Learning and vulnerability in end-of-life communication
A blog post written by Kim Devery, Lead of End-of-Life Essentials, Senior Lecturer and Head of Teaching Section, Palliative Care, Flinders University
In spring each year, postgraduate students from all around Australia leave family and work responsibilities to spend 2 intensive days at Flinders University in Adelaide. These professionals come to interact with peers and facilitators to learn more about communication at the end of life, the topic covered as core in all of our courses.
Communication, the cornerstone of excellent end-of-life care, is that delicate skill that can flourish in the fertile environment of mindful practice and supportive critique.
These professionals, a mix of doctors, nurses and allied health professionals from all kinds of clinical settings, gather to share their goals for learning, encourage each other to learn more, and share their most telling and challenging clinical stories. This is inspiring teaching and learning for me as I observe these professionals reach for higher ground in their communication skills.
I'm often impressed at how clinicians from very different practice settings have very similar challenges when it comes to end-of-life care. From NICU to ICU, acute medical to community, and from general practice to oncology practice settings these professionals bring to the intensive workshops their most carefully prepared learning need. Carefully prepared because weeks have been spent identifying areas of their practice that they wish to workshop, critique and develop. Carefully prepared because these are points in their practice that have challenged the flow and purpose of patient/professional communication. Carefully prepared because even identifying these can make a clinician/student/professional quite vulnerable: this is, after all, an admission that one could practice better. So what areas of communication are so carefully planned? These are some examples:
- Following the patient’s agenda, not mine; knowing what my agenda is and being prepared to lay it aside
- Recognising an urge to “fix” things, and being ok about letting that go
- Understanding anger and knowing how to respond
- Responding to challenging questions e.g. “How long have I got?”
- I want to say the word dying when discussing end of life with patients and families.
These themes of communication cross disciplines, are found in all different kinds of clinical settings, and are voiced by the most and the least experienced professionals. End-of-life care communication challenges are carefully shared and strengthened amongst small facilitated groups. Respect, support and mutual appreciation of this emotional work cultivates learning during the intensive.
The core communication topic PALL8430 allows all students to hold a mirror up to professional practice with a substantial critical reflection component. In that mirror we can see the stellar points of our practice and also, if we look carefully, the underdeveloped areas. Admitting that practice could be better allows for both vulnerability and an accelerated professional learning and development. This recognition of the strength of vulnerability is a huge advantage to those who wish to grow all areas of their practice and, at the same time, provide exceptional end-of-life care.
Graduate Certificate in Palliative Care, Graduate Diploma in Palliative Care, Graduate Diploma in Palliative Care in Aged Care, Master of Palliative Care and Master of Palliative Care in Aged Care.
Kim Devery, Lead of End-of-Life Essentials, Senior Lecturer and Head of Teaching Section, Palliative Care, Flinders University