I attended a practice educators’ conference at Robert Gordon University in Aberdeen last month, writes Gwyn Owen. One session involved a visit to the simulation suite – an interactive learning space carefully designed to give students opportunities to practise physiotherapy in the safety of a virtual environment.
As I entered the virtual intensive care unit, a wave of memories hit me ... the monitors, the sound of mechanised breathing and of people I’d worked with in settings like this. Some patients recovered, but others had not. I also recalled a conversation with a personal tutee about her experience of seeing patients die while on placement.
Her experience of death and nurses’ responses to her reaction to it are echoed in research conducted by and with physiotherapy students at Coventry University (Powell and Toms 2014). The research showed how staff’s responses to death and dying in clinical practice can play a significant part in shaping how students learn to make sense of their experiences of loss and grief in professional practice. The results are also changing the practice of the physio staff (see Learning curve).
If the physiotherapy workforce is to develop and maintain its capacity for compassionate care, we must look at our ability to respond to loss and grief. For centuries, the work of writers and artists has conveyed a sense of human experiences of everyday life – of birth, ageing, illness and disease, death and dying. Resources from the arts and humanities fields can help students and practitioners to talk about loss, death and dying; and to develop the emotional, cognitive and physical capacity needed to care compassionately.
Gwyn Owen is a CSP professional adviser and Jane Toms is a senior lecturer in physiotherapy, Coventry University.
Jane Toms reflects on a research study that she co-wrote with Sam Powell
My experience, as a critical care therapist and a cardio-respiratory lecturer, led me to question the way patient death was handled in both clinical settings. Sam Powell, as a mature student on placement, experienced several deaths. Although she felt able to cope, she was concerned about others in her cohort. It was clear that many students found patients’ deaths an extremely traumatic experience and perceived that many qualified staff could not provide the support they felt they needed.
Our research study explored the students’ experiences in greater depth. I believe the research has started to influence practice in three ways:
Impact 1: Clinical educators
Clinical educators were very receptive to hearing the students’ experiences as part of clinical educator training. They reported a sense of shock: they didn’t feel ‘blasé’ about patient death, or mean for an emotionally distressed student to feel ‘silly’. But they could see how they might have given that impression. Many suggested that their new insight would change their student supervision in various ways. This included having more deliberate dialogues with their students on patient death issues.
Impact 2: Students
Sharing this research with a range of student cohorts each year has opened the door to deeper engagement and learning about patient death. This is in both preparation for, and reflection on, practice. The students appear to find past students’ experiences and coping strategies to be engaging and informative. Some students have chosen to explore the topic further in their course work and dissertations. Each student has the opportunity to influence when on placement.
Impact 3: Qualified staff
Students are the physiotherapists of the future and will shape the future. Sam Powell is testament to this and continues to raise the profile of this topic wherever she works. This illustrates how one person can have a ‘multiplier effect’. In addition, physiotherapists have contacted me saying how helpful they have found our article. They say that using it in ‘journal clubs’ leads to people having productive discussions.
Death: a self-portrait
This set of online resources comes from an exhibition devoted to the iconography of death and our complex and contradictory attitudes towards it. Hosted at the Wellcome Collection, London, in 2012-2013.
This website contains resources such as 10 ‘myth-busting funeral facts’ and a set of critically-acclaimed films designed to prompt conversations about death, dying and bereavement.
This section of Healthtalk’s website contains interviews with a wide range of people with personal experience of living with dying, so that you can share in their stories.
Twitter account Dr Kate Granger
(the founder of #mynameis campaign) presents her story of being a patient coming to terms with terminal cancer.
– literature, arts medicine database
An annotated online collection of art and literature established in 1993 at New York University School of Medicine.
A collection of drawings, painting, photographs and sculpture exploring lived experiences of physiotherapy practice.
CSP’s evidence and knowledge discovery service
This searchable database contains literature demonstrating the value and impact of using arts and humanities to promote learning about loss, death and dying.
This activity comes from a blog written by a surgeon reflecting on the challenges of breaking bad news to patients.
Refilling the tank
invites readers to reflect on their experiences of delivering bad news. Although written by a surgeon, the ideas and reflective activity are relevant to our practice. Focus on a situation where you delivered bad news, perhaps when you gave someone a diagnosis or prognosis they weren’t expecting, or a conversation with someone who did not achieve their goals.
Describe the situation and how you and the other person responded to the bad news. Now step back to look at the positives when bad news is of delivered well.
In doing so, you gain space to recognise personal strengths (and potential learning needs) in a way that sustains the emotional energy needed to help the people we work with through the cycle(s) of grief.
Gwyn Owen and Jane Toms