Olwen Minford is an End of Life Care Facilitator who works in the community, hospitals, and care homes, seeking to improve the standards of palliative and end-of-life care for patients and carers through support and education of staff.
The United Kingdom Health Service ombudsman’s report ‘Dying Without Dignity’ 2015, makes for challenging reading and highlights examples of poor communication by healthcare professionals. The Francis report (2013) also looks at a number of cases where communication in End Of Life Care has gone wrong. There have been repeated recommendations and specifications for mandatory training in care of the dying for all staff including “communication skills training and skills for supporting families and those close to dying patients” (NCDAH, 2014).
What can we do differently?
Working as an End of Life Care Facilitator, I have noticed that fear and death anxiety is tangible and very prevalent among healthcare professionals. We pay lip service to the ‘taboo around death’ in words but how are we dealing with this in education and practice?
It is taken as a given that once staff have received the ‘education’ they will be able to engage in conversations about death and dying. The reality is quite different. Until staff are enabled to process their own feelings and experiences around death in a safe environment they are likely to remain frozen in fear and awkwardness in the clinical situation. There often remains an obstacle to engaging in discussions with patients and families.
The arts offer us an opportunity. Incorporating the arts in training can offer experiences that promote human maturing and give people permission to be vulnerable in a safe space. Helping staff to get in touch with their own vulnerability encourages them to show compassion towards others’ suffering. This can support professionals to create meaning from their encounters with distressed people and the qualities of empathy, resilience, and compassion are developed organically.
‘Dismantling the taboo around Death’ workshops are an example of experiential training that incorporate visual arts, poetry, role play, creative writing and provide staff with a language to begin to address the subject of death and dying. The expression of difficult feelings is facilitated that otherwise would remain hidden or unexpressed. Participants report increased confidence and skill in being able to initiate and sustain end of life care conversations.
As a recipient of a Winston Churchill Memorial Trust travel fellowship in 2014, I researched education programmes using the arts in USA and Australia. Many medical and some nursing schools are using art galleries and evidence-based visual arts programmes to enhance observation skills (Dolev et al 2001), increase empathy and emotional awareness of self and others. The programmes improve visual assessment and critical thinking and have an emphasis on reflection. Multidisciplinary team working is improved through inter-professional collaboration in the gallery and the clinical setting.
A radical shift is necessary to raise awareness and recognise the transformative power of the arts and the holistic value they can bring to healthcare education. By engaging the spirit in care and nourishing kindness in practice, they improve communication and compassionate care. Arts based training methods embedded in undergraduate programmes encourage emotional, relational and cognitive development of the ‘whole student’ (doctor, nurse, allied health professional). The result potentially is a more confident, reflective workforce, who are enabled to respond appropriately and sensitively to people in distress, especially at the end of their lives.
Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry. Last accessed 22.7.15
MCPCIL (2014) National Care of The Dying Audit of Hospitals (2014) Royal College of Physicians.
Dismantling the taboo around death workshops. Last accessed 22.7.15
Winston Churchill Memorial Trust press release. Last accessed 22.7.15
Dolev J C, Friedlaendar L, Krohner M S, Braverman I M. (2001) Use of Fine Art to Enhance Visual Diagnostic Skills, American Medical Association.
Miller A, Grohe M, Khoshbin S, Katz JT. From the galleries to the clinic: applying art museum lessons to patient care. J Med Humanit 2013 Dec; 433-8. doi: 10.1007/s10912-013-9250-8.
Perry M, Maffulli N, Willson S, & Morrissey D. ( 2011) The effectiveness of arts-based interventions in medical education: a literature review. Medical Education 45 (2)141-148.
- Olwen Minford.
- And … action! Hospice and palliative care volunteers as patients. In an earlier post on the EAPC Blog, Dr Birgit Jaspers writes about the actor-as-patient teaching method used in her palliative care unit.
Free training workshop at the Royal Academy of Arts, London
Do you see what I see? Visual arts training for healthcare professionals
3 November 2015 at the Royal Academy of Arts, Reynolds Room, Burlington House, London W1J OBD, 2-4pm.
Special guest: Linda Friedlaender, Yale Centre for British Art, Yale University. The session is open to students and clinicians from medicine, nursing, psychology, occupational and physical therapy, art therapy, and art gallery and museum staff. The session is free of charge but pre-registration is required. To register, please email your name, organisational affiliation and email address to firstname.lastname@example.org Please write ‘RA/YALEWORKSHOP’ in the subject heading and submit your request by 23 October.