Careful

Careful (2016-) is an ongoing research project centred on the creation of a dance-theatre piece about nurses. The project is conceived and directed by Dr Alex Mermikides, my sister and bone marrow donor, and continues our collaboration under the banner of the AHRC-funded Chimera Network as director and composer/sound designer respectively. Careful responds to the current crisis in nursing of low recruitment, critical drop out rates and a level of under-resourcing that might endanger patient care (Department of Health 2013, NHS England 2016, Royal College of Nursing 2018). While nursing reforms typically promote the values of care, they acquiesce to systematic tropes of female self-sacrifice and martyrdom (Smith 2012). In response, Careful differs from conventional patient-centred use of drama in medical education in its turning of the empathic gaze from patient to nurse, acknowledging health-care as an interactive relationship between carer and patient.

Supported by a grant by the Arts Council England, and in collaboration with the nursing school at Kingston University, Careful premiered “in a fully-equipped, hyper-realistic hospital ward used for nursing education, audience members were made comfortable in the patient beds and visitor chairs. In both this site-specific version, and subsequent performances in theatres, spectators are interpellated as patients through direct address” (A. Mermikides 2018). This ethos of hyper-realism, immersion and of factual presentation – as well as a profound personal experience as a hospital patient – invited a compositional approach employing Hidden Music devices. Rather than conventionally emotive scoring, the music emerges from sonification of the medical data, nurse’s routines and the sounds of the hospital itself, as explained in the following documentary extract recorded to an audience of over 300 student nurses at the Main Hall, Rose Theatre, Kingston. To date, over 650 trainee and practising nurses have seen Careful live, and over 1200 through digital resources such as Careful Encounters.

Careful Documentary Extract

Careful has been featured in the Guardian, Critical Stages, the British Journal of Nursing, the Greek national paper Kathimeriani, The Nursing Standard and a piece in Nature Immunology. It has been performed for 100s of nurses at the main house, Rose Theatre. A scheduled tour of 11 nursing schools booked for Autumn 2020 was postponed due to Covid-19, but digital learning resources were produced in response. These were distributed to over 1200 nurses going into practice early under the Nursing and Midwifery Council’s emergency standards. Towards these I contributed two animated pieces on ‘sound-based’ care for nurses – Lucid Listening and Careful Encounters, included at the bottom of the page.

Careful Scoring

Some extracts from the score and provided below, along with the hidden music device in question.

Floating after lift A translation of the breathing rates of a nurse after a long shift forms the metric template to this ‘recovery’ music
Glove Duet the movements of nurses in a hallway was captured and translated to a metric framework, with its resulting cross rhythms, unified pulse but wandering barline.
Definiton of Empathy – A clicking clock recorded on location forms the back drop to a sonification of bed occupancy data across several days, with sonic identifiers for a range of events.
Routine Between the Bedsthe inherent rhythms are sourced directly from observed nurses movements performing repetitive and deftly executed tasks, it produces long active rhythmic sequences reminiscent of Hindustani and Balkan dance metric structures.
Emergency Call – The pitches and rhythms of an emergency call siren, which all nurses must obey forms the harmonic and rhythmic framework to this dance.
Forgotten Waltz – A melody similar to this was found being sung on a hospital location by an elderly voice. I do not know its origin.
Store Cupboard Quartet – Empathy – the percussion layer is made up of sounds from common nurses’ activities. Removing gloves, taking tissues, unwrapping swabs, closing bins, swishing curtains reconfigured into a structural rhythm.
Reasonable Work Hours A schedule of nurses working hours was translated into this layers polymetric texture, which is reworking into different harmonies with as the sessions change over.

References

Department of Health (2013) Patients First and Foremost: The Initial Government Response to the Report of The Mid Staffordshire NHS Foundation Trust Public Inquiry, London: Department of Health. Available online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/170701/Patients_First_and_Foremost.pdf (accessed 4 April 2019).

Mermikides, A. (2018) “I and you” Becomes “I am you”: The Audience’s Gaze in Contemporary Medical Performance, The IATC Journal: Issue No.17

NHS England (2016) Compassion in Practice: Evidencing the Impact, London: NHS England. Available online: https://www.england.nhs.uk/wp-content/uploads/2016/05/cip-yr-3.pdf (accessed 4 April 2019).

Royal College of Nursing (2018) The UK Nursing Labour Market Review 2018, London: Royal College of Nursing. Available online: https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2019/january/007-397.pdf (accessed 11 April 2019).

Smith, P. (2012) The Emotional Labour of Nursing Revisited: Can Nurses Still Care?, Hampshire: Palgrave Macmillan.

Video of Careful performance: https://www.youtube.com/watch?v=VGfaN_EXm2o&feature=youtu.be
Digital learning resources:
Careful Encounters: https://www.dropbox.com/s/og2k3i533mlds07/Careful%20encounters.pdf?dl=0
Drama out of a Crisis: https://www.dropbox.com/s/r86ya4psi12osan/drama%20out%20of%20a%20crisis.pdf?dl=0Short documentary film about the project: https://performanceforcare.com/careful/ (scroll down to first video) Performance for Care online conference: https://performanceforcare.com

Article in Critical Stages: http://www.critical-stages.org/17/i-and-you-becomes-i-am-you-the-audiences-gaze-in-contemporary- medical-performance/

Feature in the Guardian: https://www.theguardian.com/healthcare-network/2016/dec/14/theatre-show-teaching-student-nurses- compassion

Report in British Journal of Nursing: https://www.magonlinelibrary.com/doi/pdf/10.12968/bjon.2018.27.13.728
Feature in Kathimeriani (Greek national paper): https://www.kathimerini.gr/culture/theater/904152/choreyontas-me-tis-nosokomes/ Opinion piece in Nature Immunology: https://www.nature.com/articles/s41590-020-0734-1

Feature in the Nursing Standard: https://rcni.com/nursing-standard/students/nursing-studies/drama-workshops-are-helping-nursing- students-to-find-their-voice-164601


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