The Interprofessional Team: Addressing the Spirituality of Grief

and Loss

Fear and depression are a part of life. In illness there are no ‘negative emotions,’ only experiences that have to be lived through. What is needed in these moments is not denial but recognition. The ill person’s suffering should be affirmed, whether or not it can be treated. What I wanted when I was most ill was the response, “Yes, we see your pain; we accept your fear.”

Arthur W. Frank, At the will of the body. Houghton-Mifflin, 2001.

Balfour Mount

ObjectivesObjectives

1) Discuss a holistic model of care in responding to grief and loss and explore the implications of such a model in my practice

2) Explore issues of care and interprofessional collaboration based on equal relationships

3) Develop a clearer understanding of integrating healing presence at the core of the care I provide

4) Become familiar, explore and select from a number of tools provided to enhance my personal and professional growth

5) Engage in transformative dialogue with others at the session

The skeleton woman

Tamsin Williams performing in Skeleton Woman. Photogaph: Nick Sayers.

Spirituality at the Centre Model

The spiritual dimension of care

represents the totality of one’s being and serves as an overarching perspective which unifies the various parts of the person. Journal of Religion and Health, vol.28,#3, fall 1989, “Development of a Model of Spiritual Assessment and Intervention,” by C.Farran, G.Fitchett, J.Quiring-Emblen, R.Burck,p.185-194.

7

Spirituality Unifies the Whole

c

• Our Spiritual Nature

• Our Holistic Self

Social Emotional

Physical

Intellectual

Aspects/Domains of Holistic Care

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Social/Cultural

Physical

Psychological

Spiritual

Aspects/Domains of Holistic Care

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Social/CulturalPhysical

Psychological

Spiritual

Aspects/Domains of Holistic Care

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Social/CulturalPhysical

Psychological

Spiritual

Aspects/Domains of Holistic Care

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Social/Cultural

Physical

Psychological

Spiritual

Physical Psychological

SpiritualSocial/Cultural

Holistic Care and Environmental Influences

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

FamilyFriends

Physical Psychological

SpiritualSocial/Cultural

Formal Care Givers (includes Volunteers)

FriendsFamily

Holistic Care, Environmental Influences and Interprofessional Relationships

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Holistic Care, Environmental Influences, InterprofessionalRelationships, Culture & Society

FamilyFriends

Physical Psychological

SpiritualSocial/Cultural

Formal Care Givers (includes Volunteers)

Breath Exercise: Foundation Practice

Breathing into the pain or uncomfortable feelings, not only releases the spasm but feeds the brain and can actually make us think more clearly.

Resnick, Stella, The Pleasure Zone, Berkeley, CA: Conari Press, 1997, 88-89

Healing the Heart

Tight lips, Tight gut, Tight shoulders, Tight chest, Tight….Breathe deep, Breathe long, Breathe panting, Breathe in, hold and release,

Breathe….Focus on memories of love, Focus on friends, Focus on happiness, Focus on

feelings, Focus….Soften shoulders, Soften face, Soften limbs, Soften heart, Soften….Cherish self, Cherish talents, Cherish friends, Cherish life, Cherish…Acknowledge pain, Acknowledge wrongs, Acknowledge truth, Acknowledge

potential, Acknowledge….Contemplate nature, Contemplate peace, Contemplate joy, Contemplate love,

Contemplate…Celebrate the past, Celebrate opportunities, Celebrate today, Celebrate the earth,

Celebrate…Relinquish control, Relinquish hatred, Relinquish inhibitions, Relinquish

obligations, Relinquish…Restore energy, Restore beauty, Restore relationships, Restore goodness,

Restore...and be restored.Peter Barnes, July 23rd, 2007 Anamcara, Cupids, Nfld.

Being In LifeIn the stillness, in the solitude, in the being there is life.Energizing life, reaching deep into the core, the centre, the self.Nurturing heart, nurturing love of self and others.Responding in faith by being real, genuine.Believing in oneself, created whole, well, full.No void to be filled, no emptiness, a complete package.Life is unwrapping the package, finding truth, finding home

within.No searching, no escaping, discovering peace, wholeness.From the womb we’ve come and to the earth womb we return.Remaining, living, connected by the cord, the thread of life—the

heart beat.Life pulsating in beautiful rhythm, music to the ear.The beat of life plays on and on and on.Peter Barnes, July 14th, 2007 Anamcara, Cupids, Nfld.

The Cleansing Breath It’s cleansing because it pushes carbon dioxide and metabolic

wastes out of the lungs and makes room for more oxygen. Sit comfortably on a chair with both feet on the ground, your head straight and your chin parallel with the floor. Take a deep breath slowly, through the nose, all the way up to the top of the inhale; feel your chest lift as your lungs expand. When you can’t fill up any more, pucker your lips softly and blow out in a steady stream of air all the way down to the bottom of your exhale. Suck your abdomen in slightly as you push out the last bit of old air remaining in your lungs. Keep exhaling until whatever little bit of air still left in your lungs is pushed out and the inhale happens spontaneously and naturally.

Resnick, Stella, The Pleasure Zone, Berkeley, CA: Conari Press, 1997, 95-96.

Meditate on this:

“May I be grounded. One with creation, the earth.”

Or

“Ground me, centre me!”

The Deep Sigh

Going Deeper—Take a deep sigh in and out through an open mouth and a relaxed throat. Feel your upper back widen, your “wings” stretching apart on the inhale, releasing on the exhale. Let the breath out in a deeply aspirated “hah” as though you were steaming up a pair of glasses you wanted to wipe clean. Now take three deep breaths in a row. If you find yourself yawning a lot, let it happen.

Resnick, Stella, The Pleasure Zone, Berkeley, CA: Conari Press, 1997, 96.

Meditate on this:

“May I be grounded. One with creation, the earth.”

Or

“Ground me, centre me!”

The Charging Breath

Building Excitement—The object of this breath is to build excitement, an energy boost. When you’re ready open your mouth wide, suck air all the way into your chest, and let it out all at once in a big “hah.” Relax and notice how you feel. If you liked the way that felt, do it five more times in rapid succession.

Resnick, Stella, The Pleasure Zone, Berkeley, CA: Conari Press, 1997, 96-97.

Meditate on this:

“May I be inspired and energized.”

Or

“Inspire and energize me!”

The Compassion Breath

• Notice your breath and imagine your heart smiling back at you.

• Now breathe in with your smiling heart and breathe out with smiling breath.

• Breathe in with the compassionate breath.• Breathe out with the compassionate

breath.• Breathe in with the nurturing breath.• Breathe out with the nurturing breath.

Meditate on this:

“May my heart be opened.”

Or

“Open my heart!”

Compassion to Self and to Others

“As we learn to have compassion for ourselves, the circle of compassion for others—what and whom we can work with, and how—becomes wider.” Pema Chodron, When Things Fall Apart, p.105

Breathing and Stretching (5 min.)

• Cleansing breath-head back, blow tension up and out• Inhale as head falls forward with chin to chest and blow

down.• Inhale to bring chin parallel to floor and look far over right

shoulder and blow out.• Inhale and turn head to look over left shoulder and blow

out.• Inhale and look ahead, let right ear move toward right

shoulder. Right hand on head for few moments and blow out.

• Inhale and look ahead, let left ear move toward left shoulder. Left hand on head and blow out.

Fresh Bread and Other Gifts of Spiritual Nourishment

can it be?

have I for so long forgotten to feed

myself? yes.

for nigh a year now I was slowly starving.

getting lost in busy days, tossing aside the

hunger that chewed away inside.

Yet, I did not die.

By some quiet miracle I made it to this

moment of truth:

I nearly starved to death.

It was not my body that I failed to feed.

It was my spirit, left alone for days

without nourishment or care.

And then one day I paused to look within,

shocked at what I found: so thin of faith,

so weak of understanding, so needy of

encouragement.

My starving spirit cried the truth: I can!

I will! I must be fed! Joyce Rupp, p. 16

Learning in Action

What am I learning about myself when I listen to someone who is suffering?

How can I be truly

present to someonew

ho is suffering?

The power of recognition to reduce suffering cannot be explained, but it seems fundamental to our humanity.

Frank A.W. (1991, p.104). At the will of the body. Boston, MS: Houghton Mifflin.

Emotional Intelligence

“A form of social intelligence that involves the ability to monitor one’s own and others’ feelings and emotions, to discriminate among them, and to use this information to guide one’s thinking and action” (Salovey & Mayer, 1990).

The Power of Self-Awareness

• With self-awareness, person has 50-50 chance (49%) of demonstrating self-management; without it, person has virtually no chance (4%).

• With self-awareness, person has 38% chance of having social awareness; without it, person has 83% chance of lacking social awareness.

Source: Burckle & Boyatzis (1999)

Self-Observation

The next time you find that you are in a situation where you begin to react strongly emotionally, remember the Helicopter Mode. The Helicopter Mode is the skill of observing oneself in action. As you pull up and observe yourself, you will be able to see how you are contributing to the interaction. You can then choose to act differently and adjust the interaction so that it becomes more constructive.

Ladder of Inference – Chris Argyrys

I observe something

I interpret what Iobserved.

I draw conclusions.

I noticedthat...

To methis means

that...

So, Iconclude

that...

DirectlyObservable Data

INTERPROFESSIONAL COLLABORATIVE COMPETENCIES

• Communication

• Collaboration

• Roles & Responsibilities

• Collaborative Pt/Cl-centred Approach

• Conflict Management/Resolution

• Team Functioning

(CIHC,2010; Curran et al 2009)

CommunicationAssertive & respectfulEffective use of

communication strategies

CollaborationCollaborative relationships

with others planning & providing care

Promotes integration of info & perspectives of others

Appropriate sharing of info

Roles & Responsibilities Describes one’s own r&r

clearly Describe the r&r of others Share EB/best practice

knowledge with others Integrate r&r of others with

own to optimize care Accountability for own

contributions

Collaborative Pt/Cl-centred Approach

Input from pt/family – respect re feelings, beliefs, needs, goals of care

Integration into care plan Shares options & health

info Advocates for pt/family as

partners in decision-making process

Conflict Management/ResolutionActive listeningRespectful of different

perspectives & opinionsWorks to prevent

conflict/deals with effectively

Team FunctioningEvaluates function & dynamicsShared leadership skillsEffective & meaningful

contributions

Traditional model of care

Health CareProfessional

Patient

Assumptions in this model:

Boundaries are very clear

Power is clearly delineated

Relationship is centred on the “illness” and fixing the patient

MultiDisciplinaryTeamwork

Team members work in parallel, responsible for their own professional tasks

Communication is often minimal, through chart and leader

Leader is often the physician

Often results in:

Each team member may feel “this is my patient!”

Patient Centred Care

Patient

Health Care

Professional

Assumptions in this model:It adoptsthe patient's perspective.What is it about their interaction with providers, systems, and institutionsthat patients say matters to them and affects them, either positively ornegatively.The health care professional is at the service of the patient.

This has resulted in:

Collaborative Interprofessional Patient-Centred Models of Care

Team members “collaborate” together, and include patient as a team member:Roles ‘blur’ ,but each member has unique skills.See the 7 elements of collaboration

Communication is frequent, through chart, meetings, shared decision making processes which include the patient, working toward the same goal

Leadership changes as issues change

Inter

Professional

Relational Responsibility

PatientHealth Care Professional

Assumptions: Health Care Professional and Patient are both human beings and this is the connector between them. Both retain their role as health care provider and patient but are not defined by this relationship

Martin Buber

Martin Buber speaks of the “I-Thou” relationship as a reverent being-with the other through which one’s own humanity is confirmed.“The primary word I-Thou can be spoken only with…concentration and fusion into whole being [which] can never take place alone, nor can it take place without me. I become through my relation to theThou; as I become I, I say Thou.” - Buber, 1958

THANK YOU