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A threat to rest and recuperation?

George Winter questions whether bedside entertainment systems for patients may do more harm than good

In The Convalescent (1825), Charles Lamb (1775-1834) writes: “If there be a regal solitude, it is a sick-bed.” The patient, says Lamb, “… has nothing to think of but how to get well… makes the most of himself… Sometimes he meditates… and his bed is a very discipline of humanity and tender heart.”

And when in 1930, ankylosing spondylitis confined the Scots poet William Soutar (1898-1943) to bed for the rest of his life, he continued to write and set himself — and achieved — the target of reading the Encyclopaedia Britannica.

To what extent can today’s patients plumb those inner depths of human resourcefulness evoked by Lamb and Soutar? One, I suggest, that’s limited to choosing between pressing a button to flood a screen with all manner of visual diversion… or not. Dr Humphrey Taylor had heard the clamour of things to come in 1998 when he wrote in Ophthalmology (1998, 105: 2,169-70) that trends in consumer education and empowerment were largely a function of “marketing-, media-, and entertainment-driven phenomena. They will surely change consumers’ interactions with health plans, physicians and hospitals, but they may not do much to empower most of them to make better choices or get better care.”

How right he was, because today’s patients are indeed “consumers” of healthcare. But the last thing that purveyors of “marketing-, media-, and entertainment-driven phenomena” want is that consumers be allowed some peace and quiet when they could be absorbing screen-based drivel. We now have fancified hospital telly, and entered the age of the ‘bedside entertainment system’ (BES). BESs exist to make money from patients and are dedicated to disrupting the link between thought and quietude. But you won’t catch BES companies using the word ‘consumer’, with its connotation of a non-thinking commercial unit. Thus, one BES website reveals that “patients are actively looking for a more modern way to pass some time while in hospital”, while another is confident that “after all, entertained patients are happy patients and you want to make their time in hospital as easy and carefree as it possibly can be”.

I guess that the authors of such nonsense would be genuinely surprised to learn that neither all patients crave “more modern ways” to pass the time, and nor is a patient’s happiness dependent on the high-tech equivalent of a jester in cap and bells. On the other hand, we cannot ignore the fact that BES providers cash-in on our self-evident craving for what Aldous Huxley referred to in his essay on Silence (1946) as the “pre-fabricated din” of our times.

So, it’s timely that Assistant Nurse Manager Lindsey M Nelson provides some common sense in ‘Turn Off the TV: Benefits of Offering Alternative Activities on Medical-Surgical Units’ in MedSurg Nursing (2018, 27: 9-13). Nelson makes the point that patients in medical-surgical units who are confined to their rooms where the telly is the only activity available to them may experience “decreased stimulation from (or interest or engagement in) recreational or leisure activities, resulting in boredom, restlessness, and/or depression”. She further observes that excess telly-watching and screen time are linked to sleep disturbances, adverse psychosocial effects, “increased sedentary behaviour, diabetes, cardiovascular and metabolic issues, and even mortality”. For brain-enhancing, “less modern ways” than gawping at a screen, Nelson suggests the following alternatives that a BES sales representative might regard as daft, old-fashioned pursuits: Colouring, reading, puzzles and relaxation techniques. They also have the advantages of being cheap, rewarding and superior to a mind-numbing BES.

A BES could also delay one’s departure from hospital. For example, Papaspyros et al, writing in the European Journal of Cardio-thoracic Surgery 34 (2008) 1,022-1,026, describe an ‘Analysis of bedside entertainment services’ effect on post-cardiac surgery physical activity: A prospective, randomised clinical trial’. Noting that in 2008, there were “just over 300 acute hospitals offering BES in the UK… BES includes telephone, television, radio, Internet, gaming and e-mail”, they investigated 100 patients undergoing elective cardiac surgery who they randomised to receive access to BES or not. They found that those without BES were 84 per cent more likely to walk more than those with BES, demonstrating “that the bedside entertainment systems may have an adverse effect on post-cardiac surgery patient ambulation and may contribute to an increase in hospital stay”.

I am not suggesting that there is no place for screen-based entertainment in clinical settings, or that recovery depends on patients’ rigorous engagement with, say, the lyrical wealth of Anna Akhmatova. Indeed, television can confer some benefits. For example, Östlund, writing in the Scandinavian Journal of Caring Sciences (2010, 24: 233-43) describes “ ‘Watching television in later life: A deeper understanding of TV viewing in the homes of old people and in geriatric care contexts’, and concludes that “TV viewing makes a significant contribution to their capacity to cope with disengagement in old age and can be used as a way of promoting communication and wellbeing in geriatric care”.

What I am questioning is whether a BES does much to promote Lamb’s notion that “sickness enlarges the dimensions of a man’s self to himself!”

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