelling (Akard et al., 2015; Cho et al., 2022), puppet making (Sposito et al., 2016), photography (Ebrahimpour et al., 2021; Soanes et al., 2009), drawing (Abdulah & Abdulla, 2018; Ångström-Brännström & Norberg, 2014; Vindrola-Padros, 2012), sculpting (Wallace et al., 2014), and painting (Manning et al., 2017; Schaefer et al., 2019). For example, studies have shown that children in treatment for LLIs and LTIs who completed an arts-based intervention or art activities experienced enhanced communication with family (Akard et al., 2015) and health care providers (Ebrahimpour et al., 2021), expression of emotions (Richardson et al., 2000), enhanced coping skills (Cho et al., 2022; Rollins et al., 2020), and reduced adverse side effects (Galvez et al., 2021). Importantly, arts-based activities and interventions have been found to be child- and family-centric with appeal to a variety of ages and developmental stages (Abdulah & Abdulla, 2018; Cho et al., 2022; Woodgate et al., 2014).
Thus, research shows that various art-making activities have been used such as drawing, painting, puppet making, digital storytelling, photography, and sculpting, which are suggested to be healing and improve QoL by supporting the whole family with stressful, traumatic health experiences and drawing on existing strengths. Individual studies illustrate the benefits of arts-based interventions; however, there remains a need to summarize the current literature on arts-based interventions and research methods with children and families in terms of the nature of art making that has been implemented and participants’ experiences. This knowledge can be used by family nurses and other health care practitioners to inform practice and strengthen their ability to provide care for each family member (Wright & Leahey, 2013). Informed family nursing care can facilitate improved health and reduced suffering through recognition of the impacts of illness on the whole family (Knafl et al., 2017; Van Schoors et al., 2018; Wright & Bell, 2021; Wright & Leahey, 2013). Furthermore, this review of existing use of art making can inform future research about arts-based interventions and incorporation of art as a research method.
Method
The purpose of this scoping review was to examine the nature of arts-based interventions and research methods that have been used with, and the experiences of families of children facing LLIs, LTIs, and those families who are bereaved. Such a focus is well-aligned with the broad intent of a scoping review to summarize the existing literature, as we sought to understand participant experiences and the different ways that art making has been incorporated into health care practice and research with this population. We included focus on specific types of art marking and how they have been implemented.
A scoping review was conducted using the five stages outlined by Arksey and O’Malley (2005) including identifying the research question; identifying relevant studies; selecting studies; charting the data; and, collating, summarizing, and reporting the data. In addition, Joanna Briggs Institute (JBI) guidance for conducting scoping reviews was used to support a rigorous review (Peters et al., 2020; Pollock et al., 2022). Scoping reviews are an essential starting point because they summarize and disseminate current information on a topic so that it can be used on a broader scale to inform practice and future research (Arksey & O’Malley, 2005; Munn et al., 2022; Peters et al., 2020; Pollock et al., 2022).
Stage 1: Identifying Research Question
According to Arksey and O’Malley (2005), Stage 1 of a scoping review calls for researchers to define the question they aim to answer. This question sets the parameters for the literature being included in the search; therefore, it is essential to set the question to avoid missing relevant documents (Arksey & O’Malley, 2005). Munn et al. (2022) suggested that the research questions related to scoping reviews “are exploratory in nature and aim to address wide-ranging questions” (p. 951). As such, the research questions used to guide this scoping review were as follows:
Stage 2: Identifying Relevant Studies
Arksey and O’Malley (2005) called for this stage of the literature review to be as extensive as possible to include all relevant sources. Similarly, Munn et al. (2022) and Peters et al. (2020) stated that scoping reviews “draw on research from any research methodology” (p. 2119). To accomplish this task and enhance validity of our methods, an experienced Health Sciences Librarian at the local university was consulted to support the literature search. Four online databases, CINAHL, MEDLINE (Ovid Version), PsycINFO, and Web of Science, were searched for related articles. Keywords including pediatric, children, families, critical illness, palliative, art, and art therapy were used in various configurations, and MeSH and Boolean operators were used to develop a comprehensive search (see Table 1).
Database Search Terms.
and *indicates Boolean operators and MESH terms.
Studies were limited to those that were peer-reviewed; related to children 16 years and under who were in, or have had treatment for an LLI or LTI within the past 5 years, and their family members, or family members who were bereaved; about the use of visual art with children and, or their families; available in full online text format; written in the English language; and published between January 1999 and May 2022. For the purposes of this review, the definition of visual art was intentionally broad, encompassing art-making activities that involved creation of tangible artistic products with art materials (e.g., pencils, paints, clay, puppets) or technology-supported still or moving images (e.g., camera, computer). Articles were excluded if they included nonvisual forms of art such as play therapy, interpretive dance, singing, and performative art, or a mix of nonvisual forms of art with visual art. In addition, articles were excluded if the pediatric population being assessed were not facing LLIs, LTIs, had received treatment greater than five years ago, or focused on children above the age of 16 years.
Stage 3: Selecting Studies
A search of the relevant literature was conducted between January and April 2021 and updated in May 2022 and a total of 1,083 articles were identified as possible resources. Two authors (JMGB, JM) independently applied the study inclusion and exclusion criteria in the first stage of selecting studies by examining the title of each article. After removing duplicates and those articles that did not fit the inclusion and exclusion criteria, 716 articles remained. The next round of screening included application of the inclusion and exclusion criteria to the title and abstract of each article by two authors (JMGB, JM). At this point, articles that did not report research or include children who were 16 years of age or younger, or those based on nonvisual and performative art, were eliminated, leaving 35 articles. Subsequently, a third round of screening by all authors resulted in the exclusion of 10 more articles (see Figure 1). Disagreements were brought to all authors for discussion and decision-making regarding fit with inclusion and exclusion criteria and relevance to the guiding research questions. For instance, one article (Rollins et al., 2020) reported on art made for children, as opposed to art made by a child or their family member; the co-authors discussed this article and determined that it fell within the scope of the inclusion criteria and offered a varied approach compared with other articles.
PRISMA Diagram.
Stage 4: Charting the Data
There were 25 articles that fit the inclusion criteria and were included in this scoping review. In this stage of the review, important details were extracted and organized into a Pinch Table (Pinch, 1995), which aimed to summarize details related to the source, purpose/problem, sample, type of art making, design/methodology, findings, and implications in a clear and concise manner (Pinch, 1995) (see Table 2). Charting the data leads researchers to analyze and sort the data according to commonalities and key ideas which can be used to identify gaps in the literature, inform practice, and guide future research (Munn et al., 2022; Peters et al., 2020).
Pinch Table of Included Articles.
Note. QoL = quality of life; PedsQL = Pediatric Quality of Life Inventory; HFD = Human Figure Drawing; RCMAS = Revised Children’s Manifest Anxiety Scale; K-CBCL = K-Child Behavior Checklist; KFD-R = Kinetic Family Drawing–Revised; FEATS = Formal Elements Art Therapy Scale; HSCT = hematopoietic stem cell transplantation.
KIDSCREEN-10 Index Health Questionnaire for Children and Young People (KIDSCREEN-10; Erhart, et al., 2009). bPediatric Quality of Life Inventory (PedsQL; Varni et al., 2001). cDrawing-And-Story-Procedure (D-S; Trinca, 1997). dHuman Figure Drawing Test (HFD; Koppitz, 1968). eResponse to Stress Questionnaire (RSQ; Connor-Smith et al., 2000). fSelf-Esteem Inventory (Choi & Jeon, 1993). gRevised Children’s Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1979). hDraw-A-Story Test (DAS; Silver, 1993). iK-Child Behavior Checklist (K-CBCL; Oh et al., 1997). jKinetic Family Drawing–Revised (KFD-R; Spinetta et al., 1981). kPedsQL Present Functioning Visual Analog Scales (PedsQLVAS; Sherman et al., 2006). lFormal Elements Art Therapy Scale (FEATS; Gantt & Tabone, 1998). mBrief Symptom Inventory-18 (BSI-18; Derogatis, 2001). nProlonged Grief Disorder -13 (Prigerson & MaCiejewski, 2006). oRevised Children’s Manifest Anxiety Scale–Second Edition (RCMAS-2; Reynolds & Richmond, 2008). pUCLA PTSD Index for DSM-IV (UPID; Pynoos et al., 1998). qPiers-Harris Children’s Self-Concept Scale–Second Edition (Piers-Harris 2; Piers et al., 2002). rMcMaster Family Assessment Device (Epstein et al., 1983). sMcMaster Family Assessment Devices which is explained below the table.
Stage 5: Collating, Summarizing, and Reporting the Data
In addition to presenting extracted details about each article, scoping reviews are used to highlight evidence and key characteristics present in the current literature to provide a rich descriptive account of what is known about a topic (Peters et al., 2020; Pollock et al., 2022). Thus, Elo and Kyngäs’s (2008) inductive content analysis was used to “attain a condensed and broad description of the phenomenon” (p. 108) taken from both the qualitative and quantitative research included in this scoping review. This approach to content analysis includes three phases. (a) In the Preparation Phase, all authors discussed and determined that an inductive analysis was necessary given limited knowledge about the nature of arts-based interventions and research methods that have been used with families of children facing LLIs, LTIs, and those families who are bereaved. Furthermore, knowledge from the 25 articles was considered to be fragmented, making an inductive analysis the most suitable option (Elo & Kyngäs, 2008; Lauri & Kyngäs, 2005). During this stage, the authors were guided by Graneheim and Lundman (2004) in choosing whole articles (i.e., study purpose, research questions, findings, study strengths and limitations, study implications, and conclusions) as the units of analysis for this scoping review. (b) During the Organizing Phase, the authors (JMGB, JM, MB) engaged in organizing the data through open coding, creating categories, and abstraction (Elo & Kyngäs, 2008). Open coding included independently reading each article several times, making notes in the margins, and creating headings within each of the articles to describe the content. Subsequently, the headings from each article were transferred to coding sheets. At this time, the authors (JMGB, JM, MB) came together to discuss the coding sheets and reached agreement about those that were fitting and representative of the content found in each article. Together, the authors categorized the coding sheets by comparing and contrasting data, and shifting the data into broader, higher order categories (Elo and Kyngäs, 2008). Last, abstraction was completed by all authors who met frequently to determine similarities among categories and place them in subcategories. The subcategories were compared and contrasted, and those that belonged together were amalgamated into generic categories and, finally, into three main multifaceted categories including Social Health, Emotional Health, and Family Health. (c) The Reporting the Analyzing Process and the Results phase involved presentation of the findings in textual and visual form.
Findings
Characteristics of the Studies
Of the 25 articles included in this scoping review, 13 studies were undertaken by registered nurses, five were carried out by teams from varied disciplines including nurses, academic health researchers, anthropologists, artists, art therapists, nutritionists, occupational therapists, pharmacists, physicians, and psychologists, and seven studies were completed by other disciplines (i.e., physicians, anthropologist, psychologists). A significant number of the studies were undertaken in the United States (n = 10); however, there was global implementation of arts-based research and use in health care from countries including Iraq (n = 1), Sweden (n = 2), Brazil (n = 2), South Africa (n = 1), the United Kingdom (n = 4), Iran (n = 1), Philippines (n = 1), Canada (n = 2), Korea (n = 1), and Italy (n = 1). The studies were predominantly undertaken using qualitative methodologies (n = 16), with fewer using quantitative designs (n = 8), and mixed methods (n = 1). Twenty-one of the studies focused on pediatric populations that were impacted by childhood cancers (n = 21), while the others included pediatric palliative diagnoses (n = 1), critical illnesses (n = 1), chronic illnesses (n = 1), and those children who were receiving stem cell treatment for a variety of health conditions (n = 1). Interestingly, the samples largely comprised children only (n = 16); with fewer focusing on the child and family (n = 2); samples wherein children, the parent, and the family were addressed separately (n = 2); siblings of the child (n = 2); parent–child dyads (n = 1); the siblings along with the parents of the child (n = 1); and only one study focused on a family in bereavement, while a second study had a mix of bereaved and nonbereaved families (n = 1).
In the 25 sources, art was most often incorporated as a research method (n = 16). Specifically, arts-based activities were included as a data collection tool using drawings (n = 8); photos (n = 1); photos and drawings (n = 1); photos, drawings, painting, collage, writing, objects (n = 2); making and using puppets (n = 1); and a digital drawing/journaling tool (n = 1). Seven studies used art as an intervention including handcrafting and painting (n = 1); legacy making through painting (n = 1); digital story making through photos, videos, and music (n = 2); drawing (n = 1); a professional artist’s art work (n = 1); and painting (feeling mandala art activity), family drawings, and clay and markers (animal metaphor art activity) (n = 1). In one study, art making was used as both an intervention and assessment tool (n = 1), and in another study as an assessment tool to explore the emotional well-being of children through the use of the Human Figure Drawing (HFD) technique (n = 1). Art has also been used to measure effectiveness of a camp intervention via the HFD (Koppitz, 1968) and Kinetic Family Drawing–Revised (KDF-R; Spinetta et al., 1981) (n = 1), and to assess the best tools to support child–health care practitioner interactions (observation, paper–person activity, a “Draw and Write” technique, stickers, interviews) (n = 1) (see Table 2).
Nature and Experiences of Arts-Based Interventions and Research Methods
Using Elo and Kyngäs’s (2008) inductive content analysis, three main, multifaceted categories were developed which summarized the findings from all articles included in this scoping review and included the following: Social Health (Communication, Context), Emotional Health (Feelings, Coping), and Family Health (Relationships, Reorganization) (see Figure 2). Through the presentation of these main categories, we addressed the research questions which were developed to explore art-making interventions and research methods used with, and the experiences of children aged 16 years or below who are in treatment for LLIs and LTIs, or their families and with those families who are bereaved.
Model of Multifaceted Main Categories as Represented by Number of Articles.
Social Health
Pediatric LLIs and LTIs are often viewed as occurring outside the typical expectations and hopes for a child’s life and have been labeled as “a family’s worst nightmare.” Coming to terms with the child’s diagnosis of an LLI or LTI, treatment regime, and hospitalizations can be stressful for any patient and family, yet for pediatric patients, there is the added fear of strangers, being away from home, invasive tests, and possible separation from family, friends, and school. Hence, effective communication and considering the child and families’ social context are among the most important elements of family nursing practice.
Communication
Articulating needs for children and adolescents with cancer can be overwhelming as understanding and verbalization of these complex ideas and experiences may not yet be well-developed (Woodgate et al., 2014). This is also true of younger children with cancer who are attempting to explain the symptoms they are experiencing in a meaningful way (Ångström-Brännström et al., 2013; Gibson et al., 2012; Hyslop et al., 2018; Linder et al., 2018; Rollins, 2005). Given feelings of uncertainty and guilt (Arruda-Colli et al., 2015), discomfort (Ångström-Brännström & Norberg, 2014), and overwhelm and confusion (Soanes et al., 2009), children and families wish to be kept informed about what is happening and what is going to happen during treatment and while hospitalized (Ångström-Brännström & Norberg, 2014; Arruda-Colli et al., 2015; Soanes et al., 2009). However, some families indicated that their communication and information needs were not being met (Soanes et al., 2009; Vindrola-Padros, 2012). For example, the amount and level of information was sometimes lacking or overwhelming and confusing, and delivered to children in the same way it was delivered to their parents (Soanes et al., 2009). Conversely, some children and families found that meaningful relationships with health care providers lent to helpful experiences as recorded in their drawings (Woodgate et al., 2014). Generally, it appeared that improving communication to support enhanced understanding for children and their families was essential (Hyslop et al., 2018) and, importantly, arts-based activities and interventions effectively supported this endeavor (Abdulah & Abdulla, 2018; Akard et al., 2015; Ångström-Brännström et al., 2013; Ångström-Brännström & Norberg, 2014; Brits, 2018; Ebrahimpour et al., 2021; Galvez et al., 2021; Linder et al., 2018; Manning et al., 2017; Massimo & Zarri, 2006; Packman et al., 2008; Rollins, 2005; Soanes et al., 2009; Sposito et al., 2016; Woodgate et al., 2014).
Specifically, in their study in which drawings were used to enhance data collection, Ångström-Brännström et al. (2013) reported that drawing aided a Swedish 9-year-old patient with advanced cancer in communicating with researchers and family about their experiences with comfort and discomfort following cancer relapse. This young patient used drawings of a dragon as a metaphor for their diagnosis, often using them to explain their experiences to the nurse and family members (Ångström-Brännström et al., 2013). Similarly, Brits (2018) sought to evaluate whether the HFD tool (Koppitz, 1968) could be used to evaluate emotional well-being of African school-aged children in palliative care. The author found that drawing improved communication of the needs of African school-aged children in palliative care to their providers and families which is significant because communication is deemed to be the cornerstone of palliative care (Brits, 2018). The pictures acted as a starting point for discussing emotions and other challenges the children were facing (Brits, 2018). Brits (2018) also found that HFDs (Koppitz, 1968) were helpful in screening for depression in children in this setting.
In addition, Gibson et al. (2012) explored the experiences of children (aged 4–12 years) undergoing chemotherapy and their families in the United Kingdom using photographs and drawings as a data collection method, also finding that improved communication resulted from the incorporation of drawings. For instance, pediatric cancer patients experiencing nutritional challenges during chemotherapy were able to convey their preferences through artistic depiction of favorite food items, problematic foods, and the creation of a dream menu. Drawing was also effectively used as a data collection method to improve communication and express feelings in research by Hyslop et al. (2018) with patients 4 to 7 years of age facing cancer treatment in Canada. Similarly, Linder et al. (2018) found drawings to be an effective research method for data collection in cancer patients aged 6 to 12 years living in the United States to explain the symptoms they were experiencing. In addition, Packman et al. (2008) highlighted the benefit of using the HFD (Koppitz, 1968) and the KDF-R (Spinetta et al., 1981) to evaluate a special camp intervention with the siblings of pediatric patients facing LLI/LTIs. The siblings were able to communicate their emotions and needs as they utilized HFD (Koppitz, 1968), showing significant reductions in emotional distress, and a decrease in family stress arose from using the KDF-R (Spinetta et al., 1981).
Along with drawing, other authors reported that a variety of arts-based activities supported communication. For example, Sposito et al. (2016) had patients create puppets as a means of data collection, asking children to represent themselves and then comment or use them to act out different scenarios. Ultimately, this gave patients a surrogate for portraying their complex emotions to the researchers and their families (Sposito et al., 2016). Other authors used a variety of art activities depending on participant choice and developmental stage including clay animal making (Wallace et al., 2014), crafts (Gibson et al., 2012), collage (Manning et al., 2017), computerized diary and drawing tool (Woodgate et al., 2014), diaries (Gibson et al., 2012), digital stories (Akard et al., 2015; Cho et al., 2022), painting (Manning et al., 2017; Schaefer et al., 2019), photographs (Ebrahimpour et al., 2021; Gibson et al., 2012; Manning et al., 2017; Soanes et al., 2009), scrapbooks (Gibson et al., 2012), stickers (Bryan et al., 2019), and, in one case, participants were presented with art made especially for them (Rollins et al., 2020).
The aforementioned research provides evidence that arts-based activities are an effective data collection strategy that contribute to children’s willingness and ability to share their experiences, and various arts-based activities and interventions can aid in this important aspect of patient and family care (Abdulah & Abdulla, 2018; Akard et al., 2015; Ångström-Brännström et al., 2013, 2014; Brits, 2018; Ebrahimpour et al., 2021; Galvez et al., 2021; Linder et al., 2018; Manning et al., 2017; Massimo & Zarri, 2006; Packman et al., 2008; Rollins, 2005; Soanes et al., 2009; Sposito et al., 2016; Woodgate et al., 2014).
Context
Children who are in treatment for LLIs and LTIs and their families face tremendous upheaval in their social contexts including those related to the environments in which they live and engage with health care, their peer groups, and school. Our analysis of studies in this review revealed that children and their families had to navigate new hospital and clinic settings, new health care providers, and different treatments (Manning et al., 2017; Soanes et al., 2009; Woodgate et al., 2014). In turn, this was often detrimental to normal growth and development of children but also of families (Abdulah & Abdulla, 2018; Akard et al., 2015; Ebrahimpour et al., 2021; Woodgate et al., 2014). For instance, Ebrahimpour et al. (2021) conducted a study with 20 Iranian children aged 6 to 12 years in treatment for a variety of cancer diagnoses, and found that the children were often bored, felt like they were caged in hospital and separated from their family members, friends, and school. However, using Photovoice as a means of data collection enabled children to capture pictures of the playroom, plants, paintings on the walls, and of walks outside, representing feelings of liberation, hope, normality, and a sense of calm (Ebrahimpour et al., 2021).
Similarly, in two additional studies, children with cancer diagnoses used both “draw and write” techniques (Galvez, et al., 2021) and journaling using a computerized drawing tool (Woodgate et al., 2014) as data collection methods to explore how children found an escape from the walls of the hospital and cancer. Specifically, Galvez et al. (2021) were able to explore children’s lifeworlds at home in the Philippines, among peers, and in hospital where they experienced difficulties in balancing their physical and emotional health. Hospitalizations were fraught with pain and other challenges but the children were able to meet these challenges with their own strength, the support from family and friends, and knowing they would eventually get back to school and home (Galvez et al., 2021). The study conducted by Ångström-Brännström et al. (2013) also emphasized the importance of “home” in their study. Specifically, “Victor” did not like being in hospital and, through his drawings, shared that home was the place in which he was happiest. His mum stated that when Victor was home, “a sense of peace descended over our lives” (p. 468). In addition, with reference to a return home, the children who participated in the study conducted by Woodgate et al. (2014) documented their feelings of living in an “existential vacuum” (p. 151). Through digital journaling, participants described feelings of loneliness, sadness, and wishes for an existence that included an end to treatment and a return to school, their peers, and home. The children shared drawings of a tear-streaked face, a girl in a jail cell representing the hospital, and a child standing looking at their home with the caption, “home sweet home” (p. 153) in which an 11-year-old boy longed for their cancer to be gone so that they could return to normal things such as school, studying, and special activities. Woodgate et al. (2014) concluded that the use of the digital drawing tool supported the children with making meaning of their experiences by using their imaginations to explore their feelings.
For children undergoing cancer treatment, engaging in painting and handcrafting as an arts-based intervention to improve QoL resulted in increased social activity participation (p = .016), more social relationships (p = .047), and enhanced overall health when compared with the nonexperimental group (p < .001) (Abdulah & Abdulla, 2018). Many of the children in the study worried about missing school, getting behind in school, and losing opportunities to spend time participating in school activities with peers which was depicted in drawings of children lying in bed, feeling sick, and dreaming of such activities (Abdulah & Abdulla, 2018; Linder et al., 2018; Rollins, 2005; Vindrola-Padros, 2012; Woodgate et al., 2014). Thus, the use of arts-based activities and interventions supported communication with health care providers, researchers, and families, along with sharing and, at times, making meaning of their social contexts, experiences, and hopes and dreams for healing, recovery, QoL, and comfort (Abdulah & Abdulla, 2018; Akard et al., 2015; Arruda-Colli et al., 2015; Ångström-Brännström et al., 2013; Ångström-Brännström & Norberg, 2014; Brits, 2018; Bryan et al., 2019; Cho et al., 2022; Ebrahimpour et al., 2021; Galvez et al., 2021; Hyslop et al., 2018; Jo et al., 2018; Linder et al., 2018; Manning et al., 2017; Massimo & Zarri, 2006; Packman et al., 2008; Rollins, 2005; Rollins et al., 2020; Schaefer et al., 2019; Soanes et al., 2009; Sposito et al., 2016; Wallace et al., 2014; Woodgate et al., 2014).
Emotional Health
The children and families included as participants in the studies related numerous emotional experiences including stress (Abdulah & Abdulla, 2018; Cho et al., 2022; Wallace et al., 2014), anxiety (Manning et al., 2017; Packman et al., 2008; Woodgate et al., 2014), and grief (Schaefer et al., 2019); however, positivity and hope (Ebrahimpour et al., 2021; Galvez et al., 2021; Jo et al., 2018; Manning et al., 2017; Massimo & Zarri, 2006; Rollins et al., 2020; Woodgate et al., 2014) were commonplace yet complex and often difficult to navigate. As such, art played a role in navigating complex emotions.
Feelings
The emotional toll that hospitalization can take on a child and their family can cause lasting effects on psychological well-being (Manning et al., 2017). Having an emotional outlet for patients and their families was invaluable. Arts-based interventions and research methods were described as giving patients a means to focus, share, and understand their feelings. For example, using the KIDSCREEN-10 Index Questionnaire for Children and Young People (Erhart et al., 2009), Abdulah and Abdulla (2018) found that Iraqi children and their parents who participated in art therapy sessions involving painting and crafts were less depressed and emotional, and had less stressful feelings than the control group (p = .004). Similarly, Akard et al. (2015) reported the art component of their legacy-making intervention was promising in supporting emotional aspects of children’s experiences. Ångström-Brännström et al. (2013) found that Victor and his family viewed his drawings of the dragon as an emotional outlet for him to express the complex feelings he was enduring, especially when faced with his own mortality at such a young age. Arruda-Colli et al. (2015) also found that drawing and digital storytelling were important methods of data collection and an emotional outlet for Brazilian children aged 5 to 12 years with a recurrent cancer diagnosis because it provided them with a feeling of control over their own story.
Arts-based interventions have also been used to assess the emotional well-being of patients while in care. For example, Brits (2018) used children’s drawings to create conversation and assess for signs of emotional distress through applying qualitative evaluation methods to the drawings completed by the children. In this study, 20 children drew pictures of cars, a hospital with an ambulance in front of it, and themselves. The author and someone trained in evaluation assessed the pictures for use of colors, content, the size of objects in the drawing, and applied the Emotional Indicator scale to evaluate the pictures (Skybo et al., 2007). Through this process, 12 of the children in this study were assessed as having clinical depression and appropriate follow-up was provided. In their study, Hyslop et al. (2018) highlighted that the young Canadian participants interviewed were able to draw themselves on “bad days” to explain to those around them what was bothering them. Similarly, Linder et al. (2018) found that children with cancer in the United States who were interviewed using “Draw and Tell” techniques could share their most commonly experienced symptoms including sadness, frustration, fear, irritability, and anger, along with strategies to self-manage their symptoms. In addition, Manning et al. (2017) found the use of art making as a research method was helpful for participants aged 6 to 15 years in the United Kingdom to deal with the trauma of being admitted to pediatric intensive care because it presented them with an outlet for anxiety, sadness, and fear of being stigmatized. It gave these young patients a way to express their complex feelings and traumatizing experiences. Similarly, Woodgate et al. (2014) highlighted drawings as an important emotional outlet for the patients in their study as they were able to assess the existential challenges facing pediatric cancer patients.
While several difficult feelings exist for children and families impacted by LLIs and LTIs, arts-based research supported exploration of, and a focus on other feelings including happiness, hope, and positivity. For example, Ebrahimpour et al. (2021) found that children’s use of Photovoice revealed evidence that children were hopeful about their future while hospitalized for cancer treatment through pictures of nursing staff, the playroom, their parents, and nature. Using the “Draw and Write” technique, Galvez et al. (2021) suggested that children with cancer lived in a world of negative experiences while also hoping for a better life. For example, through one child’s drawing of their home, friends, school, and family, this participant was hopeful for recovery and, given their hopefulness, able to look to the future. Also with a focus on the future, Manning et al. (2017) used arts-based research techniques with children following critical illness/injury including photographs, paintings, objects, collage, and drawings, finding that survival was dynamic and complex. Hope was found to be important and rooted in the future and return to normalcy. Similarly, Woodgate et al. (2014) reported that the digital journaling and drawings created by the participants showed that, although profoundly impacted by fears and worry, they were hopeful for recovery from cancer; for these children, hope became a “new feeling state” (Woodgate et al., 2014, p. 156). In addition, Rollins et al. (2020) shared imagery related to hope created by an artist as an intervention to evaluate the effect on the child’s heart rate and QoL. The participants who were living with chronic illness were prompted to share their thoughts about the struggles associated with childhood illness, but also shared thoughts of beauty, aspirations, and dreams that were part of their hopeful illness experience (Rollins et al., 2020).
Siblings of children with serious illnesses have also been included in art interventions, as they are significantly impacted by the life and family changes that result from diagnosis and treatment (Jo et al., 2018; Packman et al., 2008). Through the use of an Art Intervention Program, Korean siblings of children with cancer were engaged in drawing activities (Jo et al., 2018) which resulted in improvements in self-esteem, anxiety, depression, and problem behaviors. Specifically, emotional instability measured by the K-Child Behavior Checklist (K-CBCL) scale (Oh et al., 1997) was reduced postintervention (46.65 vs. 43.88; p = .022). The authors suggested that the reduction in emotional instability was due to expression of emotions through participation in the art intervention program. Similarly, drawings were used to explore the impact of attending a camp on the psychosocial functioning of both bereaved and nonbereaved siblings and parents of children with cancer in the United States (Packman et al., 2008). Both qualitative and quantitative measurements pre- and postcamp intervention were used to assess the HFD (Koppitz, 1968) as an indicator of emotional distress, and the KFD-R (Spinetta et al., 1981) was implemented with both parents and siblings to measure family distress. The pre- and postcamp scores using the HFD with siblings showed a significant decrease in the emotional indicators (EI) (t72 = 4.85, p = .00) and family distress (siblings t57 = 2.96, p = .00; parents t54 = 2.38, p = .02).
Coping
Research has demonstrated that the use of arts-based interventions and research methods can support coping in children and families throughout illness experiences. For example, Akard et al. (2015) found that the parents of children with cancer viewed their child’s digital story as a coping strategy, supporting adjustment during their child’s illness. Legacy making also helped their child cope, as parents felt their children were feeling better physically, spiritually, emotionally, and socially. In fact, parents in this study felt that the legacy-making intervention would benefit other families, endorsing its supportive nature. In another study, children graphically represented their perception that illness was a threat, but also explored ways to ensure “protection” including using their own thoughts, along with family and peer support (Arruda-Colli et al., 2015). Similarly, Cho et al. (2022) explored the impact of a digital storytelling legacy intervention in 97 children–parent dyads in the United States with recurrent/refractory cancer on adaptive coping. The authors concluded that the legacy intervention may have the potential to support healthy coping when in uncertain and stressful times for children diagnosed with recurrent/refractory cancer.
In the study by Galvez et al. (2021), participants described the hospital as the new focus of their lives and shared drawings of the things that helped with remaining hopeful and thinking positively to cope with their cancer experiences. The children drew pictures representing families, technology, and virtual support from their peers, school, and their faith which were described as things that brought back a sense of balance in their lives and helped with coping. Similarly, one of the main themes in the research conducted by Rollins et al. (2020) was “I have found ways to Cope” (p. 2225). Through data collection methods including painting, print images, interviews, and observations, it was determined that the children used various strategies to cope with their uncertain and stressful circumstances such as nature, a positive attitude, keeping a focus, and drawing superheroes which all helped with distraction and normalizing their experiences. Similarly, children with cancer from the United Kingdom and the United States seemed to respond to their experiences in a similar manner and saw themselves as resourceful even when depressed and fatigued. The authors contended that through grounded theory interviews and the use of drawing, children in this study were able to communicate how they faced their thoughts, emotions or their perceived stressors and, as such, participated in engagement coping (Rollins, 2005).
Family Health
Given the significant lack of control (Arruda-Colli et al., 2015) and social isolation (Soanes et al., 2009; Vindrola-Padros, 2012) that families face when a child is in treatment for an LLI or LTI, arts-based activities that include all family members along with children impacted by illness were deemed important as part of supportive family nursing care. Such interventions were largely effective in exploring children’s, parents’, and siblings’ experiences including those that impacted family relationships and family reorganization (Arruda-Colli et al., 2015; Ångström-Brännström et al., 2013; Ångström-Brännström & Norberg, 2014; Ebrahimpour et al., 2021; Galvez et al., 2021; Gibson et al., 2012; Linder et al., 2018; Packman et al., 2008; Rollins et al., 2020; Soanes et al., 2009; Vindrola-Padros, 2012; Wallace et al., 2014; Woodgate et al., 2014).
Relationships
When a child was in treatment for LLIs and LTIs, they sought support from those closest to them including parents, siblings, aunts, and grandparents. For example, in the study by Ångström-Brännström and Norberg (2014), children looked to their parents, aunts, and grandparents for comfort, distraction, and security. For example, through a drawing used as a data collection method, a 4-year-old child depicted herself in a separate room in isolation with her parents outside the room but close by, and another child who was 6 years old drew a picture with their aunt and their aunt’s children outside a house. The child felt happy and comforted by visits from their aunt. In the study by Galvez et al. (2021), children with advanced cancer articulated, through drawing, that grandparents were supportive and, for one boy, the base from which they could fight their cancer. Furthermore, Galvez et al. (2021) used aesthetic expression to develop a deep understanding about children’s ability to manage pain, and the struggles and the limitations imposed by hospitalization and illness with the support of their families. Similarly, the children hospitalized on a pediatric oncology unit shared photographs of their parents (typically mothers) who they felt offered reassurance, kindness, and goodness, helping to reduce some of their worries and provided hope for a quick recovery (Ebrahimpour et al., 2021). Rollins et al. (2020) demonstrated the importance of family to children with chronic medical conditions in which one boy felt surrounded by his supportive family, particularly his mom who he felt was his hero. Importantly, all the children in this research felt that they had relationships with their families that provided strength (Rollins et al., 2020). Furthermore, in another study, through his drawings, Victor was able to relate what was most important: Having his mom and dad close, just being with him.
Beyond their own illness, many children were concerned about their parents because of the constant worry (Ångström-Brännström & Norberg, 2014). Arruda-Colli et al. (2015) found that the children facing recurrence of cancer shared their worries about their family members through symbols that represented their experiences including stormy weather and threatening situations. While these children appreciated the supportive role of their family, they also recognized the strength required to care for them, and that their families also needed care and protection. Woodgate et al. (2014) echoed the same sentiment by sharing children’s existential worries about the burden of their cancer on their siblings and parents. With significant sadness, these children acknowledged the impact on family independence and autonomy, and did not want to cause any more pain (Woodgate et al., 2014).
Arts-based interventions were also found to be effective in supporting family functioning and relationships. For example, Akard et al. (2015) focused on legacy digital media projects created by pediatric cancer patients in palliative care and indicated that they fostered bonding experiences for families and a lasting memory. Packman et al. (2008, p. 46) used drawing tools (HFD and KFD-R) to measure aspects of family and distress and found that the siblings of children with cancer showed a significant improvement in perceptions of their family environment (t15 = 3.14, p = .00) after attending a special camp. As well, family distress was reduced for bereaved families postcamp (siblings t57 = 2.96, p = .00; parents t54 = 2.38, p = .02).
Reorganization
Family life was often changed given the need to reorganize the way in which they lived their lives which was commonly highlighted in art making in existing research. For example, Soanes et al. (2009) identified this theme in research using a variety of art-making activities as data collection methods; specifically, the researchers found that at least one parent in families with children in treatment for brain tumors had stopped working or lessened their hours of work to care for their child full-time. Furthermore, Soanes et al. (2009) found that there was significant separation of siblings given hospitalizations and impact on the life of the well sibling. In another study, children were saddened when their family underwent reorganization given childhood illness; specifically, when parents could not be with them and when separated from their other family members (Glavez et al., 2021). For example, one young boy drew his mom because it saddened him to be separated from her (Glavez et al., 2021). Ångström-Brännström and Norberg (2014) found that children in hospital longed for their parents who were often home with the child’s siblings.
However, siblings also felt the effects of the changes within the family. For example, in an interventional study seeking to measure psychosocial changes in siblings of children needed a hematopoietic stem cell transplantation, art-making sessions were provided for all participants including painting a feeling mandala, creating family drawings, and discussing an animal metaphor (Wallace et al., 2014). In this study, it was found that some siblings felt more alone as their parents spent more time in the hospital and one child shared that this required more independence at home, which was not easy; the child shared a picture of tears, an aching heart, and emptiness marking thoughts of life being unfair (Wallace et al., 2014). Uniquely, in one study, through the use of visual storytelling techniques, parents revealed that they took on new roles while their child was receiving chemotherapy including that of “tempter and provider” (Gibson et al., 2012, p. 269) which involved going to extremes trying to find food that their child would eat, often at great financial expense. This new role was often demanding, exhausting, and stressful (Gibson et al., 2012).
Similarly, Arruda-Colli et al. (2015) found that parents were often separated from their family members to care for the hospitalized child, sometimes having to relocate to other cities for health care. While the physical distance and financial burden were difficult, these parents found spousal support to be helpful both emotionally and for the shared responsibilities. Through the use of interviews and drawings as data collection methods, Vindrola-Padros (2012) also made similar conclusion in their study with children with cancer and their families in Argentina. This author found that families often had to travel for care, sometimes visiting several care facilities before a diagnosis was made and treatment initiated. Parents experienced loss of employment, incurred significant expenses, siblings’ education was interrupted, and it was often difficult to find a place to reside during treatment. These challenges were seen as difficult as the treatment for cancer (Vindrola-Padros, 2012).
Discussion and Implications
This scoping review included data from 25 studies that investigated the use and experiences of arts-based interventions and research methods with children impacted by diverse LLIs/LTIs and their families. Analysis revealed that the studies were conducted by varied health care practitioners and researchers, using diverse methodological approaches (qualitative, quantitative, and mixed methods), and in countries across the globe. However, key findings arising from analysis included the dimensions of social, emotional, and family health which were illuminated through arts-based interventions and research methods. Specifically, the review highlighted many potential beneficial outcomes that art making can provide families including possible improved Social Health—Supporting communication among family members and with health care providers; Emotional Health—Expressing complex feelings, and enhanced coping and support discussion of coping strategies; and Family Health—Demonstrating importance of family relationships and support, and articulating the impact of reorganization of family relationships and roles (Abdulah & Abdulla, 2018; Ångström-Brännström et al., 2013; Jo et al., 2018; Rollins et al., 2020). However, there were also limitations of arts-based interventions and research methods used with families of children aged 16 years or below who are in treatment for LLIs and LTIs, or for their families who are bereaved. Thus, it is critical to understand the strengths of using arts-based interventions and research methods, as well as the limitations and important considerations for minimizing or even mitigating the potential drawbacks.
Strengths of Arts-Based Interventions and Research Methods
The incorporation of art into nursing practice and research can expand the Social Health of children and their families. Specifically, the communicative possibilities for children, siblings, and parents included an enhanced ability to express symptoms for the ill child and the needs of all family members. For instance, in the study by Hyslop et al. (2018), children as young as 4 years old were able to express their feelings more descriptively when drawing, offering insight into how they conceptualize their health. As well, age-appropriate arts-based research methods improved communication about symptoms (Linder et al., 2018), experiences, anxieties, and feelings (Massimo & Zarri, 2006). Thus, art interventions may enhance communication between ill children and their caregivers, helping to make patients to feel understood and have more in-depth care for symptoms that might otherwise have gone unexplained (Brits, 2018; Hyslop et al., 2018).
Furthermore, art activities (e.g., “draw and write” techniques) introduced opportunities for reflection that may lead to new understandings and self-awareness (Rollins, 2005). Similarly, digital journaling stimulated active engagement of children’s imaginations, creating significant therapeutic value for assisting children with cancer to explore, understand, and manage physical suffering and the associated anxiety they live with (Woodgate et al., 2014). Generally, it appears that art making can positively effect communication between children and their family members, and with health care professionals which may lead to enhanced outcomes including softening of suffering for the family (Abdulah & Abdulla, 2018; Akard et al., 2015; Ångström-Brännström et al., 2013; Ångström-Brännström & Norberg, 2014; Arruda-Colli et al., 2015; Ebrahimpour et al., 2021; Gibson et al., 2012; Glavez et al., 2021; Manning et al., 2017; Soanes et al., 2009; Woodgate et al., 2014; Wright & Bell, 2021). As such, it is important for family nurses and allied health care providers to ensure that the family is fully supported through consideration of all dimensions of health and well-being including the social dimension.
The cumulative effects of engaging in arts-based research methods and interventions may lead to greater Emotional Health in pediatric patients and their family members. Arts-based interventions offer an emotional outlet that these populations might not have otherwise, making emotions more explainable (Ångström-Brännström et al., 2013; Brits, 2018). These interventions offer the possibility for families to tell their own story in their own way, which, in turn, is seen as empowering (Arruda-Colli et al., 2015; Manning et al., 2017). The legacy and positive impact that art interventions have on the emotional well-being of those going through bereavement after the passing of a pediatric patient is also essential to highlight (Akard et al., 2015). Specifically, the completion of arts-based legacies leaves participants with a tangible product and memory that were seen as especially important for siblings and parents of children who were terminally ill given the potential to improve bereavement (Rollins, 2005; Schaefer et al., 2019).
Arts-based interventions completed by children and their siblings and parents may also benefit Family Health. Parents and children can work on art projects together, providing a way to spend time together that is not illness-focused or overly structured (Bultas et al., 2017). In addition, children can feel like they are being heard and understood when using art as a communicative tool, which can strengthen relationships with those providing care (Hyslop et al., 2018; Linder et al., 2018; Sposito et al., 2016). Feeling heard can also make a child and their family members feel more autonomous and confident in their care, thus promoting self-efficacy and greater engagement in health care activities (Bryan et al., 2019; Sposito et al., 2016).
Along with revealing aspects of children and families’ experiences with LLIs and LTIs, the literature reviewed offers new and important insights into the use of arts-based research methods. A wide variety of art techniques and approaches were used including traditional forms of art like drawing and technology-supported art making like photography and digital storytelling. Furthermore, arts-based methods have often been used in conjunction with other methods like interviewing, seeking to complement and expand what is learned about children and families’ experiences with LLIs and LTIs (Vindrola-Padros, 2012). Similarly, an array of art activities have been used as interventions, with varying outcomes being reported in the studies reviewed. While art making has been found to have benefits to pediatric populations, this review identifies insights related to specific arts-based methods or interventions to inform future efforts. For instance, an important strength of art interventions such as drawing, puppet making, painting, and sculpting is that each activity can be low cost and easily implemented at any point throughout treatment and carried on through the course of a hospital stay and into the future (Rollins, 2005). Art has been consistently noted to be a critically appropriate care and research support tool as it is highly participatory in nature, empowering, child-centric, can be low cost, and supports focus on the family as a whole (Abdulah & Abdulla, 2018; Bryan et al., 2019; Cho et al., 2022; Galvez et al., 2021; Gibson et al., 2012; Hyslop et al., 2018; Linder et al., 2018; Manning et al., 2017; Massimo & Zarri, 2006; Packman et al., 2008; Rollins, 2005; Soanes et al., 2009; Sposito et al., 2016; Vindrola-Padros, 2012; Wallace et al., 2014; Woodgate et al., 2014).
This scoping review clearly illustrates the multiple benefits of using arts-based interventions with children and their families who have an LLI and LTI. Nurses have a strategic role and are in an optimal position to implement arts-based interventions in their family nursing practice which are proven to support the social and emotional dimension of child and family health through collaboration and enhanced communication among family members (International Family Nursing Association, 2017; Shajani & Snell, 2019). However, it can be difficult to support families in making meaning of difficult circumstances, experiences, and feelings given varied experiences related to place in the illness trajectory, age of children, and developmental stage of families. As such, it is important for nurses to understand the varied and complex feelings that children and families experience as a whole and implement innovative and effective arts-based interventions that recognize the impact of the illness and ease the suffering of the entire family (International Family Nursing Association, 2015; Wright & Bell, 2021). In addition, nurses can form partnerships with other health care practitioners to facilitate collaborative practice and a coordinated approach to shared decision-making in the implementation of arts-based interventions which is essential to the delivery of the highest quality of care for children and their families (Sullivan et al., 2017).
The evidence presented in this review shows that the integration of arts-based interventions into pediatric health care is valuable to children and families and adds to the existing state of family nursing knowledge by clearly illustrating the benefits of arts-based interventions and research methods that can fall within family nursing practice or advocacy for the engagement of art therapists and other experienced allied health practitioners. However, to provide the best care for children who are in treatment for LLIs and LTIs, and their families, future research is needed to examine, with greater depth, the experiences of children and their families across different countries and cultures. As well, additional efforts are needed to evaluate the effectiveness of arts-based interventions implemented by varied health care practitioners.
Potential Limitations and Considerations for Arts-Based Interventions and Methods
While the findings indicated many strengths of arts-based interventions and research methods, the use of arts-based interventions and research methods presents some limitations and the need for special considerations. For example, Bryan et al. (2019) noted that researchers using art-making activities should be aware of the clinical space within which patients will be engaged. These authors suggested that many busy clinical settings may have specific limitations related to space, interruptions, noise, and privacy (Bryan et al., 2019). Some authors suggested that art activities should be implemented by those with some education or training such as art therapists (Brits, 2018; Bryan et al., 2019; Soanes et al., 2009; Sposito et al., 2016) and accompanied by discussion with nurses or other health care professionals to ensure appropriate support, interpretation, and meaning-making (Massimo & Zarri, 2006; Woodgate et al., 2014). When this was not the case, there were practical issues with camera use and understanding expectations of the art-making activities, for instance (Gibson et al., 2012), and the art may not have represented actual experiences of the child participants (Massimo & Zarri, 2006).
Furthermore, while most children and family members were engaged in art making, it was not well-suited to everyone; some participants appreciated the chance to take photographs and make scrapbooks when undergoing chemotherapy for cancer, while others did not, finding it cumbersome and time-consuming (Gibson et al., 2012). Other authors found it challenging to determine artistic data collection methods that were exciting, motivating, and which took into account changing mobility and stamina (Soanes et al., 2009). Such drawbacks can deter participation in arts-based interventions and other research opportunities (Gibson et al., 2012). Recognition of individual preferences and flexibility with research activities and use of art interventions can be important to the outcomes. Offering a “toolkit” of art possibilities (Bryan et al., 2019) may lend to successful integration of art in wholistic family nursing care, as the opportunity to select the type of art promoted a sense of autonomy and empowerment (Abdulah & Abdulla, 2018; Akard et al., 2015; Brits, 2018; Bryan et al., 2019; Gibson et al., 2012; Soanes et al., 2009; Wallace et al., 2014). Interestingly, the world of technology is ever-growing, and digital art and the use of video technology can be utilized in the realm of arts-based interventions and research methods by family nurses, permitting greater accessibility, limited mess, and effective use with diverse abilities (Cho et al., 2022; Woodgate et al., 2014). This has never been more evident than in recent years in which the COVID-19 pandemic has brought about a variety of changes within family nursing research, practice, and the social world more broadly.
Strengths and Limitations of the Scoping Review
This scoping review has several strengths. To our knowledge, this is the first review and comprehensive evaluation of existing arts-based interventions and research methods in children and their families impacted by a diagnosis and treatment of an LLI and LTI. This review was conducted by four multidisciplinary researchers (nurses and a health sociologist) who have methodological and content expertise which provided enhanced synthesis through diverse knowledge and skills. In addition, following the five stages of Arksey and O’Malley (2005) coupled with the support of an experienced librarian resulted in a consistent approach and rigorous, transparent review. However, there were some limitations to note. This review included mostly children and families impacted by cancer (n = 21), living in North America (n = 14), and were mostly focused on the child who was ill (n = 16). In addition, other exclusion criteria related to age, nonvisual forms of art, length of illness, diagnosis other than LLIs and LTIs limit the generalization of these findings. Despite these limitations, this scoping review includes research from diverse cultural contexts around the globe including from South America, Africa, the Middle East, Europe, Asia, and North America. The review also included diverse forms of art making which demonstrates the wide range of possibilities that can be implemented with children and youth of various ages. As such, this scoping review presents insights that can inform future research using arts-based methods in various cultural contexts, along with providing important knowledge for family nurses and allied health care practitioners to consider when implementing arts-based interventions for children with LLIs and LTIs and their families.
Conclusion
This scoping review illustrates the variety of arts-based interventions and research methods that have been used to promote positive benefits for the Social, Emotional, and Family Health of pediatric patients and families, and support the care provided by nurses and allied health care practitioners. Most arts-based interventions and research methods are inexpensive and relatively simple for caregivers, nurses, researchers, and allied health care practitioners to implement throughout the course of families’ journey. Family nurses working with this unique population should approach the family as a whole and incorporate arts-based interventions and research methods as part of wholistic care, given the potential for positive outcomes related to communication, coping, and relationships. Family nurses can also advocate for the inclusion of art therapists and collaborate with associated practitioners within health care settings, with the aim to provide responsive, comprehensive care to the entire family unit. Despite the value of the evidence presented in this rigorous review, more research is needed to examine arts-based interventions with greater depth, diverse populations beyond pediatric oncology, and multiple family members including siblings and grandparents.
Footnotes
Acknowledgements
We are grateful to Mr. Kevin Read, Associate Librarian, for his support with the literature search.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this study was provided through the USask College of Nursing CIHR Seed Fund.
