TV is a central, but scarcely considered and definitely under-developed ward resource. The telly can be a wonderful source of interesting, funny, important things to talk about, while the programmes are going on. And you can build on ideas stimulated by what’s on, to enjoy activities before, during and after the programmes. When it’s used in a creative, thoughtful way, TV can be a powerful way of building relationships, rather than a substitute for them.
Whether talking about the latest punch-up on East Enders or gasping at the beauty of tigers in a wildlife programme, TV is perhaps the strongest source of shared experience between patients, staff and visitors.
Taking a creative and dynamic approach to TV watching turns it from being a substitute for relationship-building and activity to being a fun source of these. We’ve made up a name for it: mediated TV.
The telly is usually on in wards, whether or not anyone is watching it at the time. It’s a constant yet almost ‘invisible’ presence, and one which many staff feel uncomfortable about regarding as a legitimate or meaningful source of pleasure and information for patients. But TV is fantastic! It provides unparalleled access to sights, sounds, knowledge and entertainment, especially now there is such a vast choice of channels and ways of recording and timing viewing. And YouTube offers short films on everything from celebrities to windscreen wipers! The problem isn’t that TV is a mindless occupation – indeed the ease of watching is one of its delights. The challenge is to make TV viewing an experience over which patients have choice and control, based on their interests and emotional, physical and cognitive situation.
In Television in the Nursing Home by Wendy Hajjar the author describes how TV plays an important and very valued role in residents’ lives, and how it is an enjoyable and bonding shared experience between friends. Hajjar writes that: “Television’s strategic use represents control in a place where little control is possible….Television choices provide a form of vicarious mobility and a constant course of difference and stimulation in a world that does not otherwise change very much.” She describes how TV gives residents and staff things to talk about in an environment which is inevitably pretty limited in terms of new experiences and how residents really appreciate the memories evoked by certain programmes.
Of course, if someone with visual, hearing and cognitive impairments is simply plonked in front of the TV, this isn’t likely to be a very enriching experience for them! Especially if they don’t have the mobility to get away from it. But for us at Star Wards, perhaps the most exciting thing about TV is that when it is thoughtfully mediated, it is a brilliant (and free!) way of finding things to talk about and activities to share even with the most disabled patients.
The art is to make TV watching dynamic, interactive and multi-sensory. There is one main, and very simple, way of improving what people get from TV, and that’s for us to ditch the belief, or habit, that TV is always watched in silence. By asking questions about or commenting on what is happening in the programme or advert, this immediately makes the experience more enriched. This chatty way of watching TV could, however, be distracting or annoying for other TV viewers in the room, so this will need to be taken into account.
Although most of this feature is about TV, the concept of ‘mediated media’ applies equally to other media experiences such as listening to the radio, watching a DVD or going out to a film.
Making the most of TV
We’ll skip over all the essential but obvious stuff about where the TV is located, seating arrangements, minimising disturbances to and by TV watching, lighting, places to put a hot drink etc. On with the fun stuff!
You’ll want each person to have as much choice as possible over what they watch. There are two important stages in making an active choice about watching TV – firstly, whether the person wants to watch it at all. And then what programme they want to watch. Of course, these two are connected as someone may only want to watch TV at a particular time if there is a specific programme they want to see.
Once you know what programmes a patient likes, you can talk with them (or someone who knows them well) about:
- what other sorts of programmes or DVDs they might enjoy?
- how these experiences can be built on – eg what types of art activities use similar visual approaches? Does the library have books on this subject?
- Is there an exhibition in town which the patient might enjoy?
- are there ‘cross-over’ programmes which build on the person’s interests – eg if they enjoy cooking programmes, could they enjoy gardening ones, or a soap opera which features a café?
- Would they like to have their own weekly TV listings eg created on a computer or by using a listings magazine, and highlighting their favourite programmes?
- Are there websites related to a programme or film that they’d like to look like?
Some staff teams write people’s favourite programmes into shift plans so that they are remembered in the midst of everything else during a busy shift.
Interactive TV experiences
Pausing and repeating
If we had only one piece of advice about making TV viewing more enjoyable, it would be: WATCH IT ON DVD, or
- Sky Plus
- equivalent if your ward is lucky enough to have this. It makes all the difference to be able to PAUSE the programme so that you can talk about what’s happening. And it’s also really valuable to be able to rewind and watch something again. (And again if that helps.)
Watching on DVD makes it possible to watch clips over and over again. This is especially important for people with cognitive impairment, as it helps to build up familiarity with what’s happening and also to anticipate and enjoy more the action.
Talking about it!
Again, chatting during a programme can be a good or a very bad idea depending on the programme and who is watching it. But many patients will enjoy talking about it before and/or afterwards.
We can also get more from a programme (especially on DVD) by watching aspects of it particularly closely, for example by choosing to:
- view with no sound – to focus on what the photography is like or to see how much is lost if there is no sound (or if you can’t hear or understand the soundtrack)
- freeze the frame – again to look carefully at the composition eg where people are in relation to each other, what props or scenery are shown
- watch in slow motion – for comic effect or to study one aspect of a character or scenery
Some people, some of the time, prefer to enjoy either just the sound on the TV (eg with news or music programmes) or just the pictures – eg wildlife programmes and again music programmes.
The TV doesn’t need to be on to enjoy TV sorts of activities. Other things you can do which are to do with what’s on TV include:
- Looking at books about programmes and films
- Having friends and family over for a TV party when there’s something special going on. The 2012 Olympics is an obvious example!
- Gardening programmes provide a great opportunity to visit garden centres (and their cafés!), enjoy gardening magazines and books, do a bit of planting or even weeding….
- Scrapbooking, finding articles, pictures etc from TV and other magazines and the Internet.
Here’s an example of a media event. Around the World, is designed to simulate a travel experience. Using a travel programme or film, you could add to the event music, books, magazines, decorations, food, games or other activities, travel films, costumes, trivia questions etc. People who’ve been to the country would be encouraged to talk about it. You could try getting a representative from that country’s embassy if you’re in London.
Archive film is a fantastic way to preserve past experiences and bring memories to life. Read more here: http://www.bbc.co.uk/history/handsonhistory/film-archive.shtml
Of course, lots of people enjoy the radio as well as, or even more than TV. And it’s possible to engage with the radio in a similarly interactive way. There are shared principles of talking about it, taping it so you can pause it, using props, playing games etc. Thanks to the BBC iplayer it’s easy to choose a programme to listen to and to pause or replay parts of it.
There are lots of different ways of making TV watching an enriching experience for people with severe cognitive and sensory impairment.
Here are some ideas for helping people with high support needs (significant sensory and cognitive impairment) express a choice about whether to watch TV:
- Using the TV itself – pointing to it, or enabling the person to feel it.
- If the TV is in a different room and/or the person is sitting down, you could use an ‘object of reference’, like a remote control or a mini TV.
- Using a picture or photo of a TV, or of a TV programme, eg on a laminated card
- Noticing what signs, gestures, sounds etc the person associates with TV, probably while they’re watching a favourite programme.
Most of the above can also be adapted to help people choose what particular programme they want to watch. Another straightforward method is of course to visit the channels to see what programmes are on at that time.
People can connect what’s on the TV by:
- touching the image on the screen
- imitating eg talk, song, hand movements/gestures, body movements – eg dance (music channels), keep fit
- holding real or symbolic objects
- looking at pictures
- smelling and/or tasting relevant foods etc.
- re-enacting what went on, after the programme
There are parallels with mediated TV and Intensive Interaction. Intensive Interaction is described in the book ‘Access to Communication’ as an approach to teaching the pre-speech fundamentals of communication to children and adults who have severe learning difficulties and/or autism and who are still at an early stage of communication development. It builds on the communications’ abilities of individuals through closely observing and responding to people’s gestures and sounds.
Both mediated TV and Intensive Interaction pick up on the smallest detail and repeat it, often in an emphasised, or exaggerated, way. Intensive Interaction encourages staff to be ‘playful’, lighthearted, responsive and flexible. And like Intensive Interaction, mediated TV is multi-sensory and uses touch, especially for people who have sensory impairments.
To take a rather different tack, we don’t always have to understand what we’re watching to enjoy it. TV viewing can be a soulful experience. There are all those arty films which have no narrative or may as well have no narrative as the ‘story’ is so impossible to follow. But as T S Eliot possibly said – great poetry moves us before we understand what it means. We can connect with what we’re watching on lots of different levels. Particular patterns, or voices, or sounds or music or lighting effects can resonate very deeply – even if the plot is entirely baffling. And sometimes all we want to do is to sit quietly with others and appreciate a programme on different levels.
Use props, objects of reference
There are loads of everyday objects which you can use to re-create, or reinforce, what is being show on the TV. These props are what speech and language therapists call ‘objects of reference’ because, as the name suggests, they are a physical way of referring to (and holding!) a concept. They are particularly valuable for people with cognitive impairments.
Props are really useful to:
- Enliven watching of TV – eg if there’s a big wedding coming up on a soap, you can get mini plastic bottles of champagne bubbles which can be blown, or sparkling grape juice etc
- Help people decide whether to watch TV or what to watch
- Anticipate what programmes are about to be on
- Refer to programmes in conversation
A television! We’ve yet to find ward that doesn’t have at least one TV, and mixed wards with a women’s lounge usually have one in there as well. And we’re seeing fewer of the awful prison-style boxed TV sets, with even secure units coming up with creative alternatives such as:
Retractable plasma screens which can sink down into the cabinet are a good idea. There are tasteful ways of adding a Perspex front to a plasma screen which doesn’t make patients, staff and visitors feel like they’re in Alcatraz. Once the TV is secured to a wall or other surface, a neat screen protector finishes the job.
And with super-thin plasma screens now available, we’re looking forward to seeing these simply set into a ward lounge wall (with locked access for repairs etc), removing all issues of sets getting flung, cables as ligatures etc.
Other lovely equipment
- Cable TV, Projector + screen for real cinema experience,
- Personal sound amplifiers for TV & audio equipment
- Large screens obviously help people who are visually impaired, as well as those with full sight who can’t get enough of the X-Factor panel.
Ramping it up
- Themed groups: showing a musical film and having fresh popcorn and ice creams or food relevant to the film. Mamma Mia and Greek food are very popular as are Scottish- or Irish- themed groups with music and food from that community which reflect the cultural heritage of many of the patients.
- Patients can participate in a film discussion group.
- Linked in with cooking to make pizza to have with the film.
- Popcorn!! Hot dogs, with mustard and ketchup oozing past the fried onions onto people’s laps.
- Using Come Dine With Me as inspiration/format for ward dinner parties!
- The day after the movie night, the ward holds a film review group. Patients share thoughts, comments, and options about the movie.
- A newsgroup on a Monday where people discuss their own news from the weekend as well as look at national and international news. The group also look up news items in newspapers and on the Internet.
- Items of particular interest are put up on a display board.
- A Tuesday TV group – and as with the news group, items of interest (eg from the soaps) Are put up on a display board.
- Scrapbooking (with folders rather than scrapbooks).
- Getting photos of the cast of Eastenders which are used as flash cards.
- using puppets for characters from soaps.
- Making their own weekly TV schedules with Widgit Environments for symbol.
Equipment and planning
- In low secure and open areas of the service patients may have their own personal TV/DVD player in their room.
- Coffee shop with Sky TV.
- Including TV programmes or events in weekly activities’ schedule. Wards often do this for film and comedy nights, whether live on TV, recorded or on DVD.
- DVDs and CDs are available across the hospital either through the DVD library or accessed in the day rooms.
- There are Blue Ray players in each of the day rooms.
- I am great at organising film evenings and like to plan every detail.
- The ward can be like a protective bubble which is good but you get cut off from the outside world. So it’s good to watch the news everyday and see what’s happening in the world. Then I can be part of it somehow.
- I organise the ward’s DVD library. It’s something so do and constructive use of my time.
- Sometimes I just don’t feel like I fit in. But when we have a film evening together with all the patients and staff I have never felt such a sense of belonging.