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

Quality Education for a Healthier Scotland

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 else’s blood.’

Quality Education for a Healthier Scotland 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. ”

Quality Education for a Healthier Scotland 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)

Quality Education for a Healthier Scotland Marcel Proust ‘the real magic of discovery lies not in seeking new landscapes but in having new eyes.’ (1899)

Quality Education for a Healthier Scotland

Values based Reflective Practice (VBRP) Aim To help health and social care staff/teams/organisations provide the care they came into the service/were set up to provide.

Quality Education for a Healthier Scotland 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

Quality Education for a Healthier Scotland 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)

Quality Education for a Healthier Scotland 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?

Quality Education for a Healthier Scotland 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

Quality Education for a Healthier Scotland Dimensions of Personhood potentially diminished by in-patient institutions – patients, relatives and staff Sexual Emotional Dying/limited Powerful/authoritative

Quality Education for a Healthier Scotland What do you notice about organisation, the culture you inhabit that contribute s to the de- construction of people’s identity? What do notice that diminishes unique personhood? Wonder about the corporate shadow side of palliative care?

Quality Education for a Healthier Scotland Notice ways in which your institution, team promotes individual personhood and re- construction of identity Wonder about the difference that makes to people in the system – patients, relatives and staff

Quality Education for a Healthier Scotland 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

Quality Education for a Healthier Scotland 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?