If a hospice has moved from the paradigm of being “a provider of care” to that of being “a teaching organization” first and foremost, then teaching clinicians “how to teach” during the visit would be a topic that would receive tremendous intention. It should not be assumed that clinicians inherently have these skills. These teaching skills would be based on the methods employed by the most effective teachers that a hospice can find and the practices would be translated to the visit setting. Of course, the teaching methods employed during visits are altered and adapted as the teaching environment, students (patients/families), timeframe and subject matter are different from a traditional setting. The basic learning concepts remain the same whether in a classroom (controlled) or a visit (uncontrolled) setting.
What must be firmly established in the clinician’s mind and self-image is that they see themselves as a teacher. They must be confident that they have been trained extraordinarily well based on a conceptual framework that allows them to address many different scenarios with relative ease to create a high-quality, predictable experience. They should understand their defined role in the creation of this orchestrated care experience and why it is essential that they teach well.
Clinicians should understand that taking the time to teach well, especially with the first few visits, will radically enhance the care experience as we empower caregivers to be confident in their participation in that experience. This confidence will lessen worry and anxiety issues which are forms of non-physical pain. This participation will create a much more satisfactory experience for caregivers, even if they cannot see this point at first. When a caregiver provides extraordinary care, we have truly done our job! It is the optimal hospice experience. In addition, we are often teaching “life skills” which have much broader application for our students (caregivers in this case) that continue long after hospice is out of the picture.
Major Point: It is critical to note that this teaching emphasis goes directly against what most clinicians have been taught. Many clinicians “feel” that if they are not “providing the care” or “doing certain things” they are not doing their job. This task-oriented mindset makes clinicians actually “feel” bad about themselves as their image of an ideal clinician is not being fulfilled. Often clinicians do not recognize that by “providing the care” they are actually fostering unnecessary dependence and are “disabling” caregivers…believing that they are providing a great service in the process. This “provider of care” mindset must be replaced by new thought habits where the clinician “feels” good about themselves as they understand emotionally and intellectually why teaching is superior to doing. This is another reason the experiential learning created in the synthetic lab is so important. The habits of success must become natural and the norm.
The environment or setting of the visit is a huge variable in the teaching activities of a clinician. A patient’s space, whether in a home or a facility, is an uncontrolled teaching environment as the degree of control is limited. However, the principles of great teaching still apply. Room management must be taken into consideration. Can the clinician make a few movements and prepare the room for their “class?” This could simply be the act of closing or opening doors or windows as needed. It could be arranging the position of the clinician and the student (caregivers/patient). It would certainly mean being “prepared to teach” emotionally, mentally and physically (having your materials in order and readily available).
The Students (Caregivers and Patients)
This area needs the utmost consideration when teaching during a visit. There are times to formally teach as well as times to teach by performing tasks (although this is not ideal). Optimally teaching during a visit requires a great deal of intuition and sensitivity. What is the state of the student? Are they able to learn? What tone and type of language is needed to effectively teach? If the energy of the student is low or the person is fragile, what are most important points you need to get across? How do you know if your teaching was effective? How confident is the caregiver?
During a visit, a clinician does not have a great deal of time. This is yet another area where the visit structure comes to the rescue as the broad body of knowledge and experience that was used to formulate the structure minimizes the number of unfamiliar scenarios and challenges a clinician may face. It enables a clinician to get right to the point without wasted “windups” or clumsy explanations for routine situations. This is also where the use of common language comes into play. A top teacher builds a fairly substantial teaching arsenal over time with cues and tools to radically facilitate the teaching of topics and the ability to address concerns. Again, taking MORE time during the first few visits is the norm at a teaching hospice. It is expected that these initial visits may be 2x the normal duration. The multiple benefits of this “special time” must be understood such as decreased on-call visits and a tremendous reduction of non-physical suffering, as well as the higher satisfaction that is created with through confident, participatory caregivers.
The topics addressed during the visit are highly personalized according to the situation, needs and wants of patients and families. However, pain, both physical as well as in the non-physical domains, is common to all hospice experiences and varies in degrees. The physical pain of the patient is normally the first consideration. Failure to address this causes the overall pain of everyone involved to cascade with time. Therefore, it is first. It should also be measured, whether in hours or even minutes. After physical pain is addressed to the degree possible, then the work of addressing non-physical pain takes a more prominent place in the visit. Again, it has been estimated by some that 70-80% of pain is non-physical. This is heightened when a person is dying. Therefore, teaching on this topic becomes paramount to the creation of an extraordinary care experience.
We cannot be with patient and families all the time. In fact, for most, it is only a small amount of time. Conversely, to visit too long robs the family of sacred, nonredeemable time. Therefore, increasing the amount of time is normally not the answer. We must empower caregivers to be confident so they can become powerful extensions of our hospice. They are part of our team. This will only come about by teaching.
Teaching well matters.
~ Andrew Reed