The Interprofessional Team: Addressing the Spirituality of Grief and Loss

1. The Interprofessional Team: Addressing the Spirituality of Grief and Loss

2. 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.

3. Balfour Mount

4. Objectives • 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

5. The skeleton woman Tamsin Williams performing in Skeleton Woman. Photogaph: Nick Sayers.

6. 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 • Our Spiritual Nature • Our Holistic Self Social Emotional PhysicalIntellectual c

12. 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

13. 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.

14. Being In Life In 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.

15. 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.

16. Meditate on this: “May I be grounded. One with creation, the earth.” Or “Ground me, centre me!”

17. 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.

18. Meditate on this: “May I be grounded. One with creation, the earth.” Or “Ground me, centre me!”

19. 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.

20. Meditate on this: “May I be inspired and energized.” Or “Inspire and energize me!”

21. 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.

22. Meditate on this: “May my heart be opened.” Or “Open my heart!”

23. 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

24. 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.

25. 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

26. Learning in Action How can I be truly present to someonewho is suffering? What am I learning about myself when I listen to someone who is suffering?

27. 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.

28. 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).

29. 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)

30. 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.

31. Ladder of Inference – Chris Argyrys

32. INTERPROFESSIONAL COLLABORATIVE COMPETENCIES • Communication • Collaboration • Roles & Responsibilities • Collaborative Pt/Cl-centred Approach • Conflict Management/Resolution • Team Functioning (CIHC,2010; Curran et al 2009)

33. Communication • Assertive & respectful • Effective use of communication strategies Collaboration • Collaborative 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

34. 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/Resolution • Active listening • Respectful of different perspectives & opinions • Works to prevent conflict/deals with effectively Team Functioning • Evaluates function & dynamics • Shared leadership skills • Effective & meaningful contributions

35. Traditional model of care Assumptions in this model: Boundaries are very clear Power is clearly delineated Relationship is centred on the “illness” and fixing the patient Health Care Professional Patient

36. Multi Disciplinary Teamwork Often results in: Team members work in parallel, responsible for their own professional tasks Each team member may feel “this is my patient!” Communication is often minimal, through chart and leader Leader is often the physician

37. Patient Centred Care Assumptions in this model: It adopts the patient's perspective. What is it about their interaction with providers, systems, and institutions that patients say matters to them and affects them, either positively or negatively. The health care professional is at the service of the patient. Health Care Professional Patient

38. This has resulted in: Collaborative Interprofessional Patient-Centred Models of Care Inter Professional 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

39. Relational Responsibility 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

40. 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 the Thou; as I become I, I say Thou.” - Buber, 1958

41. THANK YOU