Action shot of guitar and singing
Toronto Western Hospital volunteer Haig Beylerian, (L), leads a group of patients in song accompanied by Olga Muir, Nurse Manger, 9A Fell, TWH, as part of 9A's ENGAGE program, which provides social opportunities for long-stay patients. (Photo: UHN)

And though the night is cloudy,
There is still a light that shines on me
Shine until tomorrow, let it be.

If you happen to be passing by Toronto Western Hospital's (TWH) in-patient unit on 9A Fell Pavilion, you might hear patients' voices tentatively singing these well-known lyrics to the Beatles' Let It Be and other classics.

Joined by staff from both the unit and Allied Health, and led by a volunteer, the music activity is one of the many different sessions that make up 9A's ENGAGE initiative – a program that provides mental, physical and social stimulation to long-stay patients in acute care who have cognitive and physical challenges. 

With the recent focus on UHN's new Purpose, Values, and Principles (PVP), the team on 9A was looking for the ways they could contribute to "transforming lives through excellence in care" to prioritize patients' needs. They identified a gap in care among long-stay patients on their unit with dementia and cognitive challenges who had little social contact.

"We had a number of patients sitting around with nothing to do, which often led to behavioural issues," says Olga Muir, Nurse Manager for 9A. "There was a need to develop something that would keep these patients occupied, entertained and help them cope with being in a hospital."

The inter-disciplinary team that supports the unit, which includes occupational therapy (OT), social work (SW), physical therapy (PT), rehabilitation assistant (RA) and patient care assistants (PCA), and TWH Volunteer Resources staff, recognized that there were many positive benefits from providing social stimulation for patients.

"Research shows that stimulation has the potential to reduce the risk of depression, anxiety, and disruptive behaviours among patients while also decreasing their isolation and loneliness," says Michelle Mohan, an OT who has worked with Orthopaedics, General Surgery, and General Internal Medicine patients. "It was often the case with our patients that the only daily social interaction they took part in was when they were served meals or given their medication and we felt the need to come up with something a bit more engaging for them."

What started as an ad-hoc approach of little games one-on-one with patients, soon evolved to a few patients having a lunch together and then blossomed into a coordinated effort, under the umbrella of the Emerging Leaders Program, to provide organized and consistent socialization opportunities for patients.

Together with TWH Volunteer Resources, the team created ENGAGE in August 2016. It provides group or individual activities for patients on 9A, including music, art, communal dining and light exercise, offered four days a week by TWH volunteers with the support of a staff member.

4 drawings on one sheet
An example of some of the art created by ENGAGE patients. (Photo: UHN)

Patients who have been previously identified as candidates for the program and have consented to participating, get together to create art work, sing-a-long to music or eat together. Feedback from the session is collected to track which activities resonate with patients, and tips are shared among volunteers so they know what different patients enjoy.

Visiting friends and family are also welcome to join and many have since organized their visits to coincide with the day's activity.

"The activities have really transformed some of our patients," says Shelley Tymoszewicz, a social worker who supports on the Orthopaedics unit. "For instance, a patient who had been withdrawn and disrespectful to staff, will smile, sing, request songs and interact positively with other patients and staff during the music activity.

"It's been really encouraging to see."

Haig Beylerian has been volunteering with ENGAGE for the past eight months, playing guitar and leading groups of patients in song as part of the music activity. He was specifically recruited for it as part of the Arts Healing Hearts program at TWH that brings music to different patient areas in the hospital.

"It's great to be able to help people through a challenging part of their lives," he says. "Patients usually have a positive reaction to music and, in some cases, the sing-along is the only time the patients show any engagement."

A trained performer who would normally focus on putting on a good show, Beylerian had to get used to how just the interaction of being in a group was already enough to have a positive benefit for the patients.

"Just saying 'hello' is enough to make a patient's day," he says. "The music is the icing on the cake of that experience."

The program continues to evolve and other units have inquired for guidance from the 9A team about how to bring ENGAGE to their patients. But Muir, who will retire in June after 27 years of service at UHN, has bigger plans for the program.

"We've had a lot of great feedback and witnessed the positive results from this program," she says. "My hope is there will be an opportunity to create a centralized ENGAGE program that pools all the available resources to make it accessible for all units and all patients at TWH."​

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