Six Easy Strategies to Open Space for Teaching Palliative Care

Six Easy Strategies to Open Space for Teaching Palliative Care

I must define the course in a way more engaging than engorging, countering my tendency to inundate students with data, and allowing them instead to encounter the subject, each other, and themselves. 

I must provide readings with substance that students need to know, but with gaps in which students can think their own thoughts – and because this virtue is most often found in primary texts, I must be well acquainted with the literature of my field.  

I must create exercises that invite students to probe the unknown, as well as exercises that reveal what they have learned.  

I must establish a schedule that allows time for the unexpected, even as it makes time to acquire the predictably necessary facts.” 

Parker, Palmer, (1998), The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life,  San Francisco, John Wiley & Sons, Inc. 

Teaching is a privilege and an honour. Even though I love teaching, I often struggle to create interesting lessons in palliative care that provide practical skills and knowledge while also providing space for inner reflection and personal growth. I hear from other instructors who share the same struggles. In addition, teaching palliative care has its unique challenges – how often have you heard students expressing these thoughts?

“I don’t want to talk about dying” or

”I don’t want to care for someone who is dying” or

“This is the part of the program that I am most afraid of”

As a new teaching year begins, and especially for those new to teaching palliative care, I feel it’s appropriate to reflect back a few decades to share Parker Palmer’s ground-breaking ideas about “opening spaces” for learning. These ideas are even more relevant to teaching today. Students in this post-pandemic time experience more threats to their holistic being than ever before. Success in the classroom is dependent upon creating safe physical, mental and emotional spaces where learning can occur.

I invite you to consider the following teaching strategies when teaching palliative care, and then share your ideas on ways that you open space in your classrooms.

Six Easy Strategies for Opening Space when Teaching Palliative Care

1 – Create an open space – with defined boundaries

As we stated above, learners may fear talking about death, dying, and palliative care. This can be a significant barrier to learning, and so, creating open space can help diminish the barriers. You “open space” to teach palliative care when you prepare students in advance for topics that they might find difficult to discuss. For example, inform them in advance about when palliative care topics such as serious illnesses, integrating a palliative approach, declining, dying and death will be addressed. Then, invite students to talk with you privately if they prefer, about their concerns with learning about dying and death, and providing palliative care.

Creating a time boundary is equally important. Inform students that although palliative care will be woven throughout the program, semester, and course, it will not be unending. Knowing how long or when a topic will be discussed allows the learner to prepare for topics that they may be fearful or apprehensive about. This strategy can help de-escalate fears and weaving the palliative care content throughout the course/program, may also help students to understand that dying is a part of living.

2 – Create a safe, trustworthy space where the person can take risks, rest, and energize. 

For each group of learners, I work with them, collaborating to establish classroom rules for a safe and trusting learning environment. Is this something you have tried in your teaching? In this environment, students can be more open and able to take the risks needed to explore their fears, beliefs, and values related to death and dying.

3 – Invite individual and group voices. 

I think that we have all been in a situation where we ask the learners to reflect on a personal experience, and suddenly the students are looking anywhere but at us!

I invite individual voices by asking students to let me know if they would like me not to call on them. Then, I am free to ask other students individually for their ideas and all students can feel safe that I will not call on them if they have so requested it. Here are a few other strategies to invite both individual and group stories:

  • Be clear that you welcome questions – all questions. A favourite instructor of mine posted on their wall, “There’s no such thing as a dumb question.”
  • Invite those who are uncomfortable with speaking up to submit their questions by email, with the agreement that authorship will not be identified in class discussion.
  • If your facility has the technical equipment, consider using an in-class app like Mentimeter – where students can anonymously answer polls, provide answers and comment on topics. Their answers are shared on the classroom screen with everyone else’s.

4 – Honour individual and big stories equally 

Make space for individual stories (personal experiences in which the learner’s inner teacher is at work)– these powerful moments can bring great insight for the person and may help listeners to develop compassion and empathy.

Make space for big stories about traditions, rituals, experiences – these stories create community and shared understanding – equally powerful forces for learning.

5 – Create space for listening to their inner voice 

Not all caregivers know that learning from and about oneself is crucial to becoming a compassionate and empathetic caregiver. Create space – physical, mental, and emotional – in the curriculum for students to reflect, to relate content to their own experiences and to build layers into their understanding of their role in providing palliative care.

6 – Create space for wonder 

Being silent (as the instructor) can be so challenging and yet so rewarding. Silence may encourage students to wonder, to create connections in their personal being and knowledge, and to reach deep to build understanding. As you well know, the role of an instructor is not always to provide the answer. Instead, it can be equally helpful at times for the instructor to point to a guidepost that will help the learner along their path or to be willing to sit with the student in times of “not knowing”, to reflect back, and ask for others to provide their thoughts 

Interested in more?  

If you are interested in more ideas, check the following lesson plan. This lesson plan takes advantage of the resources provided in the Student and Instructor memberships. Specifically, the workbook, Integrating a Palliative Approach: Essentials for Personal Support Workers, and video resources. This type of comprehensive learning activity is one of many reasons why the resources from Life and Death Matters make teaching palliative care easier.

Lesson Plan – The concept of baggage

  1. Introduce the concept of baggage as their fears, beliefs, and values. With access to student or Instructor’s memberships, present the videos, “Applying the Idea of Baggage to Caregiving,” and “Packing for a Trip.”
  2. Invite students to explore their baggage by asking this question: “How do you feel about caring for a dying person?” Exploring could be through reflective writing, a guided meditation, or group discussion.
  3. For students with memberships, assign the worksheets from the workbook, where learners can:
    • Use the Faces exercise to help identify how they feel about caring for a dying person (p. 13).
    • Describe their baggage related to caring for a dying person on the worksheet Baggage exercise (p. 14).
  4. At the end of step three, validate for learners that fears and concerns about caring for a dying person are common. Reassure students they will be supported as they learn the skills to care for a dying person.
  5. Debrief the exercises in one of these ways, inviting learners to share information to their level of comfort:
    • Provide time and invite students to add their reflections to a flip chart page on the wall.
    • Ask students to contribute reflections anonymously to a forum.
    • Ask learners to pair up and share reflections with their partner, then have one partner share to the larger group.
  6. Lead a discussion on common themes that students experience related to their baggage.

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Courtney Murrell is a PSW who works in hospice palliative care.

When she is not at work, she is spending time with her family, going on hikes or writing. Courtney is a lifelong learner and loves to share her passion for writing as a wellness practice.

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