Critical Reflections on teaching touchy feely subjects in the large group setting.Alexandra Swift

What do we mean by touchy feely subjects?

• Communication skills e.g. Breaking Bad News• Spirituality• Empathy• Grief and Bereavement

• (All of which assist the practitioner to deliver care that is both sensitive and therapeutic)

Drivers

• Compassionate practice is an explicit requirement and a key quality indicator for nursing (DH 2008; NMC 2010)

• Compassion in Practice The 6 C’s (Cummings and Bennett, 2012)

• Francis Report (2013) emphasises the need for a culture of compassion and caring in nurse recruitment, training and education.

• “Culture of Compassionate Care” (DH, 2013) Patients first and foremost

NMC Standards 2010

• Standard 7 for education- Theory and practice outcomes must ensure that the holistic needs of all patients are met, including the most vulnerable

• (Glasper , 2010)

Reactions from people

• “That’s just not possible!”

• “It’s just not teaching!”

• “Teaching communication skills to such a large group of students- you’ve got to be kidding!”

From this…………….

Proficient Practitioner

From this………….

To this!!............

Potential problems

• Distressed students

• Students unwilling to share their experiences

• Students may not engage due to the anonymity of the large group setting

• (Zavertnik et al 2010.)

•BREAKING BAD NEWS

My lesson plan

• Discuss the term breaking bad news

• Consequences of poor delivery

• Various models of breaking bad news, step by step approaches discussed.• Video

• Then, …..

FORBIDDEN IN LECTURE THEATRE!!

FORBIDDEN IN LECTURE THEATRE

Support and challengeTheory (Daloz, 1986)

Community of Practice (Lave and Wenger, 1991)

SUPPORTIVE MEASURES (Mortiboys, 2005

(Fallowfield, 1993; Mortiboys, 2005)

• Hazard warning

• Person available is students become distressed

• Offer support at the end of session

Contributing Factors

• Being a novice lecturer actually enabled me to empathise more with my students . Morss and Murray (2005) report that undergraduates can often relate more to postgraduates than academics. • Group dynamics• • Engelmann (2010) refers to the benefits of

“nursing” our students when teaching such emotive topics.

Lessons Learned

• Whilst adopting aspects of the palliative care nurse approach, it’s important to also be assertive and have classroom control.• Roving microphone. (so other students can hear

the experiences shared)• Also provide students with copies of the models

of Breaking Bad News. Ask them to identify and critique the various elements used when watching the video, thus promoting student engagement.

Engagement

• The extent to which students have been required to actively do something with what they have learned will determine how deeply they know it.

• (Brookfield, 2006)

•

• Success of any lecture is measured by the level of student engagement • (Race and Pickford 2007)

(Race, 1993)

Most importantly,…………

• “The best teaching is critically reflective, constant scrutiny of assumptions about learning/conditions fostering learning”

• (Brookfield, 2006)

Brookfield’s 4 lenses

Autobiographical

The student’s eyes

Colleagues’ experiences

Theoretical literature

References

• Benner, P. (1982) “From Novice to Expert” American Journal of Nursing, 82 pp 402-407

• Brookfield, S. (2006) The Skillful Teacher, San Francisco, Jossey- Bass.

• Cummings, J. & Bennett, V (2012) Developing the Culture of Compassionate Care. Creating a new vision for Nurses, Midwives and Caregivers, London, The Stationery Office

• Daloz, L. (1986) “Effective Teaching and Mentoring” San Francisco, Jossey Bass.

• Department of Health (2008) A High Quality Workforce: NHS next Stage Review, London, DOH.

• Department of Health (2013) Patients First and Foremost https://www.gov.uk/government/uploads/system/uploads/attachment _ data/file/170701/Patients_First_and_Foremost.pdf (accessed 20 May 2013)

• Engelmann, L. (2010) “Clinical learning:Do faculty teach how to learn?” Teaching and Learning in Nursing, 5, pp 93- 94

References continued• Fallowfield, L. (1993) Giving sad Bad News, The Lancet, 341, 8843, pp476 -478.

• Francis, R. (2013) Mid Staffordshire NHS Foundation Trust Public Inquiry. www.midstaffspublicinquiry.com (accessed 20 May 2013) Glasper, A. (2010) NMC launches New Standards for undergraduate nurse programmes, British Journal of Nursing, 19, 20, pp 1308-1309

• Lave, J. & Wenger, E. (1991) Situated learning:Legitimate Peripheral Participation, Cambridge, Cambridge University Press.

• Maslow, A. (1954) Motivation and Personality, New York, Harper.

• Morss, K. & Murray, R. (2005) Teaching at University: a guide for postgraduates and researchers, London, Sage.

• Mortiboys, A. (2005) Teaching with Emotional Intelligence, London, Routledge.

• Nursing and Midwifery Council (2010) Standards for pre-registration Nurse Education http://standards.nmc-uk.org/PreRegNursing/statutory/standards/pages/standards.aspx (accessed 20 may 2013)

References continued• Race, P. (1993) "Never Mind the Teaching — Feel the Learning!", Quality Assurance in

Education, Vol. 1 ,2, pp.40 – 43

• Race, P., & Pickford, R. (2007) Making Teaching Work, London, Sage.

• Zavertnik, J.E., Huff, T.A., Munro, C.L. (2010) “Innovative approaches to teaching communication skills to Nursing Students” Journal of Nursing Education, 49,2 pp 65-71.