Hospice and Palliative Care: whose need is being met? Disempowering or helping the other in the de/re-construction of identity Ewan Kelly

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Hospice and Palliative Care whose need is being
met?Disempowering or helping the other in the
de/re-construction of identityEwan Kelly

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Francis Report dehumanisation and
desensitisation of healthcare staff

• A patient admitted into Accident and Emergency
  (was reprimanded by members of staff for calling
  his wife)
• When I was told I was to be admitted, I was left
  in a small cubicle for several hours on a
  trolley, no pillows, no blankets, and when I rang
  to tell my wife, I was admonished quite sharply
  by someone who told me to get a life and not
  use the phone in hospital. Eventually I got a
  pillow and then an hour later, a blanket arrived
  which I refused because it was covered in someone
  elses blood.

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Culture in Healthcare when main focus on what
and when to exclusion of how and why

• Edinburgh Evening News Published on Saturday 12
  May 2012
• A DAMNING report into bullying at NHS Lothian has
  described an undermining, intimidating,
  demeaning, threatening and hostile working
  environment at the health board.

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Reflective Practice as potentially transformative

• re-connecting with a place in ourselves which
  has always been there but has been covered up by
  a huge amount of stories that we have learnt to
  accept as reality.
• (Encke in Sohet 2008, 23)

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Marcel Proust

• the real magic of discovery lies not in seeking
  new landscapes but in having new eyes.
• (1899)

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Values based Reflective Practice (VBRP)

• Aim
• To help health and social care staff/teams/organis
  ations provide the care they came into the
  service/were set up to provide.

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Values Based Reflective Practice (VBRP)

• Intended Outcomes
• To help staff/team/organisations
• (Re)connect with their core values, motivations
• Enhance their person-centred practice
• Deepen (or enable deepening) of their
  relationship with colleagues
• Develop their resilience and well-being

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Values Based Reflective Practice (VBRP)

• Trained chaplains to facilitate VBRP
• Inter-disciplinary group reflective practice on a
  case study
• Participants notice and wonder.
• Presenter and participants realise about their
  own practice
• Based on three levels of seeing in John 20)

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Insights NAMV Whose Need(s) were /are being
met? What does this experience tell me about
my/our caring Ability? What does it tell me
about Me/Us? What questions does it raise about
my/our Values (that inform my attitudes and
behaviours)? With whom did /does the power
lie? Whose voice(s) dominated or had most
value? Whose voice(s) were not heard or
undervalued?
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Promoting Cultural Change - From Reflection on
Practice to Reflection in Practice

• Whose need is being met? In and on practice
• eg pivotal question in renal multi-disciplinary
  meetings,
• Noticing and wondering

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Dimensions of Personhood potentially diminished
by in-patient institutions patients, relatives
and staff

• Sexual
• Emotional
• Dying/limited
• Powerful/authoritative

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• What do you notice about organisation, the
  culture you inhabit that contribute s to the
  de-construction of peoples identity?
• What do notice that diminishes unique personhood?
• Wonder about the corporate shadow side of
  palliative care?

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• Notice ways in which your institution, team
  promotes individual personhood and
  re-construction of identity
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• Wonder about the difference that makes to people
  in the system patients, relatives and staff

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Mutuality of Need (Campbell 1986)

• In the end the way we design our systems and
  process way we work as individuals and teams
  way we are as communities of care to meet needs
  of patients and professionals
• Key is awareness
•  

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Insights NAMV Whose Need(s) were /are being
met? What does this experience tell me about
my/our caring Ability? What does it tell me
about Me/Us? What questions does it raise about
my/our Values (that inform my attitudes and
behaviours)? With whom did /does the power
lie? Whose voice(s) dominated or had most
value? Whose voice(s) were not heard or
undervalued?