Values in Healthcare

Contents

Part 1: Introduction

Introduction ……………………………………………………………..1 WhyContents

Part 1: Introduction

Introduction ……………………………………………………………..1 Why Values in Healthcare? : an introductory paper ………………………2

. 1 A Values-based Approach…………………………………………….8

. 2 A Spiritual Approach……………………………………………….12

. 3 Values in Healthcare Programme ………………………………….14

OHPs 1–8

Part 2: Guidance for Facilitators

Introduction…………………………………………………………….25

. 1 Structure of Values in Healthcare Programme………………………25

. 2 Spiritual Tools ……………………………………………………..26

. 3 The Role of the Facilitator………………………………………….27

. 4 General Preparation ………………………………………………..29

. 5 Session Programmes and Timing Issues ……………………………..31

. 6 Process and Group Size …………………………………………….32

. 7 Background Reading ……………………………………………….33

. 8 The CD……………………………………………………………33

. 9 Session Summary and Aims…………………………………………33

. 10 Introducing the Session …………………………………………….34

. 11 The Exercises ………………………………………………………38

. 12 Movement Exercises………………………………………………..40

. 13 Session Review……………………………………………………..40

. 14 Action Planning ……………………………………………………41

. 15 Evaluation………………………………………………………….43

. 16 Closure…………………………………………………………….46

. 17 References and Resources …………………………………………..47

. 18 Ongoing Support…………………………………………………..47

. 19 Follow-on Sessions/Homework……………………………………..48

. 20 Journals ……………………………………………………………49

Part 3: Modules Module 1

Module 2 Module 3 Module 4 Module 5 Module 6 Module 7

Values ……………………………………………………..51 Inner values ………………………………………………..61 Values at work ……………………………………………..71

Peace ………………………………………………………95 Being peaceful …………………………………………….105 Peace at work ……………………………………………..120

Positivity …………………………………………………139 Being positive……………………………………………..155 Positive interaction at work………………………………..167

Compassion………………………………………………193 Finding compassion ……………………………………….205 Compassion in practice ……………………………………216

Co-operation……………………………………………..245 Understanding co-operation ……………………………….254 Working in teams …………………………………………263

Valuing Yourself ………………………………………….285 Self-care …………………………………………………..298 Support at work …………………………………………..305

Spirituality in Healthcare ………………………………..331 Exploring spirituality and healing ………………………….344 Spiritual care in practice …………………………………..357

Part 4: Spiritual Tools

. 1 Introduction………………………………………………………377

. 2 Meditation………………………………………………………..379

. 3 Visualisation………………………………………………………383

. 4 Reflection…………………………………………………………386

. 5 Listening………………………………………………………….389

. 6 Appreciation………………………………………………………392

. 7 Creativity …………………………………………………………395

. 8 Play ………………………………………………………………397

Part 5: Additional Resources

. 1 Warm-up Exercises………………………………………………..399

. 2 Setting-the-tone Activities …………………………………………405

. 3 Movement Exercises ………………………………………………409

. 4 Closures ………………………………………………………….421

. 5 Personal Development and Action Plans …………………………..426

. 6 Evaluation ………………………………………………………..434

. 7 Meditation CD Track List…………………………………………441

. 8 References and Resources………………………………………….442

Values cards

Values in Healthcare

The inspiration for the Values in Healthcare programme came from Dadi Janki, the president of The Janki Foundation for Global Health Care charity. The Foundation is committed to promoting holistic care, and supports a hospital in Rajasthan, India called the J Watumull Global Hospital and Research Centre. Dadi Janki wished the charity’s work to include supporting all healthcare practitioners in the UK. She is very aware of low morale and burnout amongst those caring for the sick and needy, and felt that a spiritual approach would enable healthcare workers to tackle the problems and build self-esteem.

A message from the President of The Janki Foundation

I have learned during my 88 years the great value of the life of a human being; and also how important it is to have values in life. Those who have developed the Values in Healthcare programme have experienced for themselves how values work inside us to influence everything around us.

The mind has a connection with the body, and the body with the mind. What goes on in the mind has an impact on the body, relationships, and the atmosphere in the world.

When we understand our spiritual identity, we are able to live according to our higher values. The mind becomes full of rich, powerful thoughts, and the heart full of honesty and truth. Then the mind remains well, relationships stay healthy, and the body is given strength. Automatically, we find it easy to co-operate with others and to serve with a generous heart.

In healthcare, patients appreciate such compassion beyond measure. Their healing is accelerated, and the blessings they feel towards those who have served them make all efforts worthwhile.

When higher values, and spirituality, inform our lives, we become happy and fulfilled. Then compassion flows easily and naturally. When there is a lack of contentment, as a result of losing sight of values and spirituality, work becomes dry and burdensome.

As spiritual power accumulates, it is as if nothing can obstruct the experience of pure, elevated feelings towards oneself and others. Then the values that are so valuable in healthcare emerge effortlessly in all our actions and interactions.

Dadi Janki

August 2004

Values in Healthcare © The Janki Foundation for Global Health Care 2004 i

Values in Healthcare © The Janki Foundation for Global Health Care 2004

The Janki Foundation for Global Health Care

The Janki Foundation is a healthcare charity dedicated to positive human development, and to working to research and promote a spiritual model of modern healthcare.

For further details about the Values in Healthcare project, including availability and information about ‘training the facilitator’ events, please contact:

Joy Rendell
The Janki Foundation for Global Health Care 449/451 High Road, London NW10 2JJ, UK Tel: 44+ (0)20 8459 1400
Web: http://www.jankifoundation.org

Core group

Project co-ordinator:

Sarah Eagger MB BS, MRCPsych
Consultant psychiatrist; honorary senior lecturer, Imperial College School of Medicine, London; trustee and former chair of the British Holistic Medical Association; executive committee member, Spirituality and Psychiatry Special Interest Group at the Royal College of Psychiatrists; scientific and medical advisor to The Janki Foundation

Project administrator:

Joy Rendell Dip COT, SROT
Senior occupational therapist, Royal National Orthopaedic Hospital & Stanmore DSC, London; trustee of The Janki Foundation

Core group members:

Jan Alcoe BSSc (Hons)
Author, publishing and training consultant in health and social care; trustee of the British Holistic Medical Association; graduate member of the British Psychological Society

Astrid Bendomir MD, MRCOG, CCST Obstetrician and gynaecologist

Craig Brown MB ChB, MRCGP
General practitioner, Sussex; scientific and medical advisor to The Janki Foundation; author of Optimum Healing; chairman, Sussex Branch Doctor-Healer network

Arnold Desser BA (Hons), CAc (China), MBAcC
Senior lecturer, School of Integrated Health at the University of Westminster, London; practitioner of traditional Chinese medicine; course leader on consultation skills courses for GP registrars and on GP-trainers course for the London Deanery of Postgraduate Medical Education; scientific and medical advisor to The Janki Foundation

Maureen Goodman LCST
Programme co-ordinator, Brahma Kumaris, London; trustee of The Janki Foundation

Anne Kilcoyne TQAP Tavistock Institute, Dip Clin Psych, BA (Hons), Cert Ed Arts and health consultant; organisational development consultant

Linda Lee

Receptionist GP surgery, meditation teacher

Kala Mistry BM BS, B Med Sci
Staff psychiatrist, Hertfordshire Partnership NHS Trust; editor of The Janki Foundation Newsletter

Anne Radford BSc (Hons), MSc
Organisational consultant working with businesses, government and community groups; editor of the AI Practitioner

Left to right: Sarah Eagger, Anne Kilcoyne, Kala Mistry, Anne Radford, Joy Rendell, Craig Brown, Arnold Desser, Maureen Goodman (front), Jan Alcoe (back)

Values in Healthcare © The Janki Foundation for Global Health Care 2004 iii

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Advisory Group

Miss Dawn Akers Chiropractor, self-employed
Mrs Eleanor Anderson Family therapist, Mental Health Services, St Charles Hospital,

London

Dr Elizabeth Archer General practitioner, NHS

Ms Susan Balmforth Retired nurse, NHS

Ms Margaret Barron Administrator, The Janki Foundation

Mrs Louise Beckerman Nurse & healing arts practitioner

Ms Christine Bell Social work group co-ordinator

Ms Carole Buchanan Trainer, corporate management development & HR management freelance

Dr Larry Culliford Consultant psychiatrist, South Downs Health NHS Trust Mr Peter Dale Health and social care consultant
Dr Valerie Davies Retired general practitioner
Ms Jane Deady Principal general practitioner

Rev Robert Devenny Spiritual research, Borders General Hospital

Mr Dave Dyall Medical representative

Mrs Brenda El-Leithy Hypnotherapist/healer, Mind2Mind

Ms Carol Evans Counsellor/psychotherapist, Association of Humanistic Psychology Practitioners

Dr Betty Farmer Dept of Nursing & Midwifery, University of Stirling Mr John Fleet Retired surgeon Pen Parc Llwyd

Rev Michael Gartland Head of pastoral and spiritual care, South West Yorkshire Health Trust

Mr Mike George Author
Dr David Goodman Retired dentist
Rev Richard Hewitt Personal development consultant, freelance
Mr Neville Hodgkinson Author & journalist
Dr Ann Hopper Accreditation officer, British Acupuncture Accreditation Board Anna Jacobs Yoga teacher
Mr Nizar Juma Former chairman Aga Khan Health Service, Kenya
Rev Chris McGinn Personal development consultant, freelance
Ms Clare Minty Psychiatrist
Ms Carmen Palmer Nurse
Ms Maggie Parle Social worker, Oxfordshire Social Services
Miss Bhavna Patani Hon Secretary, The Janki Foundation

Dr Andrew Powell Founder chair of the Spirituality and Psychiatry Special Interest Group in the Royal College of Psychiatrists

Ms Nirmala Ragbir-Day University of York; public health project manager, North and East Yorkshire Northern Lincolnshire Strategic Health Authority

Dr Thiru Raj-Manickam Consultant psychiatrist, Eastbourne & County NHS Trust Mrs Dawn Redwood Healer and tutor, Bristol Cancer Help Centre
Ms Sylvina Tate Principal lecturer, University of Westminster
Rev Gill Taylor Minister, Association of Interfaith Ministers and Spiritual Counsellors Mrs Vira Thakrar Practice manager

Dr Navin Thakrar General practitioner

Mr Sheo Tibrewal Consultant orthopaedic surgeon, Queen Elizabeth Hospital, London

Mrs Kusum Tibrewal Practice manager

Ms Anna Sofia van Hooijdonk Director Charity Sofia Care, Centre for Palliative Care

Ms Michaela von Britzke Psychiatric social worker, St Charles Hospital Community Mental Health Team

Mrs Esme Weithers Health visitor, Reading Primary Care Trust
Mrs Yvonne Winants General practitioner & assistant professor University of

Maaschicht

Values in Healthcare © The Janki Foundation for Global Health Care 2004 v

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Acknowledgements

Brahma Kumaris World Spiritual University (UK)

for its invaluable on-going support, advice, provision of meeting facilities and for piloting the modules.

Living Values Educational Programme

for its inspiration on the exploration of human values.

Pavilion Publishing

for their support during the editing and production process.

Pen Parc Llwyd, Centre for Personal Development

where John Fleet has piloted all the modules through the development phase.

Wisborough – Corporate, Personal and Spiritual Development

for advice on the content of the programme and extensive piloting of the modules

Lighthouse Studios

David Cathro for recording and editing the CD, Matthew Stephenson for the music, and Mike George, Gopi Patel and Matthew Stephenson for their mellifluent voices.

Anne Kilcoyne

A dear friend, a generous colleague and a creative and energetic soul who passed away just as the final manuscript was sent to the publishers. She understood and reflected all meanings of the word ‘light’.

and especially to Craig Brown
for his vision, perseverance and faith that it should, could, and would be done.

Endorsements

In recent years there has been a marked increase in people leaving healthcare across all disciplines and all specialties. This can be attributed to a general decline in morale amongst healthcare professionals. In order to retain professionals and to recruit we have to find ways of encouraging and supporting healthcare professionals. Values in Healthcare: a spiritual approach does precisely that, bringing hope to beleaguered healthcare workers by rekindling their early enthusiasm and building self-respect and optimism about the future and preventing burnout by promoting a spiritual model of modern healthcare. In 2000, an invited group of healthcare professionals met to explore these issues. Through their experience from work and teaching in their own specialties that included general practice, psychiatry, nursing, medical education, complementary therapy, occupational health, and organisational consulting the members of the group considered the problems and the need for healthcare professionals to find meaning and purpose in their work by reconnecting with their personal values. The group developed an educational programme to facilitate the experience of values, using a spiritual approach to address the issues on a personal level and its consequences at an organisational level. Such an approach is to be welcomed. It will allow healthcare professionals to become aware of their own needs and values so that they are able to serve their patients better and in a more satisfying manner. This approach will also encourage patients to explore the therapeutic relationship in amore holistic and satisfying manner. My congratulations to the group for thinking out the box and coming up with new models.

Dr Dinesh Bhugra

Professor of Mental Health and Cultural Diversity Institute of Psychiatry, London

I am very pleased to have the opportunity to comment on Values in Healthcare:
a spiritual approach, a personal and team development programme developed by the Janki Foundation. The Foundation is a UK-based healthcare charity dedicated
to positive human development and both researches and promotes a spiritual model of modern health care. Many people, including those involved in healthcare work, think that spirituality is the sole reserve of the health care chaplain. Whilst chaplains, lay and ordained, bring a particular perspective to healthcare settings, the spirituality of patient’s and client is everyone’s business.

If you have spent any time in hospital, you might have observed that many of the meaningful conversations which patients have, is with the ward domestic. Interaction with others is a necessary part of life. But we do not always take into account within the work-place, the need for staff to have meaningful interactions with each other, in order to make sense of the world which they inhabit. This has nothing to do with

Values in Healthcare © The Janki Foundation for Global Health Care 2004 vii

Endorsements

viii

Values in Healthcare © The Janki Foundation for Global Health Care 2004

seniority, but everything to do with how in touch we are with ourselves and those around us.

There has been an increasing interest in patient and staff spirituality in the health service in recent years. This training package, which concentrates on the key principles of: 1, putting professional care givers at the centre of healthcare delivery; 2, enabling personal values to be understood through the exploration of direct experience; 3, enabling participant’s to learn using scenarios which are relevant to the individual’s work and life.

The programme enables people to identify with and experience the core values which guide their lives. The opportunity to reflect on experience and to see the world anew would be invaluable to people of all professions.

The use of this package does not depend upon any pre-requisite religious or spiritual focus. It is well planned and is quite open in its approach. I commend this experiential learning package to you and hope that many of those who use it will find it valuable.

The Reverend Alan Brown

Senior Health Care Studies Lecturer, University of Leeds

Vocation, values and vision are essential to the physical, mental and spiritual health of anyone in the caring professions. They explain why we became health professionals in the first place and we need to keep them alive and burning if we are to be effective and satisfied in our roles. That is why Values in Healthcare provides such a unique, innovative and important resource, which is directlyrelevant to all health professionals.

With the current emphasis on technology, technical precision and organisation, it is easy to become submerged and drown with all the demands, compromises and paperwork of everyday professional life in the 21st century. That is why we need to regain our values, to restore our positivity, to sharpen our compassion and to reassess ourselves and the value of what we do.

If we lose our heart and soul as health professionals and just go through the motions then we and our patients are lost. Our jobs will always be a mixture of science and ‘caritas’.

Good clinicians are positive, inspiring, motivated and fulfilled. This course holds the promise of restoring or replenishing those aspects of our professional life, which are the most important to our patients.

Dr Michael Dixon

Chairman NHS Alliance

I am pleased to endorse the Values in Healthcare: a spiritual approach programme prepared by The Janki Foundation for Global Health Care. This work is timely and will make a significant contribution to healthcare which is still dominated by the notion that everything in the world can be quantified. However, as Einstein reputedly said, ‘not everything that can be counted counts and not everything that counts can be counted’.

Nurses know that many of the legitimate and significant factors associated with health and healing cannot be quantified but, in a climate of technical rationality, this has not stopped the erosion of the fundamental values of nursing. The suffering that this creates is felt at a personal level by individual nurses, and by patients who may not always receive compassionate care – the root value in nursing.

The provision of integrated, holistic healthcare needs a fundamental shift in how we view the world and, within this, a return to the virtues needed to sustain humanity. The Values in Healthcare programme offers managers, teachers, and personnel officers a way to nurture the roots of all health disciplines and, specifically, to help heal the healers.

Dr E S Farmer

Senior Lecturer, Department of Nursing & Midwifery University of Stirling

Values in Healthcare: a spiritual approach, a training programme is aimed at both personal and team development for healthcare professionals. Through structured and facilitated exercises, participants gain first-hand experience of peace, compassion, co-operation and self-valuing a welcome antidote to the stresses and strains of working in an overstretched and under funded healthcare system. It is hoped that Trust mangers throughout the UK will make this programme available to their staff.

Dr Peter Fenwick

Emeritus Consultant Neuropsychiatrist Maudsley Hospital

Values in Healthcare © The Janki Foundation for Global Health Care 2004 ix

Endorsements

Values in Healthcare © The Janki Foundation for Global Health Care 2004

The key aim of our Foundation is to encourage an integrated approach to our health, one that focuses on health and healing rather than just disease and treatment, and which seeks to bring together body, mind and spirit so that healthcare encompasses the whole person.

I am particularly delighted to welcome and endorse this training resource pack which focuses on the central importance of healthcare values within a spiritual context. This, it seems to me, is the right approach which will surely benefit both healthcare professionals and the patience’s and carers they provide advice, support and assistance for.

Michael Fox

Chief Executive
Prince of Wales’s Foundation for Integrated Health

As a nurse with over 30 years’ experience in clinical practice, education, management and policy-making at local, national and international level, I am very pleased to endorse the Values in Healthcare training package. The package provides a welcome and timely addition to the range of training materials available not just for nurses but for all heath personnel. As such, it provides a wonderful tool for rekindling commitment and fostering a healing and supportive environment within which to work as a team.

From a nursing perspective, the growing political concern about the global crisis in the nursing and midwifery workforce, is in some sense welcome. It provides an opportunity for employers, politicians and policy makers to understand the factors which influence recruitment and retention of staff. Increasingly, nurses and midwives are drawing their attention beyond the usual factors such as salaries and career opportunities, to more fundamental factors about the environment within which

we work. Too often and for too long the pressures of our work environments have eroded our human and spiritual sense of ‘connectedness’.

The Values in Healthcare training package is an invaluable resource to help health personnel reconnect with their personal and spiritual values and their vision for healthcare and its use is likely to be supported by wise policy makers and employers.

Overall I believe that the training pack is a very versatile resource which can be used to great effect in a variety of ways and in a variety of settings. I have no hesitation in recommending it.

Pat Hughes

International Consultant, Nursing and Health Policy

The 20th century saw the rapid development of technological medicine. The more that we understood the biological mchanisms that determined health and illness, the more we saw medicine in terms of a mechanic repairing a machine. The beloved family physician who sat by the side of the sufferer until recovery occurred or death supervened was replaced by a brash young man whose name the patient didn’t quite catch who administered a wonder drug that cured the condition in 48 hours. Unfortunately, while this approach had some success in acute diseases it proved to be totally inadequate in the face of the increasing burden of chronic illness.

There is a growing awareness among all branches of the health professions that true healing encompasses more than restoration of biological function but many professionals feel inadequately equipped to deal with these less tangible issues. Their uncertainty about their own spirituality prevents them from offering their patients the needed support in these areas.

There is a lack of clarity about what is meant by terms such as spirituality that are often applied to these questions. Many educational initiatives in this area focus on delivering an intellectual analysis of spirituality along with a protocol for dealing with spiritual problems. This has not proved to be successful. The new programme Values in Healthcare takes a much more experiential approach allowing the learner (be they student or experienced health professional) to explore their own under- standing of what it means to be human before seeking to apply their understanding to helping others. This emphasis on personal wholeness is a welcome return to the roots of medicine.

This programme provides a useful tool for medical educators in its present form and a prototype for further developments.

Professor Sam Leinster

Dean, School of Medicine, Health Policy and Practice University of East Anglia

Doctors are going through difficult times. Many say they would leave medicine if they could; the public has finally torn off doctors’ traditional protective cloak of respect and authority; the rise and rise of hi-tech medicine has turned medicine into a shop-window for frontier science and would turn practice into applied biotechnology if only it could.

Since the world of medicine is not about to change for the better, the only place to begin the long road to medical renewal is in the heart of the healer. Reflecting together on core human values can help us discover how to reconcile the science and art of medicine. This project will be an important signpost on the way.

Dr David Peters

Professor of Integrated Healthcare,
School of Integrated Health, University of Westminster

Values in Healthcare © The Janki Foundation for Global Health Care 2004 xi

Endorsements

xii

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Most if not all of us carefully chose a career in healthcare in the knowledge of a deep and inner need to be in service of ‘the other’. Also inherent within this is the constant challenge humanity faces in recognising, honouring and owning our own values and spiritual needs that lie at the core of our motivation in our professional work.

The publication of Values in Healthcare: a spiritual approach, is one of the most significant contributors to the complex education, training, continued professional and personal development for all health workers and in particular allied health professions. The sensitive and practical approach taken by The Janki Foundation for Global Care to this important area helps us all to cultivate, express and further develop awareness of our inner core values in our personal and professional lives whilst we are in service of the ‘other’ and society. I feel that this approach has an important place and will inevitably be of value to both qualified staff and healthcare students. The work profoundly reminds us that there is a need to look beyond the technical and material base of our profession to a deeper source and reference that continually rejuvenates each of us in our work. I welcome and fully endorse this wonderful incisive addition to our work and practice.

Gwilym Wyn Roberts MA PG DIP (PSYCH) DIP COT

Occupational Therapist and tutor of occupational therapy in English and Welsh
Deputy Director of Department of Occupational Therapy Wales School of Medicine, Biology, Life and Health Sciences, Cardiff University

I am delighted to see Values in HealthCare: a spiritual approach in print. The material is comprehensive, structured and well written. It offers a unique blend of group exercises, reflection, self-inquiry and an opportunity to learn through one’s personal experiences. Values in Healthcare offers a distinctive style of training. The learning tools used are based on visualisation, reflection, listening, appreciation, creativity and play. The modules cover a wide spectrum of topics including values, peace, positivity, compassion, cooperation, valuing yourself and spirituality in healthcare. The advantages of a values-based approach has many professional, personal, organisational and educational benefits. I very much hope that in the future this material will be used widely at both undergraduate and postgraduate levels for all healthcare workers.

Mr Sheo B Tibrewal FRCS, FICS, FLLA

Consultant Orthopaedic Surgeon, Queen Elizabeth Hospital and Honorary Senior Lecturer at Guy’s, King’s, and St Thomas’ Medical School

Part 1: Introduction Contents

Introduction…………………………………………………………..1 Why Values in Healthcare? : an introductory paper……………………2

. 1 A Values-based Approach…………………………………………..8 Benefits …………………………………………………………8 Key principles …………………………………………………..9 Who can benefit from the Values in Healthcare programme? . . . . . 10 The values……………………………………………………..10

. 2 A Spiritual Approach……………………………………………..12 The learning tools ……………………………………………..12

3 ValuesinHealthcare Programme………………………………..14 Modules……………………………………………………….14 Module structure ………………………………………………14 The materials ………………………………………………….15

OHPs 1–8

Introduction

Part 1 Introduction provides an outline of the Values in Healthcare programme and approach, including who can benefit from it, the settings in which it might be used and the materials which are provided in this pack. At the beginning of the section is a paper which provides the background, rationale and healthcare context for the programme, together with a list of key references for further reading and exploration of the key principles upon which it is based.

The materials in this introduction can be used in the following ways:

G to introduce the main principles and benefits of the Values in Healthcare programme to organisations and teams who are considering introducing the training

G to provide an overall introduction to groups and teams who will be undertaking one or more of the Values in Healthcare modules, providing valuable information about the aims and approach of the programme

G to outline the programme and its approach to facilitators who are interested in running the programme or individual modules, and as part of ‘training the facilitators’ sessions

G to provide a useful overview of the Values in Healthcare programme to healthcare organisations, educators, researchers and academics who are interested in a values-based, spiritual approach.

Each following section refers to a numbered OHP which can be used to present a summary of the material covered. The OHPs can be found at the end of this introduction.

Values in Healthcare © The Janki Foundation for Global Health Care 2004 1

Part 1|Introduction

WhyValues in Healthcare?: an introductory paper

During the winter months of 2000/2001 a group of people from various backgrounds in healthcare, medical education and training met to share ideas about the issues facing the healthcare professions. A question that concerned us all was how the spiritual dimension of ‘whole-person’ medicine could be integrated into current healthcare provision and into the training and education of healthcare workers.

Our aim was to develop a flexible, modular programme of personal and team development for students and practitioners throughout healthcare services. The group’s various concerns and enthusiasms gave voice to an abundance of ideas drawn from each of our individual approaches to clinical practice, learning and teaching. From these emerged four key themes: values, holism, positivity and spirituality.

Themes, influences and inspirations

Values

Our main aim was to explore how best to help others and ourselves identify and apply core values in healthcare, including ways in which we could:

G remind ourselves of the values which motivated and guided us at the outset of our careers

G bring new vitality to our practice by reflecting on these values
G assist others to rediscover their own personal values through a series of

structured exercises, activities and meditations.

In pursuing this aim we were much inspired by certain contemporary approaches to healthcare and education. Among these were Living Values (1) and Living Values: An Educational Programme, created by Dane Tillman and others (2). Published in the USA in 2000, and winner of the prestigious 2002 Teacher’s Choice Award, Living Values is a guide for teachers, community workers, parents and students. It explores human values in depth and includes educational activities that promote self-esteem, emotional intelligence and creative expression in people of all ages. Guided by this approach, we began to develop the structure and content of our programme, which became aptly entitled Values in Healthcare.

Holism

The second main influence was holism and an holistic approach to healthcare. Over the last 25 years this has been seen as a counterbalance to the technological advances of modern medicine and we drew on much of the past writing on the subject (3, 4). The term ‘holism’ was first used by Jan Smuts, soldier, naturalist and Prime Minister of South Africa in the 1920s, to describe the study of whole organisms. Since the 1970s it has been used in a more popular sense to describe an inclusive approach to

Values in Healthcare © The Janki Foundation for Global Health Care 2004

living that pays attention to the relationship of mind, body and spirit in cultivating health and treating disease. Our take on this was to apply the principles of holism not only to the treatment of our patients, but also to ourselves. The benefit of healthy practitioners to patient care was, in fact, our prime consideration in creating the Values in Healthcare programme.

Positivity

In our discussions of the current concerns facing healthcare organisations and practitioners, we decided to take a positive approach and adopted the term ‘positivity’ to reflect this in the material we produced for the Values in Healthcare programme. We turned to the Appreciative Inquiry approach to teaching, learning, consulting and discovery. This is a process building on what works well in organisations and individuals’ practices, rather than taking a critical approach which can tend to focus on identifying weaknesses, gaps, and mistakes (5, 6). We chose exercises that we knew worked well for a broad range of participants, structured the questions to be appreciative, and kept the language positive.

Spirituality

Coming into the 21st century, we were aware of the existence of a growing consensus about the inseparable links between mind and body. Yet spirituality still remained at best a mystery, at worst a problem for many healthcare workers. We knew, though, that many of our patients (especially those who are older or terminally ill) responded appreciatively to certain kinds of questions we asked and the conversations that grew out of them. We sensed, as did our patients, that our words referred not to any religious affiliation, but rather to our shared sense of a belief in a transcendent relationship between ourselves and a ‘higher being’. Apart from our own experience in this area, we drew on relevant work from nursing care (7, 8, 9), hospice work (10), chaplaincy (11) and mental health (12).

We spent many hours discussing and meditating on the meaning of spirituality and agreed that it involved using inner resources of peace, love, positivity and compassion for the benefit and healing of others and ourselves. We felt deeply that spirituality could be expressed through thoughts, feelings, attitudes and actions. By practising
in a spiritual manner we were not only able to communicate more fully with our patients but were also able to reconnect with who we and what our values were, and rejuvenate within us that which gives meaning and purpose to our lives. From this we went on to develop a method of teaching which we called the ‘spiritual approach’. This includes deep reflection, periods of silence, visualisation, listening, appreciation, and being creative and playful.

Underlying principles and the context for use

In 2002, as we began writing and designing the Values in Healthcare programme, three underlying principles became evident:

Values in Healthcare © The Janki Foundation for Global Health Care 2004 3

Part 1|Introduction

Values in Healthcare © The Janki Foundation for Global Health Care 2004

1 Physician heal thyself

Working within a framework of values is hardly a new idea. The Hippocratic Oath, for example, is one of the earliest and best-known statements of values. All medical- professional organisations have statements that refer to values in their codes of practice.

Interestingly, in 1994 the British Medical Association (BMA) hosted a conference, ‘Core values for the medical profession’, to examine the future of the practice of medicine (13). Since this conference there has been ongoing discussion in the medical profession concerning the importance of core values (14) and the need to reaffirm them (15).

It was as if the time had come to admit that, while skills are essential, humanising medicine through caring for and supporting workers and carers must be of equal importance. Traditional skills needed to be enhanced with life- or spiritual skills, particularly those of identifying core values and recognising these values in self and others. These values, derived from the doctor–patient relationship, were based on caring, compassion, integrity, competence, confidentiality, responsibility, advocacy and the spirit of enquiry. They were seen as the profession’s greatest asset, greater even than scientific knowledge and technology but, for the most part, they had been sidelined in the training of healthcare workers. Yet values are at the very heart of our vocation and need to be an intrinsic part of our education, as much as anatomy, physiology, or any of the other disciplines we study.

We shared these ideals, but also had the fundamental belief that healthcare practitioners cannot aim to heal others before nurturing and healing themselves. We also felt that any educational programme should aim to support and develop the personal well-being of healthcare practitioners, rather than specifically focus
on improving their clinical skills. In our own collective experience, the benefit of healthy practitioners to patient care in terms of raised morale and renewed sense of purpose was immeasurable.

2 Learning through experience

We believed that values in healthcare could best be understood and explored through direct, ‘inner’ experience, so we planned the programme to provide facilitated, experiential learning, rather than didactic instruction. By allowing time for silence, reflection, meditation and sharing, in a supportive environment, we hoped to encourage the discovery of personal values and insights.

Healthcare professionals are somehow expected to be calm, compassionate and caring, but very little is done to enhance and strengthen these natural qualities through experiential learning in their training. Paradoxically, these natural qualities may be trained out of us! Caring, as well as competence, are the two pillars of good medical practice and should be equally emphasised in any education programme.

Any educational programme concerning values and a spiritual approach needs to
be rigorous, with clear aims and learning outcomes, action planning, review and evaluation built into the structure. This is not only good practice but will make Values in Healthcare more acceptable to those responsible for planning educational training programmes and continuing professional development.

3 Relevance to work

Finally, we felt the learning experience – with an emphasis on reflection, action planning, review, evaluation and a commitment to ongoing learning – should be relevant to participants’ work and lives. Much has been written about the high levels of stress experienced by health professionals (16), the effect it has in practice (17), why so many doctors and nurses are unhappy (18) and what can be done to promote well-being (19). Indeed, all healthcare professionals have been worn out by work at times; much of the day-in and day-out business of taking care of people who are ill is, after all, inherently distressing. But changes (and the rate of change) in society, organisational structures, medical and communications technology, and patients’ expectations have imposed an additional burden that can lead to a state of chronic tiredness and demoralisation. Pines (20) and Maslach (21), among others, have described this exhaustion, arising from involvement in situations that are emotionally and physically exhausting, as ‘burnout’. The personal rewards of caring for others can be immense, but the cost to healthcare workers can be devastating, and is increasingly evidenced by displays of negative attitudes toward patients, low self-esteem, and other behaviours damaging to self and others.

Stress and its consequences can be addressed by working with our values as a way of preventing burnout and ill health (22). It seems self-evident that healthy practitioners will provide enhanced quality of care for patients.

Organisations, too, will benefit from a clear, values-based statement that staff at all levels can identify with. Institutions encouraging a culture of care can contribute significantly towards creating a healing environment for staff as well as patients. Such an environment can also go some way towards protecting patients from practitioners acting out their own needs in the healthcare setting (ie the desire for power, control, to be liked, needed and cared for). These needs can be more healthily addressed in an atmosphere of good staff support, an optimum environment in which to deliver high quality care and a place where people are well supported when caring for those who are distressed or suffering.

Piloting and refining the materials

Early on we realised that, however well the material was written, it was how it was presented in the workshop sessions that would reflect the spiritual approach. We therefore developed a detailed guide on process for facilitators (see Part 2 of the pack), and an explanation of the spiritual approach (see Part 4). Again, we drew on

Values in Healthcare © The Janki Foundation for Global Health Care 2004 5

Part 1|Introduction

Values in Healthcare © The Janki Foundation for Global Health Care 2004

our own experience and the work of others in training and facilitating groups (23, 24, 25, 26).

Later we had the idea of including a CD of visualisations and meditations to further emphasise and communicate the importance of process and a spiritual approach to learning.

We were keen to develop exercises that people found straightforward yet challenging, and which could be used with a wide range of healthcare practitioners at all stages in their careers, and in a variety of settings. Members of the advisory group, individuals drawn from all healthcare professions and settings, not only in the UK but in other countries round the world, provided invaluable feedback during two training weekends we held. Many went on to run sessions with groups of nurses, hospice workers, doctors, primary healthcare teams, undergraduates and managers in their own hospitals and clinics in Argentina, Brazil, Holland, India, Israel, Kenya and the USA, and their evaluations provided us with invaluable feedback.

Their evaluations were gratefully received. After all the feedback was taken into account and we integrated others’ experiences with our own, we finally settled on having seven modules, each of which could be run in a single day. Each module consists of two sessions with the emphasis on personal exploration in the first session and the practical aspects of healthcare practice in the second. This means that the whole programme can be run either as a sequence of modules over seven days, or used for single whole- or half-day sessions.

The outcome and vision

Four years later, after hundreds of hours of thinking, discussing, outlining, structuring, writing, reflecting on what had been done and what needed doing, changing, editing, testing ideas at conferences, and real-world piloting – the words, voices and aspirations were committed to the pages and the CD bound within these covers.

Our vision is that Values in Healthcare: a spiritual approach will be used widely at both undergraduate and postgraduate levels for all healthcare workers in countries throughout the world. We feel privileged to help facilitate the re-emergence of healthcare practitioners’ own inner values and to assist them in expressing these values in their work.

References

1 2 3

Gill-Kozul, C., Kirpalani, J. & Panjabi, M. (1995) Living Values: a guidebook. London: Brahma Kumaris World Spiritual University.

Tillman, D. (2000) Living Values: An Educational Program (Series). Deerfield Beach: Health Communications Inc. (For further details on LVEP, see website: http://www.livingvalues.net)

Pietroni, P. (1986) Holistic Living. London: J.M. Dent & Sons.

. 4 Brom, B. (1995) Holism: definition and principles. International Journal of Alternative and Complementary Medicine 13 (4) 14–17.

. 5 Cooperrider,D.,Sorensen,J.,Whitney,D.&YaegerT .(2000) Appreciative Inquiry:Rethinking Human Organization Toward a Positive Theory of Change. Champaign: Stipes Publishing.

. 6 Cooperrider, D.,Whitney, D. & Stavros, J. (2003) Appreciative Inquiry (AI) Handbook. Bedford Heights: Lakeshore Communications Inc.

. 7 Bradshaw, A. (1997) Teaching spiritual care to nurses: an alternative approach. International Journal of Palliative Nursing 3 (1) 51–57.

. 8 Draper, P. & McSherry, W. (2002) A critical review of spirituality and spiritual assessment. Journal of Advanced Nursing 39 (1) 1–2.

. 9 Peterson, E. A. & Nelson, K. (1987) How to meet your clients’ spiritual needs. Journal of Psychosocial Nursing 25 34–39.

. 10 Kellehear, A. (2000) Spirituality and palliative care: a model of needs. Palliative Medicine 14 149–155.

. 11 Department of Health (2003) NHS Chaplaincy: Meeting the religious and spiritual needs of patients and staff. London: Department of Health.

. 12 Swinton, J. (2001) Spirituality and Mental Health Care. London: Jessica Kingsley.

. 13 Department of Health (1994) Core Values for the Medical Profession in the 21st Century.
(Published report). London: British Medical Association.

. 14 McWhinney, I. (1998) Core values in a changing world. British Medical Journal 316 1807–1809.

. 15 Hawes Clever, L. (1999) A call to renew. British Medical Journal 319 1587–1588.

. 16 Firth-Cozens, J. (1999) Stress in Health Professionals: psychological and organizational causes
and interventions. London:Wiley.

. 17 Appleton, K., House, A. & Dowell, A. (1998) A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds. British Journal of General Practice 48 1059–63.

. 18 Smith, R. (2001) Why are doctors so unhappy? Editorial. British Medical Journal 322 1073–1074.

. 19 Yamey, G. (2001) Promoting well being among doctors. Editorial. British Medical Journal 252 232–253.

. 20 Pines, A. & Aronson, E. (1988) Career Burnout: causes and cure. New York:The Free Press.

. 21 Maslach, C. (1993) Burnout: a multidimensional perspective. In: W. Schaufeli, C. Maslach and T. Marek (Eds) Professional Burnout: Recent Developments in Theory and Research 19–32. New York:Taylor & Francis.

. 22 Brown, C. K. (2003) Low morale and burnout: is the solution to teach a values based approach? Complementary Therapies in Nursing and Midwifery 9 (2) 57–61.

. 23 Duffy, M. & Griffin, E. (2000) Facilitating Groups in Primary Care: a manual for team members. Abingdon: Radcliffe Medical Press.

. 24 Heron, J. (1999) The Complete Facilitator’s Handbook. London: Kogan Page.

. 25 Pickles, T. (1999) Toolkit for Trainers. Brighton: Pavilion Publishing.

. 26 McGinn, C. & Hewitt, R. (1995) Wisboroughs – Make a new start with a fresh view of life. Sturminster Newton: Wessex Aquarian Publications.

Values in Healthcare © The Janki Foundation for Global Health Care 2004 7

Part 1|Introduction

Values in Healthcare © The Janki Foundation for Global Health Care 2004

A Values-based Approach

Benefits (OHP 1)

One of the keys to raising morale in healthcare today is to re-emphasise the importance of values in guiding practice at all levels. There are some excellent values statements produced by healthcare bodies in the field, but for values to be meaningful, they must be owned at a personal level and then integrated into our work.

Values in Healthcare offers a unique blend of experiential group exercises and opportunities for reflection and self-enquiry that will help healthcare practitioners and teams to do this. With its emphasis on self-care and support, the programme will help participants to identify their own values and discover how their insights can enhance their personal lives and revitalise their work.

The materials and activities introduce a number of core values and encourage participants to explore ways of expressing them in their personal lives and professional practice. The learning outcomes will enable healthcare practitioners at all levels and in all settings to cope better with their work. This includes addressing the expectations of others, as well as their personal responses to situations, so helping to prevent problems of burnout, sickness absence and staff retention.

In summary, Values in Healthcare helps healthcare organisations and practitioners at four levels: professional, personal, organisational and educational. The programme provides them with opportunities to:

Professional

G Set professional standards and codes of practice
G Help resolve ethical issues
G Manage workload, expectations and change more effectively
G Work in teams with better co-operation
G Improve the quality of relationships and communication at all levels

Personal

G G G G

Build self-esteem and sense of purpose
Renew enthusiasm and vitality
Consider self-care as essential to well-being and good patient care Cope better with stress and prevent burnout and ill health

Organisational

G Improve staff recruitment and retention
G Provide better support to staff
G Boost morale in the workforce and reduce sickness absence
G Enhance performance and cost efficiency
G Introduce positive, values-based change into healthcare environments

Educational

G Introduce a holistic educational programme
G Provide opportunities for learning new caring skills
G Enhance reflective practice and personal development plans
G Develop a spiritual approach to personal and professional development

Key principles (OHP 2)

Healthcare professional training has been predominantly about acquiring knowledge and learning practical skills, with less time spent on communication and interpersonal skills, and even less time on self-care. Given the current challenges faced by people working in the healthcare field today, the Values in Healthcare programme sets out to redress the balance by adopting three key principles in teaching values:

1 Physician heal thyself

The first is to put the professional care givers at the centre of healthcare delivery and give life to the ideal of ‘physician heal thyself’. Nourishing and supporting the care giver, and paying attention to their personal development, will help to raise morale and restore the sense of purpose and altruism with which they set out in their careers.

2 Learning through experience

The second is that values in healthcare are best understood and explored through direct experience, so the programme should provide facilitated, experiential learning, rather than didactic instruction, with time for silence, reflection and sharing in a supportive environment.

3 Relevance to work

Thirdly, the learning experience should be relevant to participants’ work and lives, with an emphasis on reflection, action planning and evaluation, and a commitment to ongoing learning.

Values in Healthcare © The Janki Foundation for Global Health Care 2004 9

Part 1|Introduction

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Who can benefit from the Values in Healthcare programme? (OHP 3)

The pack can be used with a wide range of healthcare practitioners at all levels, including doctors, nurses and specialist groups, such as hospice nurses or physio- therapists, multidisciplinary groups, primary healthcare teams and outpatient teams, which may include managers, support and administrative staff.

Because of its emphasis on reflection and exploration of links between personal insights and healthcare practice, the pack will be of great value as part of Continuing Professional Development and Personal Learning Plans for all professional groups. The materials offer flexible opportunities for evaluation of learning, application to everyday work, and dissemination to team members and colleagues.

The contents can be readily cross-mapped to units and modules of qualifying, post-qualifying and in-house development courses for a wide range of healthcare workers within faculties, schools and deaneries, and within primary care and other healthcare organisations. The materials and exercises will enhance existing training in the areas of core values, communication and relationships with patients, working with colleagues and team working. Each exercise provides clear learning outcomes to help match activities to priority development needs.

The materials can be used by a broad range of educators and trainers in the field, and are sufficiently detailed to be run by practitioners who are interested in facilitating sessions with colleagues and teams.

The values (OHP 4)

In addition to identifying and experiencing core values which guide their personal lives, the Values in Healthcare programme gives participants the opportunity of exploring in depth some values which are of particular importance in healthcare practice. These are briefly described below.

Peace is introduced as our natural state, ie that within all of us there is an innate core of calm and tranquillity. The programme uses simple yet powerful ways to rediscover this inner peace. By practising peacefulness, participants can access their positive qualities, which help to build self-respect and contentment. Peacefulness is the medicine for ‘burnout’.

Positivity is about having the choice and power to change the way we think. Healthcare professionals can often think critically or even negatively out of habit, whereas positive thoughts make people feel good. The programme helps participants to recognise unhelpful patterns of thinking and change them to more positive ones by learning to observe their thoughts. Their resulting positivity and optimism brings benefits not only to themselves, but also to colleagues and patients.

Compassion brings humanity to healthcare. It is the expression of our innate qualities of patience, generosity and kindness, yet there are often personal barriers to its expression – anger, anxiety, guilt and attachments. The programme helps participants to acknowledge and tackle these barriers and to view compassion as a value they can consciously express throughout their practice.

Co-operation is about working together successfully, as individuals and teams. The programme helps participants to gain an understanding of the thoughts, attitudes, feelings and behaviour which enable successful co-operation. It enables them to build team spirit in non-competitive ways, so that tasks become enjoyable and creative.

Valuing the self requires that we recognise our own worth and, in doing so, can better acknowledge the intrinsic worth of others. Participants explore ways they currently do look after themselves and consider what sources of personal support they have available to them in particular situations. Self-confidence will grow as they develop their self-respect. This can help them to bring mutual respect and harmony into their relationships, to the benefit of themselves, their patients and colleagues.

Spirituality in healthcare is a vital concept in furthering the ideals of holistic health and in meeting the spiritual needs of patients and practitioners alike. The programme involves participants in clarifying concepts of health and healing, spirit and spirituality, in order to further develop their values-based practice.

The main premise of Values in Healthcare is that in developing a conscious, values-based approach, participants can rediscover their own peacefulness, think more positively, and act with compassion and co-operation, while putting their own self-care at the centre of their efforts. This provides the foundation for addressing how to provide better spiritual care for patients.

A more detailed discussion of values can be found in the background reading papers of the relevant sessions in Part 3 The Modules.

Values in Healthcare © The Janki Foundation for Global Health Care 2004 11

Part 1|Introduction

A Spiritual Approach

The Values in Healthcare programme has a distinctive style of training and approach. The materials are not designed to be taught, but rather to guide both participants and facilitator to experience core values. The exercises prompt an internal experience which can be surfaced, identified and subsequently expressed more consciously in personal and work situations. This differs from the more common emphasis on external frames of reference or models of thinking, and their application to furthering understanding and developing practice. Instead, Values in Healthcare provides the parameters for a voyage of inner discovery, unique to each participant but which, when shared within groups and teams, can lead to a common under- standing and to enhanced clarity with regard to values-based practice. This is what we call ‘a spiritual approach’.

The learning tools (OHP 5)

In the healthcare professions, many different methods are used to teach the skills and art of each discipline. Traditionally, formal lectures, personal study, tutorials and practical experience are used alongside apprenticeship learning. The Values in Healthcare approach requires teaching in small groups with exercises and activities which are mainly experiential. In order to emphasise and explore the essential connection between people’s humanity and their experience of living and working, the Values in Healthcare programme introduces participants to seven tools for learning, called ‘spiritual tools’. These tools provide the means by which participants engage with inner exploration and apply their insights to a wide range of situations and problems. They are briefly described below.

Meditation in this programme involves participants in being silent and using the time to learn about their minds and their thoughts. By using positive and peaceful thoughts, participants can experience quietening their minds, moving towards the silent centre of their consciousness, and bringing calm to their work.

Visualisation involves using the mind to create positive images which can help to address past negative experiences and associated feelings of failure or frustration. Visualisation exercises can help to build participants’ self-respect and positive attitudes.

Reflection is much used within healthcare training. ‘Reflective practice’ involves learning from past experience to review professional progress, evaluate concerns and improve clinical practice. The spiritual approach to reflection involves participants in taking a detached view – looking at themselves from outside, so that they can examine their own emotional reactions. From a place of calm and peacefulness, it enables them to understand and release feelings of anger, anxiety and attachment, learn from mistakes and build on positive experiences.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Listening is an essential skill in healthcare, and the quality of how we listen can bring benefit not only to those being listened to, but also to the listener themselves. Listening as a spiritual tool involves participants in deep listening and requires that the listener finds inner peacefulness, so that they can give their full attention, focusing on what the person is saying with an open heart and without judgement.

Appreciation is an important tool when dealing with many aspects of patient care, interaction with colleagues, and personal lives. As a spiritual skill, it looks at individuals and groups from the perspective of valuing what works best, drawing
on existing skills and shared values to seek solutions, rather than focusing on the problem and apportioning blame. In healthcare, the emphasis is often on developing a critical attitude. While this is essential in the technical side of medical care, practising appreciation can help participants to recognise the value of the human contribution and to encourage co-operation between colleagues and within teams.

Creativity encourages the discovery of new solutions. As a spiritual skill, it emphasises the premise that ideas come to us when we give ourselves silent space and drop our preconceptions. As part of the Values in Healthcare programme, participants are encouraged to experience the creativity which can flow though drawing, writing poetry, and visualisation. Facilitators are encouraged to experiment with activities which explore values in creative ways. For all, the sessions may involve taking risks by behaving outside our normal roles. However, the experience of heightened creativity and its application to problem solving will be a positive learning outcome.

Play introduces the idea that it is legitimate to experience fun and laughter as part
of the learning process. Being playful is being spontaneous and carefree, with a willingness to let go of barriers and overcome difficulties. While participants may feel inhibited at first, the playing of simple games can be a moving experience, connecting people at a deeper level and allowing everyone to ‘just be themselves’. Having a sense of ‘lightness’ in our manner encourages tolerance in our listening and softness in our judgements.

The seven tools are introduced and applied thoughout the programme and can become valuable resources for participants to take into everyday living and healthcare. They are described in detail in Part 4 Spiritual Tools.

Values in Healthcare © The Janki Foundation for Global Health Care 2004 13

Part 1|Introduction

Values in Healthcare Programme Modules (OHP 6)

Values in Healthcare comprises seven modules, each of which will help groups of healthcare professionals to explore values in depth, as they relate to their personal lives and professional practice:

G Module 1: Values Inner values and Values at work

G Module 2: Peace Being peaceful and Peace at work

G Module 3: Positivity Being positive and Positive interaction at work

G Module 4: Compassion Finding compassion and Compassion in practice

G Module 5: Co-operation Understanding co-operation and Working in teams

G Module 6: Valuing Yourself Self-care and Support at work

G Module 7: Spirituality in Healthcare Exploring spirituality and healing and Spiritual care in practice.

Module structure (OHP 7)

Each module consists of a full-day session, containing a mix of group learning activities, guided by a facilitator. The modules can be run as stand-alone workshops, incorporated into wider development programmes, or run in sequence as a Values in Healthcare programme. The materials can also be effectively used for self study.

Each module begins with an introduction to the theme and optional warm-ups, followed by a structured programme of activities, some active, some reflective. Time is then spent on summarising, action planning, evaluation and closure. The morning and afternoon sessions allow for a progression from personal exploration through to application of learning to work-based situations and issues.

A typical module programme includes the following:

Background reading

Introduction/review of previous session Exercises
Movement exercises
Breaks (including lunch)

Session review Action planning Evaluation Closure

Total session time

Follow-on/homework (optional)

30 mins
2 hours 45 mins 10 mins
1 hour 35 mins 10 mins
30 mins
10 mins
5–10 mins Approx 6 hours

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Detailed information about preparing for and running the modules can be found in Part 2 Guidance for Facilitators.

The materials (OHP 8)

The pack contains detailed guidance and all the necessary materials to run the seven modules, packaged into a ring binder with CD and including:

Part 1: Introduction

Introduction to the pack and the Values in Healthcare programme. Part 2: Guidance for Facilitators

Detailed guidelines on the structure of the programme, role of the facilitator, and preparing for and running the sessions.

Part 3: The Modules

Seven modules, each providing:

G background information on each module topic which can be given to participants as a handout

G timed programme
G session overview, aims and learning outcomes, and step-by-step guidance on

running the session
G exercises and feedback, session review, action planning and evaluation G exercise sheets and handouts for exercises.

The reading and exercise handouts can be photocopied for group use within an educational programme and for individual study.

Part 4: Spiritual Tools

Detailed information about the seven tools of learning employed in the sessions.

Part 5: Additional Resources

G Warm-up exercises, movement exercises and closure exercises
G Learning logs, action planning and evaluation pro formas
G References and resources for follow-up reading and exploration G Text transcription of meditations and visualisations on CD

CD of Meditations

CD containing meditations and music to be used during the meditation and visualisation activities.

Values in Healthcare © The Janki Foundation for Global Health Care 2004 15

Part 1|Introduction

OHP 1 Values in Healthcare
Benefits of a values-

based approach

Professional

Set professional standards and codes of practice Help resolve ethical issues

Manage workload, expectations and change more effectively

Work in teams with better co-operation

Improve the quality of relationships and communication at all levels

Personal

Build self-esteem and sense of purpose Renew enthusiasm and vitality

Consider self-care as essential to well-being and good patient care

Cope better with stress and prevent burnout and ill health

G G

Values in Healthcare © The Janki Foundation for Global Health Care 2004

OHP 1 (continued)

Benefits of a values-based approach

Organisational

Improve staff recruitment and retention Provide better support to staff

Boost morale in the workforce and reduce sickness absence

Enhance performance and cost efficiency

Introduce positive, values-based change into healthcare environments

Educational

Introduce a holistic educational programme Provide opportunities for learning new caring skills

Enhance reflective practice and personal development plans.

Develop a spiritual approach to personal and professional development

G G

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Part 1|Introduction

OHP 2 Values in Healthcare Principles of the

programme

1 Physician heal thyself

The professional care giver is placed at the centre of healthcare delivery, with the emphasis on self-care and personal development

2 Learning through experience

Values are best understood through facilitated, experiential learning, rather than didactic instruction, with time for reflection and sharing in a supportive environment

3 Relevance to work

The learning experience should be relevant to participants’ work and lives, with an emphasis on reflection, action planning, evaluation and a commitment to ongoing learning

Values in Healthcare © The Janki Foundation for Global Health Care 2004

OHP 3 Values in Healthcare
Who can benefit from

the programme?

A wide range of healthcare practitioners at all levels, including doctors, nurses, allied health professionals, social workers, managers, support and administrative staff

A wide range of settings including hospitals, hospices, general practice, health centres and clinics

Staff groups and teams including multidisciplinary teams, primary healthcare teams, outpatient teams and departmental teams

Qualifying and undergraduate teaching programmes as part of, or as elective elements of, curricula

Postgraduate and postqualifying courses

Continuing professional development for a range of professionals

Part 1|Introduction

G G

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Part 1|Introduction

OHP 4 Values in Healthcare The values

Peace
Positivity
Compassion Co-operation
Valuing the self Spirituality in healthcare

G G G G G G

Values in Healthcare © The Janki Foundation for Global Health Care 2004

OHP 5 Values in Healthcare
A spiritual approach

The programme provides:

an emphasis on guided experience, rather than direct teaching

an individual experience of core values which can then be expressed more consciously in personal and work situations

a sharing of experience within groups and teams which can improve understanding and clarity with regard to values-based practice

using the following learning tools:

– meditation – visualisation – reflection
– listening

– appreciation – creativity
– play

Part 1|Introduction

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Part 1|Introduction

OHP 6 Values in Healthcare Modules

Module 1

Module 2

Module 3

Module 4

Module 5

Module 6

Module 7

Values

Inner values Values at work

Peace

Being peaceful Peace at work

Positivity

Being positive
Positive interaction at work

Compassion

Finding compassion Compassion in practice

Co-operation

Understanding co-operation Working in teams

Valuing Yourself

Self-care Support at work

Spirituality in Healthcare

Exploring spirituality and healing Spiritual care in practice

Values in Healthcare © The Janki Foundation for Global Health Care 2004

OHP 7 Values in Healthcare
Module structure for a

Part 1|Introduction

one-day session

Background reading

Introduction/review of last session Exercises
Movement exercises
Breaks (including lunch)

Session review Action planning Evaluation Closure

Total session time

Follow-on/homework (optional)

2 hours 1 hour

30 mins 45 mins 10 mins 35 mins 10 mins 30 mins 10 mins

5–10 mins

Approx 6 hours

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Part 1|Introduction

OHP 8 Values in Healthcare Contents of pack

Part 1: Introduction
Part 2: Guidance for Facilitators Part 3: The Modules
Part 4: Spiritual Tools
Part 5: Additional Resources CD of Meditations

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Part 2: Guidance for Facilitators Contents

Introduction …………………………………………………………25

. 1 Structure of Values in Healthcare Programme …………………..25

. 2 SpiritualTools…………………………………………………..26

. 3 The Role of the Facilitator ………………………………………27

. 4 General Preparation……………………………………………..29

. 5 Session Programmes and Timing Issues ………………………….31

. 6 Process and Group Size………………………………………….32

. 7 Background Reading…………………………………………….33

. 8 The CD ………………………………………………………..33

. 9 Session Summary and Aims ……………………………………..33

. 10 Introducing the Session………………………………………….34

. 11 The Exercises……………………………………………………38

. 12 Movement Exercises …………………………………………….40

. 13 Session Review ………………………………………………….40

. 14 Action Planning…………………………………………………41

. 15 Evaluation ………………………………………………………43

. 16 Closure …………………………………………………………46

. 17 References and Resources………………………………………..47

. 18 Ongoing Support ……………………………………………….47

. 19 Follow-on Sessions/Homework ………………………………….48

. 20 Journals…………………………………………………………49

Introduction

This part of the Values in Healthcare pack contains both general and specific guidance on preparing for, and facilitating, the programme. If you are an experienced facilitator and also familiar with the Values in Healthcare principles and learning tools, you may only need to skim through the material, picking out any particular information you need. However, for most facilitators, including those new to the role or new to the programme and its approach, we would suggest you read through all the sections before embarking on the programme, and then revisit the detail as you prepare for a particular session. The sections are organised as follows:

G Sections 1–8 cover the structure and approach of the programme, the role of the facilitator, and general issues involved in setting up and facilitating a course or session.

G Sections 9–16 will help you to plan how to introduce and run a specific module. G Sections 17–20 will help you to plan how best to support participants in

exploring a module topic further, and in continuing their personal development.

Structure of Values in Healthcare Programme

The materials and activities are organised into seven topics or modules, each of which comprises a minimum of one day’s training. Each module includes two half-day sessions, as follows:

G Module 1 Values Session I Inner values Session II Values at work

G Module 2 Peace Session I Being peaceful Session II Peace at work

G Module 3 Positivity
Session I Being positive
Session II Positive interaction at work

Part 2|Guidance for Facilitators

Values in Healthcare © The Janki Foundation for Global Health Care 2004 25

Part 2|Guidance for Facilitators

G Module 4 Compassion
Session I: Finding compassion Session II: Compassion in practice

G Module 5 Co-operation
Session I: Understanding co-operation Session 1I: Working in teams

G Module 6 Valuing Yourself Session I Self-care
Session II Support at work

G Module 7 Spirituality in Healthcare Session I Exploring spirituality and healing Session II Spiritual care in practice

Each module is self-standing, although the topics are interlinked. If you are running more than one module, we would advise starting with the first session of Module 1, Inner values, which provides a general exploration and clarification of values which underpin the entire programme of learning.

The half-day sessions can be run as stand-alone workshops, although each pair of sessions provides a progression from the exploration of the topic at a personal level, through to the application of the ideas and learning to work settings and participants’ professional practice.

The modules and sessions can be run as discrete training events, or as a comprehensive Values in Healthcare programme in the sequence suggested above. The materials and activities can also be incorporated into wider training and development, team development, and self-study programmes.

Spiritual Tools

The Values in Healthcare training programme introduces and applies seven ‘spiritual tools’ to help participants explore the main themes and apply them to their personal lives and professional practice. These are:

G meditation G visualisation G reflection
G listening
G appreciation G creativity
G play.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

A summary of each can be found in Part 1: Introduction. The choice of these tools for learning is particularly suited to the nature and aims of the Values in Healthcare programme. Each session employs one or more of these tools, depending on its theme.

More information and guidance on the choice and nature of these tools is given in Part 4: Spiritual Tools. If you are unfamiliar with any of them, read the relevant information and practise some of the exercises which employ them before the session.

The remaining guidance in this section covers preparing and facilitating a session. Detailed guidance and session materials are contained in Part 3: The Modules.

The Role of the Facilitator

Values in Healthcare takes an approach to training and development which is mainly experiential, so we refer to the person leading the session as a ‘facilitator’ rather than a ‘trainer’. The role of facilitator is to guide the programme, rather than to deliver it, contrasted with the trainer’s more directive role within which they may remain distanced from participants.

The success of the sessions will be largely dependent on how they are conducted by the person/persons in the lead role. As facilitator, you will need to be familiar with the material and have practised the exercises. Draw on your own experiences, which will reveal not only your ‘wisdom’ in spiritual terms, but also your vulnerability. Personal experiences, anecdotes and stories are often the most effective way of presenting the material.

The sessions themselves are best presented with ‘lightness’. Exercises should not be rushed but conducted at an easy pace (see 5 Session Programmes and Timing Issues on page 31). Some of the questions in the exercises may seem simple but they can be quite profound. Participants often value the time to share in pairs and in small groups, as it can be a rare opportunity for healthcare professionals to discuss some of their own issues.

How the facilitator comes across – how comfortable you seem with yourself – will provide an example for participants on which to model themselves. For this reason, it is more important that you have an awareness of your own spirituality and practice than it is for you to be an experienced teacher.

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Good practice

Some good practice principles when facilitating groups include:
G Keep the group to the theme/task.
G Stay neutral, be non-judgemental.
G Do not play expert. Your role is to facilitate learning and sharing.

G Ensure everyone is heard. Each person has a point of view and has a contribution to make. Ensure that one person speaks at a time without interruption. Avoid personal agendas.

G Encourage sharing and deep exploration of the subject.

G Be positive, be flexible; be creative and imaginative in creating solutions.

G Be aware of group energy, observe group process and ‘go with the flow’ (within an overall session structure).

G Start and finish on time.

In addition, as facilitator it will be important for you to take into consideration participants’ motivation and behaviour during the session. First, what are participants’ motivations for attending? Are they attending voluntarily or is the session part of a required training programme? Are they a ‘mixed’ group from different backgrounds, disciplines or organisations, or have they come from a particular profession/work setting? Have they had any experience of spiritual practice before? The answers to these questions will help you to decide how best to plan and facilitate the session programme and assess the likely responses to it. For each module, you will find helpful information in the Background Reading which will help you establish the context for, and relevance of, the session in relation to any particular group.

Participant behaviour

Each session provides an opportunity for a group of people to meet to explore a topic where the emphasis is on learning through participation. They will gain a deeper understanding of the subject through direct experience and explore how to apply what they have learned to their daily living and work. In facilitating this process, it is worth remembering what makes a successful learning experience, in terms of participant behaviour. Some features include:

G G

Participants feel empowered, motivated and assume responsibility for what they say and do.

They show respect and want to co-operate.

The output from a group working well together is often greater than the sum of all the individual contributions.

G A group working well is creative and inspirational for each individual and the group as a whole.

Setting the ‘tone’ for each session will greatly assist in establishing these kinds of behaviour. You will find helpful guidance on this in 10 Introducing the Session on page 34, and in Part 5: Additional Resources.

A trusting environment is important, as many of the exercises touch deep, personal beliefs and issues. Some participants will be experienced in personal development approaches, whereas others may find some of the activities personally challenging. You will need to anticipate unexpected, emotional responses to some of the exercises and be able to offer follow-on support. It is essential to acknowledge that as we touch deeper aspects of ourselves, so we will reveal the ‘dark’ side as well as the light. This exposing of our vulnerability is part of the personal healing of the ‘wounded’ healthcare professional and is an essential insight into the way we can project our own attitudes onto patients.

This type of session is best held off-site, away from the normal working environment. There should be no opportunity for participants to run back and check work during breaks. If observers are requested to evaluate the modules or sessions, they should be present as full participants.

Taking up the challenge

We would encourage you to take up the role of facilitator. All you need to start is an interest in bringing about positive change. The presentation is clear and there should be enough detail to encourage even people inexperienced in group work to run workshops. Facilitating is the way to learn about a subject in depth and the participants will be appreciative of your effort.

Finally, you may be facilitating a programme of training and development with specific organisational aims. In this case, it may be helpful to invite someone in the group to record findings to present as a summary to the group or the organisation following the session. This could be simply a brief report of the group’s conclusions or a consensus vision with recommendations. It is also helpful to include inspirations and ideas that did not fit with the consensus, so everyone feels that their view has been acknowledged. The report may include an action plan, recording ‘who’ will do ‘what’ by ‘when’ (see 14 Action Planning on page 41 for more detailed guidance).

General Preparation

These guidelines have been written for those who may be inexperienced at facilitating group sessions or unfamiliar with the themes, but would like to try out the material

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with their team or with a mixed group of healthcare workers. Those with more experience may still like to look through the following sub-sections for any useful pointers on the content and approach of these particular training materials.

Familiarise yourself with the Values in Healthcare programme approach, including its principles and aims. These are covered in Part 1: Introduction where you will also find some OHP outlines which you can use, if you wish, to introduce the programme at the beginning of your course or session.

Reflect on the topic of the session/s you are going to lead. You will find detailed, step-by-step guidance for facilitating each session in Part 3: The Modules. Look at the Background Reading paper at the beginning of the module so that you are familiar with the way in which the topic and themes are being introduced and explored. Consider some examples and stories you could draw on from your own experience. You may also want to look up some of the references and resources suggested for the module in Part 5: Additional Resources. Think of some of the questions and issues participants are likely to bring up during the session and ways in which you might help the group to address them during the exercises and action planning which are included in the programme.

Familiarise yourself with the main ‘spiritual’ learning tools which are being used in the session. The tool or tools which are being used most in any particular session will be mentioned at the beginning of each exercise under the heading Process. Read about them in Part 4: Spiritual Tools, practise some of the suggested exercises, and ensure that you are comfortable with the approach.

Plan your programme for the session, taking account of the time you have available and the suggested programme plan. (See 5 Session Programmes and Timing Issues on page 31 for detailed guidance.)

Make sure that you have all the equipment and materials suggested for the session to hand. Photocopy any worksheets listed in the session guidelines under Materials, together with copies of the background paper to give participants at the end. Most sessions will require the use of the following:

G flipchart paper and pens

G paper and pens, coloured pens or coloured pencils

G Blu Tack, pins or other means of attaching finished work to walls or display boards

G CD player/tape recorder and Values in Healthcare CD or relaxation music tapes.

Attend to practical preparations. Ensure that the temperature of the room is comfortable and arrange seating in a way which encourages discussion and sharing
(a circle or horseshoe). Note the location of toilets and refreshment areas and arrange for hot drinks and water to be available during break times.

It is a good idea to prepare yourself ‘inside’ as well as ‘outside’, so that you are able to communicate the values and qualities being explored during the session. You may want to visualise the session with positive outcomes, as well as drawing on your own inner qualities that you will need to guide people through it.

Session Programmes and Timing Issues

The suggested programme for each module lasts for a full day (approximately six hours plus lunch break). Most of that time will be spent in experiential exercises, each one being followed by a short feedback session. However, there are also a number of additional activities which are featured in each module, and for which small amounts of time are built into the programme. These include:

G Introduction (30 minutes)
G Movement Exercise (5–10 minutes am and pm)
G Break (15–20 minutes am and pm, plus lunch break) G Session Review (10 minutes)
G Action Planning (30 minutes)
G Evaluation (10 minutes)
G Closure (5–10 minutes)

Each of these activities is covered in the sub-sections below.

The suggested programme is fairly full and you may want to adjust the timing of particular exercises (or the additional activities listed above) to provide a different balance, depending on the nature and needs of the group. The pace should be unrushed, as much of the material touches deep aspects of ourselves. If you want to run the kind of session which allows for more leisurely reflection, you may even want to omit one or two of the exercises so that there is greater time for self-enquiry, sharing and action planning.

Half-day sessions

If you are running a module as two half-day sessions, you will need to adjust the suggested programme timings to allow for introductions at the beginning of both, and session reviews, action planning, evaluation and closures at the end of both. You could keep the introduction to the second session fairly brief, in favour of a longer action planning and evaluation at the end, looking back over the entire module.

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Extending the day

If you wish to explore a module topic in more depth, there are a number of options for doing this, again depending on the needs of the group and their learning objectives. These are:

G Allowing more time for some of the introductory activities, possibly by incorporating Warm-up exercises or Setting the tone exercises provided in
Part 5: Additional Resources (see also 10 Introducing the Session on page 34).

G Reviewing the previous session (if you have run one) and/or any homework or relevant experiences since the last session.

G Allowing more time for individual exercises and/or for feeding back – sharing experiences and exploring their application to participants’ home and working lives.

G Building in optional Follow-on exercises which you will find at the end of each module. These are not essential to meeting the module aims, but will extend participants’ exploration of the topic and build on the experiences which the main exercises provide (see 19 Follow-on Sessions/Homework on page 48).

G Allowing more time for action planning and/or evaluation (see 14 Action Planning and 15 Evaluation on pages 41 and 43).

G Allowing more time for closure by incorporating a longer closure exercise (see 16 Closure on page 46).

Process and Group Size

Each module allows a progression of exploration and discovery from the personal (the emphasis in the first session) to healthcare settings and participants’ work practice (the emphasis in the second session). It may be helpful to mix groups across disciplines and settings for the first session, so that everyone can benefit from sharing across a broad spectrum of experience. However, in the second session it may prove more useful for work colleagues/teams to spend time together, so that they can relate their exploration and resulting insights to their own practice and settings. This will be particularly useful in the action planning towards the end of the day.

Most exercises involve a progression from working individually to working in pairs or small groups of 3/4 people, through to feedback in the main group. The ideal group size for a single facilitator is between 8 and 14 people. For bigger groups of up to 25 or 30, two facilitators will be needed to help the group work to its full potential, taking stock of the work being done in pairs and small groups, assisting where needed and handling feedback in the large group.

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The programme can be adapted for much larger numbers, for example, those in undergraduate education or attending a conference, by dividing into smaller groups, each with their own facilitator and scribe, and by following the instructions and questions for each exercise. You may wish to arrange some way of reporting back at the end.

Background Reading

You will find an introductory paper setting out the background and context for the Values in Healthcare programme as a whole in Part 1: Introduction. Some references and resources are listed at the end of this paper, should you wish to explore the rationale for, and topics of, the programme in more depth. At the beginning of each module there is a short Background Reading paper which will help you to familiarise yourself with the topic, introduce the session, and understand the theme and context of each individual exercise. The paper can be copied as a handout to give to participants at the end of the session, so that they have a valuable summary of the module.

Further resources relevant to the Values in Healthcare programme and to particular module topics can be found in Part 5: Additional Resources. These can also be provided to participants as handouts.

The CD

The Values in Healthcare pack contains a CD of 23 tracks designed to guide participants into meditation or visualisation as part of session activities. You will find a complete listing of these in Part 5: Additional Resources. The number of any track/s to be used in a particular session or exercise will be listed under Materials in the session notes for facilitators. The notes will also provide you with a text version of the track which you can read out, should you not be using the CD. In this case, you may wish to play your own relaxing background music on a tape recorder or CD player.

Session Summary and Aims

At the beginning of each module you will find a statement of aims and a brief description of the process for the day which you can use in your session introduction. The aims are about the process of learning, ie what participants will do during the session, rather than outcomes. Learning outcomes are provided for each individual exercise.

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Introducing the Session

The way in which a session is introduced is obviously vital to getting things off to a good start. Participants need to feel that they have ‘arrived’ and are ready to engage fully in the session to come. Introducing the session with thought and care will also help participants to feel comfortable with each other and to get the most out of the activities ahead.

All module programmes include a suggested introduction of about 30 minutes. You may need to adjust the timing if you want to incorporate introductory exercises (see page 35).

If you are running several modules or sessions, you may wish to begin by giving a short introduction to the Values in Healthcare programme as a whole, including its approach, principles and aims. You will find information and OHP pro formas for this purpose in Part 1: Introduction.

Plan your introduction to the module before the day. You may wish to include any or all of the following.

Quiet time

Beginning with a couple of minutes’ quiet will encourage participants to relax and just ‘arrive’, leaving behind their journey to the training venue, their home, work, etc. It will bring everyone into the present moment, enhancing their receptivity and focus.

Ask everyone to sit comfortably, and explain that you would like to begin with a couple of minutes’ quiet time to help everyone to relax and focus on the session ahead. You may want to introduce some breathing exercises, play some soft, relaxing music, or just sit quietly. Use the following commentary if appropriate:

❝ Before we start, we are going to spend a few moments of quiet time. Get yourself comfortable and relax… (pause).You may have rushed to get here or had a difficult start to the day. If so, briefly recap and then let the scene go. If you have any current concerns, acknowledge them in your mind and then, for the duration of this session, put them to one side. Now feel yourself becoming peaceful and calm, back in this room and ready to begin. ❞

This brief period of quiet may be a powerful and new experience for some participants and should be handled with sensitivity. At the end of this quiet time, you can gently focus the group on getting into the session.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Introductions/optional warm-up exercise

Depending on the nature of the group and whether and how well participants know each other, you will want to facilitate some kind of introductory and/or warm-up activity.

Allow time for introductions, and acknowledge each person individually in the group. This helps to encourage everyone to participate in the session, and brings them into the group. Warm-up exercises additionally create a positive and participatory atmosphere.

You may want to introduce one of the Warm-up exercises in Part 5: Additional Resources as a way of enabling people to learn new things about each other, and get away from established work roles. These playful activities can help to overcome fears and prejudices which may exist, even in work groups.

If participants do not know each other, a warm-up exercise is a good way of meeting another person and feeling more at ease. It can help to engender a feeling of safety and goodwill.

If participants work together in a well-established team, you may want to keep this introductory activity quite short and devote more time to the session itself and to team action planning at the end.

As a minimum, encourage every person to give their name and some information about themselves to the whole group. Consider whether giving job titles may produce an unhelpful sense of ‘ranking’ in a mixed group. Where the group is going to work together over several modules or sessions, it is worth spending longer on introductions, as this will lay the foundations for good individual support and team dynamics.

A selection of Introductory and Warm-up activities are provided in Part 5: Additional Resources.

Overview of session

Once participants are feeling more settled, they will be wanting to know more about the session ahead and what to expect. Some may be anticipating a lecture, others a workshop. Some may have elected to come to the session, others may have been sent. Some will be new to healthcare, while others may be very experienced. Some may think the session’s focus will be on patients, not on themselves. For all these reasons, it is important to set out the context of the module. You may want to run through the following, using prepared flipcharts/overheads where relevant:

G introduction to Values in Healthcare programme (see Part 1: Introduction) G themes, context and relevance of session/module (see Background Reading

paper for the module)

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G aims and process of module/session G programme/plan for the session
G practical considerations
G any questions.

You will find most of the information listed above in the facilitator’s notes for each module. You may wish to relate some of your own experiences relevant to the topic and themes as a way of encouraging participants to be open and sharing during the session.

Setting the tone

Setting the tone refers to the way in which the session is conducted and the responsibility which everyone has for its success. It can be helped by preparing the physical environment – removing clutter, arranging the chairs in a way which encourages participation – and by background reading and research.

More importantly, you need to prepare yourself mentally, so that you are a good example of what you are teaching. Participants may not remember what you say, but they will remember how you said it and the impression they had of you. Your ‘quality of being’, expressed in your body language, enthusiasm and attitude, will have a greater impact than the words you speak, and will help people to get a sense of what the session is truly about.

Remember that you are ‘modelling’ the values which underpin this teaching pro- gramme. If you are talking about peace, you need to be peaceful; if you are talking about positivity, you need to be positive. In general, most healthcare professionals are in a hurry to finish one job and get onto the next, so set an example of being in the moment by giving sufficient time for exploration and reflection.

Setting the tone at the beginning of a series of modules is particularly important, as this will create a ‘contract’ for participants. You may need to spend 20–30 minutes exploring ‘What things we can all do to make the programme successful’. Some examples might be confidentiality, listening, tolerance, support, co-operation, honesty, participation, respect, commitment, enthusiasm. Each group will select their own key words and issues, but some, if not raised, need to be drawn to the group’s attention, such as confidentiality and respect. Self-responsibility for one’s own actions is another key issue, as is how to support those who find it difficult to express themselves in a group. The resulting contract will need to be referred to at the beginning of each module and amended if necessary.

A contract might also involve engaging the group in setting their own more specific ‘ground rules’. Typical rules might include:

G confidentiality of all that is shared in the group

G start and end on time
G listen from the heart, without interrupting G speak from the heart and be positive
G own what you say
G leave ‘baggage’ outside.

Some rules might sound prohibitive but can be re-framed as positive qualities. For example, ‘no smoking’ could be re-phrased as ‘respect for non smokers’. Try to phrase all suggestions in positive terms, for example, ‘be supportive’, ‘be respectful of others’ views’, ‘act in a co-operative way’.

Finally, you may wish to allow time in this part of the introduction for participants to share their own expectations of the session. They may have specific learning out- comes they wish to address or more general wishes which can be noted and returned to during the session evaluation. If some of these are unrealistic, given the content and suggested learning outcomes of the session, it is important to point this out and give the reasons why. It may be possible at the end of the session to look at how additional needs can be met, as part of the action planning.

You will find further information about Setting the tone and some optional Setting the tone exercises which address the above issues in Part 5: Additional Resources of this pack.

Review of last session/homework

If you have run a previous session, you may also wish to build in time to review the last session and how today’s topic links with it. This gives value to participants’ previous learning and action planning by recognising the thought and efforts they have put in during the intervening time. Participants can be asked to review their learning from the previous session and ways in which they have put it into practice. Any homework which they have undertaken, including journaling (see 20 Journals on page 49), can also be shared if appropriate, together with relevant experiences which have occurred.

Building in this kind of review, as part of the introduction to the day, can help to emphasise the process of continuous learning (see also 18 Ongoing Support on page 47). It helps participants to clarify and share their ideas, and helps the facilitator to build on their learning. Suggested questions (on a flipchart) could include:

G What has happened since last time, that has ‘struck’ you? G What have you learned?
G What have you been able to use at work?
G What are you doing differently?

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Participants could be given a few minutes to reflect on their own and look at their notes from the previous session, before brief sharing in the whole group.

If you are running a series of sessions and build in this kind of review, there is no need to carry out more than a brief introduction to the next session.

The Exercises

Each session includes a number of timed exercises during which participants work individually, in pairs and in small groups on a range of experiential and exploratory activities. The nature of the activity echoes the theme of the session, and uses the appropriate tool or tools for learning (see Part 4: Spiritual Tools). For instance, in the module on peace there is an emphasis on experiencing ways of achieving stillness and peace (through relaxation, meditation and visualisation), and on listening.

Each exercise is usually followed by a brief feedback which enables participants to come together in one group to share and reflect on their experiences. Sometimes they are also asked to look at ways in which they might use their learning in practice, either in their healthcare practice or in their wider lives. Any ideas which are generated can be recorded and brought into the action planning activity towards

the end of the session.
For each exercise, you will find the following guidance and information:

Context

A brief rationale for the exercise, set in the context of the module and its aims (see the Background Reading paper for the relevant module).

Process

An indication of the process of learning, such as the main learning tool (eg visualisation) or form of working (eg sharing in pairs).

Timing
Suggested timing for the exercise, including feedback. Adjust the timing of any

exercise if you wish to allow longer for exploration or for feedback and processing.

Learning outcomes

A statement of what the participant will understand or be able to do as a result of undertaking the exercise.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Materials

A list of any numbered worksheets which will need photocopying, together with other materials eg flipchart, pens and paper, suggested CD tracks.

The worksheets have the same number as the exercise they relate to and are not, therefore, consecutively numbered. They not only provide structure and guidance for some of the activities, but support for further learning and individual review beyond the session itself. The worksheets are located at the end of each module.

Facilitating the exercise

Step-by-step guidance on how to lead the exercise are given in normal type. Suggested wording for spoken instructions and commentaries are ❝ highlighted by speech marks.❞

Feedback

After each exercise, the experience is usually shared briefly in pairs or small groups and then, if appropriate, within the larger group. A suggested timing for the feedback part of the exercise is stated alongside the facilitator’s guidance.

Notes are provided for the facilitator on how to lead this feedback session in order to allow participants to reflect on their experience and integrate it more consciously.

The larger group sharing is used to reflect on and explore process, rather than personal experiences. However, it may be useful to ask for some examples from the pairs or small group discussions.

Sometimes questions are provided to help participants process their experience. Keep any questioning open-ended, rather than channelling participants to a specific conclusion. Open questions will allow them to explore the ideas at different levels of complexity and in a way which is most meaningful to them.

You may wish to adjust the form of feedback depending on the spiritual tool utilised in the exercise. The tools of meditation, visualisation and reflection are calming and centring, whereas the tools of listening, creativity and fun are more active and engaging. The feedback session could aim to maintain the quality of energy generated, or begin to shift it. For example, you can stir up energy through ‘thought-showering’, asking for quick responses in the form of ideas, thoughts and suggestions which can be put on a flipchart. Alternatively, you can slow things down by pausing for inner reflection.

Some groups may not be used to sharing, particularly if they have not met each other before, or work in the same organisation but are not in the habit of communicating.

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In these cases, using a worksheet for eliciting feedback might be helpful.

Not everyone will want to speak in the main group, but encourage the quieter ones to speak, however briefly.

Recording feedback on flipcharts is a useful way of engaging the group in working together and will help in summing up at the end of the session. It will also provide valuable reference for action planning, ensuring that good ideas are not lost and that participants’ action plans can draw on all the learning from the session (see 14 Action Planning on page 41).

Helpful hints

Where relevant, additional advice is provided on how to facilitate the exercise and/or move on to the next activity, eg what kinds of issues the exercise might raise and how to deal with them, additional points which could be discussed, how the activity links on to the rest of the session.

Movement Exercises

Throughout a session it is important to aim for a general balance between thinking, discussion, relaxation and movement. Movement can help to bring the learning experience into the body. It also gives participants a chance to refresh themselves after sitting and being still, and come back to the session with renewed energy.

Plan a movement exercise into each session. Time for this is built into every programme (5–10 minutes am and pm). A range of Movement exercises is included in Part 5: Additional Resources. The exercises are brief, simple and offer an enjoyable way of bringing mind, body and spirit together and of observing the physical sensations within the body.

Try out the exercises yourself before the workshop in order to get a feel for the nature of the movement and the timing it requires. Do it often enough to feel that you can demonstrate it to participants when you introduce them to it.

Other opportunities for movement can be built into lunch and refreshment breaks before reconvening, for example, a minute of stretching or deep breathing.

Session Review

Each module plan builds in a short period of review (10 minutes) before moving on to action planning and evaluation. Here you can include:

Values in Healthcare © The Janki Foundation for Global Health Care 2004

G a very brief summary of the session aims and learning outcomes, and what was covered (using the handouts as prompts). It is helpful to display the aims and programme plan on a flipchart to refer to here, and again during action planning and evaluation

G any significant learning points recorded

G display of any work generated by participants

G distribution of the Background Reading paper to this module for participants to take away and refer to

G distribution of the References and resources handout (see Part 5: Additional Resources) to help participants explore the topic in more depth, should they wish to.

Action Planning

Each session allows about 30 minutes for action planning, although you might want to plan in extra time, depending on the nature of the group and the desired outcomes of the session.

Action planning provides an important opportunity for participants to review the learning which has occurred and to see how it might apply to their personal and work lives. It forms a bridge between the session itself (and all the experiences, sharing and discussion which took place), and the ‘going home’ or ‘back to work’ situations, by giving a valuable opportunity to consider ‘How might things be different, or better, on my return?’ and ‘What can I do to make changes?’ Encourage participants to focus on realistic and practical changes in their way of living and practice.

Overcoming resistance

Action planning can help to tackle feelings of frustration and anger or sadness which may have arisen in reflecting on difficulties at home or work. It is easy at this stage for participants to get ‘hung up’ on the barriers to change, particularly in an area like healthcare, for example, too few resources or likely opposition from managers. Encourage participants to see that they all have an area of influence, however small, which they can bring to bear in making things better. Small changes can be just as powerful as big ones, since even making a change in how an individual greets another person can have a ‘ripple’ effect through many other people and their behaviour. If individual participants feel that they are likely to meet resistance at home or at work, they may want to identify another participant who they can team up with and offer mutual support, or a friend or colleague who is likely to be receptive to their ideas and proposed action.

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Focus for action plans

Each module allows a progression of exploration and discovery from the personal (the emphasis in the first session) to healthcare settings and participants’ work practice (the emphasis in the second session). Action planning may need to provide opportunities to apply learning from both. For example, in Module 2 Peace, the first session (Being peaceful ) may encourage participants to create ways of being more peaceful in their everyday lives, eg meditating for 10 minutes every morning. The second session of the same module (Peace at work) will provide scope for individuals to look at a range of changes in their own practice at work, eg from sitting peacefully for one minute before a consultation or meeting, through to a team plan for making the physical environment more peaceful to work in. All modules suggest particular action planning exercises which follow on from what has gone before. Other suggestions for action planning can be found in Part 5: Additional Resources.

Action planning can be informal or it might be formalised. At its simplest, it will include small changes which individuals can choose and decide to commit to, through to more ambitious changes which could be planned for and undertaken after the session, or even begun as a team exercise during the session. Whatever the scale and nature of the commitment or plan, the power of such changes cannot be underestimated and so it is important to allow time for ideas to begin to formulate.

Some useful questions to ask as part of action planning might include:
G What is your view of ……………. now?
G What could you do differently to allow yourself more time for …………….? G How does ……………………….. work towards your team vision?
G How could you allow/help others to move towards …………………..?
G What effect would this have on your workplace?

Written plans

It is a good idea to encourage participants or teams to write their ideas, goals and intended actions down, so that they are not lost on returning to the business of everyday life. Goals should be written as observable and, if relevant, measurable actions, so that it is easy for the participant (and others) to know when they have been achieved.

Some action plan forms for individuals and teams are included in Part 5: Additional Resources to assist in this process.

Reviewing plans

Finally, it is important to encourage participants to review and evaluate their action plans, and to adjust them in the light of their subsequent experience. This might be done by inviting them to enter a personal or work-related review into their diaries in a number of weeks’ time. The review could be a date with themselves to re-look at the personal goals they set, or with peers or colleagues to look at broader action plans. If you are working with an established team, you might consider building in

a review session to help them review their team plan.

Evaluation
Each session programme allows about 10 minutes to begin the process of evaluation.

Why evaluate?

It is essential to give people the opportunity to evaluate any training session by taking time to reflect on its usefulness and relevance. Evaluation is also a means of providing valuable feedback to the facilitator on the materials, approach and presentation, helping to improve the planning and delivery of future training.

Feedback and evaluation provides opportunities for participants to say what has been happening to them and, as such, may be positive or negative. While it is pleasant and rewarding to receive positive comments, it is often more beneficial to a facilitator’s professional development to listen to criticism about an event, so that the source of the difficulties can be understood and learning derived from the process. The Values in Healthcare training can challenge people’s assumptions and approach to life and work, and as such, is a learning and development experience for all those who get involved, including the facilitator. Evaluation provides a further opportunity to learn from that same event.

Evaluating Values in Healthcare training

Evaluation of Values in Healthcare training is not as easy to pin down and quantify as it is for some training programmes. Examples of the kind of feedback participants have given from attending some of the sessions have included:

G ‘I felt at ease with myself for the first time in ages.’
G ‘I was able to share concerns about my work relationships.’ G ‘It was helpful to have time for me.’

Many comments have suggested subtle shifts in attitudes, rather than the acquisition of specific knowledge and skills.

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Part 2|Guidance for Facilitators

Values in Healthcare © The Janki Foundation for Global Health Care 2004

The success of this form of training will depend very much on how individuals have progressed in their own spiritual understanding, and how much the session suited them. Some people, particularly those who have no experience of spiritual ideas and practice, will find it difficult to evaluate something which they feel is not relevant to them, or has not touched them in any way. Others who are more familiar or comfortable with a spiritual approach may find it easier to express their responses. It may not be possible to measure the success of the training in any conventional way, as changes are often internal and subtle and may not be demonstrable for weeks or even years to come.

However, while acknowledging the difficulties, facilitators should not shrink from attempting an evaluation. There needs to be clarity around what is being evaluated, for what purpose and for whom. Each is briefly discussed below.

End-of-session evaluation

At the end of a session, it may only be appropriate to ask participants for some quick and immediate feedback on various aspects of the training, particularly if they have spent much of the session in deep reflection. Some of the questions you may want to cover at this point include:

G To what extent did the session meet with your expectations/stated aims and learning objectives?

G What did you gain/learn from the session?
G How relevant/useful was the session to your personal life/working practice? G How would you improve the session?
G How satisfied were you with the practical arrangements?

As an alternative, you could encourage a more reflective approach, focusing on the impact of the session on participants’ lives and practice. Here are some questions you could include:

G What have you learned about yourself?
G What are you taking away from the session?
G What can you put into practice in your own life? G What can you put into practice in your work?

Encourage participants to be as open and honest as they can in giving their immediate reactions, stressing that their feedback will help to improve the session and materials for future use. Of course, some people may feel more comfortable completing an evaluation sheet and handing it in, rather than speaking out, particularly if there were aspects of the course which didn’t work well for them.

As a more participatory evaluation exercise, you might prefer to invite people to design their own evaluation. Here is a suggested lead into this kind of activity:

❝What sort of questions could you ask to evaluate the value of the session? Find a partner to discuss and draw up a short list of questions.Then share and compare your responses to them.❞

Evaluation after the session

It may take time for participants to be able to look back on what they have done and consider how helpful or relevant it has been to their personal and work lives, and to meeting any learning objectives they originally had. It may be that the session was very different to what they had been expecting, that it had unanticipated, hopefully positive, outcomes. This more considered feedback might best be captured through the completion of an evaluation form sent to participants some time after the course.

Facilitator evaluation

Finally, you as facilitator should undertake your own evaluation of ‘how it was for you’. You may want to note down how well you think the session went in terms of achievement of aims, content, process etc. It is also useful to record any issues which came up, both on a practical level, eg timing difficulties, to problems and reactions which particular exercises might have prompted and which you had not anticipated. You may also want to reflect on your own learning and ways in which you could make use of this in running future sessions, and in your wider personal and work life.

Approaches to evaluation

As with action planning, evaluation can be formal or informal. If participants are attending the session as part of a formal training programme or for continuing professional development, there may be particular evaluation requirements which need to be met, eg forms to be filled in and feedback to be given to colleagues and managers. If not, participants may wish to design their own evaluation or follow a more participatory approach.

Much of the focus of the Values in Healthcare exercises is on process and that process is participatory, reflective and meditative. However, we have set broad aims for each module and learning objectives for each exercise that will help keep a perspective on outcome as well. The key question we need to ask ourselves is,
‘Will the information from such evaluation results change my practice?’

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Part 2|Guidance for Facilitators

Other areas which you may want to evaluate include:

G practical arrangements (pre-session administration, venue and location, lunch, timing etc)

G session activities – nature and balance G session content
G session materials
G presentation and pacing.

Further information about evaluation and some evaluation forms are included in Part 5: Additional Resources.

Closure
Each session programme allows for 5 to 10 minutes at the end for closure.

Give some thought to how the session could end. A brief concluding ritual, particularly one in keeping with the theme of the session, can bring the session
to a close in a way which gives everyone a feeling of completion. It can also affirm the spiritual experience of the day, and help people to learn to say goodbye.

A simple, meaningful ritual can encapsulate the experience of sharing and learning together at a deep level, and can promote the idea of ongoing learning and support.

Each module includes a suggested closure in keeping with the theme of the module. Alternatively, you may wish to choose your own. The type of closure you plan will depend on the session, your own experience, and the participants.

Some general closure activities include the following:

G ask participants to take a moment’s silence to reflect on what the group has done to improve their understanding of, and skills in, the theme of the session, or what they are looking forward to doing to ensure that these are used in their lives

G play some music while people are leaving the room, or ask participants to sing a song that they all choose

G ask people to walk by a candle on their way out of the room and express their silent thanks for the gift they have given themselves in this session.

There may be elements of a particular session which you want to emphasise in your closure. Alternatively, you may wish to put emphasis on one or more of the following in order to bring the session to a fitting close:

G appreciation
G farewell/goodbye

Values in Healthcare © The Janki Foundation for Global Health Care 2004

G reflection and integration of learning G celebration
G action and pledges
G gifts.

To help you select an appropriate activity, a range of Closure exercises is provided in Part 5: Additional Resources.

References and Resources

In addition to the references listed at the end of the introductory paper in Part 1: Introduction, you will find suggestions of useful references and resources for each module in Part 5: Additional Resources. This is not an exhaustive or comprehensive listing, but it may help to provide some sources of reading and listening which can be added to by yourself and participants. The list can be photocopied for participants to take away from the session or programme and use to continue their exploration and learning.

In addition to the resources suggested in this pack, you may want to locate locally available resources before facilitating the session, or share knowledge about useful resources within the group, for example, leaflets and newsletters, local organisations and support groups, classes in yoga, meditation and other activities, and information relevant to the module topic.

Ongoing Support

The Values in Healthcare programme can only provide a starting point for exploring and implementing values. Participants should see each module as part of an ongoing process, perhaps the first step on a journey to explore their own spiritual development and values in healthcare. They may want information on further seminars or workshops, encouragement in setting up their own support groups,
and further instruction in some of the spiritual tools.

What happens after a session is important. Participants may have evaluated the session as useful or even inspiring, but after days or weeks they may find difficulties in sustaining their enthusiasm and insights in practice.

Providing participants with copies of the background papers for each module will provide them with a summary of what has been covered during the day. The references and resources list (see Part 5: Additional Resources) will point them to further resources which will help them to build on their knowledge and experience.

Part 2|Guidance for Facilitators

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Part 2|Guidance for Facilitators

Helping participants to identify a mentor or ‘buddy’, or to set up ‘buddy groups’ or self-development groups may be effective ways of reminding them of their intentions and providing support.

Follow-up meetings or forums after a workshop may be attractive to some participants and you will need to have given thought to ways of offering these beforehand (see Section 19 below). A handout at the workshop with details and information on further proposed meetings will encourage a continuation of learning.

Follow-on Sessions/Homework

Follow-on sessions will help to emphasise and support the ongoing process of personal development and, where relevant, team development. The focus will be on reviewing personal insights and their application, rather than on clinical review per se. Follow-on sessions may also help to sustain morale by providing an important source of support for individuals and opportunities to network with people who are similarly motivated.

At the end of each module in Part 3 of this pack, you will find suggested exercises which might form the core of a follow-on session, or for individuals/work teams to carry out as ‘homework’ between sessions. These exercises build further on the personal and group exploration which will have already occurred during the main sessions of the module. They may extend the learning by exploring an additional topic connected to the main theme of the module, for example, the exercise on
‘the place of ceremony’ as a follow-up to Module 7 Spirituality in Healthcare. Alternatively, they may provide lighthearted or additional, creative ways of exploring the module content, for example the ‘adverts’ exercise which follows on from Module 5 Co-operation. Some exercises might be particularly valuable to use with work teams, as part of team building and ongoing team development.

Since opportunities for inner reflection are so important to the process of exploring values, you might also wish to select a meditation or visualisation which the group has not used before from the CD which accompanies this pack.

When planning a follow-up session, depending on the time available, you may wish to build in some or all of the following components (see detailed guidance in the relevant sections above), in addition to the suggested exercises:

Values in Healthcare © The Janki Foundation for Global Health Care 2004

G G G G G G

warm-up and setting the tone movement
meditation or visualisation action planning

evaluation closure.

You could also usefully encourage individuals to undertake a brief journal review (see Section 20 below) and to continue to update their learning logs (see Part 5: Additional Resources).

In addition to journaling, individual homework could involve undertaking appropriate follow-on exercises, writing a reflective piece on a module theme, or undertaking a visit to a healthcare or spiritual setting which is unfamiliar, eg a hospice or place of worship, in order to broaden knowledge and understanding.

Journals

Encourage participants to keep a daily or weekly record of what they have learned and been inspired by, as a useful way of charting their spiritual progress. Journal keeping can be related to a session or could be about anything useful which comes up during daily life or work, including:

G connections made
G interesting conversations G successes
G moments of inspiration.

Anything helpful, big or small, which has had a personal impact is worth recording. A simple idea is to invite people to keep their journal by their bedside and record five things they have learned, or five things they are grateful for, at the end of each day. This helps the writer to go to sleep and wake up in a positive frame of mind. Later, the writer can reflect back on progress over the months.

Alternatively, ask participants at follow-up meetings to write down what they have achieved during that week and share it with the group.

Finally, remember to keep a similar record yourself, charting your own spiritual journey and feeding back your experiences and insights into the sessions you go on to lead. That way, you can ensure that the Values in Healthcare training maintains a quality of learning through living, which is at the heart of its approach.

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Part 2|Guidance for Facilitators

Part 3: Modules Contents

Module 1

Module 2

Module 3

Module 4

Module 5

Module 6

Module 7

Values ……………………………………………………51 Inner values ………………………………………………61 Values at work…………………………………………….71

Peace …………………………………………………….95 Being peaceful …………………………………………..105 Peace at work ……………………………………………120

Positivity ……………………………………………….139 Being positive……………………………………………155 Positive interaction at work ………………………………167

Compassion…………………………………………….193 Finding compassion ……………………………………..205 Compassion in practice ………………………………….216

Co-operation……………………………………………245 Understanding co-operation ……………………………..254 Working in teams ……………………………………….263

Valuing Yourself ………………………………………..285 Self-care …………………………………………………298 Support at work …………………………………………305

Spirituality in Healthcare ………………………………331 Exploring spirituality and healing ………………………..344 Spiritual care in practice …………………………………357

Background Reading

Why Values?

Values can be said to underpin everything we do and say in our work and life as healthcare professionals. If we lose sight of our values, we may begin to experience a loss of meaning in what we do and who we are, leading to a diminished sense of self-esteem. Our work suffers, and we begin to suffer at work and, inevitably, in our personal lives. With the demands placed on us it is easy to lose our vitality. By consciously setting out to rediscover and strengthen our values, however, we can renew our sense of purpose and revitalise confidence in our judgement. Our values, after all, are the reasons we were drawn to work in the caring professions in the
first place.

Purpose of module

The purpose of this first module is to help us remember what our innermost values are and to remind us about what drew us to our work and what inspired us. There are certain core values that are relevant both to our conduct as individual moral beings and to our practice in healthcare and related professions. The spiritual approach to healthcare begins by taking time to identify and recognise these core values.

Values represent an internal framework that has the potential to provide meaning to our lives and the way in which we lead them. These inner beliefs can guide and enhance our thoughts, and our external actions and relationships with others. Knowing and living by our values enriches our self-development and leads to an understanding of the purpose of our lives. Values are helpful in maintaining our personal self-esteem in the face of challenge and disappointment. They are the principles by which we choose to live in the outer world.

To bring effective positive change in the way we work means first making changes within ourselves. It involves more than merely reading and talking about values. We need to consider practical ways of weaving them into the fabric of everyday action. As our values flourish, so do we.

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Module 1|Values

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Introduction to the Values module

This module helps us to identify our own personal values and those values that have particular relevance for healthcare. Central to the module is the notion that, while professional practice depends crucially upon our training, skills, attitudes and experience, the well-being of everyone involved in healthcare (practitioners and patients/clients, administrators and managers alike) can be enhanced through an explicit framework of values that forms the basis for how we view ourselves and behave towards others.

Themes of Exercises

My favourite things (1.1, 1.11)

Stopping and reflecting about the things we like is a way to identify the values that influence our personal preferences. By asking ourselves questions like, ‘What is it about a song, poem or book that I enjoy and get pleasure from?’, ‘What is it that touches me and I consider being important?’, we can get a sense of the underlying values. It can be difficult at first to find words to express these, but through reflection and discussion with others we can begin to build a vocabulary of values to bring to our exploration during the session.

What are values? (1.2)

Values can be described as core beliefs or principles. Our values form the foundation of our judgements about what is good and bad, right and wrong, what we hold to be admirable or important in life. In turn, they determine the basis of our actions, particularly those actions where other people are involved.

However, everyday language involves a great deal of shorthand, and we are used to denoting values in simple, one-word terms. For example, ‘compassion’, ‘co-operation’ and ‘peace’ seem to us to be values in the sense that they stand for beliefs or principles concerning, for example, the goodness, rightfulness or importance of being compassionate, co-operative or peaceful. In this sense, we can make a value out of any quality or virtue.

While values are core beliefs, qualities or virtues tend to describe our actions or behaviour. Sometimes, if a quality or virtue is an important feature of the way in which we lead our lives, then it can be seen to be a core value. For example, a person who decides to live their life by giving away their possessions may be said to be upholding generosity as a core value. On the other hand, a person who from time to time behaves generously is not necessarily upholding a core belief in the importance of generosity; they may be acting out of pity or some other motive.

We have tried to distinguish between the words ‘values’, ‘qualities’, ‘beliefs’ and ‘virtues’ but accept that words can have different emphases of meaning for different people, so the actual definition is not so important as getting a sense of the meaning.

A high point in my working life (1.3)

As healthcare professionals, we are all used to being highly critical of our work as a way of maintaining high standards. We are also perhaps too critical of our colleagues and ourselves. It can be refreshing to think of something we have done really well, as

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Module 1|Values

Values in Healthcare © The Janki Foundation for Global Health Care 2004

considering a ‘high-point’ brings feelings of success. It is often not so much what we did but how we were at the time. It is when we have the courage to be truly ourselves that we express our special qualities and underlying values.

Values that matter most to me (1.4, 1.10)

Having begun to explore values, we will perhaps have identified 10–20, or even more. While all these values are likely to be important, some may matter more to us than others. Yet we can acknowledge that we will each have a different mixture of personal values and this is what makes us unique and special. Acting on these personal values, we will demonstrate certain qualities that are likely to be important for the delivery of healthcare and the well-being of others. This is why identifying our personal values is important, as it determines the values we bring to our work environment.

Experiencing personal values (1.5) and Rekindle the dream (1.7)

When we reflect at a deep inner level, we are more able to identify those values that regularly inform what we do. This reflection can become a meditation which connects us with our inner being. It allows us to explore whatever gives a sense of meaning and purpose to our lives – the values that underpin our individual thoughts, impulses, intentions, speech and actions. It holds the potential for a journey into who we are and the place we occupy in the scheme of things. It may also allow us to feel connected to a higher source, so that we can continually renew and refresh our values. When we act in accordance with our personal values, we act from strength in a humane and harmonious fashion. When we recognise and connect with these values, we live our lives more co-operatively and find peace and contentment.

Heroes and heroines (1.6)

There are many people we admire; individuals who inspire us and who we would wish to be like. What is it they do and say that influences us in a positive way?
What are the values that they are expressing, or just seem to have in their manner?
If we can develop these qualities perhaps we can be like them. In this process we may discover that we already have many of their qualities, and perhaps we have a hero or heroine within.

Values in healthcare (1.8)

Identifying group values can be a very effective way of team building; it can connect us as human beings at a level deeper than the roles we play, and help us create a

common vision for the group. Using a creative exercise is an ideal way of getting a team to see beyond their work roles, building on ideas together.

When the focus of the exercise is to have a common set of values, we can create a ‘vision statement’ which reflects the values that we wish to work by. It can be an inspiration for the team and those they care for. Morale in the team will improve and patients will benefit as a result.

Taking values back to work (1.9)

For us to be able to function both as individual moral beings and professional practitioners, we need to recognise that our values are an inner resource that we can access and draw upon. By identifying our values we can go on to consider how we can apply them at work when with patients and colleagues. We may hold in our mind one value, such as patience or tolerance, and observe how we can embody that value more, and what effect it has on ourselves and others. The values we demonstrate are likely to be important for the delivery of healthcare and the well- being of others. This is why identifying and giving priority to values in our work environment is important.

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Module 1|Values

The Facilitator’s Guide to Module 1

Session I: Inner values Aim

G To provide an opportunity for participants to explore and experience their personal values

Process

In this session you will lead participants in an exploration of the concept of values, providing them with an opportunity to identify their own personal values. Identifying and feeling comfortable with our personal values and the qualities that express them can lead to a greater sense of purpose and meaning in living and working.

Through exploratory exercises in pairs, participants begin to identify their personal values, first by reflecting on their favourite songs, poems, paintings etc, then by discussing personal values in pairs. Further reflections on memorable experiences at work and looking at the values that matter most to them pave the way for participants to experience their personal values at a deep level through meditation.

Session II: Values at work Aims

G To provide participants with the opportunity to explore, experience and develop work-based values

G To identify ways of integrating these values into their practice Process

This session focuses on the recognition of the values and qualities that healthcare practitioners bring to their work and on the way in which they can be expressed.

The session begins with participants identifying the values of someone who has inspired them in their work, followed by an exercise in which they are encouraged to create their ideal working environment, through guided visualisation. Participants then work together in groups to identify values important to healthcare and to express these, in a creative way, as a values statement for their work. Action planning and a closure exercise focus on looking at ways of expressing important values at home and work.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Programme/plan for Module 1 Values

Module 1|Values

Introduction

SESSION 1

Exercise 1.1

30 minutes My favourite things 20 minutes

Inner values

Exercise 1.2 What are values? 35 minutes

Movement exercise 5 minutes Break 20 minutes

Exercise 1.3 A high point in my working life 30 minutes

Exercise 1.4 Values that matter most to me 20 minutes

Exercise 1.5

Lunch break

SESSION II

Exercise 1.6

Experiencing personal values 20 minutes

Values at work

Heroes and heroines 20 minutes

Exercise 1.7 Rekindle the dream 20 minutes

Exercise 1.8 Values in healthcare 60 minutes

Movement exercise 5 minutes Break 15 minutes

Session review 10 minutes

Action planning

Exercise 1.9 Taking values back to work 30 minutes

Evaluation 10 minutes

Closure

Exercise 1.10 Living values 10 minutes

Total time 6 hours

Follow-on/homework

Exercise 1.11 Being creative with values 1 hour

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Module 1|Values

Materials G G G

Paper and pens
Flipchart and marker pens
CD player/tape recorder (optional)

Session I

G Worksheet 1.1 My favourite things

G Handout 1.4 List of values

G CD track no. 1 Experiencing personal values (or relaxing background music)

G Sticky notes or small pieces of paper and pins/tape – 3 sheets per participant

Session II

G Worksheet 1.7 Rekindle the dream

G Worksheet 1.9 Taking values back to work

G CD track no. 2 Rekindle the dream (or relaxing background music)

G Values cards (see Part 5: Additional Resources) G Pinboard and pins or Blu Tack to display work
G Poster-size paper or flipchart paper
G Coloured pens or paints

G Old magazines and/or collage materials G Glue sticks and scissors

Follow-on/homework

G Worksheet 1.11 Being creative with values (A) Reflections G Worksheet 1.11 Being creative with values (B) A reflective

poem
G CD/tape of relaxing background music (optional) G Paper or coloured card, and pens
G Flipchart

Preparation

1 Read the introductory notes at the beginning of the session/s so that you are familiar with the way in which the theme is being introduced and explored. Review the list of references and resources for this module in Part 5: Additional Resources and reflect on your own experiences.

58 Values in Healthcare © The Janki Foundation for Global Health Care 2004

. 2 Familiarise yourself with the main learning tools which are being used in the session (see Part 4: Spiritual Tools).

. 3 Read through the session guidelines and look at the suggested session programme which will incorporate:

G Session introduction G Exercises
G Movement breaks
G Breaks

G Session review G Action planning G Evaluation
G Closure

Plan each part of the session and timings in detail, using the session notes, Part 2: Guidance for Facilitators and the optional exercises in Part 5: Additional Resources for more detailed suggestions.

4 Photocopy any handouts and exercise sheets, and make sure that you have any other equipment listed under Materials.

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Module 1|Values

Introducing the Module

30 minutes
Run through your planned introductory session which may include:

Quiet time
Introductions/optional warm-up exercise Overview of session
G Theme of session
G Aims and learning outcomes
G Programme/plan for the session
G Practical considerations
G Any questions
Setting the tone
G Ground rules/principles
G Participants’ expectations

See Part 2: Guidance for Facilitators for further guidance on introducing the session.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

The Exercises

Session I: Inner values Exercise 1.1

Module 1|Values

Learning outcome

Materials

Facilitating the exercise

My favourite things

Process:

Reflection

20 minutes
At the end of this exercise participants should be able to:

✔ understand ways in which values can be identified through personal preferences.

G Worksheet 1.1 My favourite things G Flipchart and marker pens

1 Give out Worksheet 1.1 My favourite things and explain to participants that they will be reflecting on some questions and then sharing with a partner, as follows.

❝For each question you will have a chance to give a response. Approach the questions in a relaxed way, allowing your choices to be spontaneous rather than considered. Don’t worry if you can’t think of anything to write now; you can reflect on it later if need be.❞

Allow 10 minutes.

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Module 1|Values

Feedback 5 minutes

2 Ask participants to join up with a partner and share their responses to the questions on the worksheet. Allow 5 minutes for this.

In the main group, ask participants to share some of their responses. List the values they mention on a flipchart and display for the rest of the session.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Exercise 1.2

Module 1|Values

Learning outcomes

Materials

Facilitating the exercise

What are values?

Process:

Discussion in pairs

35 minutes
At the end of this exercise participants should be able to:

✔ understand more clearly what is meant by the term ‘values’ ✔ identify some of their personal values.

G Paper and pens
G Flipchart with the following questions written on it:

– What do you both understand by the term ‘values’?

– What particular values do you hold to be important in your own life?

G Marker pens

1 Run through the learning outcomes for this exercise explaining that understanding what we mean by the term ‘values’ helps us to clarify what our personal values are.

2 Ask participants to get into pairs, and lead the exercise as follows, reminding them when it is time to move on to the next part of the exercise:

❝Sit with your partner and introduce yourselves – saying a little about yourselves generally.❞

Allow 5 minutes.

3 Move participants on to the main exercise, displaying the pre-prepared flipchart:

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Module 1|Values

❝Now have a discussion with your partner on what you both understand by the term ‘values’, and what particular values you hold to be important in your own life.

After some discussion you may like to write down what you agree by the term ‘values’ and some of your own, personal values.❞

Allow 10 minutes.
4 Ask participants to move into the final stage of the exercise:

❝Turn to another pair and compare your definitions and lists of values.❞

Allow 5 minutes.

Start by asking for examples of personal values and make a
list on the flipchart. Use the remaining time to explore what participants understood by the term ‘values’; use the Background Reading paper as a benchmark for discussing their definitions.

Z 5 minutes Break

20 minutes

Feedback 15 minutes

Movement exercise

64 Values in Healthcare © The Janki Foundation for Global Health Care 2004

Exercise 1.3

Module 1|Values

Learning outcomes

Materials

Facilitating the exercise

A high point in my working life

Process:

Appreciation and listening

30 minutes
At the end of this exercise participants should be able to:

✔ identify values which underpin fulfilling work experiences ✔ recognise how values can be expressed in work.

G Paper and pens
G Flipchart and marker pens

1 Introduce the exercise as follows:
❝Sit with a partner but initially reflect on your own…

Look back on your working life and reflect on a ‘high point’, a time when you worked at your best, a time that was significant or meaningful for you, when you felt most alive, creative or effective.❞

Allow a couple of minutes for this.
2 Introduce the next step of the exercise as follows:

❝Now, share the story of the ‘high point’ you identified with your partner.What made it a successful or memorable experience? What felt truly special about it? Take it in turns to interview, for about 5 minutes each.❞

Allow 10 minutes in total.

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Module 1|Values

Feedback 10 minutes

3 Move participants on to the next stage of the exercise:

❝Next describe to each other the values you saw in your partner’s story, and then choose three values that you both felt to be important and note them down.❞

Allow 5 minutes.

Gather the main group back together.

Ask participants for values that they felt were most important and list these on a flipchart.You could spend a few minutes comparing it with the flipchart list generated in Exercise 1.2.

Participants may wish to share their stories with the main group. If anyone chooses not to share their story, this choice should be respected.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Exercise 1.4

Module 1|Values

Learning outcomes

Materials

Facilitating the exercise

Values that matter most to me

Process:

Reflection

20 minutes
At the end of this exercise participants should be able to:

✔ identify their most important personal values
✔ recognise how values can be expressed through people’s

personal qualities.
G Handout 1.4 List of values

G Sticky notes or small pieces of paper and pins/tape (3 small sheets per person)

1 Distribute copies of Handout 1.4 List of values and ‘Post-it’ sheets (3 per person).

2 Ask individuals to reflect on the discussions they have had in the previous exercises and, using the list as an additional source of ideas, identify three values which matter most to them.They should write each of the values on a ‘Post-it’ pad (ie one per sheet).

Allow 5 minutes before moving on.

3 Ask everyone to stick their sheets up on a wall or board.

4 When they are all displayed, invite the group to suggest which ones could be clustered together as being the same or similar. Move the sheets around as they suggest similarities and identify some of the most popular ones.

Allow 5 minutes before moving into feedback.

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Module 1|Values

Feedback 5–10 minutes

Choose one or two of the most commonly mentioned values and discuss how people might express these values in their personal qualities.Which of these values might be particularly important for the well-being of others and the delivery of healthcare?

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Exercise 1.5

Module 1|Values

Learning outcome

Materials

Facilitating the exercise

Experiencing personal values

Process:

Meditation

20 minutes
At the end of this exercise participants should be able to:

✔ experience their core values through meditation.
G CD track no. 1 Experiencing personal values (or relaxing

background music)
G CD player/tape recorder (optional) G Paper and pens

Let participants know that they will now have the opportunity to experience the 3 core values they identified in the previous exercise at a deeper, inner level.

. 1 Invite people to sit comfortably and to relax. Encourage participants to sit upright, their hands held loosely in their laps, legs uncrossed and feet placed firmly on the floor.

. 2 Play CD track no. 1 Experiencing personal values, or read the following text to the group (read slowly and clearly in a gentle voice pausing at ellipses (…) to allow time for reflection), playing background music if you wish.

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Feedback 5–10 minutes

❝Sit comfortably on your seat… allow your body to relax. Let your feet rest on the floor and your hands rest on your lap. You can close your eyes or keep them open. Gently focus your awareness on your body and breathing… Take a deep breath… let go of any tension as you breathe out… repeat this… then allow your breathing to settle into its own rhythm… gently in… and gently out.

As you focus on yourself, begin to feel more relaxed… your thoughts slow down… they become calm.

In your mind allow an image or feeling of your deepest inner values to arise. Focus on one value. Does an image, colour, sound or phrase come to mind associated with that value? Take time to really experience it… What is it like to be that value? (long pause)

Choose another value… experience it as deeply as you can. Does an image, colour, sound or phrase come to mind associated with that value? What is it like to be that value? (long pause)

In your own time move to a third value… get a sense of what it is like to be that value (long pause).

Now remember the three values, experiencing each in turn (long pause).

Gradually, become more aware of your body… sitting on a chair in this room… feel your feet on the ground… begin to wriggle your toes and fingers… and when you are ready, open your eyes… Have a stretch and shake, so you feel fully aware.❞

Participants may wish to sit quietly or share how they felt, depending on whether they have practised any similar meditative exercise before. If anyone had an image, colour or phrase that arose for them they might like to share it with the group, or

Ysimply write it down or draw it for themselves. Lunch break

70 Values in Healthcare © The Janki Foundation for Global Health Care 2004

Session II: Values at work Exercise 1.6

Module 1|Values

Learning outcomes

Materials

Facilitating the exercise

Heroes and heroines

Process:

Reflection

20 minutes
At the end of this exercise participants should be able to:

✔ describe the values of someone who has inspired them and influenced their work in a positive way

✔ illustrate the ways in which values are demonstrated through behaviour and actions.

G Paper and pens
G Flipchart with the following questions written on it:

– Who has inspired you and influenced your work in a positive way?

– What values do/did they demonstrate in the way they carry out their work?

and marker pen

1 Ask participants to find a partner to share some reflections with.

2 Lead the exercise as follows:

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Module 1|Values

Feedback 10 minutes

❝First of all, on your own, think of someone who has inspired you and influenced your work in a positive way. For example, it could be a colleague, manager or friend, or a public or historical figure.

Write down their name on a piece of paper and the values they demonstrate in the way in which they carry out their work.❞

Allow 5 minutes before moving on to the next step.

3 Invite participants to share their reflections with their partner. Allow a further 5 minutes.

Ask participants to name their person (if they wish to) and the values they have identified in this person, while you record them on a flipchart. Invite participants to share and discuss ways in which these people demonstrate particular values through their behaviour and actions.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Exercise 1.7

Module 1|Values

Learning outcome

Materials

Facilitating the exercise

Rekindle the dream

Process:

Visualisation

20 minutes
At the end of this exercise participants should be able to:

✔ visualise their ideal values-based work environment. G Worksheet 1.7 Rekindle the dream

G CD track no. 2 Rekindle the dream (or tape/CD of relaxation music)

G Tape recorder/CD player
1 Introduce the visualisation as follows:

❝I think most of us have a dream of how we would want things to be at work.That dream may be part of the reason we choose to work where we do. For a few moments, you will be led into a visualisation to rekindle that dream and see what you come up with. It may resemble your current place of work or it may be different.❞

. 2 Ask participants to follow the words in their imagination and be as relaxed and creative as they feel possible.

. 3 Play the CD track no. 2 Rekindle the dream or read the following words, playing background music if you wish (speak clearly and in a gentle tone, pausing at ellipses (…) to allow time for reflection).

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Module 1|Values

Values in Healthcare © The Janki Foundation for Global Health Care 2004

❝Sit comfortably on your seat… allow your body to relax. Let your feet rest on the floor and your hands rest on your lap. You may wish to close your eyes. Gently focus your awareness on your body and breathing… notice your breathing and follow the flow of your breath. After some moments, you may notice your breath calming down. Let your body relax.

As you relax, imagine a large bubble softly floating down next
to you… This bubble has a door, and on the door there is a sign which reads, ‘Step inside, and the bubble will float you to the workplace of your dreams’.

Step inside the bubble… the bubble begins to float… It floats above this building and begins to travel… Enjoy the scenery below you… Gradually, the bubble reaches the workplace of your dreams and starts to descend… As the bubble gently lands on the ground, you see the building where you work.You notice the plants outside and the shape of the building… You slowly walk up the path, noticing how you feel…

It is early in the morning and a few staff are arriving… you watch what they are doing… and how they interact with each other.
As you enter the building, you catch the expressions and feelings of your colleagues as they say good morning… You start the day, getting a sense of everyone’s attitude as they work.

You walk around the building, noticing the spaces, colours and light… this is how you would really like it to be.You go to the place where you usually work and observe the changes and the way people are behaving… your colleagues, patients and everyone involved in patient care… What does it look like…? What is the atmosphere like…?You watch people work together… and with you during the day… What is the feeling at your workplace and how do you feel?

Picture the rest of the day in your mind… (pause for 20 seconds).

When you are ready, say good-bye… and step into the bubble that is waiting for you…The bubble floats up above the building… and begins to bring you back here…

You are back here now and as you feel yourself sitting in your seat the bubble disappears… and you bring your attention back to this room.❞

4 Invite participants to form pairs, and distribute Worksheet 1.7 Rekindle the dream.Ask them to share their experiences from the visualisation, using the prompt questions on the sheet.

Allow participants to have free expression in their descriptions but also encourage them to identify the underlying values and how these were expressed in the environment and in people’s attitudes and behaviour.

Allow 10 minutes for this final stage.

Module 1|Values

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Module 1|Values

Exercise 1.8

Learning outcomes

Materials

Facilitating the exercise

Values in healthcare

Process:

Creativity

60 minutes
At the end of this exercise participants should be able to:

✔ ✔ ✔

G G G G G

describe core values which are important to healthcare create a values statement for work
identify ways in which core values can be expressed at work.

Poster-size paper or flipchart paper Coloured pens or paints
Old magazines and/or collage materials Gluesticks and scissors

Pinboard and pins (or wall surface and Blu Tack) to display finished work

Invite participants to form small groups of four. If you are facilitating one or more work teams, participants may wish to work in their team/s.

Ask groups to spend the first few minutes discussing which values they feel are most important in healthcare today and to agree on two or three ‘top’ values.

Allow up to 5 minutes before moving on.

Next, encourage each group to produce a values statement (sometimes called a vision statement) and ask them to write it down.

This is an opportunity for participants to create a values statement for the group, team, their unit or hospital. For example, one general practice group used this exercise to make a statement on their headed notepaper,‘The friendly, caring practice’.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Allow up to 10 minutes for this part of the exercise.

4 Now ask each group to work together on representing their values statement as a painting or collage. Provide them with large paper, paints and/or collage materials and a surface to work on.

Allow up to 35 minutes.

1 Ask each group to briefly show their work and explain how they represented their chosen values.

2 Invite a brief discussion about how each value might be expressed in their healthcare practice. Encourage them to share examples from their own experience.

Participants will already have identified important personal values in Session I. Although personal and professional values may differ, it may be helpful to discuss whether participants’ personal values do play an equally important part in their professional lives.

Z 5 minutes Break

15 minutes

Feedback 10 minutes

Helpful hints

Module 1|Values

Movement exercise

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Module 1|Values

Session Review

10 minutes Guidance notes

. 1 Briefly review the session by displaying the session aims, learning outcomes and session programme. Remind participants of the activities they have undertaken.

. 2 Pick out any highlights, referring to materials that participants have produced and which you have displayed.

. 3 Hand out the Background Reading paper for participants to take away, pointing out any references and resources for this module, should they wish to explore the theme in more depth.

See Part 2: Guidance for Facilitators for further guidance.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Action Planning

See Part 2: Guidance for Facilitators and Part 5: Additional Resources for information and guidance on action planning. Below is a suggested action planning exercise.

Exercise 1.9

Learning outcomes

Materials

Facilitating the exercise

Taking values back to work

30 minutes
At the end of this exercise participants should be able to:

✔ select values which can be integrated into different aspects of working life

✔ describe practical ways of expressing these values. G Worksheet 1.9 Taking values back to work

G Paper and pens

1 Distribute Worksheet 1.9 Taking values back to work
to participants and ask them to choose a value for each work situation, looking back at the values they have identified during the module.

2 Then invite them to consider some practical ways in which they might express these values through their own behaviour and any changes they could make, for example, to the physical environment, administrative systems etc.

Allow 20 minutes to complete the worksheet and a further 10 minutes for feedback and sharing.

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Helpful hints

Participants may wish to undertake this action planning in their work teams, if appropriate.

Participants could also look at incorporating ideas which arose during Exercise 1.7 Rekindle the dream.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Module 1|Values

Evaluation

10 minutes

Materials

G Copies of evaluation pro forma (if being used) G Pens

Guidance notes

Run though your planned evaluation activity (see Part 2: Guidance for Facilitators and Part 5:Additional Resources for information and guidance on evaluation).

As an alternative or additional activity, you may also want to give out a more formal evaluation form at this point for participants to complete now or return by a given date.

Remember to plan in some time as soon as possible after the session to complete your own evaluation of how you think the session went.

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Module 1|Values

Closure

Lead the group in your planned closure activity (see Part 2: Guidance for Facilitators and Part 5:Additional Resources for information and guidance on closures), or use the suggested activity below.

Exercise 1.10

Learning outcome

Materials

Facilitating the exercise

Living values

5–10 minutes
At the end of this exercise participants should be able to:

✔ choose further qualities/virtues that can be integrated into all aspects of life

G Values cards (see Part 5: Additional Resources) G Paper and pens for participants
G Relaxing background music on tape/CD (optional)

1 Lay the values cards out in the centre of the group in a fan shape, perhaps around a candle or flower. Play some relaxing music if you wish.

2 Ask each participant to choose two values that are important to them as follows:

❝Become very still and quiet and ask yourself:

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Which two values are important to you? Write them on a piece of paper.

What action could you take personally to start to live these values? Decide on one action for each value, first at home then at work.Write the actions down against each of the two values.❞

Helpful hints

Take the opportunity to emphasise that this session has been about acknowledging our own personal values. Each time we remember our values, we make them more powerful.

Participants could also draw on the values they generated in the previous exercises in this session.

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Module 1|Values

Follow-on/homework Exercise 1.11

Learning outcome

Materials

Facilitating the exercise

Being creative with values

Process:

Creativity & Reflection

1 hour
At the end of this exercise participants should be able to:

✔ G G

G G G

1 2

experience values using reflection and creativity.

Worksheet 1.11 Being creative with values (A) Reflections (3 sheets)

Worksheet 1.11 Being creative with values (B) A reflective poem

Paper and pens
Flipchart and marker pens
Tape recorder/CD player and tapes/CDs (optional)

Divide the group into pairs and ask each pair to team up with another, so that they form groups of four.

Ask the group to choose a value from those they have identified during the module – a value they think is important in healthcare and one they would like to reflect on.

Explain that this is a reflective exercise which is in two parts. In Part A participants will work alone, reflecting on a number of images and scenes which capture the essence of the underlying value, and then sharing it in pairs.You might like to play some relaxing background music.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Module 1|Values

Helpful hints

Part A: Reflections (30 minutes)

1 Distribute Worksheet 1.11 (A): Reflections which contains three separate sheets: Images, Snapshot of the past and Snapshot of the future. For each sheet, follow the four steps below, reminding participants to reflect on their own and jot down words or phrases which come to mind on the relevant part of the worksheet.

G Read aloud through the sheet, pausing after each question. G Allow a few minutes for participants to complete their

notes.

G Invite individuals to share their responses briefly in pairs.

G After a few minutes, move on to the next sheet, until all three have been addressed.

Encourage participants to give spontaneous responses rather than to spend too long deliberating.

Allow 20 minutes in total for this part of the exercise.

2 Ask each group to share their individual images, assigning one member to write them on a flipchart.

Allow 10 minutes before moving on to Part B. Part B: A reflective poem (20 minutes)

Distribute Worksheet 1.11 (B):A reflective poem and ask the small groups to continue working together on the task described.

After 20 minutes, move into feedback.

Refer to the creativity tool in Part 4: Spiritual Tools.

Be confident in running this second part of the exercise; it has been done by many workers who initially thought they were not creative.You don’t need to tell them that the task is to write a poem, but just let it emerge from the process…

The success of the poem-generating exercise depends on accepting that there are no ‘right words’ or ‘wrong words’. Participants should say whatever comes into their heads without judgement or editing; it should be spontaneous and quick!

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Module 1|Values

Feedback 10 minutes

If you want to give the groups some inspiration, or if a group can’t seem to get going, read out the examples below written by groups on the value of honesty:

❝HONESTY

Honesty was the look in his eyes in a moment of silence. Honesty is a plain, solid, average-sized oak tree.
Honesty is an ordinary green apple.
Honesty is rolling green hills on a cloudy day.

A bed in a hospital. White sheets, steel bowls.
Her words were honest, hard earned in the dying embers of her life.
She asked my forgiveness for her years of judgement
The burden of my confusion slipped away
And love suffused us both.

Conflict at work
Now my name is missing from the board for the work of that week
And I decide to be egoless about it.
Freedom.

Honesty is to climb to the top of the Himalayan mountains, To leave my past behind.
Dishonesty is to stay in the valley with too much luggage Including sweet memories.

An old man with cancer. Nobody speaking of cancer or death Everyone fearful of hurting the other
Until suddenly Honesty enters the sick room
Suddenly Love is given a chance.❞

Bring everyone back together. Invite each small group to read their poem aloud, one after the other, in order to create a continuous poem.This is a contemplative exercise – that is, participants should either sit in silence or with quiet background music, and reflect as the words are read out. Encourage participants to avoid ‘explaining’, asking for explanations, interpreting or querying someone else’s experience.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Worksheet 1.1

My favourite things

1 Think of the songs you love.What values are reflected through the words and music? Write them down.

2 Think of poems, quotes, books that are important to you. What values are reflected in them?

3 What images are important to you? Think of your favourite scenes, views, paintings or perhaps statues.What values and feelings do they evoke?

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Module 1|Values

Handout 1.4

List of values

Acceptance Balance Centredness Commitment Co-operation Creativity Dignity Flexibility Generosity Honesty Humility Integrity Listening Loyalty Optimism Peace Practicality Respect Simplicity Trust

Appreciation Benevolence Clarity Compassion Courage Dependability Enthusiasm Forgiveness Gratitude Hope Humour Kindness Love Openness Patience Positivity Reflection Responsibility Tolerance Wisdom

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Worksheet 1.7

Rekindle the dream

In pairs, share your experience.This may include:

What was the environment like?

How did you feel?

What were the other people like?

What were their attitudes?

How did they behave (verbal and non verbal)?

What did you enjoy about the staff, colleagues and patients/clients?

What were the underlying values being expressed in this work environment?

Module 1|Values

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Module 1|Values

Worksheet 1.9

Taking values back to work

Choose a value which you will take back to work for each situation below. Note down some practical ways in which you could express this value through your own behaviour, and any changes you might make, for example, in the physical environment, administrative systems, etc.

. 1 Which value will I use with patients/clients?
How?

. 2 Which value will help with my manager/colleagues?
How?

. 3 Which value will inspire me throughout my working day?
How?

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Worksheet 1.11

Being creative with values (A) Reflections

Images

Think of your chosen value ……………………………………………………..

Imagine that it is a flower or plant – describe it

Imagine that it is a fruit – describe it

Imagine that it is a sculpture – describe it

Imagine that it is a landscape – describe it

Imagine that it is a person – describe her or him

Module 1|Values

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Module 1|Values

Worksheet 1.11 (continued)

Being creative with values (A) Reflections

Snapshot of the past

Your chosen value……………………………………………………….

Let your mind go back to the very first time that you became aware of this value

Where were you? In a room? In an open space?

What did the place look like?

What could you hear, smell, touch?

Who else was there?

What was happening?

What was the moment of understanding?

Can you paint the picture in words?

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Worksheet 1.11 (continued)

Being creative with values (A) Reflections

Snapshot of the future

Your chosen value………………………………………………………. Imagine a short scene in which the value comes into play.

Where are you?

Who else is there?

What is happening?

Is there a moment of understanding?

How do you feel inside?

Does it change anything for you?

Module 1|Values

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Module 1|Values

Worksheet 1.11

Being creative
with values
(B) A reflective poem

As a group, write a four-line poem or four short sentences or phrases which communicate your images of the group’s chosen core value.

The aim is to write a short four-line poem that may not have any rhyme or reason (ie it doesn’t have to make literal sense; it can be metaphorical).

You can work from the words you have already written; you can change them, re-order them, add to them or start afresh.

Write the group’s poem on paper or flipchart.

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Background Reading

Why Peace?

Stress is a problem for the providers of modern healthcare. It may be about
meeting deadlines, dealing with difficult patients, or feeling overwhelmed by piles
of unfinished work. If we are feeling stressed at work, we may also be feeling the same way at home, worrying about doing all the things that keep our household functioning, wondering whether there’s food for dinner, feeling guilty about not calling our parents or helping our children with homework. Stress and worry can adversely affect our health, which in turn will affect the care we give to our patients. The antidote to all this is to develop an inner peacefulness.

There are methods or tools such as meditation and visualisation, which can reduce stress as well as improve our sense of well-being. However, we can also discover peacefulness through action and the way in which we approach our day-to-day activities and tasks. By actively practising peacefulness, we lay the foundation stones for well-being, hope, self-respect and contentment.

Purpose of module

This module does not analyse the causes of stress but looks at how to promote inner peace. When we experience tranquillity we find that we are better able to cope with problems, and the anxiety, fear, worry, guilt and illness they might cause.

By practising peacefulness, we can develop the ‘habit’ of peacefulness, and by being peaceful we are more able to access other positive resources or qualities within the self and develop our own wellbeing.

We know on some level that if we are peaceful in ourselves, then those around us calm down and become more relaxed. This has a positive impact on colleagues, patients, family and friends and, in turn, generates an atmosphere of peace that ripples outwards and benefits everyone.

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Module 2|Peace

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Introduction to the Peace module

The exercises in this module give simple yet powerful ways to rediscover our inner peace. For those who are skilled at being peaceful they will provide an opportunity to build on or add to those skills. If this is a new area for some or all participants, it will provide a place to start and to experiment with discovering an inner sense of peace.

Whatever an individual’s level of ‘skill’ and competence, the ability to be peaceful can be practised anywhere and at any time (at home, in the garden, on the tube or bus, while washing up!). The more we can make this an integral part of ourselves, the more it can positively affect the way we live, work and interact with others.

Themes of Exercises

The meaning of peace (2.1)

Peace can mean many things to different people. For some, peace may be defined
by the absence of stress in their lives. On a bigger level, it may be a political state when there is absence of war. Remembering peaceful moments is a good start to re-create feelings of inner peace and to consider what peace means to us. Do we only discover peace in certain places and with particular people? Do certain environments encourage us to be peaceful, like listening to natural sounds or music? What is the essence of that peacefulness? By reflecting upon and understanding the meaning of peace for ourselves, and when and where it occurs, we can start to create new peaceful situations for ourselves. This is not easy in the busy lives we all live, but

just to have the intention to find peace is a significant step on the journey.

Practising peace (2.2, 2.3, 2.9, 2.10)

The first step to finding peace may be to stop; just physically stopping what we are doing can create moments in our day when we can take a break and sit still in a relaxed way. It can be anywhere, preferably somewhere quiet. Techniques of muscle relaxation, tensing and relaxing muscle groups in turn, can help us to achieve a deep level of physical relaxation and help us to experience peacefulness.

However, the real challenge is to quieten our minds. Sometimes we do stop physically; we sit down and look forward to a rest. Our body stops and begins to relax, but our mind does not. It races, still thinking about what there is to do, or worrying about what hasn’t yet been done. Our thoughts jump about from one subject to the next with worries about the past and concerns about the future. These thoughts may provoke anxieties, fears and strong emotions such as anger, guilt, jealousy and attachments.

We need to learn to still the mind and slow these thoughts down; allow them to be there but not hold centre stage. Observing our thoughts is a technique which we can use to connect mind and body; as the body relaxes so does the mind, and vice versa. By relaxing the body first, we can turn our attention to our thoughts, watch them, slow them down, and begin to focus on the silence in between our thoughts. We also have a choice of what thoughts we have, so we can begin to choose and to introduce peaceful thoughts. These thoughts will begin to resonate with our inner nature of peace, and so we will begin to experience our true selves.

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Module 2|Peace

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Peace in action (2.4)

It is not only through inaction that we experience peace. Peace can occur from different kinds of activity; this gives us the potential for experiencing it as part of carrying out our everyday lives. For some, feelings of peace can arise from deep concentration – being absorbed in an activity like gardening, painting or writing. For others, it may arise from watching others in action, for example, watching a football match, or from watching nature, for example, a waterfall, a river flowing
or clouds moving across a sky. Peacefulness can come from high levels of physical exertion, like running or repetitive exercise, where we seem to transcend the physical and reach a place of quietness within. It can also come from relaxing activity, like walking along a beach or rocking a baby.

An important factor is the intention or ‘mindset’ we have before we embark upon
a task or activity. For example, if we feel stressed and hurried we may find washing up or cooking a meal an unwanted, additional burden which we will undertake in a stressed and hurried way. If we decide to use the same activities as a way of taking time out for reflection, we might find ourselves enjoying a sense of peace and of ‘time standing still’ in the middle of a busy day.

Peaceful listening (2.6)

By feeling stable, peaceful and internally strong, we can give more focused attention to others. When others realise they are being listened to, their anxiety and angst gradually transform. On the other hand, listening in a half-hearted, hurried or anxious way inhibits good communication and, therefore, the possibility of such transformation.

For those of us in contact with patients or clients, it is useful to consider the effect of our listening to them in silence. This deep listening stems from being peaceful within and demands that we listen with our full attention, if possible without interruption, comments, noises or facial expressions, all of which can influence or detract from the person expressing their feelings and telling their story in their own way. Peaceful listening involves being curious, if necessary making gentle enquiries through open-ended questions, rather than questions which elicit only a ‘Yes’ or ‘No’. Above all, it means listening with an open heart by having an open posture,

a receptive and calm expression, and a kind, non-judgmental attitude.

Peaceful listening can make us empathic witnesses to our patients’ stories and, at the same time, enable us to remain relaxed. We can contemplate how much of the placebo effect may be attributable to this.

Peace at work (2.5, 2.7, 2.8, 2.11)

Imagine applying the same attitude of peacefulness in our work environment and interactions with colleagues. There are many ways in which we can do this, through our own behaviour and the way in which we organise our workplace.

By functioning from a peaceful state we are able to create and sustain meaningful interactions with all those we work with and relate to. It is almost as though people ‘try harder’ (paradoxically using less effort) when they know that they are working from the best part of themselves – their real selves.

Finding peacefulness will lead to positive changes at work, for example:

G arriving at a meeting composed, having walked rather than run there

G taking a few moments to relax between meetings or patient consultations, in order to bring our full attention to listening

G discussions with colleagues, rather than arguments, about improving practice.

As well as creating a peaceful state within, it is important to bring a sense of peace into our work surroundings; in this way, ‘outer’ can reflect and enhance ‘inner’. We can do this by clearing clutter and finding ways of creating a sense of space. We can also choose plants, pictures, colours, sounds and furnishings which contribute to a sense of calm and well-being.

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Module 2|Peace

The Facilitator’s Guide to Module 2

Session I: Being peaceful Aims

G To experiment with and compare the effects of several methods of relaxation and achieving a state of peace

G To give participants different experiences of peacefulness, in action and at rest G To create an image of peace at work

Process

In this session participants explore what peace means to them as individuals and effective ways of achieving a peaceful state. They begin by reflecting on a time when they felt peaceful in order to consider the meaning of peace. Two further exercises allow them to experience peacefulness by practising muscle relaxation and breathing, followed by focusing on silence, and to evaluate and compare the effects of these techniques on their body, thoughts and feelings. A playful exercise in teams allows participants to discover peace through action, both as actors and as observers. A visualisation of a peaceful day at work provides the stimulus for a creative exercise

in which participants represent their vision through words, art or movement.

Session II: Peace at work

Aims

G To experience and evaluate the practice of peaceful listening
G To explore ways of introducing peace into participants’ practice and workplaces

Process

The session starts with a listening exercise in pairs which introduces the tool of peaceful listening, giving participants the opportunity to practise it and evaluate its benefits and effects. This is followed by a short, individual exercise to identify positive changes in the outer environment which might promote and reflect inner peace. After the break and session review, individuals move into action planning, focusing on changes they can make to create peace at work, and sharing and developing these further with other participants. The session concludes with meditation which encourages participants to create a lasting inner vision of peace.

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Programme/plan for Module 2 Peace

Module 2|Peace

Introduction 30 minutes SESSION 1 Being peaceful

Exercise 2.1 The meaning of peace 25 minutes

Exercise 2.2 Practising peace – muscle relaxation
and breathing 25 minutes

Exercise 2.3 Practising peace – becoming silent 30 minutes

Movement exercise 5 minutes Break 20 minutes

Exercise 2.4 Discovering peace in action 35 minutes

Exercise 2.5 A peaceful day at work 40 minutes

Lunch break

SESSION II Peace at work
Exercise 2.6 Discovering peace at work 60 minutes

Exercise 2.7 Outer reflects inner 10 minutes

Movement exercise 5 minutes Break 15 minutes

Session review 10 minutes

Action planning

Exercise 2.8 Designing peace 30 minutes

Evaluation 10 minutes

Closure

Exercise 2.9 A peaceful anchor 10 minutes

Total time 6 hours

Follow-on/homework

Exercise 2.10 A peaceful image 10 minutes

Exercise 2.11 Valuing your ability to be peaceful at work 25 minutes

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Materials

G Pens and paper
G Flipchart and marker pens
G CD player/tape recorder (optional)

Session I

G Worksheet 2.2 Exploring muscle relaxation and breathing

G Worksheet 2.3 Exploring focus on becoming silent

G CD track no. 3 Practising peace through muscle relaxation and breathing*

G CD track no. 4 Practising peace through becoming silent*
G CD track no. 5 A peaceful day at work*
G Creative materials, eg magazines, coloured paper, paints, clay

Session II

G Worksheet 2.6 (A) A dialogue on peace
G Worksheet 2.6 (B) Listening as a spiritual tool G CD track no. 6 A peaceful anchor*
G Pinboard and pins or Blu-tack to display work

Follow-on/ homework

G Coloured pencils/pens

*or relaxing background music

Preparation

. 1 Read the introductory notes at the beginning of the session/s so that you are familiar with the way in which the theme is being introduced and explored. Review the list of references and resources for this module in Part 5: Additional Resources and reflect on your own experiences.

. 2 Familiarise yourself with the main learning tools which are being used in the session (see Part 4: Spiritual Tools).

. 3 Read through the session guidelines and look at the suggested session programme which will incorporate:

G Session introduction G Exercises
G Movement breaks
G Breaks

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G Session review G Action planning G Evaluation
G Closure

4 Photocopy any handouts and exercise sheets, and make sure that you have any other equipment listed under Materials.

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Introducing the Module

30 minutes
Run through your planned introductory session which may include:

Quiet time
Introductions/optional warm-up exercise Overview of session
G Theme of session
G Aims and learning outcomes
G Programme/plan for the session
G Practical considerations
G Any questions

Setting the tone

G Ground rules/principles G Participants’ expectations

Review of last session/homework

See Part 2: Guidance for Facilitators for further guidance on introducing the session.

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The Exercises

Session I: Being peaceful Exercise 2.1

Module 2|Peace

Learning outcomes

Materials

Facilitating the exercise

The meaning of peace

Process:

Reflection

25 minutes
At the end of this exercise participants should be able to:

✔ recount an experience of peace
✔ identify different meanings of peace which people may have ✔ recognise that they have an inner resource of peace.

G Paper and pens
G Flipchart and marker pens

1 Ask participants to get into pairs and hand out paper and pens. Invite them to do the following, working individually for the first part:

❝Sit quietly and reflect for a few minutes on what it is like to feel really peaceful.You may wish to recall a time when you had a moment of peace, or you can use your imagination to think of a peaceful place.Write down what peace means to you, including what you recalled or imagined peace to be. Circle the words in your account that best capture the essence of peace for you.❞

Allow 5 minutes.
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Feedback 10 minutes

2 Ask participants to share briefly their words/meaning of peace with their partner, taking it in turns to speak.

Allow 10 minutes, prompting pairs to change talking/listening roles after 5 minutes.

Gather everyone back into the main group and spend the remaining time facilitating feedback:

G Ask the group for words associated with feeling peaceful. Make a note of them on a flipchart. Mark the ones that several people bring up.

G Lead a discussion on what peace is.

G Aim for the group to acknowledge that peace can mean many things to many people. However, everyone has some access to an inner resource of peace, which they will focus on recapturing in this session.

Individual lists can be used in the Session review at the end of the module to help participants remind themselves what peacefulness means for them.

Helpful hints

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Exercise 2.2

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Learning outcomes

Materials

Practising peace – muscle relaxation and breathing

Process:

Muscle relaxation, breathing and reflection

25 minutes
At the end of this exercise participants should be able to:

✔ experience a relaxed and peaceful state through the use of muscle relaxation and breathing

✔ identify the effects of muscle relaxation on their own body, thoughts, emotions and felt sense of peacefulness

✔ appraise the potential benefits of using muscle relaxation as a way of experiencing peace.

G Worksheet 2.2 Exploring muscle relaxation and breathing G CD track no. 3 Practising peace through muscle relaxation

and breathing (or relaxing background music) G CD player/tape recorder (optional)

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Facilitating the exercise

1 Introduce the next exercise in the following way:

❝Some people experience being peaceful while engaged in activity, others prefer to take some time out. This is the first of a series of exercises which ask you to experiment with ways of experiencing peace.You may already know them but not necessarily be using them. Much of the work is in observing and comparing your own responses to each exercise, and then considering how you might best use the techniques in everyday life.❞

2 Use CD track no. 3 Practising peace through muscle relaxation and breathing which contains a simple physical relaxation exercise. Alternatively, you can speak the following commentary, playing background music if you wish. Speak in a clear, gentle voice, pausing at ellipses (…) to give time for relaxation.You may have a relaxation exercise of your own that you would prefer to use.Your choice may be influenced by the size of the group and room, and by participants’ experience of this relaxation method.

❝Sit comfortably… uncross your legs and feel your feet on the floor… rest your hands on your lap so your shoulders feel relaxed… feel your bottom on the seat… and your spine nice and straight… as if a string is holding your head up from the crown…

Begin by being aware of how your body is feeling now… start by focusing your attention on your right hand… clench your fist as tightly as you can… hold for a count of three and let go… do the same with the left hand… tighten and hold for three and let go… try to compare how it feels between holding yourself tight and relaxing… repeat, clenching the right hand and letting go… then the left… now tighten the whole right arm, bending it at the elbow… hold and count to three… and let go… do the same on the left side… bend, tighten, count to three and relax… compare how it feels again between tension and relaxation.

Now focus your attention on your right foot… tighten all your muscles for a moment… hold for three, and then relax them… let them stay relaxed… do the same on the left… tighten, hold for three… relax.

Now become aware of your whole right leg… tighten the muscles for a count of three… and then relax them… do the same on the left… tense for a count of three and let go… get a sense of how your arms and legs feel now.

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Do the same with the stomach muscles… tense for three and relax… Next lift your shoulders and tense right through from shoulders to hands… hold for three… and relax… Repeat, lifting your shoulders and tensing through from shoulders to hands…hold a bit longer for five seconds if you can, and relax… feel the difference in your shoulders, as this is where we hold a lot of tension.

Finally, to tighten the face muscles, close your eyes tight and clench your teeth… hold for three and relax… once more tense, count to five… and relax. Sit for a few moments and feel how your body is now.

Pause for one minute before continuing:

Again, sit comfortably with your feet on the ground, hands on your lap, and a straight spine… this time the focus is on your breathing. Observe your breath… with your mouth closed you can probably notice the air flowing in and out through your nostrils… just watch it gently… as it finds its own rate… in… and out… keep your attention on your breathing… and relax… slowly in… and out… a relaxed breath comes from the abdomen… so as you breathe in, the abdomen gently rises… and as you breathe out it slowly falls… you can put your hands across your stomach to feel your abdomen rising and falling… so watch your breath… try not to force it… in… and out…

at its own rate.

As you breathe out you can let go of any tension… breathe out… let go of tension… and now breathe in… saying to yourself,‘I am breathing in peace’… let out tension… breathe in peace.

Pause for up to a minute.

When you are ready, become aware of your body sitting on the chair… feel your feet on the ground… deepen your breathing… and in your own time, open your eyes.❞

. 3 After the relaxation, ask people to stretch, rub their hands together, shake themselves gently, walk or jump up and down. All these are ways to make sure people are fully awake.

. 4 Distribute Worksheet 2.2 Exploring muscle relaxation and breathing and ask participants to spend a few minutes recording their impressions quickly, using the questions on the sheet as prompts. As soon as they have finished, move on to the next exercise in practising peace.

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Helpful hints

For beginners in a small group, it may be best to facilitate physical relaxation in a comfortable space where they can lie down (if so, you will need to make minor amendments to the introductory text).With a larger group you can still do the exercise with people sitting in their seats. Encourage participants to sit upright, with their backs against the backs of their chairs if they need support.

People may be drowsy after experiencing deep relaxation.Try to be sensitive to participants who may be lingering in their experience, which could have touched them at a deep level. Be respectful of this and gently encourage them to record their experiences.

You will find a longer relaxation exercise in Part 5:Additional Resources Section 3 Movement exercises, together with some more detailed guidance on muscle relaxation.There is an accompanying CD track on the CD (CD track no. 23 Long muscle relaxation).

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Exercise 2.3

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Learning outcomes

Practising peace – becoming silent

Process:

Meditation and reflection

30 minutes
At the end of this exercise participants should be able to:

✔ experience a relaxed and peaceful state through becoming silent

✔ identify the effects of becoming silent on the body, thoughts, emotions and felt sense of peacefulness

✔ appraise the potential benefits of becoming silent as a way of experiencing peace

✔ compare the effects and benefits with those of muscle relaxation and breathing.

G Worksheet 2.3 Exploring focus on becoming silent
G CD track no. 4 Practising peace through becoming silent G CD player/tape recorder (optional)

1 Play CD track no. 4 Practising peace through becoming silent. Alternatively, read out the following text, using a soft, gentle voice and pausing at ellipses (…) in order to allow participants to follow you into a relaxed state.

Materials

Facilitating the exercise

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❝Sit comfortably on your seat… allow the body to relax. Let your feet rest on the floor and your hands rest on your lap. Focus your awareness on your body and breathing… notice your breathing and follow the flow of your breath. Observe your breathing… follow its rhythm as it slows down… you can close your eyes or keep them open.

Your thoughts may wander… thoughts from the past… concerns about the future. Let them go… Try not to analyse or sort out problems… instead, focus on the spaces between thoughts, before thoughts, after thoughts or beyond thoughts – find the stillness and peace that is there…

As you do so, say the following to yourself silently: I notice many thoughts and feelings arising in my mind. I turn these thoughts away from things of the outside world and focus on thoughts
of peace. All the other thoughts and ideas I leave behind… I let them go… Gradually my thoughts begin to slow down and I sense that within me there is peace… I simply create the thought: ‘I am a peaceful being’.

As I create this simple thought, then the feeling arises… and I am drawn towards that feeling of peace… even though thoughts may come to distract me, I acknowledge them and I am aware of what they may be telling me about myself… I accept them… but I don’t dwell on them… I allow them to come, I acknowledge the feelings they bring, and then I bring myself back to that one thought: ‘I am a peaceful being’.

As I do this and my thoughts begin to slow down I experience a state of rest – of stillness – of calm within my mind. As I become absorbed in this experience of peace I realise that I am peace. Once again I focus on this one thought and experience it for as long as I can…

Now, in your own time, bring your attention back into the group and this room. Gently move your hands and feet.❞

2 Distribute Worksheet 2.3 Exploring focus on becoming silent and allow a few moments for participants to briefly record their impressions, using the questions on the worksheet as prompts. Ask them to consider the final question, comparing the effects with the previous exercise on muscle relaxation and breathing, and to jot down some notes before moving into feedback.

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Feedback 10 minutes

Z 5 minutes Break

Invite participants to share their experiences of Exercises 2.2 and 2.3, comparing the effects of both techniques of practising peace on mind, body and emotions.

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Movement exercise

20 minutes

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Exercise 2.4

Discovering peace in action

Process:

Play

35 minutes
At the end of this exercise participants should be able to:

Learning outcomes

Facilitating the exercise

✔

1 2

experience and compare the effects of different kinds of action on thoughts and feelings, both as observer and participant

evaluate the potential of achieving a peaceful state while engaged in different kinds of action.

Ask participants to form two groups, Groups 1 and 2, sitting facing each other on either side of the room.

Run through the exercise as follows:

G One group will be asked to mime or act out several actions whilst the other group observes.

G Those who are acting should keep words or sounds to a minimum as much as possible.

G The aim is for those acting to notice what happens in their minds whilst in the action and after the act, and for the observers to notice the effects of observing the act.

G This is a playful, self-discovery exercise, not an exercise in acting ability!

Ask Group 1 to mime the actions listed below (give them one topic at a time without being overheard by Group 2), and to observe the activity in their minds during and after the action. Ask Group 2 to observe the actors, reminding them to notice

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Feedback 10 minutes

the effects of each activity they observe on their own thoughts and feelings.Allow 1–2 minutes for each activity.

G Going round a busy supermarket doing the family shopping. G Painting a picture of a beautiful landscape.
G Changing a bed.
G Sitting by a waterfall or river, observing the flow of the water.

4 When Group 1 has completed all four actions, ask them how it felt to do them.What effects did each have on their thoughts, concentration and feelings? Which one was the most calming, which was the most stimulating? Which required the most concentration? Ask Group 2 the same questions from their perspective as observers.

5 Invite the groups to switch roles and take Group 2 through the following activities, one at a time, again allowing 1–2 minutes for each.

G Cooking a big family meal in the kitchen.
G Watching a televised sports championship while the country

you support is playing!
G Using an exercise bike or treadmill at the gym.
G Sitting on a bench in a quiet garden on a summer’s day.

6 Ask Group 2 how it felt to do these exercises.What effects did each have on their thoughts, concentration and feelings? Which one was the most calming? Which was the most stimulating? Which required the most concentration? Ask Group 1 the same questions from their perspective as observers.

1 Ask the groups to share whether it felt more peaceful to observe or to act.

2 For the remaining time invite the group to explore:
G whether there are any activities they do at work or at

home which give them a sense of peace

G to what extent it might be possible to experience a relaxed and peaceful state while engaged in different kinds of home- or work-related activities.

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Helpful hints

The aim is for each individual to discover what kinds of activity give them most peace.When we are aware of our own experiences of peace, whether in action or at rest, we can plan our activity to maximise this potential.The reflective activity (river or garden) is actually the most challenging as it will invite unwanted thoughts to wander through the mind. People may find differences in the effect of activities which are highly absorbing (eg painting) or physical (eg changing a bed) or repetitive (eg jogging, washing dishes). (It is possible that having worked on being peaceful in the preceding exercises, some individuals are at peace whatever the activity they partake in!)

You may find it useful to discuss the importance of intention, ie how you approach an activity, and its effect on peacefulness (see Background Reading paper for more information).

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Exercise 2.5

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Learning outcomes

Materials

Facilitating the exercise

A peaceful day at work

Process:

Visualisation and creativity

40 minutes
At the end of this exercise participants should be able to:

✔ develop a vision of a preferred peaceful working environment ✔ express this vision through writing, art or movement.

G CD track no. 5 A peaceful day at work (or relaxing background music)

G CD player/tape recorder (optional)
G Some creative materials, eg magazines, coloured paper,

paints, clay

1 Part A:Visualisation (10 minutes)
Tell participants that they are about to take part in a

visualisation exercise.

❝While you listen in this part of the exercise, relax, think about the themes and see what comes up in your mind’s eye… what it feels like …how it affects you … Visualise from your heart, allow your inner world to communicate to yourself, create something new, something fresh for the future.❞

2 Play CD track no. 5 A peaceful day at work, or read through the following visualisation. Again, use a gentle, voice, pausing at ellipses (…):

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❝Sit comfortably in your chair and take a few deep breaths. Focus your awareness on your breathing and then on your thoughts. Remember a time when you felt optimistic and secure about yourself… a time when you felt positive and inspired, when you were happy and content. Get a sense of being at peace with yourself. Breathe in that experience and let it reach every cell in your body.The feeling of peace… of balance… makes you feel stronger and more confident.You feel able to go through situations with greater ease.

Imagine you have a whole week at work where everything flows well.Whatever situation comes along it is easy for you to handle. You feel at peace with yourself for the whole week.

Now imagine just one of the days in the middle of that great week and that day goes so well. How do you feel waking up in the morning? Where are you…? What time is it…? What are the sounds around you…? What are your surroundings like…? What are you aware of around you…?

You go to work and everything goes well… What do you see yourself doing throughout the morning and the afternoon…? How do you see and hear your interactions with others… what words are you using? How does this make you feel…?

You also have plenty of time to do something else… Do you go for a walk, meet a friend or are you enjoying your own company…? How does this make you feel…?

See yourself going home feeling good… and find time to talk and relax… and as the end of the day approaches, allow yourself time to reflect on how much you enjoyed the day… As you go to sleep, what is your last thought?

In your own time, begin to move your hands and feet and become aware of the room you are in.❞

Part B: Creative expression of a peaceful day

(20 minutes)

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Ask people to sit quietly for a few minutes and reflect on their experience and how they could express it. Give them the following choices:

G G

in words, writing down insights, ideas or writing a poem

using creative materials, eg painting, creating a collage, using clay or sand

Feedback 10 minutes

Helpful hints

G as a mime or dance which could be shared with a partner or performed to the group.

2 Provide people with their chosen materials and allow them to work on their vision individually for 20 minutes.

1 Share the creative outcomes of the exercise in whatever way is appropriate.

2 Gently, begin a discussion on what people felt while being peaceful and creative.

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For information and ideas on using creativity as a spiritual Ylearning tool, see Part 4: Spiritual Tools.

Lunch break

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Session II: Peace at work Exercise 2.6

Learning outcomes

Discovering peace at work

Process:

Peaceful listening

60 minutes
At the end of this exercise participants should be able to:

✔ describe their own and others’ images of peace at work ✔ identify some ways of increasing peacefulness at work

✔ utilise the tool of peaceful listening as a way of eliciting another’s feelings and interests

✔ identify what they learned about themselves and how this may be incorporated into their practice.

G Worksheet 2.6(A) A dialogue on peace
G Worksheet 2.6(B) Listening as a spiritual tool G Flipchart and marker pens

This listening exercise is a good opportunity for each person to be heard as well as being a ‘peaceful’ listener. Refer to the tool of listening in Part 4: Spiritual Tools before doing this exercise and encourage the group to practise listening in the manner outlined.

Materials

Facilitating the exercise

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1 Explain to the group that this exercise is in two parts: part A begins with an exploration of peace at work and part B explores listening as a spiritual tool.

2 Run through the main features of peaceful listening as follows:

❝To be a peaceful listener:

G be peaceful within, calming the mind in order to listen deeply

G listen with your heart by keeping an open posture, a receptive and calm expression, and a kind, non-judgmental attitude

G listen with your full attention
G only if the person finds it difficult to speak, be curious,

encouraging them by making gentle, open-ended enquiries

G be aware that interruptions (making comments, noises or facial expressions) are not necessary; sometimes they can influence or detract from the person expressing their feelings or telling their story in their own way.❞

Part A: A dialogue on peace (20 minutes)

1 Encourage people to pair up with someone they do not know well. Give out Worksheet 2.6(A) A dialogue on peace for the interview questions.Ask each pair to begin to fill in the sheet for their partner, as follows:

❝Choose someone you do not know well as a partner.

Ask each other in turn the questions in Part 1 of Worksheet 2.6(A) A dialogue on peace. Be peaceful inside as you ask the questions.

Listen to your partner carefully – practise peaceful listening and be very curious about their answers. Allow each person 5 minutes to speak.❞

Allow 10 minutes in total, prompting pairs to switch roles half way through. At the end of this time, ask everyone to spend a minute of quiet time before moving on.

2 Invite pairs to move on to Part 2 of the same worksheet, as follows:

❝Now go on to ask the questions in Part 2 of Worksheet 2.6(A) A dialogue on peace and note down your partner’s 3 wishes. Allow 5 minutes for each person to speak.❞

Allow 10 minutes in total, prompting pairs to switch roles halfway through. At the end of this time, move everyone into feedback.

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Feedback 10 minutes

Ask some of the group to feed back their partner’s view of peace at work.Ask them if any shared themes came up in their discussions.Are there any themes in their 3 wishes? Let the group discuss this and record any workable suggestions to return to in Action Planning later on in the session.

Part B: Listening as a spiritual tool (15 minutes)

. 1 Give out Worksheet 2.6(B) Listening as a spiritual tool
and ask each pair to join another pair to make a group of four.

. 2 Invite each group to reflect on and discuss the questions on the sheet. Remind them to keep practising their peaceful listening skills in the larger group.

You may want to ask people what enabled them to be good listeners and what they learned about themselves that they will incorporate it into their practice. Record any suggestions for Action Planning later in the session.

Feedback 10 minutes

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Exercise 2.7

Module 2|Peace

Learning outcomes

Materials

Outer reflects inner

Process:

Reflection

10 minutes
At the end of this exercise participants should be able to:

✔ recognise ways in which the physical environment can help to promote a peaceful state

✔ identify a change that they can initiate to make their work or home environment more peaceful.

G Paper and pens

G Pre-prepared flipchart with the following question written
on it: ‘What would make my home or workplace a more peaceful place?’

and marker pen

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Facilitating the exercise

1 Invite participants to work individually on the following short task:

❝Ask yourself the question,‘What would make my home or workplace a more peaceful place?’

Choose one or two things you can do. It may be something simple like bringing in a plant or changing a picture. Or you may want to make a more radical change such as rearranging furniture or decorating a room. It may be about clearing up old newspapers or some other type of clutter.You may sense within yourself what is needed. By improving your environment you will help yourself to be more peaceful.You can make changes in your environment that will make your surroundings more peaceful and this will encourage an inward change. They are not separate, as the outer reflects the inner.You may have come to that decision because of inner reflection or just because you are more aware of your environment. It does not matter what came first; improving your environment will encourage you on your path
to peace.❞

2 Ask everyone to write down one change they will make to create a more peaceful environment either at work or at home.

Allow 5 minutes in total before moving into feedback.

Use the remaining time to ask each person in the group to read out their action point and write it on the pre-prepared flipchart under the heading question.

The intention of this exercise is to help people be more aware of their surroundings and see what ways they can improve it to support themselves as peaceful beings.

See the Background Reading paper for more information.

Feedback

Helpful hints

Z 5 minutes Break

15 minutes
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Movement exercise

Session Review

10 minutes Guidance notes

. 1 Briefly review the session by displaying the session aims, learning outcomes and session programme. Remind participants of the activities they have undertaken.

. 2 Pick out any highlights, referring to materials that participants have produced and which you have displayed.
❝Having come to the end of the session, you will find that you have looked at your ideas of peace and created a vision of peace and how that can be applied at work.You have experienced what it is like to be peaceful, improved your listening skills and been creative and reflective. You can use some of these in the action planning exercise which follows.❞

. 3 Hand out the Background Reading paper for participants to take away, pointing out any references and resources for this module, should they wish to explore the theme in more depth.

See Part 2: Guidance for Facilitators for further guidance.

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Action Planning

See Part 2: Guidance for Facilitators and Part 5: Additional Resources for information and guidance on action planning. Below is a suggested action planning exercise which will help participants to build on some of the ideas they have generated in the previous exercises.

Exercise 2.8

Learning outcome

Materials

Facilitating the exercise

Designing peace

Process:

Reflection and sharing

30 minutes
At the end of this exercise participants should be able to:

✔ make an action plan for creating peace in the workplace. G Paper/cards and pens

G Action planning pro formas (optional – see Part 5:Additional Resources)

So far, participants have shared ideas about what it means to be peaceful, practised peaceful listening and developed their own personal vision of peace at work.The final exercise involves planning some actions based on these experiences and insights.

1 Introduce the action planning as follows:

❝This next exercise is in three parts.You will have time to record your own, personal reflections on peace, develop some individual action plans, and share and develop these with other people.❞

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Part A: Individual planning (10 minutes)
1 Ask participants to sit with a partner, but to work individually

on the first part of this exercise. Introduce it as follows:

❝Take a few minutes to quietly reflect on your peaceful vision at work.Think about the different ways you can make that vision a reality.Then select the smallest thing you can do that will put you on the path to that vision. For example, it might involve a change in your own behaviour, using peaceful listening as a work-based skill, or making a change to your work environment.

Then choose another small action you could follow it up with.

For each action, try to identify a time when you have been successful in doing this kind of action before.Think of something real and something achievable.

Ask yourself: does it match with what interests you about peace?

You are creating your personal action plan, a kind of pledge to yourself.

Allow yourself at least 5 minutes to think about it and write your personal action plan.❞

2 After 5 minutes, move on to the next part of the exercise. Part B: Sharing with partner (10 minutes)

1 Ask each pair to work together, as follows:

❝Now, share your thoughts with your partner.You may want to put the final touches to the plan – such as when and where? Who needs to know that you intend to do this? Is there any modification required to your plan to reflect your personal enthusiasm?

It is important for you to have a vision that is so compelling you will be eager to make it happen and enjoy the results.❞

Allow 10 minutes in total, prompting pairs to switch roles half way through.

2 After 10 minutes, move everyone into the final stage of the exercise.

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Helpful hints

Part C: Sharing with more people (10 minutes) 1 Introduce the last part of the exercise as follows:

❝The sharing of your ideas can either be done in pairs or simply walking around a room and exchanging ideas with the people you meet. Pick one or two of your actions and tell the person. For example:

G ‘I plan to sit quietly at my desk each day before starting work.’ G ‘I plan to walk in the park during my lunch break.’
G ‘I am going to smile more.’

Share your plans with as many people as you can, one at a time.❞

2 After a few minutes sharing, ask participants to copy on card or paper each action, and pin that onto a board for the group to share and read. In this way, the group can see how far they have come in developing ways of being more peaceful in work situations.

If you are running this exercise with a work team, begin with individual planning and then invite people to pool their individual commitments, developing some of the common themes into a team action plan.

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Evaluation

10 minutes Materials

G Copies of evaluation pro forma (if being used) G Pens

Guidance notes

Run though your planned evaluation activity (see Part 2: Guidance for Facilitators and Part 5:Additional Resources for information and guidance on evaluation).

As an alternative or additional activity, you may also want to give out a more formal evaluation form at this point for participants to complete now or return by a given date.

Remember to plan in some time as soon as possible after the session to complete your own evaluation of how you think the session went.

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Closure

Exercise 2.9

Learning outcome

Materials

Facilitating the exercise

A peaceful anchor

Process:

Visualisation

10 minutes
At the end of this exercise participants should be able to:

✔ G G 1

create a lasting image of peace through visualisation.

CD track no. 6 A peaceful anchor (or relaxing background music)

CD player/tape recorder (optional)

Ask participants to sit quietly, again with the purpose of feeling peaceful.They may become aware of their thoughts as they
are doing this. Play CD track no. 6 A peaceful anchor or read the following guidelines, playing background music if you wish. Pause at ellipses (…) to give time for visualisation.

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❝Sit comfortably on your chair, legs uncrossed, and allow the body to relax. Let your feet rest on the floor and your hands rest on your lap. Sit in silence for a while… you may become aware of your thoughts… just let them pass… (pause for 10 seconds).

Turn the focus of your thinking to your breath and just observe it.Your breathing is likely to follow its own rhythm, its own pattern… you may notice your breath calming down. Just observe the breath going in and coming out for one minute… and enjoy the peacefulness of this… (pause for 30 seconds).

Now, turn your thoughts to your mind and start to consider what the term peace means to you…See the word peace and then allow an image that has been very peaceful for you, or which evokes peace for you, to come into your mind. This image may be anything you like: a scene in nature, or a calming person, or a place, or an event.

More than one image may go through your mind; choose one that carries the experience of calm or tranquillity with it. Focus on it until it becomes clear in your mind.You may prefer to focus on an image that carries a calming or peaceful sound with it, for example, a piece of music, the wind blowing through trees, ocean waves or a running stream.

Stay with your image or concept of peacefulness or calm. Observe your image and imagine you are really there with it. Stay there… … this image is your anchor, and your aim is to stay with this picture as long as you are able. If thoughts about other situations, people or events come into your mind, simply turn your attention back to your image.

If thoughts are persistent or seem to intrude into your mind, gently but firmly guide your thinking back to your image, again and again. If this becomes difficult to do, take your attention back to your breath and observe your breathing.When you are ready, go back to your image. Even persistent and intrusive thoughts will eventually go.

Stay with your image for the next few moments… (pause for 10 seconds).

When you ready, gently bring your attention back to the present moment… and back to your surroundings. Move your hands and feet and stretch a little.❞

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Follow-on/homework Exercise 2.10

Learning outcome

Materials

Facilitating the exercise

A peaceful image

Process:

Creativity

10 minutes
At the end of this exercise participants should be able to:

✔ create an image that represents how they see themselves when they are being peaceful.

G Paper and coloured pens/pencils

Ask people to take a few minutes to write down or draw an image that represents how they see themselves when they are being peaceful. It might be a beautiful oak tree – tall, strong, with deep roots, yet flexible. For others, it might be a piece of fine china – seemingly delicate, almost translucent, and designed for strength. Some might see or hear themselves as a beautiful piece of music with flowing melodies and grand chords.

Some may wish to share their words or drawings with each other.

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Exercise 2.11

Module 2|Peace

Learning outcomes

Materials

Facilitating the exercise

Valuing your ability
to be peaceful at work

Process:

Reflection and sharing in the group

25 minutes
At the end of this exercise participants should be able to:

✔ reflect on and evaluate what has been learned about being peaceful at work

✔ apply this learning to their practice and work setting. G Flipchart and marker pens

1 Facilitate discussion and sharing among the whole group, focusing on the value of what has been learned and how this might be applied in their work. Some questions you may like to ask the whole group or put on a chart might include:

G What is your view of being peaceful at work now?
G What will you do differently to allow yourself to be more at

peace?

G What will you do differently to allow others to be more peaceful?

G In what ways do you think your workplace as a whole will benefit from what you will do differently?

G Did you meet others who shared the same ideas as you? What were these ideas? (You might wish to work on these further together at work or in a local group.)

G Were there other ideas you heard and liked?
G How could you sustain yourself and colleagues in being more

peaceful at work?

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Worksheet 2.2

Exploring muscle relaxation and breathing

Observe what you experienced in your body and your mind and note it down. You may like to use the following questions as a guide:

What did you feel:
G In the muscles of each limb? G In the shoulders and back? G In the face and scalp?

Did you notice any effect on: G Your thinking or attitude? G Your attention?
G Your emotions?

G Your felt sense of peacefulness?

You may wish to compare how you feel now with how you were feeling before this exercise.

G How long do you think any changes will last?

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Worksheet 2.3

Exploring focus on becoming silent

Observe what you experienced in your body and your mind and note it down. You may like to use the following questions as a guide:

What did you feel:
G In the muscles of each limb? G In the shoulders and back? G In the face and scalp?

Did you notice any effect on: G Your thinking or attitude? G Your attention?
G Your emotions?

G Your felt sense of peacefulness?

You may wish to compare how you feel now with how you were feeling before this exercise.

G How long do you think any changes will last?
G Did you experience any differences in effects or benefits between muscle

relaxation/breathing and becoming silent?

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Worksheet 2.6(A)

A dialogue on peace

To be a good listener you need to:
G be peaceful within, calming the mind in order to listen deeply

G listen with your heart by keeping an open posture, a receptive and calm expression, and a kind, non-judgmental attitude

G only if the person finds it difficult to speak, be curious, encouraging them by asking open-ended questions

G listen with your full attention. Be aware that interruptions (making comments, noises or facial expressions) are not necessary; sometimes they can influence or detract from the person expressing their feelings or influence them telling their story in their own way.

Part 1:

Interview, listen and share an interest in being peaceful.

Tell me about you and your work (a brief overview).
What attracts or interests you about a more peaceful working environment? What image do you have of what a peaceful working environment means to you?

Part 2:

If you had three wishes to increase the peacefulness at work what would they be? 1

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Worksheet 2.6(B)

Listening as a spiritual tool

Small group work

Each pair should link up with another pair so there is a group of four. In this group, reflect on and discuss the questions below. Ensure that each person has an opportunity to speak.

. 1 How did it feel to interview your partner, asking open questions and being peaceful?

. 2 How did it feel to be interviewed and listened to in this way? Did you learn anything about yourself?

. 3 What did you like about your interaction with each other?

. 4 How effective was this way of listening in eliciting your partner’s feelings and interests?

. 5 How might you use peaceful listening in your work?

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Background Reading

Why Positivity?

The Values in Healthcare approach is essentially a simple one: having a positive attitude improves health. Being positive leads to greater energy and satisfaction, enhanced clarity in decision-making and an increased sense of well-being. All of this leaves a vibrant impression on family, friends, patients, clients and colleagues. This seems to happen because people around us recognise a change in the atmosphere, a change that is generated by how we think, how we say things and the manner in which we behave.

Workers in healthcare and related professions are trained to be highly self-critical. Consequently, we are more likely to be aware of what we don’t do well, rather than what we are proficient at. Critical thinking obviously helps to maintain high standards, but may not always be appropriate when dealing with patients and colleagues at an interpersonal level. Changing our thinking to being more positive about our own work and that of colleagues will improve our own self-esteem and raise morale.

When we as practitioners are positive about ourselves, then we can encourage a positive or life-enhancing change in our patients’ and clients’ attitudes. When we think positively, those with whom we are in contact will also begin to change.

Purpose of module

It seems that we all have some idea of what being positive means and most people will relate well to the metaphor of the glass half-filled with water. Whether it’s half empty or half full has long been seen as an indicator of someone’s pessimistic or optimistic nature. In this module we aim to ‘top up’ the half-full glass so that it overflows!

Being light and optimistic may come easily to some but for others, being encouraged to be positive can sometimes have an infuriating, equal and opposite effect! In this module we will look at the skill of positivity as one we all have that we can nourish, develop and take out for practice-runs.

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Introduction to the Positivity module

The first half of the module is mainly about recognising the benefits of positive thinking and about developing positive thoughts about oneself and others. The second half builds on these insights by applying the learning to work contexts, and by introducing some more specific techniques for dealing with negative thoughts and cycles of thinking.

Themes of Exercises

The benefit of being positive (3.1)

Positivity can be expressed in many ways, for example: liking yourself; valuing yourself as you are; being able to make people laugh; calming disputes; or arranging flowers so that they ‘uplift’ a room.

Being positive does bring individual gains and this in itself can create or facilitate change. However, having a positive impact on others around us, in minor and major ways, produces broader gains which all add up. Examples of specific benefits of being positive may be:

G physical – aids recovery from illness and increases energy G mental – improves self-esteem and makes tasks easier
G social – improves relationships
G spiritual – increases the capacity to be hopeful.

Valuing the self (3.2)

Thinking about ourselves in a positive way is not showing off or being arrogant. If we monitor our thoughts we will usually find that for most of the time most of our thoughts are at the negative end of the spectrum, thoughts like ‘I am no good at that sort of thing’, ‘I always get that wrong’, ‘I seem to make too many mistakes’. Thinking about our own attributes in a positive way gets us in touch with who we truly are and is essential in building self-esteem.

It is important to acknowledge our best attributes without embarrassment or conceit, and to accept praise. When we receive criticism it may be useful to acknowledge it and consider its validity, but not to be resentful of it.

Negative thinking is a matter of habit and can be changed. We were not born with a negative thinking pattern. On the contrary, deep down we are optimistic, trusting and peaceful beings.We may have forgotten that but, if we slow down, the memory will return. We do have control over our thoughts, so we can change the way we think. With practice and determination our thinking can become positive.

The only way to prove the benefits of positive thinking is to try it and observe and recognise the benefits, not only to yourself but to everyone around you.

Surfacing positive thoughts (3.3, 3.10)

Positive thoughts leave us feeling hopeful, lead to inner calm and more creative approaches to challenges that we face. Having some positive thought or belief about

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the self is crucial in this. It is important to identify and affirm the positive thoughts and underlying beliefs we have or have had, in order to identify their potential influence and explore how we could make best use of them in our lives.

A preliminary step to thinking positively is consciously to acknowledge and appreciate the best in oneself and others, rather than focusing on negative attributes. Further steps may involve reinforcing and creating new positive thoughts, attitudes and beliefs. Being open to listening to our positive selves and reminding ourselves to look for and focus on solutions, rather than dwell on problems, are important methods to start the ball rolling! Eventually, new ways of thinking, perceiving and responding become habitual.

When we start to retrain ourselves to be positive, we are not just engaging on a superficial, ‘fast-track’ project to better ourselves, but a more thoughtful task of reconnecting to a profound, yet naturally positive inner self.

Below are some examples of positive statements about oneself, others, a current situation, and the future:

G The self: I do like myself; I accept my weaknesses; I understand myself; I have special skills and qualities; I value myself; I believe in myself; I am loveable.

G Others: I accept others as they are; I look for the best in others; there is something good in everyone I meet; I appreciate others.

G A current situation: I am capable of handling the situation; I have all I need; I am fortunate; there is a bright side to everything; nothing lasts forever.

G A difficult situation: I look forward to each day; this is an opportunity/challenge in disguise; each day brings something new and beautiful, something to learn.

Thought exchange (3.4)

Mind and thoughts

How the mind works and what thought is have fascinated philosophers and scholars for centuries. What follows is a simple way of looking at types of thinking:

G Positive thinking is valuable; it energises, makes us feel cheerful and leads to improved well-being.

G Negative thinking is superfluous; it drains energy, makes us feel unhappy and ill at ease. The resulting state of dis-ease can lead to illness.

Superfluous thoughts are mainly worries or concerns about past events or the future and may be associated with feelings of guilt, resentment, insult, fear, hurt, jealousy, frustration, possessiveness etc. Certain attitudes may fuel these feelings and thoughts; consider what you are like when you or others around you are exhibiting criticism, competition, stubbornness, inadequacy, arrogance, anger or greed.

Other thoughts in this category are those that begin, ‘If only…’. When these become habitual, they drain our energy. Other habits, such as contemplating or discussing the weaknesses of others or even listening to others making negative comments, drag down our thinking and can create a miasma of negativity that entraps us.

Health practitioners are all too familiar with this; many patients come to complain of their ailments, and those who do the listening are exposed to a daily diet of negative thinking.

A deep source of negative thinking (some would say the deepest) is based on messages about ourselves from the past. As children, we are trusting and believe what others say to us. These messages become imprinted and can accumulate and transform themselves into a belief system that sticks like peanut butter to the roof of our mouths. As adults, however entrapped we feel, we have a choice in how we look at our positive and negative attributes.

Valuable thoughts contain nuggets of positive feelings – patience, unconditional acceptance, kindness, generosity, good-will, happiness, trust, openness and peace. Such positive thoughts leave us feeling hopeful and lead us to search for creative solutions. Positive thoughts can both calm the mind and recharge it with a powerful energy.

Changing negative thoughts into valuable ones

By constantly checking our thoughts and switching from being critical to being accepting, affirmative or appreciative, we can change superfluous and wasteful thoughts to valuable ones. The following list of questions may help us to do this:

G What qualities have I exhibited today while talking with others? G What quality thoughts have I had today about others?
G What qualities have I shown in my actions?
G What qualities do I still need to develop?

We may find it difficult to change our habitual thoughts yet, no matter how much it sounds like a cliché, we do have the power to alter the way we think.

Taking responsibility to change is an immense challenge. However, as we become aware that thoughts are the seeds of feelings, attitudes, beliefs, speech and actions, the importance of transforming thoughts becomes self-evident – changing our thoughts will change what we say, feel, think and do. It can change how we behave towards others and ourselves.

Below is a list of questions that may be running through our minds when we are anxious, bored, irritated or upset:

G Why isn’t this working? G Why is it taking so long?

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G Whose fault is it, anyway?
G Why don’t I understand?
G Why can’t I do this?
G Why does this always happen to me?

Yet we do not have to think like this; we can change these to questions such as:

G What’s working well here?
G What have I achieved already?
G I wonder how this will change things for the better? G What do I know already?
G What alternatives do I still have?
G How can we best find a solution?

Inspired to be me! (3.5, 3.12)

Another difficult aspect of being positive about ourselves is that even contemplating being positive appears to be an uphill, laborious task as it implies change and a review of where we are coming from. An alternative approach is to look upon being positive as re-connecting with, or returning to, a state of calm, contentment or joy that already exists within us. Often we are not sure how to take the first step in moving towards an inner state of positive attitudes, beliefs, motives and perceptions, or may doubt that it exists. However, if we consider that, for many of us, positive thinking has lain dormant under a sediment of negative thoughts, experiences and attitudes for a period of time, then we can look for the methods to resurface it.

What would happen if our starting point, our spiritual premise, was a fundamental core belief that we are innately positive? And what if we expanded that further by adding qualities of peacefulness, contentment, compassion, joy, light-heartedness, determination, wisdom, honesty, integrity and strength to that core belief?

Getting in touch with that inner core in silence, through meditation, gives us the experience of being positive at a deep level. This is done by relaxing physically, allowing the thoughts in our mind to slow down and our emotions to become calm. It is then that we begin to get a sense of our inner self with all our positive qualities.

Appreciating others at work (3.6)

When children are learning to walk, write or ride a bike, we encourage them with physical support, smiles and helpful words. We know almost instinctively that they will respond to praise, and so learn more quickly. It seems so easy and natural that we do not even need to think about it. Adults are learning all the time too, yet with them it is different. Praise is rationed and criticism is the order of the day. The result

is that there is little motivation to change. Somehow we have lost the ability to give praise and may even feel embarrassed about it.

There are four simple rules when appreciating others:

G be sincere
G be specific
G identify the quality G beware of ‘spoilers’.

Be sincere

It is not just a matter of choosing the right words of encouragement, we have to be genuine in what we say. We all intuitively know what feelings really lie behind what is said, so when giving praise we really have to mean it – this involves being positive about ourselves and looking for the positive in others so that our comments come naturally. Respect for others is also shown through friendly gestures and maintaining good eye contact – these aspects of our body language are a physical demonstration of our sincerity and commitment to what we are saying.

Be specific

For people whose self-esteem is good, and who are comfortable with themselves, taking praise can be easy. But those who have poor self-esteem will often reject praise because they cannot believe it. ‘Well done’ and ‘Good show!’ may sound a bit empty. Many of the phrases we have used in the past to congratulate actually sound quite dated now – perhaps a sign of how unused society has become to giving praise. So we have to choose our language carefully for it to sound real and believable.

If you wish to encourage a student, choose something specific. For example, for a nurse laying out an instrument trolley, you might say, ‘That’s very helpful, you have assembled everything in the right order’. The nurse can look at what s/he has done and see that the observation is true. Similarly, with patients, a physiotherapist could say, ‘That’s great. You really remembered to look ahead when using the walking frame’.

Identify the quality

If we can identify the quality that someone is demonstrating by their positive behaviour it gives the praise a depth and builds on a person’s self-respect. A senior ward sister said to a nurse in training, ‘You washed that patient efficiently, and with such kindness and gentleness’. That comment has stayed with the nurse through all her working years. As a result, she tries to bring kindness and gentleness into all her work. She identified these qualities as part of her personality and her practice, and consequently is more aware about living them in practice. Praise is a very powerful tool and a wonderful gift we can give to others.

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Beware of spoilers!

Sometimes, people really try to praise or encourage, but end their comment with a ‘spoiler’. For example, how does a student pharmacist feel when her tutor says, ‘You did a great job cleaning the drugs cupboard – it looks so organised. I don’t know why you don’t keep it like that all the time. It’s always such a mess!’? That is a spoiler! Other examples are:

G A surgeon says to a junior, ‘You’ve stitched up that wound very neatly… why can’t you do that more often?’

G A staff nurse says to an auxiliary, ‘You concentrated and finished your work quickly. Well done. If you’d only do that all the time, it wouldn’t be such a hassle every day.’

In each case, the comment starts out well but then turns to reproach, and refers to, reminds the person of and therefore reinforces, past negative behaviours – consequently, the praise isn’t effective and the positive feelings usually diminish quickly.

S.O.S.: Standing back, Observing, Steering (3.7)

It is possible to apply a process that enables us successfully to transform a negative response to a difficult situation or event into a set of constructive thoughts.

Many of us are familiar with the concept of taking time out. We can do this at work, individually or as a team, when stressful situations occur, especially if these events have an impact upon the whole team. We may take a few minutes, physically, to leave the situation, or to stand back mentally from the scene. Visualisation, a breathing technique, or being in silence alone or together are all activities which

can put a space between the situation and us.

The next step is to re-view the situation, as if we are an onlooker or a detached observer. Being as silent as possible, we can ask ourselves if the thoughts we are having are ones we wish to keep, if they are going where we would choose them to.

In the resulting silence, it is possible to steer our thinking to where we want it to be; perhaps to a personal affirmation we use to calm and soothe us. This affirmation may be part of our faith or spiritual tradition, or one we have adopted from other sources, something along the lines of: ‘I am aware of myself as calm and peaceful’ or, ‘…as happy and content’ or, ‘I know I am inwardly at peace and I regain that’ or, ‘I see myself as tranquil and cool’. These are all powerful methods to regain quietness or positive states of mind.

The ‘S.O.S.’ technique will not always change situations, nor will it necessarily influence how others respond. Sometimes, the only change may be that our own attitudes or feelings change and so we feel relaxed or lighter. But we do have the power to change the way we think.

Saying ‘STOP’!

Sometimes, our thoughts can cause havoc with our emotions and we may try to become still, change the thought or stop it, but, in fact, find that we can’t. At these times, it is useful to think, ‘STOP!’

Here, the word is used like the full-stop at the end of this sentence. It replaces or stalls any further thought and exhorts us to stop dwelling, speaking or acting on it. Putting this ‘STOP’ to the thought ends the sentence, and ends the thought.

‘STOP’ can thus defuse charged emotions and allow a painful thought to dissolve. If the thought or emotion returns, it is possible to apply ‘STOP’ again and again!

The impact of being positive at work (3.8)

Being positive does bring individual gains and this in itself can create or facilitate change. Any individual change will have a positive impact on others around them in the workplace, including patients/clients, colleagues, the team and the broader organisation.

Examples of specific benefits of positivity may be:

G health and effectiveness at work – having more energy, better workload management

G relationships with patients/clients – able to listen more receptively, provide a sense of hope

G relationships with colleagues/team – more open to collaborating on problem solving.

Recycling thoughts (3.9, 3.11)

Cycles of thinking

Even with the best intentions, we can find ourselves stuck in cycles of negative thinking; frequently, these are fuelled by negative self-belief. These cyclic thoughts are, at best, wasteful of our time but more often, they are depressing or even destructive, especially if the cycle is tapping into a deep-seated lack of self-esteem, self-respect or self-confidence. Cyclic negative thoughts are harmful and, by definition, have become a habit.

Imagine a situation such as facing an examination or a driving test. Some people will respond to this with anxiety, foreboding or a fear of failure. These feelings conjure up images of past failures and this in turn taps into deeper anxieties and self-doubt. Should the examinee now fail, it will confirm that s/he truly cannot pass such tests and that the original fear of being a failure was justified. Thus the prophecy is self- fulfilled; the cycle now propagates and rapidly becomes habitual.

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However, cycles of thinking can be positive too. Some people invariably respond to tests or events with feelings of optimism; they see success, prepare adequately and are confident. If this is not natural to us, we can train ourselves to respond in this way. Being optimistic taps into images of past success and generates a quiet self-assurance. These prophecies are also self-fulfilling and thus a cycle of positive thinking is propagated and will, in time, become a habit.

Should the driver fail, s/he is able to accept it with self-respect, acknowledge that more practice or knowledge was necessary, and move on. To conclude, creating habits of positive thoughts, feelings, attitudes or beliefs is possible but not quite as easy as ordering a pizza! So we will need to focus specifically on this task, and this we can regard as a retraining of our minds.

2 The Facilitator’s Guide to Module 3 Session I: Being positive

Aims

G To gain awareness of our own thought patterns and the beliefs which underpin them

G To consider the concept of choice in how we think
G To practise and recognise the benefits of positive thinking G To transform negative cycles of thought into positive ones G To practise appreciation of the self and others
G To create a positive self-image

Process

In this session, participants consider the benefits of being positive, before undertaking some appreciative self-questioning. A reflective exercise follows during which they recall positive thoughts and beliefs they employed in a number of situations, and apply their discoveries to a future, difficult scenario. These exercises provide a foundation for the more challenging task of changing negative cycles of thinking into positive ones. Finally, the tool of meditation is utilised to further strengthen positive thinking and consolidate participants’ positive self image.

Session II: Positive interaction at work

Aims

G To explore and recognise the benefits of being positive at work

G To practise using positive affirmations in the workplace

G To practise a technique for steering away from negative thinking towards positive thinking

G To apply positive thinking to difficult work situations Process

This session begins by exploring some ‘rules’ for appreciating others, and applying these to a work context. A visualisation provides the opportunity to practise a technique for standing back from negative thoughts and steering towards positive

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thinking. A further exercise involves participants in acting out difficult work situations and then re-enacting them in a positive way, in order to explore and identify the benefits of positivity in the workplace. Following the session review, action planning invites participants to identify one positive thought or belief which they can incorporate into their life or work. The session closes with making affirmations both for the self and for other participants.

Programme/plan for Module 3 Positivity

Module 3|Positivity

Introduction 30 minutes SESSION I Being positive

Exercise 3.1 The benefit of being positive 25 minutes

Exercise 3.2 Valuing the self 15 minutes

Movement exercise 5 minutes Break 20 minutes

Exercise 3.3 Surfacing positive thoughts 45 minutes

Exercise 3.4 Thought exchange 10 minutes

Exercise 3.5

Lunch break

SESSION II

Exercise 3.6

Inspired to be me! 15 minutes

Positive interaction at work

Appreciating others at work 35 minutes

Exercise 3.7 S.O.S. – a visualisation 25 minutes

Movement exercise 5 minutes Break 15 minutes

Exercise 3.8 Being positive at work 40 minutes

Session review 10 minutes

Action planning

Exercise 3.9 Thoughts into action 30 minutes

Evaluation 10 minutes

Closure

Exercise 3.10 Appreciating the self and others 10 minutes

Total time 5 hours 45 mins

Follow-on/homework

Exercise 3.11 Re-cycling thoughts 30 minutes

Exercise 3.12 Tuning into positive thoughts 20 minutes

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Materials

G Pens/coloured pencils and paper
G Flipchart and marker pens
G CD player/tape recorder (optional)

Session I

G Worksheet 3.1: The impact of being positive

G Worksheet 3.2: Valuing the self

G Worksheet 3.3: Surfacing positive thoughts

G CD track no. 7 Inspired to be me (or relaxing background music)

G Coloured paper/cards (A5)

Session II

G Handout 3.6 Appreciating others
G Worksheet 3.6 Appreciating others at work
G Worksheet 3.8 Being positive at work
G CD track no. 8 S.O.S. (or relaxing background music)
G Pinboard or other surface for display, and Blu-tak or pins G Values cards (see Part 5: Additional Resources)
G Coloured paper/cards (A5)

Follow-on/ homework

G Worksheet 3.11 Re-cycling thoughts
G CD track no. 9 Tuning into positive thoughts

Preparation

. 2 Familiarise yourself with the main learning tools which are being used in the session (see Part 4: Spiritual Tools).

. 3 Read through the session guidelines and look at the suggested session programme which will incorporate:

G Session introduction G Exercises
G Movement breaks

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G Breaks
G Session review G Action planning G Evaluation
G Closure

4 Photocopy any handouts and exercise sheets, and make sure that you have any other equipment listed under Materials.

Helpful hints about this module

Some participants may find the focus on being positive quite challenging and not sufficiently ‘reality-based’.The aim of this session is to recognise that we all have inner beliefs based on ‘positivity’ which we can surface and find ways of expressing, with many benefits on how we see ourselves and how we relate to others. However, some of the exercises may bring out difficult reactions, including negative thoughts and memories.You may need to be prepared to alter the timing of exercises according to the process within the group or team.You may also need to allow any very unhappy member of the group, who is finding it difficult to come up with positive options, to opt out until s/he feels able to rejoin the group. In this case, be prepared to give some time to such a person or arrange for appropriate support to be on hand.

In preparing your introduction to the session, it may be worthwhile to emphasise that, while the session may be challenging, there are many worthwhile outcomes which the exercises can surface. Even one ‘new’ positive approach or way of thinking can become a valuable resource for the individual or group to use in their personal and working lives.

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Introducing the Module

30 minutes
Run through your planned introductory session which may include:

Quiet time
Introductions/optional warm-up exercise Overview of session
G Theme of session
G Aims and learning outcomes
G Programme/plan for the session
G Practical considerations
G Any questions

Setting the tone

G Ground rules/principles G Participants’ expectations

Review of last session/homework

See Part 2: Guidance for Facilitators for further guidance on introducing the session.

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The Exercises

Session I: Being positive Exercise 3.1

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Learning outcome

Materials

Facilitating the exercise

The benefit of being positive

Process:

Reflection and discussion in pairs

25 minutes
At the end of this exercise participants should be able to:

✔ identify the potential benefits of being positive on different aspects of health and well-being.

G Worksheet 3.1 The impact of being positive G Flipchart and marker pens

1 Distribute Worksheet 3.1 The impact of being positive and ask participants to get into pairs.

2 Introduce the exercise as follows:

❝Begin by sitting quietly and on your own reflect on times when you felt positive about yourself. Then, looking at the worksheet, consider the gains or benefits of being positive on each of the areas listed. Jot down any spontaneous thoughts.❞

Allow 5 minutes for this.

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Feedback 15 minutes

3 Ask everyone to briefly share their thoughts with their partners.

Allow 5 minutes before moving into feedback.

Gather everyone back into a large group and facilitate a brief feedback on each of the areas listed on the worksheet.You could note responses on a flipchart under the four headings, and display this during the session for reference.

Invite comments and comparisons on what positivity (being positive) means to different individuals.

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Exercise 3.2

Module 3|Positivity

Learning outcomes

Materials

Facilitating the exercise

Valuing the self

Process:

Appreciation

15 minutes
At the end of this exercise participants should be able to:

✔ utilise appreciative self-questioning to identify positive thoughts and qualities about themselves

✔ recognise the benefits of valuing the self. G Worksheet 3.2 Valuing the self

G CD player/tape recorder and relaxing background music (optional)

1 Distribute Worksheet 3.2 Valuing the self.

2 Ask participants to answer each of the questions on the worksheet on their own. Encourage them to answer the questions spontaneously, rather than giving considered responses, since any deliberation may lead to self-criticism, doubts and negative thinking.

Carry out this part of the exercise in silence or with background music.

Allow 5 minutes before moving on to group feedback and discussion.

Within the group, ask individuals to discuss how they felt undertaking the exercise. Some prompt questions could include:

G Was it challenging to be positive about yourself? If so, why? G Why is it useful (and acceptable) to have positive thoughts

about oneself? (Link back to Exercise 3.1) G How do you feel having done this exercise?

Feedback 10 minutes

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Z 5 minutes Break

Movement exercise

20 minutes

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Exercise 3.3

Module 3|Positivity

Learning outcomes

Materials

Facilitating the exercise

Surfacing positive thoughts

Process:

Reflection

45 minutes
At the end of this exercise participants should be able to:

✔ identify positive thoughts and beliefs in relation to different situations, through reflection

✔ apply positive thoughts and beliefs to a difficult situation in order to bring about positive change.

G Worksheet 3.3 Surfacing positive thoughts

G Flip chart and pens

G CD player/tape recorder and relaxing background music (optional)

The first part of this exercise is a guided reflection during which participants will be invited to identify and write down certain positive thoughts that may occur to them.This is followed by
a discussion on how to put into practice what they have discovered.

1 Distribute Worksheet 3.3: Surfacing positive thoughts. Ask participants to work in silence and to be alert, but comfortable, so that they can write as they reflect. Play quiet background music if you wish.

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2 Introduce the exercise as follows:

❝I am going to ask you to recall a number of situations and
to identify the positive thoughts or underlying beliefs you experienced in them.Try to stay relaxed and respond to each
in a spontaneous way. Jot down your thoughts on the worksheet as I ask you to. For this exercise, try to ignore or bypass negative thoughts. We will look at these in later exercises.❞

3 Slowly read the instructions below, pausing after each question and allowing about a minute for participants to write down their thoughts.

❝We will be contemplating four situations which are on your sheet. For each, I will ask you to identify any positive thoughts, and also any underlying beliefs you might hold:

Theme 1: The self
Recall a time when you felt very positive about yourself; perhaps you felt particularly happy or content. Go into this experience for a moment (allow 3 minutes).

G What were your thoughts about yourself? Write them down.

G Can you identify the underlying belief you had about yourself? It may be a quiet voice or thought you rarely listen to. If you can put it into words, write this down.

Theme 2: Others
Recall a time when you felt happy with people you did not expect to find it easy to be with. Recall what happened in that scene to make it positive (allow 3 minutes).

G How did you start to think and feel about these people as you changed your attitude towards them? Write this down.

G What was the old and new belief or assumption you were holding about them? Think about this and write it down.

Theme 3: A current situation
Recall a situation that some people would say was hard but which you usually deal with very positively or very well.Take your time (allow 3 minutes).

G G

How do you think about this situation? What do you believe may be helping you?

Feedback 15 minutes

Theme 4: Anticipation of a difficult situation
Think of a difficult situation that you know you will have to face in the near future. Contemplate what you think you will find most challenging (allow 3 minutes).

G Is there one of your current thoughts about it that you are willing to change? What would you like to change it to? Write these down.

G Are there any core beliefs you can have about yourself or the situation that will help you sustain this thought? Write these down.❞

Allow about 20 minutes for this main part of the exercise, before moving into a brief discussion in pairs.

3 Invite participants to spend 5 minutes sharing their responses with a partner, listening with respect to their partner in turn. Ask them to try to draw out thoughts and beliefs which seem of most value to them, perhaps concentrating on theme 4.

Allow 5 minutes for each person to share, prompting pairs when it is time to swap roles.Then reconvene the group for feedback.

1 Begin by emphasising that with each situation and for each person, there may be one particular thought or belief that is especially powerful in transforming negative into positive experiences. In any situation, we can choose what we think – in fact, this choice is our responsibility.

2 Now invite each pair to feed back one or more important thought or belief. Record these on a flipchart.

3 Encourage participants to contribute any further useful and positive thoughts or beliefs they had, and add these to the flipchart. Examples of positive thoughts might include:

‘I look forward to each day’;‘This is an opportunity/challenge in disguise’; ‘Each day brings something new, something to learn’.

4 Ask participants to sit quietly again and to reflect individually on the final situation, drawing on the group’s ideas and their own conclusions and making any additional notes on their worksheets.

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If you have extra time available, discuss some of the following questions:

How did you find the exercise – could you identify positive thoughts and beliefs?

Can you connect your positive thoughts and beliefs to your feelings and actions?

Which comes first – a positive experience or a positive thought?

By changing your thinking, can you change how you experience other people and situations?

What implications does this exercise have for our thoughts about patients or clients?

Exercise 3.4

Module 3|Positivity

Learning outcome

Materials

Facilitating the exercise

Thought exchange

Process:

Appreciation and play

10 minutes
At the end of this exercise participants should be able to:

✔ change negative thoughts into positive ones. G Paper (A5) and pens

1 Give each participant a sheet of A5-size paper and introduce the exercise as follows:

❝Write down a negative thought, about yourself or others, that you want to throw away.❞

Allow 2 minutes.
2 Ask everyone to do the following:

❝Fold the paper, marking it with a symbol or sign so that you can quickly identify it again.Throw it into the middle of the room. If you feel like it, sigh with relief, shake your hands or feet, jump around.❞

Allow 2 minutes.
3 Ask everyone to do the following:

❝Pick up from the floor one of the discarded pieces of paper (not your own).Write down a positive affirmation on the bottom of the card to counteract the negative thought.

Return this paper to the centre of the room.❞ Allow 2 minutes.

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Helpful hints

4 Finally, ask participants to find their own, original piece of paper:

❝Pick up your own original piece of paper, read the affirmation and absorb it.❞

Allow 4 minutes. Remind the group that:

G it may be easier to practise ‘re-cycling’ our thinking when we are doing it for others

G negativity may enhance our drive to create something positive G doing something positive is a stimulus for creating positive

thoughts or affirmations.

Being appreciative of others can seem superficial or superfluous when we are not used to doing it. However, real appreciation can be conveyed by identifying a quality which reflects what we wish to impart and delivering it with sincerity.With a little practice, it is easy to train our attitudes, beliefs and perceptions to be appreciative rather than cynical.

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Exercise 3.5

Module 3|Positivity

Learning outcome

Materials

Facilitating the exercise

Inspired to be me!

Process:

Meditation

15 minutes
At the end of this exercise participants should be able to:

✔ use meditation as a tool for creating a positive image of themselves and for encouraging the development of positive thinking.

G CD track no. 7 Inspired to be me (or relaxing background music)

G CD player/tape recorder (optional) G Paper and pens/coloured pencils

This exercise will use reflection and the power of imagination at a deep level, which helps to build inner strength.

. 1 Ask the group to sit comfortably and relax.

. 2 Play CD track no. 7 Inspired to be me! or read out the following text, playing background music if you wish.The text needs to be spoken slowly and clearly, pausing where you see an ellipse (…) to allow time for reflection, and pausing longer where you see two ellipses (… …), to allow time for developing an idea.

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❝Sit comfortably on your seat with your feet on the floor and hands resting on your lap. Let your body, shoulders and face relax.

Allow yourself to become quiet.Take a few deep breaths to draw in fresh air, and breathe out, letting go of any tension or negative thoughts. With each in-breath, imagine that you are filling up with positive thoughts and feelings… Breathe in positivity, letting it reach up to your scalp, and then breathe out, feeling your whole body relax…

Turn your thoughts towards how you see yourself at present… do you accept yourself as you are? Reflect on this for a moment… … View yourself however you are and begin to accept what you see… You may like to focus on what you value about yourself, your strengths and special skills that perhaps you take for granted… nonetheless, these qualities and skills are special and make you unique. Appreciate these in yourself… value these in yourself, just as they are… …

You may start to notice the peace that lies within you when you are being positive… … Appreciate that the essence of your being is strong and positive… that qualities you value or treasure, lie within… …

How would it be if you could maintain a positive frame of mind about yourself, no matter what was happening…? How would you cope in situations…? How would you see yourself and how would you relate to others… …?

Take a moment to create that image… Now, in your mind, make a list of qualities that relate to this image… … List the qualities you would like to acquire or create anew… Let these take shape… … This is a new you.

Allow this image of your more content self to become clearer… spend some moments being this… experience it fully… …

Finally, when you are ready, turn your thoughts back to your breathing, the sense of calm and peace in your body, back to where you are sitting, comfor table and relaxed. Return your awareness to the room.❞

Lunch break

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Module 3|Positivity

Session II: Positive interaction at work

Exercise 3.6

Learning outcomes

Materials

Facilitating the exercise

Appreciating others at work

Process:

Appreciation

35 minutes
At the end of this exercise participants should be able to:

✔ understand the value of appreciating others
✔ create positive, appreciative statements about others.

G Values cards (see Part 5: Additional Resources) G Handout 3.6 Appreciating others
G Worksheet 3.6 Appreciating others at work
G Cards or pieces of paper and pens

G Pinboard or other surface to attach cards to
Part A: Rules for appreciating others (10 minutes)

Distribute Handout 3.6 Appreciating others and allow everyone to read it through, asking participants to pay attention to the four rules on giving real recognition.You may wish to go through this briefly, inviting or offering examples and reminding participants to beware of ‘spoilers’.

Allow 10 minutes before moving on to the next part of the exercise.

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Part B: Appreciating others in practice (10 minutes)

. 1 Distribute Worksheet 3.6 Appreciating others at work
and ask participants to form pairs.

. 2 Run through the task described on the worksheet and ask participants to work on it in their pairs.
Allow 10 minutes before moving on to the next part of the exercise.

Part C: Appreciating each other (10 minutes)
There are two variations at this point, depending on group size

and whether the group members know each other.

. 1 Ensure everyone has a card or piece of paper. Form groups of up to 8 people.

. 2 (a) If it is a work team who know each other, lead this part of the exercise as follows:

❝Write your own name at the very bottom of your piece of card or paper. Pass the card to the person on your left and accept a card from your right.

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Write an appreciation of the person named on the card.Write it at the top of the card and fold it so the words are not visible. Each person in turn will write and fold again, so a fan or concertina is created!

Now pass the card to the person on your left and accept a card from your right. Write an appreciation at the top, fold the card and pass it to the person on your left as before. Continue until you have your named card back.

Read your card slowly to yourself and accept the gifts it contains.❞

Allow up to 10 minutes before moving into feedback.

(b) This next version of the exercise can be used for teams, irrespective of whether group members know each other well or not. Spread out the values cards on the floor and lead the exercise as follows:

Feedback 5 minutes

❝Please write your name clearly at the bottom of your card on one side (Side A) and in the middle of your card on the other side (Side B).You will be writing an appreciation on the cards of some of the people in this room. Put your card in the centre of the group, Side B showing, and sit down.

Now choose a card at random from the pile.Write an appreciation at the top of Side A (one sentence or phrase only), by using either your knowledge of, or your intuition about, this person, or by picking a values card.

Fold down the top so your words do not show. Pass this card to the person on your left and repeat this up to six times. If you get your own card, you may wish to swap with someone. Place all the cards back in the centre and find your own. Read your card slowly to yourself and accept the gifts it contains.❞

Allow up to 10 minutes before moving into feedback.

1 If there is time, briefly discuss the benefits of using appreciation in the workplace.

2 You may wish to ask everyone to display their cards on a pin board so that everyone can read the types of appreciation being expressed.

3 Invite people to share anything they feel touched by.

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Exercise 3.7

Learning outcome

Materials

Facilitating the exercise

S.O.S. – a visualisation

Process:

Visualisation

25 minutes
At the end of this exercise participants should be able to:

✔

G G

1 2

use the S.O.S. technique to stand back and observe negative thoughts and steer thinking towards the positive.

CD track no. 8 S.O.S. (or relaxing background music) CD player/tape recorder (optional)

Explain the technique of ‘S.O.S.’, drawing on the Background Reading paper.

Explain to participants that this is a visualisation exercise. Invite them to sit upright in a comfortable position, with feet on the floor and hands held loosely in their laps.

Play the CD track no. 8 S.O.S. or read the following in a clear, gentle voice, pausing where you see this sign (…) to allow an opportunity for reflection. If you are reading aloud, you may wish to play background music.

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❝Sit comfortably and relax. Let your body relax… let your breathing become easy… and your thoughts quiet…

Now, think of a difficult or unresolved situation in your working life at present. Picture that scene as though from a distance… Observe the scene from a safe place as if looking at it on a screen… you are an observer looking on… … (pause for 20 seconds).

Ask yourself: What is the interaction like…? What thoughts and feelings are being experienced and exchanged…? What is each person’s body language …? What is the expression on your face…? What is the atmosphere…? What effect is it having on your body…? What effect does it have on others around you…? What is the outcome…?

Be silent for a minute and allow yourself to be calm and return to a positive inner space. Imagine what value or quality you would like to bring to that situation.

Put this quality into your mind… really hold it and tune into it… See that quality, sense it, hear it and touch it… Imagine that quality is going into your whole being, into your muscles, your face, your shoulders, your chest, your back, your skin, your jaw… in fact, into your whole being…

Now, having taken time to create new thoughts, picture another screen close to you, in front of the previous one. Play that same scene again, but with your chosen qualities in action. Can you see your positive qualities or values affecting that situation or interaction…? Reflect on this for a few moments….

What is the interaction like now…? What are your thoughts or feelings…? What is your body language… the expression on your face…? What is the effect on your body…? How do you feel…? What is the atmosphere like…? What is the effect on others…? What is the outcome now…?

What other positive qualities are you able to use in that situation or interaction…?

As you reflect on the difference, what did you let go of…? What have you added …?

Now, slowly allow yourself to become aware of the room, take a few deep breaths and have a stretch if you wish.❞

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Feedback 10 minutes

Helpful hints

Z 5 minutes Break

Bring the group together for discussion to consider any points arising from the exercise.

Remind participants of the ‘STOP’ technique for repetitive, negative thoughts, especially if they are involved in very emotionally charged situations (see Background Reading paper).

Movement exercise

15 minutes

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Exercise 3.8

Being positive at work

Process:

Play

40 minutes
At the end of this exercise participants should be able to:

✔ recognise the benefits of being positive at work. G Worksheet 3.8 Being positive at work

G Pre-prepared flipchart with three headings (allowing space to write a list under each):

a) Your health and effectiveness at work
b) Your relationships with patients/clients
c) Your relationships with colleagues/your team

G Flipchart and marker pens
1 Ask people to from groups of between 4 and 6 people, and

distribute Worksheet 3.8 Being positive at work.

2 Explain that each group will think of a particular difficult situation (step 1), act it out amongst themselves (step 2) then re-enact it in a positive way (step 3), introducing some of the ideas and techniques for positive thinking and appreciation they have explored during the session.

Allow up to 25 minutes for this exercise, prompting the groups to move through the three steps of the exercise as necessary.

Learning outcome

Materials

Facilitating the exercise

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Feedback 15 minutes

Gather everyone back and ask each group to briefly feed back on the situation they chose and how they brought positivity into it.What effects did they experience?

Broaden out the discussion by inviting comments and comparisons on what positivity at work (being positive) means to different individuals.

Using your pre-prepared flipchart, share and consider the benefits or gains of being positive at work in each of the three areas, making a list under each heading.

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Session Review

10 minutes Guidance notes

Briefly review the session by displaying the session aims, learning outcomes and session programme. Remind participants of the activities they have undertaken.

Pick out any highlights, referring to materials that participants have produced and which you have displayed.

Hand out the Background Reading paper for participants to take away, pointing out any references and resources for this module, should they wish to explore the theme in more depth.

See Part 2: Guidance for Facilitators for further guidance.

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Action Planning

See Part 2: Guidance for Facilitators and Part 5: Additional Resources for information and guidance on action planning. Below is a suggested short action planning exercise which could be incorporated into this session.

Exercise 3.9

Materials

Facilitating the exercise

Thoughts into action 30 minutes

G Flipchart from Exercise 3.3 Surfacing positive thoughts G Paper and pens

1 Draw on the list of positive thoughts and beliefs the group generated in Exercise 3.3 Surfacing positive thoughts.

2 Invite each participant to choose one positive thought or belief they would like to adopt for the coming week ahead. It should be linked to a situation where changing their thinking could make a difference.

2 Ask them to write the situation and the thought or belief on a sheet of paper and to share them with a partner.

Allow 15 minutes

4 Invite each pair to discuss ways in which they could introduce some of the ideas and techniques into their work situation.

Allow 15 minutes
The last part of this exercise could be done in work teams.

Helpful hints

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Evaluation

10 minutes

Materials

G Copies of evaluation pro forma (if being used) G Pens

Guidance notes

Run though your planned evaluation activity (see Part 2: Guidance for Facilitators and Part 5:Additional Resources for information and guidance on evaluation).

As an alternative or additional activity, you may also want to give out a more formal evaluation form at this point for participants to complete now or return by a given date.

Remember to plan in some time as soon as possible after the session to complete your own evaluation of how you think the session went.

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Closure

Exercise 3.10

Learning outcomes

Materials

Appreciating the self and others

Process:

Appreciation

10 minutes
At the end of this exercise participants should be able to:

✔ accept and identify positive qualities in the self ✔ affirm positive qualities in others.

G Coloured paper (A5) or cards
G Pens
G A hat or dish to hold the cards
G CD player/tape recorder and background music (optional)

Distribute pieces of coloured paper or card, so each person has two. Inform them that they will give a gift to each other and to themselves.

You may wish to play some music during this closing exercise.

Facilitating the exercise

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Part A: Sharing affirmations (5 minutes) 1 Invite participants to do the following:

❝On one piece of card write a positive affirmation that you would like to give as a special gift to another person. It can be written in the form of, ‘You are special because…’ or, ‘You have the qualities of…’. You may like to think of someone who inspires you to help you with ideas, if you wish.❞

2 Collect the cards, folded up, into a dish or hat; mix them up and then ask each participant to pick one out at random.

❝This is a special gift for you to reflect on and absorb.Take it away in the awareness that this is something you already have within you.❞

Part B:Affirmations for the self (5 minutes) Invite participants to do the following:

❝On your second card write 5 positive affirmations or statements about yourself, starting, ‘I love/like myself because…’. Be sincere with yourself and be positive. This is your gift to yourself, an affirmation of your own ability to appreciate.❞

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Follow-on/homework Exercise 3.11

Learning outcomes

Materials

Re-cycling thoughts

Process:

Listening

30 minutes
At the end of this exercise participants should be able to:

✔ identify negative cycles of thinking
✔ change negative into positive cycles of thinking.

G Worksheet 3.11 Re-cycling thoughts

1 Briefly explain the concept of negative cycles of thinking and the problems associated with this, drawing on the Background Reading paper.

2 Ask participants to get into pairs, and give out Worksheet 3.11: Re-cycling thoughts. Introduce the exercise as follows:

❝First, on your own, write down a cycle of negative thinking with which you are familiar. It is useful if this is a cycle that you recognise in yourself, even if it is occasional.Then jot down as many positive thoughts as you can that may help to counteract the negative cycle.❞

Allow 5 minutes.

Facilitating the exercise

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Feedback 10 minutes

Helpful hints

3 Ask participants to work in their pairs as follows:

❝Share your negative cycle of thinking with your partner, and any positive thoughts you have come up with.Work together with the positive thoughts to create cycles of positive thinking that may be helpful to either of you. By the end of the session you will each have a positive cycle of thought to turn to.❞

Allow 15 minutes.

Invite pairs to feed back on how effective they were in working together on solutions, and to give an example of a cycle of positive thought they created.

This is a co-operative task that requires listening. Often participants find they can help each other despite finding their own cycle difficult to move out of. It may be that partners come up with one positive cycle that both can utilise equally well.

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Exercise 3.12

Learning outcome

Materials

Facilitating the exercise

Tuning into positive thoughts

Process:

Meditation

20 minutes
At the end of this exercise participants should be able to:

✔ practise a meditation exercise which will help them to experience the benefits of positive thinking and further develop their capacity for positivity.

G CD track no. 9 Tuning into positive thoughts (or relaxing background music)

G CD player/tape recorder (optional) 1 Introduce the exercise as follows:

❝To be creative and to consolidate new ideas, we must often first become silent. In this exercise we will do this. A guided meditation can help us tune into our inner positivity, even when we are stuck in a negative cycle of feelings about the self. The following exercise has been devised with this context in mind. Note down any ideas, thoughts or inspirations that arise as you follow this exercise.❞

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Play the CD track no. 9 Tuning into positive thoughts or read the following text in a clear, gentle voice, pausing at ellipses (…).You may wish to play background music if you are reading aloud.

Feedback

Helpful hints

❝Sit comfortably with your feet on the floor, and hands, shoulders and face relaxed. Allow yourself to become quiet and take a few deep breaths to draw in fresh air… Breathe out, letting go of any tensions. With each in-breath, imagine that you are filling up with positive thoughts and feelings… Breathe in positivity, letting it reach up to your scalp, and breathe out, feeling your whole body relax and all tension draining away…

Breathe naturally… observe your breathing as you breathe in and observe it as you breathe out. Let your breathing settle down and become deeper… perhaps there are thoughts whirling around… …

Take your mind back to the image of a relaxed and positive you that you created in an earlier meditation… this image reflects what you can be when tapping into your inner strength… it reflects your inner self, and you may like to stay with that image or create a new one…

Sitting in silence… let a thought about being content come
into your mind… it may be a thought about what being satisfied and content means to you… be content for a moment… … (pause for 8 seconds).

You can feel your inner calm and tranquillity start to resurface… you experience how different it is to shift from one mind-set to a more soothing and contented mind-set… … (pause for 10 seconds).

So you stay with this soothing, comforting thought… … perhaps in your mind’s eye you can stay there for a longer time and really start to absorb this change… Soak in the calm… or the thought or image that evokes peace and contentment in you… stay there… … (pause for 8 seconds).

When you are ready, turn your thoughts back to the calm of your breathing… return to observing your breath… become aware of your body and your chair… and your surroundings.❞

Ask for comments from the group.Allow about 5–10 minutes for their feedback.

Encourage participants to do something similar when they feel stressed at home, and also perhaps in the workplace as a team.

With practice, this type of meditation can be very effective in shifting negativity from the mind, and only takes a few minutes.

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Worksheet 3.1

The impact of being positive

On your own, consider what are the gains or benefits of being positive, on:

a) Your body or physical health?

b) Your mind or mental health?

c) Your relationships or social health?

d) Your spirit, faith or belief system?

In pairs, consider the benefits or gains of being positive.

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Worksheet 3.2

Valuing the self

Identify your positive qualities and thoughts by answering the questions on this sheet. Be spontaneous and jot down any thoughts which arise, rather than spending too long considering your response:

What qualities have I shown today while talking with others?

What positive thoughts have I had about others?

What positive thoughts have I had about myself?

What have I done well today?

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Worksheet 3.3

Surfacing positive thoughts

List some positive thoughts and beliefs which come to mind in each of these areas:

1 Self

2 Others

3 A current situation

4 Anticipation of a difficult situation

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Handout 3.6

Appreciating others

When children are learning to walk, write, or ride a bike, we encourage them with physical support, smiles and helpful words. We know almost instinctively that they will respond to praise, and so learn more quickly. It seems so easy and natural that we do not even need to think about it. Adults are learning all the time too, yet with them it is different. Praise is rationed and criticism is the order of the day. The result is that there is little motivation to change. Somehow we have lost the ability to give praise, and may even feel embarrassed about it.

There are four simple rules when appreciating others:

G be sincere
G be specific
G identify the quality G beware of ‘spoilers’

Be sincere

It is not just a matter of choosing the right words of encouragement; we have to be genuine in what we say. We all intuitively know what feelings really lie behind what is said, so when giving praise we really have to mean it – that means being positive about ourselves and looking for the positive in others so our comments come naturally. Respect for others is also shown through friendly gestures and maintaining good eye contact – these aspects of our body language are a physical demonstration of our sincerity and commitment to what we are saying.

Be specific

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Handout 3.6 (continued)

Appreciating others

If you wish to encourage a student, choose something specific. For example, for a nurse laying out an instrument trolley, you might say, ‘That’s very helpful, you have assembled everything in the right order’. S/he can look at what s/he has done and see that the observation is true. Similarly, with patients, a physiotherapist could say, ‘That’s great. You really remembered to look ahead when using the walking frame’.

Identify the quality

If you can identify the quality that someone is demonstrating by their positive behaviour it gives the praise a depth and builds on a person’s self-respect. A senior ward sister said to a nurse in training, ‘You washed that patient efficiently, and with such kindness and gentleness’. That comment has stayed with the nurse through all her working years. As a result, she tries to bring kindness and gentle- ness into all her work. She identified these qualities as part of her personality and her practice, and consequently is more aware about living them in practice. Praise is a very powerful tool and a wonderful gift we can give to others.

Beware of spoilers!

A surgeon says to a junior, ‘You’ve stitched up that wound very neatly… why can’t you do that more often?’

A staff nurse says to an auxiliary, ‘You concentrated and finished your work quickly. Well done. If you’d only do that all the time, it wouldn’t be such a hassle every day.’

In each case, the comment starts out well but then turns to reproach, and refers to, reminds the person of, and therefore reinforces, past negative behaviours – consequently, the praise isn’t effective and the positive feelings usually diminish quickly.

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Worksheet 3.6

Appreciating

others at work

With a partner, practise giving appreciation. Discuss together and write down a few ways you can be more appreciative of others in 3 or 4 work situations. The ‘others’ might include a patient, a student or supervisee, a colleague, an administrative assistant etc.

Using the guidelines in Handout 3.6, write down some specific things you might say to be appreciative of them.

Remember to:

G be sincere
G be specific
G identify the quality G beware of ‘spoilers’.

At the end of your discussion, make one commitment to be more appreciative that you can apply at work or at home:

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Worksheet 3.8

Being positive at work

. 1 Think of a difficult situation for one of the themes below.

. 2 Act out the difficult situation in the group in some way, eg as a mime or
play, with one person directing the roles people have to play.

. 3 Now repeat the same situation in a positive way.

The themes

. a Your health and effectiveness at work

. b Your relationships with patients/clients

. c Your relationships with colleagues/your team

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Worksheet 3.11

Re-cycling thoughts

Positive words

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Cycle of negative thinking

Cycle of positive thinking

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Background Reading

Why Compassion?

Competence and compassion are the two most important aspects of good healthcare. We would contend that compassion needs to be valued at least as much as competence in our work and in education.

Much of what we do can leave us physically, psychologically and spiritually exhausted. We are expected to and want to be compassionate, yet the cumulative exposure to patients at times of crisis in their lives can take its toll on our own well-being, leading to burnout.

Purpose of module

There are many reasons why we find it difficult to be compassionate in our job; often there is not enough time to respond to competing demands, we have to concentrate on our tasks, we feel too exhausted physically, mentally and emotionally to give any more. Then there are the negative feelings that block out compassion. Being clear about what we mean by compassion can help us to understand how it can be an integral part of our work. This will help us to be caring in our work, without suffering compassion fatigue and burnout.

Introduction to the Compassion module

This session explores some of the challenges involved in putting compassion into practice. At the beginning of the module we clarify for ourselves what we mean by compassion, exploring compassion in others and ourselves. One of the main tools to help us develop and practise compassion is listening in a special way and at a deep level. By doing so, we can learn to be compassionate without suffering ourselves. Indeed, we can feel that we are giving without becoming depleted.

Our own negative feelings, such as anger and guilt, can prevent us showing our compassion. By understanding those feelings and how they affect us, we can release them and allow ourselves to be more compassionate. Compassion can be likened to the sun; it is always there but sometimes it cannot shine through because of the clouds. The clouds are the negativity that obscures our true nature of compassion.

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Themes of Exercises

Compassion in action (4.1)

Most people can remember a compassionate act. It may be an everyday situation or something that stands out as very special. Examples may be sitting holding the hand of a distressed patient, or simply smiling and being positive. Reflecting on such acts helps us to identify the qualities of compassion that a person may express, such as patience, tolerance, generosity and calmness. By thinking about acts of compassion and the people that perform them, we can begin to get a sense of what compassion means and, with further reflection, how we have shown these same qualities ourselves.

The word ‘compassion’ (4.2)

We all use words in different ways to describe how we feel and what we mean, and the meaning can change in different settings. We need to come to some understanding of the word ‘compassion’, redefining it for ourselves. Compassion is a value that is central to all healthcare. It can mean simply kindness; it can mean patience, generosity, respect and understanding. It is unconditional love.

Yet as healthcare professionals, how do we maintain being compassionate in our daily work without feeling run down ourselves? When we try to describe compassion in the healthcare setting, it is worth looking at the words sympathy and empathy as this may help us understand how we can be caring without being left exhausted.

Showing sympathy towards another person’s suffering is acknowledging their suffering, for example, ‘I am sorry that you have broken your arm’. We recognise that they are injured or ill without really engaging at a feeling level.

Empathy is when we literally share a feeling with someone, we ‘walk in their shoes’, for example, ‘I feel really upset that you are so depressed about losing your job’. This can bring great comfort to the person we are empathising with, but the comfort to them can be at our expense and leave us feeling drained. If we identify too closely with them, it can also make it difficult for us to help them.

An expansion of empathy is a word called interpathy where we relate to another’s suffering although we may not understand why they are suffering. This may be because they are from a different culture or because their feelings may seem inappropriate given the situation, but we are curious, we try to understand. In doing so we reach a point of contact that is therapeutic in itself.

Compassion is all these words – sympathy, empathy, interpathy – yet it is more
and it is less. We acknowledge a patient’s illness, we sense how they feel, we try to understand how it affects them, yet with compassion we do not become emotionally

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involved. We are engaged yet detached. We are standing back and looking on with kindness. By showing compassion in this way in the healthcare setting, it allows us to be compassionate without suffering from ‘compassion fatigue’ or ‘burnout’. We learn to do this by developing the skill of ‘compassionate listening’.

Compassion is the non-judgmental and unconditional aspect of love, which has been described in the following way:

‘Love is not simply a desire, a passion, an intense feeling for one person or object, but a consciousness, which is simultaneously selfless and self-fulfilling. Love can be for one’s country, for a cherished aim, for truth, for justice, for ethics, for people, for nature, for service, and for God. Love flows from truth that is, wisdom. Love based on wisdom is real love, not blind love; and to discover the secrets of love is to watch the secrets of life unfold.

‘The basis of real love between people is spiritual. To see another as a spiritual being, a soul, is to see the spiritual reality of the other. To be conscious of that reality is to have spiritual love: each person, complete within, independent yet totally interconnected, recognizes that state in the other.’

Living Values: A Guidebook (1995) London: Brahma Kumaris World Spiritual University.

Compassionate sound (4.3)

Although being compassionate is acting with kindness towards others, we need to remember to be compassionate towards ourselves – not to judge too harshly, to be forgiving, patient and kind towards ourselves. We need to remember to accept compassion openly when it is offered to us.

It can be important to remember that the main way we express compassion is through our voice, not just the words but the way we say them. The tone we use in our voice creates a receptive space for others, but also an inner atmosphere for ourselves.

Meditation on compassion (4.4)

To really understand compassion, we have to experience it for ourselves. We can observe and admire others; we can even acknowledge that we have behaved compassionately on some occasions, but how do we develop our compassion? If we can find a place of inner silence where we can slow down our thoughts and touch our deepest nature, we will discover that it is peaceful and compassionate. This is the source of our compassion and the more we experience it the more it will become part of our actions. Meditation reminds us that we are compassionate at our core, and brightens the light that is shining through the dark clouds.

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Compassionate listening (4.5)

The spiritual tool of listening emphasises three aspects: being peaceful, being attentive, and listening with our heart. Compassionate listening is when, besides being peaceful and attentive, we can listen with our heart, we can feel open, generous and loving.

Yet compassionate listening also means that we are detached emotionally whilst keeping that spiritual connection. When we talk about being detached, we are not talking about being cold, uncaring or uninvolved. Detachment in this context must be based on love and understanding. It is often crucial to ‘stand back’ from a situation in order to view it objectively and constructively, and therefore be better able to support people. To be detached is not to be disengaged.

To develop the skill of compassionate listening is first to focus on our own inner stillness. With practice – through breathing exercises or meditation – this is something we can become proficient at quite quickly.

The next step is to expand our awareness to a space of infinite peacefulness. Some use the idea that we are each of us like a point of light and this greater awareness
is like an ocean of light. The ocean of light can be a source of peace, calm and compassion, which we can first use to replenish ourselves and then direct to our patients. This feeling or vibration of compassion passes through us rather than coming from us. This is the key to compassionate listening and is the way to prevent ourselves from feeling drained.

In a healthcare setting, compassionate listening is not intended to elicit a medical history; it is about allowing the person the conditions to tell their story in their own way and feel understood. It is like listening to a child, where you pay attention to their concerns with a loving understanding that supports them as an individual. Remember, with this type of listening, we are not analysing what the person is saying to make some type of assessment but just being alongside them.

Understanding anger (4.6)

To a greater or lesser degree, we have all experienced anger in our everyday lives. In that sense, anger is very normal and natural. However, experiencing feelings of anger generally has a negative effect, whether we express it as rage, which can be destructive, or hold it back as resentment, which can leave us feeling regret and shame. In some circumstances, anger can be helpful to raise us out of apathy into action; however, more often it results in unhappiness in others and ourselves.

Also, have you noticed that anger in one person will often provoke an angry reaction in another? This then perpetuates rather than solves the problem. Indeed, it often makes it worse. Put simply, being angry is an unskilful way to communicate.

Asking ourselves how we experience anger and how we express it is a useful way of beginning to ‘own’ it. We can then consider more skilful and appropriate ways to burn off the heat of anger, such as:

G taking exercise – running, playing sport or dancing

G talking to a friend and sharing the problem

G using reflection as something we can do on our own to release our feelings – writing our feelings down or doing something creative to express them in a more positive way.

Breathing out anger (4.7)

The key to dealing with anger is that we acknowledge that the feeling we are experiencing is our anger and not caused by someone else. This may sound simple, but when we are angry we are all too ready to blame something or someone – someone else makes us angry. Yet we are the ones experiencing our anger and we have the choice to change how we feel. Through habit, we may react to situations in an angry way, but habits are not something we are born with, and we have the power to change them.

Someone else may have provoked our anger, but ultimately it is something we have to deal with ourselves. By recognising that we are responsible for our own anger, we can decide to let it go. This can be done when we are inwardly calm and can reflect on the anger and let it go. Breathing practice can help us in this process.

Standing like a tree (4.8)

When we are angry we a full of energy; wanting to move about, charged up emo- tionally and with our mind racing. Standing completely still is the opposite. This is something we can do ourselves when we are angry or when someone else is angry; it involves thinking of the opposite quality to anger, such as calm and peacefulness. We can then bring that experience into ourselves and we can watch the anger dissipate.

Mistakes (4.9)

Most people in our profession are motivated by the desire to care. None of us intends to make mistakes or to deal with things badly, and we are disappointed with ourselves when we do. Taking time to reflect on our practice, and our mistakes, is an important tool in improving the care and support we can provide. But unfortunately, we are often left with feelings of guilt instead of a more constructive reflection, and this can make us dwell on the problem and prevent us from moving on in a positive way.

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Cliché as it is, it is a fundamental inevitability that ‘we all make mistakes’. What distinguishes between us is how we respond to those mistakes. Our responses to our own mistakes vary. One response is to try and lay the blame somewhere else – on another individual or on ‘the system’. Another response is to feel ashamed, with a desire for self- or another’s punishment. It is important to identify these feelings so they can be released; then we can focus on our own, more positive qualities. This enables us to express genuine remorse, and move on to reflection and learning from the situation.

At an organisational level, it is often a series of small, practical mistakes and erroneous attitudes that lead, ultimately, to a significant mistake being made by one individual. As a result, many managers now encourage their employees to report mistakes in the knowledge that there will be no blame attached. This no-blame attitude means that mistakes are readily reported and can be corrected quickly. This helps to ensure the future safety of patients and is good for staff morale.

Forgiveness (4.10)

Forgiveness is the means of releasing the feelings of guilt that can prevent an individual expressing their true, peaceful, compassionate nature. It is not a matter of pardoning others or forgetting the lessons learned. First, one needs the motivation to forgive; that is reached through being aware of the burden of carrying feelings that only lead to unhappiness. It is an act of will to let go of all the negative feelings and remember our inner virtues. When we are calm and have a detached attitude, as in meditation, we can reflect on situations and help to release negative attitudes at a deep level.

Walking into happiness (4.11)

We all wish to be happy, and often think of things that may make us happy. But what does it feel like to be happy? Happiness is not just an idea in our minds but is a feeling in our body. Certainly, when feeling completely happy, there is no room to have negative attitudes and these need to be released or let go of. A simple and quick method is to remember these negative feelings and, using our imagination, to let them go. Similarly, we can use our imagination to create a sense of happiness. This can be done by using a sense of space to hold these feelings, and moving from one to the next, stepping from anger and guilt to compassion and happiness.

Positive plans (4.12)

The module introduces a number of techniques which people can use in their everyday lives to release negative feelings and to surface the positive qualities of compassion, for example, Meditation on compassion, Compassionate listening,

Breathing out anger, Standing like a tree, Forgiveness. It is important to build in an opportunity to reflect on which techniques might make a positive difference to our reactions and to the reactions of others in real-life situations. We can also work together to identify a future, difficult situation and plan ways of approaching it in a positive way, using the insights gained from the session.

Compassionate gifts (4.13)

Being compassionate towards ourselves can be very difficult, especially for healthcare practitioners who feel they should provide all the compassion for others. Yet we can only be compassionate towards others if we practise the same compassion towards ourselves. This means nourishing ourselves at all levels – physical, mental and spiritual. Thinking of ourselves, not in a selfish way, but by being in the best of health, we can then serve others. And it is important for us to learn to accept compassion from others, as this will also replenish us.

Yes–No game (4.14)

Anger can develop a lot of energy but it often goes nowhere or causes further problems. A way to illustrate this is to get two lines of people to stand opposite each other and one line shout ‘Yes’ and the other ‘No’. It can generate a lot of energy but it clearly doesn’t solve anything! It often ends up in a shouting match and eventually people run out of energy. However, this game does illustrate how easy it is to get in touch with anger and provides people with an opportunity to experience various feelings around anger.

Changing situations (4.15)

We are players in an unscripted drama and are bound to make mistakes – our own personal reactions to situations may contribute to making them worse. If we see this as an essential part of learning, we can make corrections to prevent those same mistakes from happening again. This can be done at a very practical level by recounting the situation and looking at alternative scenarios. We can also become aware that others sometimes act out of their own pain and problems.

Protection (4.16)

Often, when faced with stress at work or at home, we can feel quite drained. Indeed, we may have noticed how certain individuals or particular situations are draining. We feel as if all our energy has been drawn out of us and it leaves us tired and exhausted. Although this sort of energy cannot be measured in the scientific sense,

it has a certain reality in our minds. And that gives us the key to prevention – using the power of imagery to stop us feeling drained. We can imagine that we are encased

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in a sphere of golden light and that nothing can penetrate the sphere, so any negative feelings or energies cannot affect us. In a detached way we can view what is happening and can act appropriately, but we are not touched by the stress. It may seem fanciful, but experiment and see if you benefit. This method of using your imagination to create protective shields can be used at any time, such as going into a stressful situation, and before or during seeing a patient.

2 The Facilitator’s Guide to Module 4 Session I: Finding compassion

Aims

G To gain an understanding of compassion as a quality in healthcare G To experience an inner compassion
G To practise compassionate listening

Process

This session looks at the quality of ‘compassion’ in depth, and at how we recognise compassion in others and ourselves. It begins with describing the qualities of a compassionate person, followed by a playful word exercise to help to understand compassion and how people relate to it. This understanding is deepened through a breathing and movement exercise and a meditation. After the break, time is spent practising and exploring the key skill of compassionate listening.

Session II: Compassion in practice

Aims

G To explore personal expressions of anger and its effect on feelings

G To release anger and reconnect with compassion

G To understand personal responses to making mistakes and to practise forgiveness

G To find ways of changing difficult situations through bringing compassion into practice

Process

This session explores some of the challenges of putting compassion into practice, in particular dealing with negative feelings of anger and guilt. In the first part of the session, participants explore their own anger and experience a meditation to release anger and connect with compassion. A useful breathing and movement exercise leads into a sharing of the feelings around making a mistake, followed by a powerful meditation on self-forgiveness. A final group exercise encourages participants to look at ways of transforming difficult situations, by changing their personal responses and bringing compassion into practice.

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Programme/plan for Module 4 Compassion

Introduction 30 minutes SESSION I Finding compassion

Exercise 4.1 Compassion in action 30 minutes

Exercise 4.2 The word ‘compassion’ 30 minutes

Movement exercise

Exercise 4.3 Compassionate sound 10 minutes

Break 20 minutes

Exercise 4.4 Meditation on compassion 15 minutes

Exercise 4.5

Lunch break

SESSION II

Exercise 4.6

Compassionate listening 60 minutes

Compassion in practice

Understanding anger 30 minutes

Exercise 4.7 Breathing out anger 10 minutes

Exercise 4.8 Standing like a tree 10 minutes

Exercise 4.9 Mistakes 35 minutes

Exercise 4.10 Forgiveness 10 minutes

Exercise 4.11 Walking into happiness 10 minutes

Break 15 minutes

Session review 10 minutes

Action planning

Exercise 4.12 Positive plans 30 minutes

Evaluation 10 minutes

Closure

Exercise 4.13 Compassionate gifts 10 minutes

Total time 6 hours 15 mins

Follow-on/homework

Exercise 4.14 Yes–no game 10 minutes

Exercise 4.15 Changing situations 60 minutes

Exercise 4.16 Protection 10 minutes

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Materials

G Pens and paper
G Flipchart and marker pens
G CD player/tape recorder (optional)

Session I

G Worksheet 4.2 Compassion ‘scrabble’
G Worksheet 4.5 Compassionate listening
G CD track no. 10 Meditation on compassion*

Session II

G Worksheet 4.6 Understanding anger G Worksheet 4.9 Mistakes
G CD track no. 11 Breathing out anger* G CD track no. 12 Standing like a tree* G CD track no. 13 Forgiveness*

G Small cards (one per participant) Follow-on/ homework

G Worksheet 4.15 Changing situations *or relaxing background music

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Preparation

. 2 Familiarise yourself with the main learning tools which are being used in the session, in particular, listening (see Part 4: Spiritual Tools).

. 3 Read through the session guidelines and look at the suggested session programme which will incorporate:

G Session introduction G Exercises
G Movement breaks
G Breaks

G Session review G Action planning G Evaluation
G Closure

4 Photocopy any handouts and exercise sheets, and make sure that you have any other equipment listed under Materials.

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Introducing the Module

30 minutes
Run through your planned introductory session which may include:

Quiet time
Introductions/optional warm-up exercise Overview of session
G Theme of session
G Aims and learning outcomes
G Programme/plan for the session
G Practical considerations
G Any questions

Setting the tone

G Ground rules/principles G Participants’ expectations

Review of last session/homework

See Part 2: Guidance for Facilitators for further guidance on introducing the session.

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The Exercises

Session I: Finding compassion Exercise 4.1

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Learning outcome

Materials

Facilitating the exercise

Compassion in action

Process:

Reflection

30 minutes
At the end of this exercise participants should be able to:

✔ describe the qualities of a compassionate person. G Paper and pens

G Flipchart and marker pens

This exercise is in two parts.

Part A: A compassionate person (10 minutes)

1 Ask participants to form small groups of three. Introduce this first part of the exercise as follows:

❝Spend 10 minutes discussing the following:
Give an example of a compassionate person – a colleague, or

someone you admire.They can be a living or a historical figure. Can you give some examples of the sort of things they may

have done? What qualities do/did they demonstrate?❞ Allow 10 minutes before moving into feedback.

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Feedback 5 minutes

On the left side of a piece of flipchart paper, list the names of the compassionate people that each small group has chosen; list one or two of their qualities on the right side of the paper.

Ask for some examples of situations in which these people have acted with compassion.

Part B: Personal qualities (10 minutes)
1 Introduce the second part of the exercise as follows: ❝Again, get into your groups.

On your own, think of a time when you feel you acted with compassion. Identify the particular qualities that you showed. Share your thoughts with the group.❞

Allow 2–3 minutes for individual thought, and the rest of the time for sharing.

Invite participants to feed back the qualities which came up in their sharing, listing them on a flipchart. Compare this with the list generated in Part A.

Feedback 5 minutes

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Exercise 4.2

The word ‘compassion’

Process:

Play

30 minutes
At the end of this exercise participants should be able to:

✔ understand the word ‘compassion’ and how we relate to it. G Worksheet 4.2 Compassion ‘scrabble’

G Flipchart and marker pens

1 Distribute Worksheet 4.2 Compassion ‘scrabble’ and introduce the exercise as follows:

❝This exercise is about redefining compassion for ourselves. One way is to think of the various meanings and words associated with ‘compassion’ and build connections as though playing the game of Scrabble.

On your own, look at the worksheet and use the letters of ‘compassion’ to add other words associated with compassion, working horizontally and vertically, as in the game of Scrabble. A tip is to write down some of the words in the space at the foot of the page then try to get them to fit.

If you wish, we can add up your scores and see who gets the best score, but it is more about finding as many words as you can.❞

Allow up to 10 minutes.

2 Ask participants to form groups of three or four people and to do the following:

❝In your small group, briefly share your responses and choose up to ten words that you all feel best describe compassion.❞

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Learning outcome

Materials

Facilitating the exercise

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Feedback 10 minutes

Allow 10 minutes then ask the groups quickly to decide on their ‘top three’ words, before reconvening.

Ask each group to choose one person to feed back three of the words they felt were most important in defining ‘compassion’. Make a list on the flipchart and display it during the rest of the session.

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Learning outcome

Facilitating the exercise

Movement exercise 4.3

Compassionate sound

10 minutes
At the end of this exercise participants should be able to:

✔ further experience their own inner compassion.
1 Ask participants to stand in pairs or as a large circle.

2 Lead the exercise as follows, pausing at ellipses (…) to allow participants to follow you:

❝Feel your feet ‘rooted’ deep into the ground… Place both hands on your chest towards the left over your heart, one hand on top of the other…

Take a long, slow, enjoyable breath… in and out… deep and slow.

This time, as you breathe out, let the sound ‘Aah’ ride on the breath and feel a sense of giving out compassion from the heart. As you do this, your top hand extends outward in a wide-open gesture of giving.Take as long as it comfortably takes.

With the arm still outstretched take another long enjoyable in-breath… and as you sound ‘Aah’ again, bring your arm slowly back to the heart area… with a sense of bringing compassion home to the self… and receiving all the compassion that the world has to offer.

Be still for a few moments, breathing naturally, and allow this feeling to permeate.

Repeat several times.You can swap hands to breathe out and then breathe in compassion.❞

Allow between 2 and 3 minutes.
Invite feedback from the group along the following lines:

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Feedback 2 minutes

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❝What did it feel like? Which was easier, to give out compassion to others or to bring it home for yourselves?❞

It may be best to demonstrate the exercise first and then allow participants to practise saying ‘Aah’ on one in-breath and again on one out-breath.

The ‘Aah’ sound does not have to be sung, but encourage everyone to make their own audible ‘Aah’ sound of compassion. (‘Aah’ is the vowel that resonates with the heart area and is a sound we make when we feel sympathetic, loving towards, or

Zmoved by someone.) Break

20 minutes

Helpful hints

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Exercise 4.4

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Learning outcome

Materials

Facilitating the exercise

Meditation on compassion

Process:

Meditation

15 minutes
At the end of this exercise participants should be able to:

✔ experience their own inner compassion.
G CD track no. 10 Meditation on compassion (or relaxing

background music)
G CD player/tape recorder (optional)

For this exercise you can play CD track no. 10 Meditation on compassion, or read out the following text accompanied, if you wish, by background music.

1 First, invite participants to sit upright, with hands held loosely in their laps, and feet on the floor. If you are reading the text, speak in a soft, calm voice, pausing at ellipses (…) to allow participants to follow you in a relaxed state.

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❝Sit comfortably and relax. Become aware of your feet on the ground. Feel the connection to the ear th. Allow the muscles of your shoulders and neck to relax… Allow the tension to dissolve and move down into the ground.

Let the muscles of your arms feel calm and relaxed… next your legs… now your face…

Now focus your attention on your breathing… let it find its own calm rhythm… breathe in peace and breathe out any negative feelings… gently breathe in peacefulness and calm.

Allow your mind to slow down… try to watch your thoughts… do not judge them as good or bad… they are just thoughts… acknowledge them and let them go… they are like clouds in the sky that you can watch drifting past. Beyond the clouds is the deep blueness of the sky… feel that deep calm of the blue sky.

Now focus on your own inner calm… that place that is deep within yourself… that is peaceful… where your inner compassion lies… here you are patient… tolerant… generous… understanding… all these qualities are here which make up your own inner compassion. Experience the feeling of compassion… feel it within you… and see it focused as a point… a point of light… (long pause).

Now raise your awareness beyond yourself… to a place of infinite peace… see it first as a small point of light. As you move towards it, it becomes brighter… it is like an ocean of peace… a space of calm, of love, of compassion… you feel connected… part of that ocean of deep peace and love… it surrounds you like a cloak, it fills you up, absorbing every part of you with a comfortable warmth.

Rest in that feeling of being loved… it is like energy… a vibration… a light filling you… until you overflow…. (pause for 8 seconds).

Now, slowly you move away from the ocean – as a point of light. You still have that memory of being loved… and can reconnect at any time you wish…

Gradually become aware of your body. Feel your feet on the ground… … begin to deepen your breathing… and in your own time, open your eyes. When you feel ready, stand up and have a stretch.❞

Allow everyone time to stretch and move around, before progressing on to the next exercise.

Exercise 4.5

Module 4|Compassion

Learning outcomes

Materials

Facilitating the exercise

Compassionate listening

Process:

Listening

60 minutes
At the end of this exercise participants should be able to:

✔ practise the skills of compassionate listening
✔ understand the effects of compassionate listening ✔ experience the giving and receiving of compassion.

G Worksheet 4.5 Compassionate listening
G CD player/tape recorder and background music (optional)

Introduce the theme of compassionate listening, referring to the notes on compassionate listening in Part 4: Spiritual Tools and in the Background Reading. Explain that the exercise is in
two parts.

Part A: Practising compassionate listening (25 minutes)

Most participants will have had some communication skills training and others may have learned and practised specific counselling methods. If so, ask them to ‘set aside’ their previous training and experience, and, instead, focus on the following when in the ‘listener’ role:

G Maintaining an inner stillness and a sense of peacefulness. G Being fully present for the speaker with no interruptions,

including making encouraging noises, facial expressions, etc. G Listening from the heart.

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Feedback 15 minutes

Helpful hints

1 Introduce the exercise as follows:
❝Choose a partner.You are going to practise listening.

This is a sharing exercise so remember that everything said is held in confidence.The feedback session will be general.

Each of you will receive 10 minutes of undivided attention from your partner.

One will be A and the other B.

A has the chance to talk about anything you wish.Think of something about the session so far, or some current issue, or something that has been an issue for you for a long time.

B is to listen and not to interrupt.Try not to prompt. Really try and give your full attention. B must not say anything or make any encouraging noise or facial expressions.❞

2 Play background music, if you wish, and after 10 minutes prompt partners to reverse roles.Allow a further 10 minutes.

3 Distribute Worksheet 4.5 Compassionate listening and ask everyone to make some brief notes on their own about how it felt to be the listener and the speaker, to share during the feedback session.

Allow 5 minutes.
1 Ask for general feedback first.

2 Then invite feedback on what it felt like being the listener, using the prompt questions on the worksheet.

3 Next ask what it felt like being the talker, again referring to the questions on the worksheet.

4 Finally, invite comments on what the quality of compassionate listening felt like. How did the experience differ from other forms of listening that participants may be more familiar with?

Healthcare professionals rarely have an opportunity to share their difficulties at work, eg, professional problems, relationship problems, conflicts between the job and home life.This exercise is to give participants protected time with undivided attention to talk about their problems.

Background music will prevent participants from becoming distracted by others talking.

Giving looks or making sounds of encouragement is considered judgmental – it can prevent a person following their own thoughts that can lead to resolving a problem for themselves.

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Feedback 10 minutes

Helpful hints

Part B: Giving and receiving compassion (10 minutes) Next, invite participants to get into their pairs again and

introduce Part B of the exercise as follows:

❝One person will be giving compassion and the other receiving. This exercise is done in silence.

You can sit next to or opposite your partner, or stand behind with arms on their shoulders or slightly off the shoulders.

If facing your partner you can maintain eye contact or close your eyes. Do what you find you are comfortable with.

Sit in silence and try and direct positive, compassionate thoughts to your partner.

Sitting in silence, the giver, A, generates the compassion and B is the passive recipient. Do not try too hard. Be light and easy about it. If your mind wanders, direct it back to the positive qualities of compassion and see the other person having those qualities.

The person giving compassion holds the feeling of calm and love within themselves and connects to something greater as in the exercise before the break.

The receiver needs to sit calmly and try to be open.❞
Play background music if you wish and prompt the partners to

change roles after 5 minutes.

Participants may wish to discuss their experience as before in Part A.

Invite everyone to consider what they have learned from both parts of the exercise and how this learning might benefit their professional practice. Note down any ideas to return to in the action planning stage of the session.

This type of sitting with someone in silence and directing positive thoughts and feelings through yourself is essentially what spiritual healers do when giving healing by laying on of hands.They usually do it in silence, but it can also be done when someone is talking.

Module 4|Compassion

YThis ‘linking’ not only benefits the recipient (patient), it also brings direct benefit to the giver.

Lunch break

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Session II: Compassion in practice

Exercise 4.6

Learning outcome

Materials

Facilitating the exercise

Understanding anger

Process:

Reflection and listening

30 minutes
At the end of this exercise participants should be able to:

✔ understand the ways in which they express anger at work and its effects on their feelings and on others.

G Worksheet 4.6 Understanding anger

1 Invite participants to get into pairs.
2 Distribute Worksheet 4.6 Understanding anger and

introduce the exercise as follows:

❝Think of a work situation when you were angry, and describe it to your partner. Perhaps choose something to begin with that is more of an irritation than a deep-seated anger. Your partner should then ask you the questions on the first part of the worksheet, jotting down your responses. Then swap roles and repeat.❞

Allow 5 minutes each, prompting pairs to swap roles after the allotted time.

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Feedback 10 minutes

Helpful hints

3 Ask participants to continue working in pairs, looking at the second part of the worksheet, as follows:

❝When you have finished talking and listening about a work situation, move on to each share how you generally show your anger. Use the questions on the second part of the worksheet.❞

Allow a further 5 minutes each, prompting pairs to swap roles after the allotted time.

1 Invite participants to compare some of their responses and comment on the following:

G Are there work situations in which the response of anger is more appropriate than in others?

G How does it affect others and the situation itself?
2 Briefly, discuss some of the ways of burning off the ‘heat’

of anger, covered in Background Reading.

Referring to the Background Reading paper the facilitator should highlight that anger leads to unhappiness within us, but that it is possible for us to change the way we respond.This is the focus of the breathing exercise that follows.

Module 4|Compassion

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Exercise 4.7

Learning outcome

Materials

Facilitating the exercise

Breathing out anger

Process:

Meditation

10 minutes
At the end of this exercise participants should be able to:

✔ experience the release of anger through meditation. G CD track no. 11 Breathing out anger (or relaxing

background music)
G CD player/tape recorder (optional)

For this exercise you can play CD track no. 11 Breathing out anger or read out the following text accompanied, if you wish, by background music.

❝Sit comfortably in your chair, with your feet flat on the ground and your hands relaxed, resting on your lap. Make sure you are in a position to breathe easily, sitting upright in your chair.

Allow your breathing to slow down… gently out… and in… with your own natural rhythm.Watch the breath… focus on the calm out-and-in of the breath… slow and easy… exhale… inhale. Now think of a situation where you were angry with another person and follow these words:

As I breathe out I release my anger… and as I breathe in I fill myself with compassion… Breathe out anger… breathe in compassion (pause for 1 complete breath).

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As I breathe out I let go of resentment… and as I breathe in I fill myself with tolerance… … I breathe out resentment… breathe in tolerance… (pause for 1 breath).

As I breathe out I release feelings of revenge… and as I breathe in I gain understanding… breathe out revenge… breathe in understanding… (pause for 1 breath).

As I breathe out I let go of all worries… and as I breathe in I experience peace… … breathe out worries… breathe in peace… (pause for 1 breath).

As I breathe out I let go of all blame… and as I breathe in I forgive myself… … breathe out blame… breathe in forgiveness… (pause for 1 breath).

As I breathe out I release my anger… and as I breathe in I fill myself with compassion… Gently watch your breath… out and in… breathing out all traces of anger… and breathing in compassion (pause for 1 breath).

Now see the other person and send them good wishes. See the situation and feel compassion for all involved (pause for 10 seconds).

Sit with yourself, breathing easily… calm… at peace… and experiencing the qualities of compassion… understanding… forgiveness… tolerance. Begin to feel you have let go of anger… experiencing compassion… as you breathe out and in.

Send that feeling of compassion to the other person… to the situation… to all places you know where there is anger… send compassion to all places on the planet… where there is hatred and anger.

Sit with yourself… calm… at peace… full of compassion… breathing easily…

Now in your own time deepen your breathing… open your eyes. When you are ready, feel your feet on the floor… and have a stretch.❞

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Exercise 4.8

Materials

Facilitating the exercise

Standing like a tree

Process:

Meditation

10 minutes
G CD track no. 12 Standing like a tree (or relaxing

background music)
G CD player/tape recorder (optional)

This exercise involves developing the imagery of a tree. Play CD track no. 12 Standing like a tree or read out the following text, pausing at ellipses (…). If you are reading aloud, you may wish to play some background music.

❝Stand and place your feet about the same distance apart as your shoulders and with your toes pointing forward… Bend your knees slightly and with gentle bounces move your weight from foot to foot… until you feel completely balanced. Now allow your shoulders to relax and your arms to hang loosely at your side.

Imagine there is a cord in the centre of your head holding your head up, so your spine is nice and straight…

Now focus on your breathing… so that it is slow and even… and it begins to find its own natural rhythm.

Hold your hands out in front of you as if you are holding a large beach ball… relax, and allow your shoulders to loosen while you hold the ball. Alternatively, place your arms down by your side, palms facing forward and held away from you.

Imagine that you are a tree… and from the soles of your feet feel your roots go deep into the earth… Feel your feet firmly on the ground so you are deeply connected to the earth…

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If you have any negative feelings of anger… anxiety… resentment… or jealousy, allow them to slip down your body… down into the roots, coming out from the soles of your feet… deep into the earth…The earth will recycle this negativity as it does compost.

So now see yourself as a healthy tree… with branches reaching out… but firmly rooted into the earth.You are strong… stable… as all the negative energy seeps away.

The leaves absorb the warmth of the sun; breathe in the air that gives you vitality. Stand for a few moments longer, feeling the warmth of the sun giving you energy, and breathing the fresh air, cleansing your whole body… …

Thank you … in your own time, give your arms a shake and sit down.❞

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Exercise 4.9

Learning outcome

Materials

Facilitating the exercise

Mistakes

Process:

Reflection and listening

35 minutes
At the end of this exercise participants should be able to:

✔ recognise the feelings associated with past mistakes, and the reasons for holding on to them

✔ construct positive, alternative ways of behaving as a means of releasing painful memories.

G Worksheet 4.9 Mistakes

This exercise is in three parts, each described in Worksheet 4.9. First, participants will reflect on their own, and then share with a partner.

Distribute Worksheet 4.9 Mistakes to participants and ask them to sit in pairs.

Part A Recalling a mistake (15 minutes)
1 Ask everyone to work individually for a few minutes on

Part A of the worksheet, giving the following guidance:

❝On your own, recall a mistake you have made.Think of the circumstances, and then identify who or what was to blame, which may include yourself.

What are the feelings that you have towards this mistake? Sometimes, our feelings are clear but we may find that they are often confusing.Try to bring the various feelings into your mind. Do you have any feelings of guilt, regret, shame, revenge or humiliation? Did you feel you ‘let yourself down’ or let others down? Write down all the feelings you associate with the memory of this mistake.❞

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Feedback (optional)

Allow 5 minutes for this.
2 Invite everyone to share their situation in pairs, as follows:

❝Working in pairs, share the situations you each identified. Treat this as a listening exercise so that you each share your story for a few minutes, how you felt then and how you feel now.❞

Allow 10 minutes in total, prompting pairs to swap roles halfway through.

Part B Letting mistakes go (10 minutes)
Invite pairs to move on to look at Part B of the worksheet,

making notes individually if they wish:

❝Still in pairs, think again of how long you have held onto these feelings towards others, and towards yourself. What are the reasons you have for holding onto them? What is stopping you letting them go?

Share what you think with your partner.❞
Allow a further 10 minutes, prompting pairs to swap roles

halfway through.

Part C: Preferred situation (10 minutes)
Ask participants to spend a few minutes looking at the questions

in Part C of the worksheet, making brief notes if they wish:

❝On your own first, reflect how you would have preferred the situation to have been.You have several options, which could include a change in the circumstances. However, try and think of the situation with the same circumstances, but with everyone having a different attitude, including yourself. How would you have preferred everyone to have behaved? Try not to have any negatives in your preferred scene. Run that through in your mind.

Share this preferable situation with your partner.❞
Allow 10 minutes, prompting pairs to swap roles halfway

through.

If you have time, bring the group back together and ask people to share some of the experiences they have discussed.

Module 4|Compassion

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Helpful hints

In Part A of the exercise, acknowledge that the recognition of mistakes can be difficult and painful. Remind participants that anything shared is in confidence; they may be sharing a secret they have had for years.

If people do not want to share a particular situation in detail, ask them to share how they feel about that situation, without mentioning any person or the particular circumstances.

This is an exercise to heal the memories with positive alternatives so in Part C participants should be encouraged to be creative in their attempts to consider preferred options.

Some participants may find that the exercise brings back memories and feelings which are quite difficult for them to speak about. Encourage everyone to be sensitive and patient when listening
to each other.

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Exercise 4.10

Module 4|Compassion

Learning outcome

Materials

Facilitating the exercise

Forgiveness

Process:

Meditation

10 minutes
At the end of this exercise participants should be able to:

✔ consider and explore the possibility of self-forgiveness using meditation.

G CD track no. 13 Forgiveness (or relaxing background music) G CD player/tape recorder (optional)
G Flipchart and marker pens

Play CD track no. 13 Forgiveness or read out the following text in a clear, gentle voice, pausing at ellipses (…). If you are reading aloud you may wish to play some relaxing background music.

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❝Sit comfortably and relax. Recall the feelings associated with your mistake or other mistakes you have made in the past. Connect with any feelings of resentment and revenge; connect with any feelings of guilt and how you felt you had let others and yourself down; the shame and the humiliation you may have felt… …

Now ask yourself:

What good is it doing me or others to hold onto these feelings…?

What benefits does it bring me? How does it help me, or the other people affected…? (pause for 30 seconds).

Now, say the following to yourself inside your mind:

‘I decide that I have held onto these feelings long enough and
it is time to let them go… This is a matter of reason as they no longer serve me, and a matter of my will at a deep level to release them… I feel all these negative feelings and let them go… I release them… let them go…’

Now, unconditionally, forgive yourself… you have made a mistake… you have learned from that mistake… there is nothing to be gained from having feelings of guilt or shame… let them go… forgive yourself… forgive everyone else who may have contributed… it is time to let it go…

Now focus on your inner feelings of peace… Think of and feel your inner qualities of honesty, tolerance, kindness and generosity. Focus on them, as this is who you truly are… a peaceful, compassionate, forgiving being…

Now, in your own time, open your eyes if they are closed, come back into the here-and-now of this room. Have a stretch. Breathe in deeply. Feel your feet on the floor and rub your hands together.❞

Exercise 4.11

Walking into happiness

Process:

Learning outcome

Materials

Facilitating the exercise

Module 4|Compassion

Movement

10 minutes
At the end of this exercise participants should be able to:

✔ experience changing states of feeling/emotion from negative to positive.

G A4 or A3 sheets of paper (3 per participant)

1 Give each participant three sheets of A4 or A3 paper.

2 On the first sheet of paper, ask participants to write one word to fill the page that describes a feeling attached to a mistake which they made, a feeling they would wish to change, such as ‘anger’, ‘guilt’, ‘jealousy’, ‘grief ’.

3 On the second piece of paper, ask participants to write the word ‘compassion’.

4 On the third piece of paper, ask them to write the word ‘happiness’ or ‘wholeness’ or another word of fulfilment that suits them.

5 Now lead the exercise as follows, pausing after each step to allow participants time to experience each feeling:

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Helpful hints

❝Find a space on the floor and lay out your three pieces of paper.

Stand on or next to the first sheet, on which you have identified the feeling connected to a mistake you would like to deal with. Try to experience briefly what it is like to feel that emotion and think about the issues surrounding it. Now take a deep breath and, on the out-breath, try and let go of that feeling.

Step onto your second sheet, on which you have written ‘compassion’. Fully experience for a few moments what it is to be loved… to be cared for… to be understood and to be forgiven.

Now move onto the final sheet, that describes fulfilment. Experience that feeling of being at peace… that comfortable, warm feeling.❞

This is a simple exercise which can nevertheless have a profound effect on people.Take it slowly and give people a chance to feel the different ways they can be. It is about exploring how feelings and emotions affect the way we are in our body, and about how we can consciously change those feelings.

Z Break
15 minutes

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Session Review

10 minutes Guidance notes

Briefly review the session by displaying the session aims, learning outcomes and session programme. Remind participants of the activities they have undertaken.

Pick out any highlights, referring to materials that participants have produced and which you have displayed.

Hand out the Background Reading paper for participants to take away, pointing out any references and resources for this module, should they wish to explore the theme in more depth.

See Part 2: Guidance for Facilitators for further guidance.

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Module 4|Compassion

Action Planning

See Part 2: Guidance for Facilitators and Part 5: Additional Resources for information and guidance on action planning. Below is a suggested action planning exercise.

Exercise 4.12

Learning outcomes

Materials

Facilitating the exercise

Positive plans

Process:

Reflection and sharing in pairs

30 minutes
At the end of this exercise participants should be able to:

✔ choose and practise a useful technique for surfacing compassion, identifying situations where the technique may make a positive difference to their reactions and the reactions of others involved

✔ identify a future, difficult situation and plan ways of approaching it in a positive way, using the insights they have gained from the session.

G Paper or action planning sheet (see Part 5:Additional Resources)

G Pens
Part A: Personal reactions (10 minutes)

During the Session Review you will have run through a number of techniques which people can use in their everyday lives to release negative feelings and to surface the positive qualities of compassion, for example, Meditation on compassion, Compassionate listening, Breathing out anger, Standing like a tree, Forgiveness.

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Helpful hints

. 1 Make sure that everyone has paper or action planning sheets and pens to make notes during both parts of the exercise.

. 2 Ask participants to individually reflect on the insights they have gained today into their personal reactions to situations, and to identify any techniques which they have found useful in relation to these.
Allow up to 5 minutes.

. 3 Invite each individual to choose one technique which they would like to practise for the coming week ahead. Encourage them to identify situations which are likely to occur during the week, where the technique may make a positive difference to their reactions and the reactions of others involved.
Allow 5 minutes.

Part B: Planning for a difficult situation (20 minutes)

. 1 Invite participants to work with a partner for the second part of the exercise.

. 2 Lead the exercise as follows:

❝Individually, identify a difficult situation which may arise in the near future and the kinds of personal reactions you may have towards it. Share these with each other, using compassionate listening as your partner briefly describes their own situation.❞

Allow 5 minutes before moving on.
3 Now invite each pair to do the following:

❝Help each other to plan ways of approaching the situation in a more positive way, using the insights you have gained today. Write down some specific actions each person can take to prepare for the situation and handle their personal reactions during the situation.❞

Allow 15 minutes.
The second part of this exercise could be done as a work team.

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Evaluation

10 minutes

Materials

G Copies of evaluation pro forma (if being used) G Pens

Guidance notes

Run though your planned evaluation activity (see Part 2: Guidance for Facilitators and Part 5:Additional Resources for information and guidance on evaluation).

As an alternative or additional activity, you may also want to give out a more formal evaluation form at this point for participants to complete now or return by a given date.

Remember to plan in some time as soon as possible after the session to complete your own evaluation of how you think the session went.

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Closure

Exercise 4.13

Module 4|Compassion

Learning outcome

Materials

Facilitating the exercise

Compassionate gifts

Process:

Appreciation

10 minutes
At the end of this exercise participants should be able to:

✔ experience receiving and giving a gesture of compassion.

G Small cards (one per participant)

G Pens

G CD player/tape recorder and relaxing background music (optional)

1 Lead the exercise as follows, playing some gentle music if you wish:

❝Think of something that would be nourishing to yourself – something you would really like to be done or said to you that you would really appreciate. It is a gesture of compassion to yourself.

On the card supplied, write down what the ‘compassionate gift’ would be. Write it as a positive statement. For example: ‘Your smile lights up the room’, ‘You are always so kind.’ Write your name on the corner of the card.❞

Allow 2 or 3 minutes.

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Helpful hints

2 Now invite everyone to do the following:

❝ Now, walk slowly around the room holding your card. When you meet someone, stop and greet them and exchange cards. Read their card and take it on as a personal compliment. Move on and exchange cards again with someone else.❞

Allow a further 2 or 3 minutes.

3 Ask participants to find their own card and to sit quietly with it before leaving.

This closure is best done to music, with participants moving around the room then sitting quietly before leaving with their own card.

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Follow-on/homework Exercise 4.14

Yes–no game

Process:

Play

10 minutes
At the end of this exercise participants should be able to:

✔ understand how anger can be expressed and how they feel when angry.

1 This exercise enables participants to explore feelings of anger in a dynamic way.

Clear aside any chairs and ask participants to stand in two lines facing each other, about 1 or 2 metres apart. Allocate one line to be the ‘Yes’ line, and the other to be the ‘No’ line.

2 Lead the exercise as follows:

❝Start by saying aloud ‘Yes’ or ‘No’ repeatedly to the person facing you, as if you are in a conflict situation. Say the word you have been allocated as if you are trying to convince the person opposite.You can experiment with different ways of saying it.❞

Allow up to 2 minutes, giving a clear start and finish signal.

. 3 Invite the lines to change over from being ‘Yes’ to ‘No’ and vice versa. Repeat the exercise.
Allow up to 2 minutes, giving a clear start and finish signal.

. 4 Ask everyone to sit down for feedback.

Module 4|Compassion

Learning outcome

Facilitating the exercise

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Feedback 5 minutes

Ask how participants felt about doing the exercise:

G Did they hold back or not?

G Is it how they respond when angry?

G Did it remind them of a past situation where there was shouting, or where anger was suppressed?

G Did their feelings change during the exercise? G How do they feel after the exercise?

Discuss what they may have learned about themselves when being angry. Is it ever appropriate to shout?

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Exercise 4.15

Module 4|Compassion

Learning outcomes

Materials

Facilitating the exercise

Changing situations

Process:

Reflection and play

60 minutes
At the end of this exercise participants should be able to:

✔ identify the possible effects of negative, personal feelings and responses on situations and on the people involved

✔ identify ways of changing difficult situations through changing personal responses and reconnecting with compassion.

G Worksheet 4.15 Changing situations G Flipchart and pens

This exercise presents an opportunity to change personal responses in ways that might positively transform difficult situations, in particular, releasing negative feelings and reconnecting with compassion.

. 1 Invite participants to get into groups of 4 or 5 and identify a difficult work situation which one of them has recently experienced, and in which they felt their responses had contributed to the difficulty or had been unhelpful in resolving it.
Allow 5 minutes before moving on.

. 2 In order to explore the situation further, encourage groups
to take up the roles of the key people involved and, with the individual’s help, briefly re-enact or ‘walk through’ the scenario.
Allow 10 to 15 minutes.

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Feedback 10–15 minutes

3 Distribute Worksheet 4.15 Changing situations and ask groups to discuss the questions, concentrating on question 2. Encourage them to experiment with different responses, eg being compassionate, forgiving themselves/others for making a mistake, and to try these out by taking on the roles.

Allow up to 30 minutes for them to explore the effect of different personal responses on others’ feelings and on the situation as a whole.

Ask each group to feed back any insights, writing up useful points to return to in any further action planning session.

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Exercise 4.16

Feedback

Helpful hints

Module 4|Compassion

Learning outcome

Facilitating the exercise

Protection

Process:

Meditation

10 minutes
At the end of this exercise participants should be able to:

✔ practise a method of self-protection using meditation.

This is a very short protective meditation which can be used at any time, particularly before or after difficult or stressful situations. Read the following in a calm, gentle voice, pausing at ellipses (…).

❝Pause and still yourself… feel yourself grounded… Check that your breathing is calm and then, using your imagination, pull down light through the crown of your head to your heart and fill yourself with golden warm light… Let the light expand to form a large sphere around you. From your heart, you replenish this sphere, as you are connected to a source that fills you up.❞

Allow some sharing of the experience of the process.

This exercise can be quite short and repeated with eyes open to show how easy and quickly it can be to switch conscious levels.

The exercise should be done in a light manner which is detached from the outcome.That way we can be compassionate without being drawn into the suffering of others.

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Worksheet 4.2

Compassion ‘scrabble’

SCORES:A,E,I,L,N,O,R,S,T,U = 1 D,G = 2 B,C,M,P = 3 F,H,V,W,Y=4 K=5 J,X=8 Q,Z=10

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Worksheet 4.5

Compassionate listening

Module 4|Compassion

The talker

How interested did your partner seem in your story?

What was their body posture like?

What was eye contact like?

What encouraging gestures did they use?

What disapproving gestures did they make?

Did they interrupt you or make comments?

The listener

How easy or difficult was it to stay silent?

How easy or difficult was it to refrain from making facial expressions or gestures?

How comfortable or embarrassed did you feel?

Were you able to give your full attention? If not, why not?

Were you able to feel an inner calm?

Did you feel ‘drained’ at the end?

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Module 4|Compassion

Worksheet 4.6

Understanding anger

1 Think about a specific situation at work when you were angry…

What triggered the anger?

How did you express your anger? What did you do and say?

How did your anger affect others?

How did you feel at the time and afterwards? How does it make you feel now?

2 Think about when you are angry generally…

How do you generally show your anger? Do you hold it back or do you do something?

What do you look like when you are angry?

How do you feel inside when you are angry?

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Worksheet 4.9

Mistakes

PartA

On your own, recall a mistake you have made.Think of the circumstances, and then identify who or what was to blame, which may include yourself.

What are the feelings that you had towards this mistake?

How do you feel now?

Share your responses with your partner.

Part B

How long have you held onto these feelings towards others, and towards yourself?

What are the reasons you have for holding onto them? What is stopping you letting them go?

Share your responses with your partner.

Part C

How you would have preferred the situation to have been?

Share your responses with your partner.

Module 4|Compassion

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Module 4|Compassion

Worksheet 4.15

Changing situations

1 What happened?

What feelings did the main individual experience in their role?

How did s/he express your these feelings?

What were the effects of the individual’s responses on the other key people and on the situation as a whole?

2 Making changes

How could the individual’s personal response have been different? In particular, focus on releasing negative feelings and reconnecting with compassion.

How might the individual’s response have affected the others’ responses and the situation as a whole?

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Background Reading

Why Co-operation?

‘Human achievement is like a mountain range with cliffs, crags, slopes, and valleys.
To aim for excellence in collective achievement is to aspire to climb to the crowning point. The endeavour requires each climber to be equipped with essential skills and knowledge and good amounts of determination and willpower. However, no climb should ever be undertaken without the most indispensable piece of equipment: the safety rope of co-operation. Co-operation ensures equanimity, empowerment, easiness, and enthusiasm. Co-operation provides the means for each climber to take a step, no matter how small, and for those steps collectively to reach the pinnacle.’

Living Values: A Guidebook (1995) London: Brahma Kumaris World Spiritual University

Delivering healthcare is highly complex, requiring not only the clinical skills of individual practitioners but also effective strategies, management and organisation at all levels – government, health authorities, hospitals, clinics, patients and staff. Co-operation between these levels and within each level is essential to delivering an efficient and effective healthcare system.

Purpose of module

Achieving successful co-operation can only be done by first understanding what co-operation means to each of us at a personal level, before applying it to a work unit or organisation. This module aims to provide a personal experience and to use personal insights in co-operative team tasks. What are the values of co-operation and how do we apply them at work? Everyone has their own specialities that can make a worthwhile contribution and by working co-operatively the outcome will be greater than the sum of individuals’ efforts. By adopting a co-operative approach and really understanding what that means for us, our colleagues and our patients, we can have happier and more effective teams.

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Introduction to the Co-operation module

This module focuses on experiencing and evaluating the qualities and skills of successful co-operation. To co-operate, we have to understand and value each other so that we can accept and build on each other’s ideas. We have to want to understand, and want to be understood. This connection is often helped by revealing something of ourselves – allowing others to see beyond the behaviour, sharing our values or beliefs, our passions, our fears and our hopes. To do this, however, we need to feel safe and to know that we are not being judged.

Co-operation, therefore, involves the recognition of a shared responsibility for creating and maintaining a good and trusting relationship.

Themes of Exercises

Co-operation – what does it mean? (5.1, 5.9)

We can all recollect situations when things really go well, when things just ’click’ and fall into place. We feel good and everyone involved in the process seems to benefit. So it is worth while reflecting on why such situations are successful. What are the behaviours and skills people show when they do co-operate and how does that make everyone feel?

Inner values of co-operation (5.2)

When people work well together they will express underlying values such as respect, patience, tolerance and understanding. In addition, good listening skills, calmness, creativity and humour make for good co-operation. When we get in touch with these qualities in ourselves, we act in a co-operative way which results in having consideration and respect for others.

By constantly reminding ourselves of our own inner values we gain an inner strength and can maintain equanimity and work in a co-operative way. This can be done in silence by reflecting on the words and feeling what it is like to be ‘calm’, ‘patient’, ‘tolerant’ etc. We can then consider how we can bring such values into some action at work. Through meditating on the values of co-operation we can build a positive approach to our thinking and develop new beneficial habits.

Co-operative listening (5.3)

A key spiritual tool to co-operation is listening. We need to really hear and understand the other person if we are to work with them in a co-operative way.

These are three things to remember when using listening as a spiritual tool:

G be peaceful
G be attentive
G listen with your heart.

All three aspects of listening are important but the emphasis in this module is listening with full attention to a person’s views without interruption. It is learning to listen to each other in a non-judgmental way and being curious about them and what they are saying.

Attentive listening is about paying attention to what the other person feels deeply about, and it is not influenced by their status or personality. Being non-judgmental releases us to be ourselves. If we stop worrying about (judging) how well we are

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doing and what the other person thinks of us, we can give all our energy to listening to that person.

Listening with curiosity demonstrates an interest in the other person as an individual. What are their values and beliefs, and why do they have such feelings? Such curiosity is the sign of a healthy, enquiring, open mind. We can examine and evaluate different practices, and be willing to learn and change if appropriate. It means we never become complacent, never become fixed in our attitudes, and certainly never assume that we don’t need to go on learning. Curiosity involves us constantly asking questions to clarify and understand both what others are saying and the beliefs and values their words are based on.

Co-operative solutions (5.4)

There are always solutions to what may seem the most difficult and ‘stuck’ situation. There are many situations in our work settings or in our personal lives that seem impossible to resolve. Yet we can all draw on our innate creative abilities to bring fresh insights and produce new answers. Bringing in positive values and methods is a sure way of making the situation better for everyone, and it can be fun. Using drawing, acting, writing or anything that encourages creativity can change things for the better, and quickly.

A co-operative workplace (5.5)

Creating positive thoughts of how we would like a co-operative workplace to be is the first step in making it a reality. We can think of our own special qualities which we can bring to our work; we can listen and support others; we can encourage and be enthusiastic, and the results may well be far greater than we could expect. Being co-operative leaves everyone feeling good about themselves, about other people and what has been achieved.

Team co-operation (5.6, 5.10)

Team co-operation is basically working in a non-competitive way. It is about respecting everyone in the group by listening to their views and encouraging their contribution. It is not about ‘scoring points’ over others, or a bargaining game in which one person’s success is achieved at the expense of others. The aim of co-operation is mutual benefit in human interactions, so that implementing a task is beyond individual status and personalities in the group.

With co-operation, a task becomes creative and enjoyable. There is a feeling of support and togetherness, in short, ‘team spirit’. The process of co-operation itself will be remembered, as well as achieving something special.

Team vision

A vision is an ideal of how we would want things to be. It is about looking positively to the future and being creative in that process. It is about drawing on our wildest hopes for a better future, about building these into a shared vision, and then working co-operatively to achieve it.

A vision can relate to an outcome in terms of a concrete achievement, such as, ‘We will create a positive working environment’. Visions can also be seen in terms of a process, how we are doing a particular task or living our lives, eg ‘We will be patient and enthusiastic in our work’. It is important that the vision is shared and owned by everyone, rather than just one person’s good idea that he or she tries to get everyone to adopt.

Exploring the process of co-operation (5.7)

Working co-operatively in a group may be a new experience for many people and it is useful to consider in what way it is different from how groups usually behave.

Often, team training focuses on understanding the different roles people can take within a team. However, roles can be restricting as we tend to behave according to the role and how others expect us to behave in it. This can be true of our position
at work or at a group meeting. For instance, in team training, one person may be allocated to the role of ‘scribe’ which may lead to their creative contributions or facilitating behaviours being ignored or not valued. Behaving according to prescribed roles may not necessarily lead to creative outcomes.

During this module, we experience how it is possible to go beyond this behavioural concept and achieve a ‘deeper’ level of co-operation. At this level, roles can constantly change as the individual’s needs, group needs or task needs change. Each individual has the opportunity to contribute and it will be valued. It is each person’s responsibility to facilitate the group process by exhibiting the necessary qualities and skills.

Taking it back to work (5.8, 5.11)

Having experienced the qualities and skills of co-operation, it becomes possible to explore new ways of tackling difficult situations at work and of improving the way in which we interact as colleagues and teams. We can consider how we can go on improving working together so that we benefit, others benefit and ultimately our patients benefit.

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The Facilitator’s Guide to Module 5

Session I: Understanding co-operation

Aims

G To identify the qualities and skills of co-operation
G To experience and evaluate co-operative listening
G To apply the values and process of co-operation to real-life situations

Process

This session focuses on understanding and experiencing co-operation. Participants begin by identifying a successful co-operation, working in pairs to explore the qualities and skills involved. A meditation follows, allowing participants to experience the qualities of co-operation at a deep, personal level. After a movement exercise, participants explore the skill of co-operative listening in pairs, and evaluate this important skill as a basis for effective co-operative interaction. A final exercise uses cartoons to help participants work individually on applying their insights and ideas to a real life scenario, in order to achieve a more co-operative outcome.

Session II: Working in teams

Aims

G To use creativity as a tool for co-operative group working
G To work co-operatively in teams to create a joint vision
G To reflect on and evaluate the process of co-operative team working G To apply learning to team working and co-operation in practice

Process

This session uses specific tasks to explore the process of working co-operatively in teams. The first exercise uses a visualisation of a co-operative workplace. The insights gained provide the basis of a team exercise developing a collective vision
of co-operative working, and then representing the vision as a piece of art work. There is then an opportunity for individuals and teams to reflect on this experience of co-operative working and to evaluate the process. An optional action planning exercise helps small groups to apply this learning to work situations which involve team working or co-operation.

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Programme/plan for Module 5 Co-operation

Module 5|Co-operation

Introduction/Review 30 minutes SESSION I Understanding co-operation

Exercise 5.1 Co-operation – what does it mean? 25 minutes

Exercise 5.2 Inner values of co-operation 15 minutes

Movement exercise 10 minutes

Exercise 5.3 Co-operative listening 40 minutes

Break 20 minutes

Exercise 5.4

Lunch break

SESSION II

Exercise 5.5

Co-operation cartoons 35 minutes

Working in teams

A co-operative workplace 10 minutes

Exercise 5.6 Creating a team vision 55 minutes

Movement exercise 10 minutes

Exercise 5.7 Exploring the process of co-operation 30 minutes

Break 15 minutes

Session review 10 minutes

Action planning

Exercise 5.8 Taking it back to work 30 minutes

Evaluation 10 minutes

Closure
Exercise 5.9 Temple of co-operation 10 minutes

Total time 5 hours 55 mins

Follow-on/homework

Exercise 5.10 Adverts: an exercise in team co-operation 30 minutes

Exercise 5.11 Creating new perspectives 45 minutes

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Module 5|Co-operation

Materials

G Pens and paper
G Flipchart and marker pens
G Coloured pencils/pens
G CD player/tape recorder (optional)

Session I

G Worksheet 5.1 Co-operation – what does it mean?
G Worksheet 5.3 Co-operative listening (2 sheets)
G Worksheet 5.4 Co-operation cartoons
G CD track no. 14 Inner values of co-operation (or relaxing

background music)

Session II

G Worksheet 5.7 Exploring the process of co-operation G Worksheet 5.9 Temple of co-operation
G CD track no. 15 A co-operative workplace (or relaxing

background music)
G Flipchart paper or A1 card G Magazines
G Scissors and glue sticks

Preparation

. 2 Familiarise yourself with the main learning tools which are being used in the session (see Part 4: Spiritual Tools).

. 3 Read through the session guidelines and look at the suggested session programme which will incorporate:

G Session introduction G Exercises
G Movement breaks
G Breaks

G Session review G Action planning G Evaluation
G Closure

4 Photocopy any handouts and exercise sheets, and make sure that you have any other equipment listed under Materials.

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Introducing the Module

30 minutes
Run through your planned introductory session which may include:

Quiet time
Introductions/optional warm-up exercise Overview of session
G Theme of session
G Aims and learning outcomes
G Programme/plan for the session
G Practical considerations
G Any questions

Setting the tone

G Ground rules/principles G Participants’ expectations

Review of last session/homework
See Part 2: Guidance for Facilitators for further guidance on introducing

the session.

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The Exercises

Session I: Understanding co-operation

Exercise 5.1

Learning outcome

Materials

Facilitating the exercise

Co-operation – what does it mean?

Process:

Reflection and sharing in pairs

25 minutes
At the end of this exercise participants should be able to:

✔

G G G

1 2 3

describe the qualities and skills of co-operation.

Worksheet 5.1: Co-operation – what does it mean? Flipchart
Paper, pens

Distribute Worksheet 5.1 Co-operation – what does it mean? to participants, along with paper and pens.

Ask participants to choose a partner, introduce themselves, and sit together.

Introduce the exercise in the following way:

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Feedback 10 minutes

❝First, work on your own for a few minutes and think of a situation at home or at work where you experienced successful co-operation. Also, reflect on what made that situation successful. What were some behaviours and skills that were useful in being co-operative? What were the qualities and values that people were expressing? Write your answers on the worksheet.❞

Allow between 5 and 10 minutes for this.

4 Next, invite pairs to share their situations with each other, as follows:

❝Now share your situations and findings, making a list of the qualities and skills of co-operation.Write down as many possibilities you can think of.❞

Allow 10 minutes.

1 Bring the whole group back together and ask each pair to share some of the qualities and skills they have listed, writing them up on a flipchart.

2 Invite participants to consider any similarities or differences between the qualities and skills of co-operation in home and work settings.

Module 5|Co-operation

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Module 5|Co-operation

Exercise 5.2

Learning outcome

Materials

Facilitating the exercise

Inner values of co-operation

Process:

Meditation

15 minutes
At the end of this exercise participants should be able to:

✔ experience qualities of co-operation and their expression through meditation.

G CD track no. 14 Inner values of co-operation (or relaxing background music)

G CD player/tape recorder

This exercise is a guided meditation which will help participants to identify with, and find their own personal experience of, the values of co-operation.

You can either use the CD track no. 14 Inner values of co-operation, or read out the following commentary, using your own background relaxation music. If you are reading the text, speak in a clear, gentle voice, pausing at ellipses (…) to allow participants to follow you into a relaxed state.

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Ask participants to choose 3 qualities from the previous exercise. Invite them to sit comfortably on their seats, with their backs supported against the chair backs if necessary, so that the body can relax.Ask them to place their feet on the floor, with legs uncrossed, and rest their hands on their laps.

Helpful hints

❝Sit relaxed in your chair… and as your body relaxes so does your mind… you feel calm and peaceful.

Now consider some of the qualities of co-operation.Which of these are your special qualities? Think of just one of these qualities and really experience it… what does it feel like to be that quality…? Does an image, colour or phrase come to mind associated with the quality? Can you see yourself being that quality in your everyday life… …? (pause for 20 seconds).

When you are ready, think of another quality of co-operation, and again try to feel what it is like to be that quality… Images or colours may come to mind… experience the quality as deeply as you can… experiment with it, comparing how similar or different it is from the first quality you chose… … (pause for 20 seconds).

When you are ready, move on to a third quality and experience it as deeply as you can… How is it different from the other two? Can you see yourself being that quality… …? (pause for 20 seconds).

All these qualities are part of the peaceful and co-operative person that you are… get a sense of that person… feel at peace with that person (pause for 20 seconds).

In your own time, become more aware of your body… feel your feet on the ground… Begin to wiggle your toes and fingers… and, in your own time, open your eyes… have a stretch and a shake.❞

This exercise will help participants to identify with the qualities of co-operation at a deep, personal level.They can then bring their co-operative essence, ie more of themselves, into the co-operative exercises which follow.

If you have time, you could invite participants to draw or write down some of the images of co-operation which came to them in this meditation.These could be displayed throughout the session or at the end as part of the closure.

Movement exercise

10 minutes
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Exercise 5.3

Learning outcome

Materials

Facilitating the exercise

Co-operative listening

Process:

Listening

40 minutes
At the end of this exercise participants should be able to:

✔ describe and evaluate the process of co-operative listening as an important skill in co-operative interaction.

G Worksheet 5.3 Co-operative listening (2 sheets) G Paper and pens
G Flipchart and marker pens

This exercise is in two parts. Invite participants to sit with the same partner from the previous exercise.

Part A: Favourite music (15 minutes)

. 1 Distribute the first sheet of Worksheet 5.3 Co-operative
listening, entitled Part A: Favourite music.

. 2 Lead the exercise as follows:

❝First of all, on your own, remember a piece of music you particularly like. Hear it in your head for a moment. Briefly write down your responses to the questions on the worksheet.❞

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Allow 5 minutes.

Invite participants to share their responses with their partners in the following way:

Module 5|Co-operation

Feedback 10 minutes

❝Now share your answers with your partner, allowing about 5 minutes each.

As the listener, encourage the person to tell you about the piece of music so that you really understand why it is important to your partner. Use the questions on the worksheet as prompts. Be curious to find out what it is that really makes the music mean so much to them, for example, it might be a romantic song which reminds them of someone or something special.❞

Allow 10 minutes, prompting participants to reverse roles after 5 minutes.

Part B:The process (15 minutes)

. 1 Ask participants to work in the same pairs and distribute the second sheet of Worksheet 5.3 Co-operative listening, entitled Part B:The process.

. 2 Invite pairs to explore the process of co-operative listening, using the questions on the worksheet.There are questions about:

G the experience of describing the music

G the experience of listening, and

G the experience of the co-operative interaction between two people.

Allow a further 15 minutes before moving into feedback.

Reconvene the group to discuss some of the main learning points about the process of co-operative listening. Below is a list of personal discoveries which might come up at this point:

. 1 Music is ‘soulful’ and a piece of music can be used to remind you of who you truly are.

. 2 As the ‘speaker’ you can be more involved in the conversation. You want your partner to understand something about you and the piece you have chosen.

. 3 As the ‘speaker’ you just get on with describing the music, and trust that the situation is safe enough that no ‘harm’ will come to you.You believe that you are good enough, that you are able and complete just as you are.

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Helpful hints

. 4 When you are enthusiastic, you stop judging yourself, and you stop judging other people so much.This helps you see the best in other people in the team.

. 5 Sharing something which is important and has meaning for you is part of forming good relationships with others and makes you feel good.When encouraged, you reveal more about what you feel passionate about.You begin to stop worrying about what the other person thinks about you.You stop comparing yourself with others in the room and realise that you have the same qualities as they do.

. 6 As the listener, your encouragement stops you from judging, you begin to see different aspects of the other person.You also learn about yourself and your own values.

. 7 As you tell your story and are really listened to, you find common ground. So the key is to use co-operation to express your true self and to help others to do the same.

. 8 Usually with a co-operative exchange, you feel enthusiastic and positive.

Most people have a favourite piece of music and often feel passionately about it, although they may not be fully aware of their feelings. It is up to the listener to be curious about this passion.This is a conversation which should be free from ‘ego’ (personality and status), when individuals can interact at a more

Zmeaningful level. reak

20 minutes

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Exercise 5.4

Module 5|Co-operation

Learning outcome

Materials

Facilitating the exercise

Co-operation cartoons

Process:

Creativity

35 minutes
At the end of this exercise participants should be able to:

✔ apply ideas and methods of co-operation to real life scenarios in order to achieve a more co-operative outcome.

G Worksheet 5.4: Co-operation cartoons G Paper, coloured pens/pencils

1 Distribute Worksheet 5.4 Co-operation cartoons, paper and pens to participants.

2 This is an exercise for participants to work on individually. Guide them into the exercise as follows:

❝Take a moment to think of a situation in your work or personal life in which there is no co-operation and which you would like to change for the better. Draw the scenario in the square on the left as it seems at this moment, with all its complexity. Use very simple cartoon figures and simple behaviours so that you know exactly what’s going on.

Write in your thoughts, feelings and words, as well as those of others involved in your chosen scenario, in the appropriate places within the scene, using speech bubbles.❞

Allow about 10 minutes for this part of the exercise.

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Feedback 10 minutes

Helpful hints

3 Next, invite participants to complete the next step as follows:

❝Now in the space between the squares, write down any steps, methods, values or thoughts that may be needed to transform the unco-operative scenario into a co-operative one, eg stepping back, calmness, listening, positivity.

It is important that you complete these steps before you proceed further.❞

Allow about 5 minutes for this part of the exercise.

4 Finally, ask participants to create the new, co-operative scenario as follows:

❝See if you can now draw a new cartoon scenario in the square on the right where co-operation is now obvious.❞

Allow about 10 minutes for this part of the exercise.

5 Ask participants to finish working at this point, whether or not they have achieved a satisfactory cartoon.

1 Invite participants to share briefly which values and methods of co-operation they used to create a more positive scenario.

2 Explain to participants that they can continue with this process beyond the session itself, by trying out different values and methods until they come up with a satisfactory cartoon. This activity could extend over several weeks, allowing time to develop a sequence of cartoons, and one that finally expresses co-operation in their scenario.

An alternative process for this exercise is for groups to work on an individual’s chosen scenario using role play or tableaux.The individual would act as ‘director’ of the first, unco-operative scenario, asking other participants to take on the roles or stances of the people concerned.The group would then work together on methods of transforming the scene, before creating and acting out a co-operative alternative.They could discuss how it felt to

Ybe in the first scene, compared with the second. Lunch break

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Module 5|Co-operation

Session II: Working in teams Exercise 5.5

Learning outcome

Materials

Facilitating the exercise

A co-operative workplace

Process:

Visualisation

10 minutes
At the end of this exercise participants should be able to:

✔ describe the qualities and behaviours within a co-operative workplace, using guided visualisation.

G CD track no. 15 A co-operative workplace (or CD/tape of relaxing background music)

G CD player/tape recorder (optional) G Paper and pens

This exercise is a guided visualisation which will help participants to visualise the qualities and features associated with a co- operative workplace.This is a preparation for the next main exercise on creating a team vision.

You can either use the CD track no. 15 A co-operative workplace, or read out the following commentary, using your own background relaxation music (read in a clear, gentle voice, pausing at ellipses (…) to allow time for reflection).

1 Make sure that every participant has a sheet of paper and pen to hand (although they may wish to put it on the floor or to one side while they are carrying out the visualisation).

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2 Play the CD or read out the following text:

❝Sit comfortably on a chair so that your body can relax… Place your feet on the floor and rest your hands on your lap. Feel the tension release from your muscles and your breathing become even and regular… Allow your thoughts to slow down and become calm.

You are going to think about work and create a picture in your mind… Think of your workplace and how you would like it to be truly co-operative. How would it be if everyone was working well together…? What comes up in your ideal workplace…? What is it like…? What is the atmosphere…? How are people behaving…? What are they saying…? What feelings are they sharing in their interactions…? What qualities are they showing…?

You may get pictures, feelings or words coming to you… colours, sounds, a texture… let your mind wander freely… is there a symbol or particular image…?

What would it be like at your workplace if everyone were co-operating…? Observe what emerges for you.

When you are ready, become aware of your body sitting on the chair. Feel your feet on the ground… begin to deepen your breathing… and in your own time, open your eyes.❞

Allow a few minutes for participants to note down or draw any images, words, symbols etc. If time, you may like to invite people to share these, but only if they wish.

Exercise 5.6

Module 5|Co-operation

Learning outcomes

Materials

Facilitating the exercise

Creating a team vision

Process:

Creativity

55 minutes
At the end of this exercise participants should be able to:

✔ work co-operatively in small groups to achieve a collective vision

✔ produce a representation of the vision by working creatively together.

G Flipchart paper or A1 size card/paper G Coloured pens and pencils
G Magazines
G Glue sticks

G Scissors
This exercise is about creating a vision of a co-operative team.

. 1 Ask participants to form teams of six to eight people.These could be based on real work teams where relevant.

. 2 Lead the exercise as follows:

❝You are going to work together to create a vision of a co-operative team, and produce a poster which represents this vision.

Begin by sharing some of the insights you gained from the visualisation exercise, using your notes as reference. Drawing on these, produce a collective vision of what a co-operative team might look like, in terms of qualities, attitudes and behaviour.Try to involve everyone in this process.You might wish to ask one person to make some notes at this stage.❞

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Feedback 10 minutes

Helpful hints

Allow 15 minutes for this first stage.

3 Ask the teams to undertake the second stage of the exercise as follows:

❝Now work together on creating a poster which conveys this vision. Share ideas for images, words and colours. Decide on the size and shape of the poster, and how you are going to produce it by working co-operatively. You can use coloured pens, pencils and magazine cuttings of pictures and words.

Again, try to involve everyone in the process. Some people may have ideas for design and colours, others may be more focused on the process of producing the poster, and others may come up with symbols or words which encapsulate everyone’s thoughts.❞

Allow 30 minutes for this stage before moving into feedback.

1 Invite each team to share their poster and how they feel about it.They will have the opportunity of reflecting on the process by which they achieved their outputs in the next exercise.

2 At the end of this exercise mention to the group that some people may see the vision in terms of outcome and others in terms of process, and that the next exercise will focus particularly on the process.

This exercise is based on groups letting go of personal agendas, status and roles in order to focus on a common task. During the stillness of the preceding visualisation, creative ideas will have emerged; the challenge is then to work with them to achieve a collective vision and fulfil the task of representing that vision. The sharing, the fun, and being non-judgmental about oneself and others lead to co-operative success.

Movement exercise

10 minutes

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Exercise 5.7

Module 5|Co-operation

Learning outcomes

Materials

Facilitating the exercise

Exploring the process of co-operation

Process:

Reflection and sharing in groups

30 minutes
At the end of this exercise participants should be able to:

✔ appreciate the process of co-operation in teams
✔ describe and evaluate the main factors which positively

affect working co-operatively in groups.
G Worksheet 5.7 Exploring the process of co-operation

G Flipchart and marker pens
1 Give out Worksheet 5.7 Exploring the process of

co-operation.

2 Ask participants to stay in the same teams, but to spend a few minutes looking through the questions on the sheet individually, reflecting on the process of working together to produce the poster in the previous exercise.

Allow up to 5 minutes.

3 Invite everyone to share their responses in their teams.Ask each team to prepare to report back on the main learning from this exercise, in terms of successful team co-operation. They may wish to write the main points on a flipchart sheet, as a reference for action planning at the end of the session.

Allow 20 minutes for team discussion.

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Feedback Invite each team to briefly report their conclusions. 5 minutes

Z Break

15 minutes

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Session Review

10 minutes Guidance notes

Briefly review the session by displaying the session aims, learning outcomes and session programme. Remind participants of the activities they have undertaken.

Pick out any highlights, referring to materials that participants have produced and which you have displayed.

Hand out the Background Reading paper for participants to take away, pointing out any references and resources for this module, should they wish to explore the theme in more depth.

See Part 2: Guidance for Facilitators for further guidance.

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Action Planning

See Part 2: Guidance for Facilitators and Part 5: Additional Resources for information and guidance on action planning. Below is a suggested action planning exercise.

Exercise 5.8

Learning outcome

Materials

Facilitating the exercise

Taking it back to work

Process:

Reflection and sharing in groups

30 minutes
At the end of this exercise participants should be able to:

✔

apply principles of co-operation to resolving problems and issues at work.

Paper and pens

Ask participants to begin by identifying, individually, a problem/issue where they need to co-operate with others at work to achieve a positive outcome or resolution.

Allow 2 or 3 minutes for them to consider this.

Ask participants to form groups of three and to work co-operatively on how each person in the trio can apply what they have learned today to their problem or issue.

Allow 20 minutes.

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Feedback 5–10 minutes

If you have time, ask participants to share how they felt about applying the principles/experiences of co-operation to tackling real problems and issues. Concentrate this feedback on the effectiveness of problem solving through co-operation, rather than sharing of the situations themselves.

Summarise the importance of reviewing action plans as follows:

❝It is important that you undertake regular reviews to see how you are doing and to remind yourselves of the vision you created.This will help you celebrate the success of the outcome; it will keep you focused on the vision; and it will also keep you on track or show you if you need to take a new direction.

Finally, success breeds success. When people have a sense of achievement – both from successfully completing the task, and from working well together – they gain extra energy to do more.❞

See Part 2: Guidance for Facilitators and Part 5: Additional Resources for information and guidance on action planning and review.

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Evaluation

10 minutes

Materials

G Copies of evaluation pro forma (if being used) G Pens

Guidance notes

Run though your planned evaluation activity (see Part 2: Guidance for Facilitators and Part 5:Additional Resources for information and guidance on evaluation).

As an alternative or additional activity, you may also want to give out a more formal evaluation form at this point for participants to complete now or return by a given date.

Remember to plan in some time as soon as possible after the session to complete your own evaluation of how you think the session went.

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Closure

Exercise 5.9

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Materials

Facilitating the exercise

Temple of co-operation

Process:

Creativity

10 minutes
G Worksheet 5.9 Temple of co-operation

1 Give out the Worksheet 5.9 Temple of co-operation and ask participants to work in small groups.The handout shows the temple of co-operation comprising: the foundation, pillars and roof.

2 Ask participants to colour these parts of the temple and write what they consider to be the qualities, behaviour and attitudes that best represent the foundation, the pillars and the roof in a temple of co-operation. Each group can share their temple with the main group to end the session.

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Follow on/homework Exercise 5.10

Learning outcome

Materials

Facilitating the exercise

Adverts: an exercise in group co-operation

Process:

Creativity and play

30 minutes
At the end of this exercise participants should be able to:

✔ describe the effects of creativity on co-operative working in teams.

G A selection of objects which could be the focus of an advert, eg an egg, a bar of soap, a fruit or other food, etc.

1 Invite participants to form groups of four or five people. 2 Lead the groups into the task as follows:

❝The task is to make up aTV advert.You have 15 minutes to make up a two-minute advert which you will be performing to the other groups.

Choose one of the objects as the focus for your advert (or an alternative object, if you wish). Work together quickly, being as creative and non-judgmental as you can.❞

After 15 minutes, ask each small group to perform their advert.

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Feedback 15 minutes

1 Invite everyone to share what has been learned from the exercise, in particular:

G What was the effect of working creatively on team co-operation?

G How creative was the group able to be?

G Additional discussion points: levels of energy; what helped or hindered creativity; what effect did being creative have on individuals and the group, additional factors in the process of co-operation (see discussion points on Worksheet 5.7 Exploring the process of co-operation).

2 As the facilitator, summarise as follows:

❝This exercise shows how creativity can help in the process of co-operation. Creativity makes us feel good, it raises energy. Creativity is soulful – that is, it enables us to connect with our real selves.

In a creative process there is no time or space to be self-judging or have self-doubt, which lowers energy. We take the ‘third corner’, in other words, we are all concerned about the best solution, rather than worrying about ourselves or the other person.

So, if we want to encourage co-operation we can look at our own contribution and increase our own individual energy by
not judging others, or ourselves. As a team, we can reduce the judgements we make about each other by being creative and focusing on something we all think is important at the moment.❞

This exercise deliberately focuses on objects which are far removed from the workplace, in order to encourage participants to experience the creative process and its effect on co-operation, rather than the outcome.

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Helpful hints

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Exercise 5.11

Learning outcomes

Materials

Facilitating the exercise

Creating new perspectives

Process:

Reflection and sharing in pairs

45 minutes
At the end of this exercise participants should be able to:

✔ identify solutions to problem situations, based on putting qualities of co-operation into practice

✔ translate solutions into specific actions, as part of an individual or team action plan.

G Paper and pens

1 Distribute sheets of paper and pens to participants and ask them to work on their own, as follows:

❝Think on your own of a difficult clinical or organisational situation that is relevant to you and where you wish to seek a clearer solution.

Write the essence of what the tricky situation is.❞ Allow two or three minutes before moving on.

2 Invite participants to reflect on solutions as follows:

❝Go into silence and reflect on possible solutions, thinking of a co-operative quality or tool that might transform or adequately deal with that situation, drawing on the experiences and insights gained during the main session. Examples might be listening, visualisation, understanding, creativity.

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Feedback 10 minutes

Helpful hints

Now write down how the situation or problem might change for the better as a result of using this quality or tool.❞

Allow up to 10 minutes for this part of the exercise. 3 Ask individuals to share with a partner as follows:

❝Share with a partner how the original situation might change as a result of using a co-operative quality or tool. Discuss how this new solution might work in practice.❞

Allow a further 5 minutes.

4 Invite each pair to help each other develop an action plan for translating their solution into a set of specific actions to take away.

Allow a further 15 minutes.
If time allows, ask the whole group for feedback on the process.

G How did using a quality change the situation?
G What kind of action plans did individuals come up with?

Often, when difficult situations arise, solutions are not always obvious or satisfactory. A new perspective, based on reflection, can help the process of finding a solution.

You could use the Values cards in this pack and ask each participant to choose one as a focus for the exercise.

An alternative or additional exercise can be carried out, asking everyone to describe their problem or situation on paper and to put it into a bowl in the centre of the group.Then each person takes out one piece of paper and uses a quality to create a solution, which they write on the same sheet of paper. In this way, the solutions are anonymous and can be read out to the whole group.

If the group constitutes a working team, or if participants work within the same unit/service, they may wish to identify a situation which is relevant to all of them.Their individual solutions could then be shared and used as a basis for working on a team plan

of action.

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Worksheet 5.1

Co-operation – what does it mean?

Describe a situation at home or at work where there was successful co-operation.

What made the situation successful?

What were the behaviours and skills people showed?

What were the qualities and values people expressed?

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Worksheet 5.3

Co-operative listening

Part A: Favourite music

Why have you chosen that piece of music/song?

What makes it special to you?

What does it reminds you of?

How does it make you feel?

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Worksheet 5.3 (continued)

Co-operative listening

Part B:The process

When you described the music:

What effect did remembering your piece of music have on you?

How did you feel about the possibility of your partner or others judging you? How safe did you feel?

How enthusiastic were you and what was the effect of this?

What effect did your partner’s encouragement have on how much you disclosed?

As a listener:

What effect did this exercise have on you?

As an exercise in individual co-operation:

What common ground did you discover?

What are your energy levels like now?

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Values in Healthcare © The Janki Foundation for Global Health Care 2004

Worksheet 5.4

Co-operation cartoons

1 Think of a scenario in which there is no co-operation and that you would like to change for the better. Draw
the scenario in the ‘before’ square as
it seems at this moment, with all its complexity. Use simple cartoon figures and simple behaviours so that you know exactly what is going on.

2 Write in your thoughts, feelings and words, as well as those of others involved, using speech bubbles.

3 In the space between the squares, write down any steps, methods, values or thoughts that may be taken for co-operation and transformation to occur, eg stepping back, looking at myself and others.

4 Now, connect and apply ideas and methods of co-operation to the cartoon you have drawn. Draw a new cartoon scenario in the ‘after’ square in which co-operation is now visible.

Before

During

After

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Worksheet 5.7

Exploring the process

of co-operation

Discuss the three main questions below as they relate to your experience of the previous exercise on creating a team vision. If you have time, consider some of the additional discussion points given.

1 Contribution

What encouraged individuals to contribute?

Additional discussion points: the effect of having a clear aim; level of focus; whether you took on roles; whether you all maximised your contribution, and if not, why not?

2 Qualities of co-operation

Which of the qualities and skills of co-operation did the group exhibit?

Additional discussion points: what was easy/difficult in working together; whether individuals felt included/excluded; whether and how you worked differently from your usual experience of group/team working.

3 Learning

What have you learned from the exercise about the process of co-operative team working?

Additional discussion points: what effect did being successful or having fun have on the group; whether the group took on different energies during the process; how you might have co-operated more effectively?

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Worksheet 5.9

Temple of co-operation

Module 5|Co-operation

Colour the temple and write in words to show what qualities, behaviour and attitudes might be needed:

G As the foundation for co-operation G To support co-operation (the pillars) G To maintain co-operation (the roof)

Values in Healthcare © The Janki Foundation for Global Health Care 2004

Background Reading

Why Valuing Yourself ?

As healthcare professionals we tend to focus on what is best for the patient. By putting patients first and doing things for others, we often forget to care for ourselves. However much of a truism it may be, it is important to look after ourselves, not only because it will benefit our patients by setting a good example of ‘self-care’, but for our own sakes.

In addition, sick staff have implications at an organisational level. There are financial and efficiency implications. In the long term, it affects morale and staff retention. It also affects people’s families and their work colleagues.

‘Physician heal thyself’ is a maxim that puts valuing the healthcare practitioner at the centre of healthcare. It is by nurturing ourselves that we heal ourselves, in order that we can effectively support the healing of others. This healing is more than keeping free from illness and promoting a healthy lifestyle. It is about developing self-confidence and self-respect, as well as learning through our experiences to find meaning for ourselves.

Purpose of the module

Valuing yourself is a way of preventing burnout and its consequences. Any personal development plan is not just about educational development at work but about self-care and personal growth as individuals. We reflect not just on our work performance but where we fit as individuals in our world at home, work and life.

Introduction to the Valuing Yourself module

This module helps us to explore our own self-care, but also our self-confidence and need for support, in order that we can introduce positive change and self-renewal in our lives, respect ourselves, and create opportunities for self-discovery.

In recognising our own worth, we are better able to acknowledge the intrinsic worth of others. This leads to mutual respect and harmony in all our relationships. We benefit, our colleagues benefit, patients benefit; our self-respect becomes an example to others, and in turn earns respect from others.

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Themes of Exercises

Caring for myself (6.1)

Many healthcare practitioners rarely think of how they care for themselves and it can be difficult for them to address their own needs, as the view that ‘the patient comes first’ is firmly entrenched in the healthcare culture. Nevertheless, if we ourselves are not in good health at all levels, how can we truly be at our best for others?

Physical

We advise our patients to follow a balanced diet, take regular exercise, have adequate rest, restrict alcohol consumption, and refrain from smoking. Yet how many of us follow that advice for ourselves?

Keeping fit for our job by adopting a healthy lifestyle is basic common sense. There are some simple, practical ways in which we can look after ourselves on a physical level – making sure we take meal breaks, working reasonable hours – which ensure we get enough rest and exercise to maintain the energy we need to do our job well.

Mental

Mental well-being is part of maintaining a healthy lifestyle and this requires addressing and managing the stress that is part of the type of work we do. We need to plan time off by taking regular holidays, free days within the week and breaks during the day. When we are not working we need to find space to relax and pursue other interests. We need to reflect on what causes us stress and make plans to change, and we need to learn to say ‘No’, to delegate and to have fun.

Emotional

In healthcare, we often find ourselves called on to deal with difficult emotional situations. To cope well, we need a good sense of self, the support of colleagues and sometimes we need to ask for professional help, such as counselling.

Social

Making time for family and friends is essential. This where we find our main support, can relax, have fun, and give and receive care and love. It is not something we should put off; it needs attention to grow and flourish, otherwise it will wither. We need to socialise out of work, be involved in the community, and pursue non- work interests, for example, by doing something creative, and developing sporting, cultural or intellectual activities.

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Environmental

We tend to focus on providing the best environment and conditions for our patients, but it is also important to consider what working environment and conditions are good for us. This, in turn, will have a positive impact on those we are caring for.

Spiritual

We must learn to look after ourselves at a spiritual level and take care of our ‘inner self’ with the same kindness and gentleness we would wish for our patients. Finding times of silence helps us to reflect and connect with that much deeper self. This can be when we are walking in nature or simply sitting in a garden or park. It can happen when we relax in a bath or when we are absorbed in a task. It can be during exercise or when we practise meditation.

A healing space (6.2)

We all need a place where we feel safe and relaxed. We may already know of such a place in our own home or in nature. It needs to be a place where we can be ourselves, with all our special things around us. At the present time such a place may not be possible because of practical reasons, but if it was, what would it look like? What would it feel like? Although it will not necessarily make our minds calm, an outer space where we feel relaxed and secure will promote an inner peace.

Being cared for (6.3)

Healthcare practitioners are used to caring for others, but how often do we allow ourselves to be cared for? At work we are used to focusing our attention on patients so that all their needs are met when they are ill. We attend to them physically, mentally and spiritually. We are good at giving, but how good are we at receiving? How often do we allow people to do things for us, either on a physical level such as a massage, or on a mental-spiritual level when we unburden our troubles on others? How do we nurture ourselves and give ourselves treats or even just space to be alone?

We can create a healing and nurturing place or presence in our minds first – perhaps this is the first step to making it a reality.

Self-confidence (6.4)

Traditionally, healthcare professionals receive a great deal of respect from their patients. In part, this is based on a regard for their sense of duty when supporting the sick and less able. It also comes from recognition of their expert skills. And not least, healthcare professionals have long been regarded as trusted confidantes.

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However, in recent years many healthcare professionals say their poor morale is due to a lack of respect. Many factors are cited for this change, including the social and cultural trend of materialism and the high expectations of patients.

Respect from others towards healthcare practitioners is something we have no control over, but we do have a say in the respect we pay ourselves and others. If we give ourselves this self-respect and treat others with respect it will encourage those around us to behave in the same way.

This respect for the ‘self’ involves recognition of our own values and worth. Self- respect is the experience of being at peace with ourselves, accepting ourselves at this deep level for who we are, and at the same time being open to changing our attitudes and habits.

It follows that self-confidence in our abilities as healthcare practitioners will grow as we develop our self-respect. When faced with difficult circumstances our main resource is recognition of our inner qualities. We can draw on this understanding and make decisions with a self-confidence that has humility at its core, rather than arrogance or power.

Sources of support (6.5)

For healthcare practitioners, emotional trauma and witnessing the suffering of others can be emotionally draining and spiritually challenging. We can end up ‘burnt out’, exhausted and of little help to our patients.

An example of the need for support is that of John, who had been an ambulance worker for 15 years and who had an opportunity to share the reasons for his feelings of stress and exhaustion at a Values in Healthcare session:

‘Week after week, year after year, mangled and dead bodies. It has got to me at last. All the images of accidents I have attended and people who have died keep coming back to me.’

John had never shared this with anyone before. He did not want to burden his wife, felt his friends would not really understand, and knew that his colleagues were under the same strain as he was. It was one of those unwritten rules that you did not talk about such matters in the ambulance service. Rushing from one emergency to another was all part of a day’s work.

John’s story illustrates a common dilemma – how do we unburden ourselves and where do we look for support, not only in our jobs but in our personal lives? We may have friends and family to turn to in a crisis, but how much do we share of the day-to-day trauma of our work, and with whom? It is something we need to personally examine by looking at mentoring and counselling, or considering formal systems of support at our workplace.

The pressures of work can be like a log-jam in a river – the water slowly builds up until there is a head of pressure that eventually breaks the dam. We need to develop our own coping strategy, develop our own ways of redirecting the flow of water, by considering to whom and to what we can turn when faced with emotional and spiritual crisis. We all need to ask ourselves, ‘Where do I find the support in my job? Who do I turn to when I am feeling the strain?’.

Cleansing colours (6.6)

Stopping and having a break, even for a few minutes, is a useful way to escape from the stress of work and everyday living. It may be just sitting in a corner or getting outside for some fresh air. These breaks can be opportunistic when there is a lull at work, or may be pre-planned to happen several times a day. But what is important during these breaks is to avoid our thoughts continuing to race in our minds and to achieve a sense of calm. This can be done by breathing and thinking through a visualisation such as cleansing colours. This kind of exercise helps to restore calm and balance, and also promotes energy for the rest of the day.

Making changes (6.7)

A major source of stress is change. Change itself is not necessarily stressful but how we perceive the change can be. When it is imposed by someone else, such as our bosses, managers or the government, we are left feeling powerless, since we have not been consulted or involved. Yet we do have control over many of the changes in our own life, and can introduce changes which improve our level of well-being.

Before making changes we have to decide what we want and make time to reflect on what is really important for us, asking ourselves questions like, ‘What would I really love to happen?’, ‘What is it that I have always wanted to do?’, ‘What qualities do I want to develop?’ or even, ‘In what way do I wish to serve the world?’ It is by writing it down and sharing some of our ideas that changes can begin to become real. We can then observe and begin to understand the underlying values of the things we wish to achieve and how it will feel once we have achieved them. Does it make us feel content, boost self-esteem, make us happy?

To make space for these new changes, we must let certain things go. This may provide a sense of relief as we do many things out of a sense of guilt or because we ‘ought’ to. Spending time reflecting on what we can give up, and considering the resources we will need to overcome obstacles, provides a way of making positive changes.

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Four seasons (6.8)

There is value in developing an attitude to change that is accepting, non-judgmental, and flexible. We can learn to take a detached view and see changes in our lives as challenges and opportunities that are part of the inevitable cycle of life. We can see
a parallel in the natural changes of the seasons and how each living thing goes through birth, growth, maturation, decay and death. A visualisation gives us a chance to experience such natural changes and helps us develop a more accepting attitude so changes in our life will be less stressful.

The roles we play (6.9)

At one level, we are used to answering questions about our identity every day – we give our name, our job title and description, and we may add interests, hobbies, what we like to do. But does that encapsulate everything about us?

When considering caring for the self, it is important to spend some time on exploring who the self is. ‘Who am I?’ ‘What are my values?’ ‘What do I hope to achieve?’ ‘What sense do I make of everything?’ – these are the eternal spiritual questions that we need to address if we hope to find happiness and fulfilment.

We can begin to address the question of ‘Who am I?’ by looking at the various roles we find ourselves in, and by considering what qualities we express in each of these.

One way to think about this is to look at the roles we play in the various activities and relationships we have, and ask ourselves some key questions:

G What am I like as a brother/sister, as a son/daughter, as a partner?

G Am I the same person at home and at work?

G What are the positive qualities and negative attributes I show in each of these roles?

G Do I behave differently with strangers and friends?

G When I reflect on all my roles, am ‘I’ the sum of them all? If you take away those roles, where is the ‘Me’ that remains?

If we take this a step further, we can delve deeper. We may ask:

G G

Which part of me is asking these questions?

How does this ‘Me’ part relate to my inner world of senses, intuition and instinct?

Who am I? (6.10)

When we are calm and peaceful, we can go deeper, explore beyond the roles we take on in life and search for that inner self. It is this searching, this journey, that begins to give insights into some of the spiritual questions we ask. We can begin to get a sense of who we truly are when we create a peaceful space within.

Creating happiness (6.11)

The culture within healthcare itself is often competitive and critical, and this tends to eat away at self-esteem and lead to unhappiness. We need to tap into our inner values to prevent the erosion of self respect, reminding ourselves of our positive aspects, in order to create an inner happiness.

Many healthcare professionals say they are unhappy with their job. Pay and workload are often given as causes, along with the increasing expectations of patients and government. The job itself has become more stressful as it has become increasingly complex and emotionally demanding. In addition, doctors and other healthcare workers can be self-critical and have a poor record of support within their professions, with little training in the managerial skills and working in teams that their jobs now demand. Solutions can be found to some of these problems, but what can be done now to help us to find more happiness in our lives and work?

We all have an idea of what it is like to feel happy. Call it Nirvana, Heaven or Utopia, it is a place where we could experience complete peace, contentment, joy and freedom from all worries. This individual image of perfection is something that we can draw on and give us something to aim for.

Every day we all seek happiness, whether through our possessions, our relationships, satisfying our physical needs or trying to fulfil our ambitions of status and wealth. Yet such achievements leave us short of lasting happiness.

It is the turning inwards to seek the riches of our own spiritual values that results in true happiness. It gives us the confidence to live and act by being true to ourselves, regardless of what is happening around us. It is not an easy path to follow, as we are held back by our own attitudes and habits and are influenced by negative images and attitudes around us. By constantly reminding ourselves that we are peaceful beings who naturally wish to act with compassion, and that we have all the wisdom we need within, we can begin to feel a more real, and lasting sense of happiness.

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The Facilitator’s Guide to Module 6

Session I: Self-care

Aims

G To identify ways of looking after one’s self
G To create a healing space in which to relax and recharge
G To identify the attitudes, values and qualities of self-confidence G To develop plans for improving self-confidence

Process

This session focuses on self-care and self-confidence. Participants begin by thinking about what they currently do to look after themselves, sharing their thoughts in pairs and in the group. This is followed by a playful, creative exercise in which participants create a healing space for themselves, and then represent this in a visual way using art and craft materials. A healing visualisation allows participants to develop this concept at a deeper level, adding in the idea of a nurturing presence which can support them. Following a break and short movement exercise, participants work individually and in small groups on an extended exercise which enables them to consider the attitudes, values and qualities involved in developing self-confidence. This leads into identifying ways of building their own self-confidence in their lives.

Session II: Support at work

Aims

G To identify and develop personal and inner sources of support G To develop a plan for positive change in self-care
G To experience change and self-renewal at a deep, personal level

Process

Participants begin this session by considering what sources of personal support they have available to them in particular situations, identifying gaps and planning to improve their support where needed. This is followed by a short, revitalising visualisation and breathing exercise, based on the experience of colours. Participants then move into a review of the session and action planning, during which they work

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on identifying a change to improve their self-care, together with exploring resources and ways of overcoming obstacles which will help them to achieve their plans. They are then guided through a final, closing meditation which helps them to experience change and self-renewal at a deep level.

A follow-up session incorporates an enquiry with a partner around the theme of ‘Who am I?’, and their reflections are further developed through a meditation on the same theme. An optional exercise explores personal happiness.

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Programme/plan for Module 6 Valuing Yourself

Introduction 30 minutes SESSION I Self-care

Exercise 6.1 Caring for myself 30 minutes

Exercise 6.2 A healing space 40 minutes

Exercise 6.3 Being cared for 5 minutes

Break 20 minutes

Movement exercise 5 minutes

Exercise 6.4

Lunch break

SESSION II

Exercise 6.5

Self-confidence 60 minutes

Support at work

Sources of support 60 minutes

Exercise 6.6 Cleansing colours 10 minutes

Movement exercise 5 minutes Break 15 minutes

Session review 10 minutes

Action planning

Exercise 6.7 Making changes 45 minutes

Evaluation 10 minutes

Closure

Exercise 6.8 Four seasons 10 minutes

Total time 5 hours 55 mins

Follow-on/homework

Exercise 6.9 The roles we play 45 minutes

Exercise 6.10 Who am I? 15 minutes

Exercise 6.11 Creating happiness 30 minutes

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Materials

G Paper and pens
G Coloured pens/pencils
G Flipchart and marker pens
G CD player/tape recorder (optional)

Session I

G Worksheet 6.2 Design your healing space
G Worksheet 6.4 Exploring self-confidence (3 sheets)
G CD track no. 16 Being cared for*
G Old magazines/pictures of interior and exterior scenes G Pieces of fabric/materials with different textures
G Glue sticks

Session II

G Worksheet 6.5 Sources of support G CD track no. 17 Cleansing colours* G CD track no. 18 Four seasons*

Follow-on/ homework

G Worksheet 6.9 The roles we play (2 sheets) G CD track no. 19 Who am I?*
G Length of rope or cord (optional)

*or relaxing, background music

Module 6|Valuing Yourself

Preparation

. 2 Familiarise yourself with the main learning tools which are being used in the session (see Part 4: Spiritual Tools).

. 3 Read through the session guidelines and look at the suggested session programme which will incorporate:

G Session introduction G Exercises
G Movement breaks
G Breaks

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G Session review G Action planning G Evaluation
G Closure

4 Photocopy any handouts and exercise sheets, and make sure that you have any other equipment listed under Materials.

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Introducing the Module

30 minutes
Run through your planned introductory session which may include:

Quiet time
Introductions/optional warm-up exercise Overview of session
G Theme of session
G Aims and learning outcomes
G Programme/plan for the session
G Practical considerations
G Any questions

Setting the tone

G Ground rules/principles G Participants’ expectations

Review of last session/homework
See Part 2: Guidance for Facilitators for further guidance on introducing

the session.

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The Exercises

Session I: Self-care Exercise 6.1

Learning outcome

Materials

Facilitating the exercise

Caring for myself

Process:

Reflection and sharing in pairs

30 minutes
At the end of this exercise participants should be able to:

✔ identify ways of caring for themselves. G Paper and pens

G Flipchart and marker pens

1 Invite participants to get into pairs but to work alone on the first part of the exercise.

2 Introduce the exercise as follows:

❝Spend a few minutes working on your own, listing some of the ways in which you care for yourself. Don’t just think about things you do in your time off, but also things you do to care for yourself at work.Your list can include trivial things, as well as some which you consider more significant or important.

At this stage, please write down what you actually do now, rather than what you would like to do. Examples might be: always having a coffee break mid-morning to chat; going for a run every day; taking your maximum holiday allowance each year; having a massage once a month. Include some ways in which you pamper or treat yourself.❞

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Feedback 15 minutes

Allow 5 minutes.

3 Now ask participants to get into pairs and share their lists, as follows:

❝With your partner, share some of the general areas you have written down and, within each area, some of the specific things you actually do to look after, or care for yourself.❞

Allow a further 10 minutes.

1 In the main group, invite participants to suggest how the items on their lists group into areas or themes, and write these up on a flipchart, eg relaxing activities, finding a quiet place, doing something which is very different from work. Alternatively, use the main headings from the Background Reading paper: physical, mental, emotional, social, environmental, spiritual.

2 Ask each person in turn for one good suggestion that they may have learned from their partner, and record them on the flipchart.

3 If you have time, invite a discussion on why self-care is so important in the context of participants’ working lives (see Background Reading paper for further information).

Some of the participants may list practical things they do; others may consider emotional or spiritual support important.

In grouping self-care activities, it will become apparent that many activities nurture us on more than one level. For example, going running with a friend may help to improve our physical health, but may also be an important social contact and provide a means of reducing mental stress.

This exercise is extended during the action planning part of the session, by inviting participants to develop a specific plan for making an improvement in their self-care. Keep the ideas on the flipcharts for reference.

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Helpful hints

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Exercise 6.2

Learning outcomes

Materials

Facilitating the exercise

A healing space

Process:

Creativity and play

40 minutes
At the end of this exercise participants should be able to:

✔ identify and describe the features of a space which they can use for their own self-healing

✔ visually represent the space in a creative way.

G Worksheet 6.2 Design your healing space
G Paper and coloured pens/pencils
G Old magazines/pictures of interior and exterior scenes G Pieces of fabric/materials with different textures
G Glue sticks

1 Distribute Worksheet 6.2 Design your healing space and explain the exercise as follows:

❝This is an opportunity to design a healing space where you can go for rest, reflection and recharging. It might be a room, a space within a room, or a sheltered place within a garden.❞

. 2 Ask participants to work individually, first of all making brief notes in response to the questions on the worksheet.
Allow 10 minutes.

. 3 Next, invite everyone to make use of the magazines, pictures, fabrics, coloured pencils etc to visually represent their space in any way they wish, for example, as a collage, painting, design.
Allow a further 25 minutes.

Invite everyone to share their creations and to comment on the kind of space they chose.

Feedback 5 minutes

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Exercise 6.3

Module 6|Valuing Yourself

Learning outcome

Materials

Facilitating the exercise

Being cared for

Process:

Visualisation

5 minutes
At the end of this exercise participants should be able to:

✔ experience a sense of being cared for through visualisation. G CD track no. 16 Being cared for (or relaxing background

music)
G CD player/tape recorder (optional)

1 Invite people to sit comfortably and relax. Encourage participants to sit upright, their hands held loosely in their laps, legs uncrossed and feet placed firmly on the floor.

2 Play CD track no. 16 Being cared for, or read the following text to the group. If you are reading aloud, speak slowly and clearly in a gentle voice, pausing at ellipses (…), and playing background music if you wish.

❝Take a few deep breaths in and out… observe your breathing… … On the in-breath, instruct yourself to relax… on the out-breath, allow all your tensions to fall away…

Imagine you are sitting comfortably in a room, looking through a large window with sunlight streaming through it… Outside there is a beautiful scene of nature… just looking at it brings
a sense of calm and inspiration…

The interior of the room is set up in a way that is in harmony with your inner self. Look around you and describe this room to yourself…What are the colours…? What are the textures, the furniture and objects in the room…?

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Here you stay as long as you want, whenever you want… You can sit, walk, talk, as you wish… there is no-one to determine how you should be… you just are… appreciate your uniqueness. Relax and enjoy being in this peaceful, beautiful room.

Imagine there is someone nearby, who you care for and who cares very deeply for you… understands you more than you even understand yourself. At times, when you need them most, you can sense their caring thoughts and feelings supporting you… in those moments, you feel at peace with yourself and the world.

(Pause)

In your own time, become aware of your body sitting on the chair, move your limbs and look around.❞

Allow participants time to come out of the visualisation, invite them to stretch and move into the break.

Break

20 minutes Movement exercise

5 minutes

For this part of the session, start with a movement exercise which emphasises self-care/nurturing, eg participants stand in a line all facing the same way and each person massages the shoulders and back of the person in front.They then face the other way and repeat the exercise.

Alternatively, introduce a relaxation exercise, asking people to lie or sit comfortably while you guide them through a muscle relaxation or breathing practice (see Part 5:Additional Resources for some ideas).

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Exercise 6.4

Module 6|Valuing Yourself

Learning outcomes

Materials

Facilitating the exercise

Self-confidence

Process:

Reflection and sharing in small groups

60 minutes
At the end of this exercise participants should be able to:

✔ identify attitudes and values which demonstrate self-confidence

✔ plan to improve their self-confidence in specific areas. G Worksheet 6.4 Exploring self-confidence (3 sheets).

G Pre-prepared flipcharts for Parts A and B, each headed with the main question from the corresponding worksheet, and listing the items from the worksheet down the left-hand side, with space to write against each.

G Paper and pens
G Flipchart and marker pens

This exercise explores aspects of building and sustaining self-confidence in the individual.

Divide the participants into groups of 3 people.
The exercise is in three parts. Lead each part as follows:

Part A: Attitudes (15 minutes)

. 1 Distribute the first sheet of Worksheet 6.4 Exploring
self-confidence, headed Part A.

. 2 Ask them to work on their own to complete Column 1 on the worksheet, answering the question ‘What is the attitude of a self-confident person towards…’ in relation to each of the items listed. Remind them to use only one or two words per item.
Allow a few minutes for this individual work.

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Feedback 5 minutes

3 Invite participants to share their responses in their small groups, and to agree on one answer to each item. Ask them to write this in Column 2 of the worksheet.

Allow a further 10 minutes for this.

Ask one person from each of the small groups to feed back on one or two items, until all items have been covered. Record their answers on your pre-prepared flipchart.

Part B:Values (15 minutes)

. 1 Distribute Part B of Worksheet 6.4 Developing
self-confidence.

. 2 Ask participants to work on their own and complete Column 1, naming two values a self-confident person would have in dealing with each of the people or situations listed.
Allow a few minutes for this.

. 3 Invite everyone to share their responses in their small groups, again choosing one answer for each item.Ask them to write these in Column 2 of the worksheet.
Allow 10 minutes.

Ask one person from each of the small groups to feed back on one or two items, until all have been covered. Record their answers on your pre-prepared flipchart.

Part C: Qualities (5 minutes)
1 Distribute Part C of Worksheet 6.4 Developing

self-confidence.

2 Ask participants to work on their own again, and to list their special qualities of self-confidence on the worksheet, together with which qualities they wish to develop further.

1 For the remaining time, you may wish to facilitate some discussion about people’s responses and the process.

2 If there is time, go on to invite participants to suggest what specific actions they would take to develop their self-confidence in the areas they identified on Part C of the worksheet, and to produce a timed action plan. Alternatively, they could undertake this task as part of the Action Planning session later in the day.

Lunch break

Feedback 5 minutes

Feedback 15 minutes

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Session II: Support at work Exercise 6.5

Learning outcomes

Materials

Sources of support

Process:

Reflection and sharing in pairs and groups

60 minutes
At the end of this exercise participants should be able to:

✔ appreciate the qualities involved in giving support

✔ identify gaps in personal support

✔ identify people who act as personal sources of support in specific situations

✔ develop an action plan to improve support. G Worksheet 6.5 Sources of support

G A pre-prepared flipchart sheet for Part C of the exercise, containing the following:

Gaps in support

– Who and where might you turn to in each specific circumstance?

– Who would be your ‘Number 2’ if that person were not available?

– How would your chosen people respond to your request for support?

– Are there any particular actions you could take now, to improve or increase your sources of support?
G Paper and pens

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Facilitating the exercise

This exercise is in three parts.
Part A: Support at work (20 minutes)

1 Split participants into small groups of three or four people. Introduce the first part of the exercise as follows:

❝Share an experience of an occasion when you were supported at work.❞

Allow 5 minutes.
2 Next, invite participants to share as follows:

❝Now, think of a time when you supported someone at work, and briefly share that experience with the group.❞

Allow a further 10 minutes.

3 Invite each group to try to identify the qualities demonstrated by themselves and other people when giving support, and to note these down.

Allow 5 minutes.

Ask groups to share some of the qualities demonstrated by people giving support. List them on a flipchart and ask for some individual examples.

This exercise provides an opportunity for people to share issues around support at work. Encourage participants to focus on the qualities that people exhibit when giving support, rather than on negative aspects.

Part B: Personal support (15 minutes)

Feedback 5 minutes

Helpful hints

Distribute Worksheet 6.5 Sources of support and ask participants to work individually, filling in their responses to the questions on the sheet.

Allow up to 5 minutes.

Invite participants to reflect on their responses and share
with a partner what they have discovered. Are there any gaps?

Allow a further 10 minutes before moving on to the final stage of the exercise.

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Feedback 10 minutes

Helpful hints

Part C: Support plan (10 minutes)
1 Display your pre-prepared flipchart and lead participants into

a brief action planning exercise as follows:

❝Work on your own to develop an action plan for addressing the gaps in support you have identified.

Be specific about to whom and where you might turn in each specific circumstance. Who would be your ‘Number 2’ if that person were not available? Consider how your chosen people might respond to your request for support.Are there any particular actions you could take now to improve or increase your sources of support?❞

Allow the remaining time for feedback as a whole group.Ask participants:

G What have you learned from the exercise?
G Did you identify one or two key people or a broad network

of people?

G What kinds of action have you identified to improve your personal sources of support?

This may be an opportunity for the group to consider ways
that they could build up a support network. Examples may be provision of counselling, mentoring, getting together at work breaks, and identifying support networks as part of the training. (Remember: a support group needs an experienced facilitator to keep it on track.)

If participants have come together as a work team, they may wish to develop a plan for strengthening support to the team, as well as individual members.

Remind participants that they may want to extend their work on identifying and planning support in the Action Planning part of this session.

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Exercise 6.6

Learning outcome

Materials

Facilitating the exercise

Cleansing colours

Process:

Breathing and visualisation

10 minutes
At the end of this exercise participants should be able to:

✔ practise a colour breathing exercise to restore calm, energy and balance.

G CD track no. 17 Cleansing colours (or relaxing background music)

G CD player/tape recorder

1 Invite people to sit comfortably and relax. Encourage participants to sit upright, their hands held loosely in their laps, legs uncrossed and feet placed firmly on the floor.

2 Play CD track no. 17 Cleansing colours, or read the following text to the group (read slowly and clearly in a gentle voice, pausing at ellipses (…) and playing background music if you wish).

❝Sit quietly and comfortably… slow your breathing until it finds its own gentle rhythm.

Watch the breath… moving in and out at its own pace. In this exercise you are going to imagine breathing colours through different areas of your body.

We will start at the base of your spine… focus on that area… breathe in and out at your own pace… and see the colour of the breath to be a warm red… breathe this red in and out until you feel it is the right shade and texture for you. See it fill your whole body.

Now move on to focus your attention just below the navel… breathe in and out slowly… and see the breath as a rich orange colour. Breathe in and out and see the breath reaching your whole body.

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Helpful hints

Z 5 minutes Break

15 minutes Values in Healthcare © The Janki Foundation for Global Health Care 2004

Move up to the solar plexus, breathe into this area of the body, this time using yellow… Again, ‘watch’ the breath gently moving in and out… and settle on a shade of yellow that you feel happy with. See the breath fill your whole body.

Move up to your heart in the centre of your chest… breathe in a green so it fills your lungs and spreads to your whole body… breathe in and out slowly until you have a clear green throughout your body.

Turn your attention to the throat and imagine the breath is blue… breathe in a pure blue so it fills your whole body.

Now focus on the forehead and breathe in the colour indigo… at your own pace, breathe in indigo for several breaths until it reaches a colour you feel comfortable with and fills your body.

Finally, on the top of the head, at the crown, imagine the breath is the colour violet.Think of the colour violet and breathe it in. As you breathe out, imagine yourself breathing away any toxins that may distort the colour.At your own pace breathe in violet… in and out three times until you feel there is a pure violet colour entering through the crown of your head to fill your whole body.

See yourself as a radiant rainbow person… …

In your own time be aware of the room again and then gently move your hands and feet and look around the room.❞

This can also be done with the sound for:

addition of sound, making the

Base (red)
Sacral (orange)
Solar plexus (yellow) Heart (green) Throat (blue)
Brow (indigo) Crown (violet)

OH OH EH AH OO EE AMH

(as in bOne) (as in Oval) (as in Enter) (as in fAst) (as in fOOt) (as in clEAn) (as in fARM)

Movement exercise

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Session Review

10 minutes Guidance notes

. 1 Briefly review the session by displaying the session aims, learning outcomes and session programme. Remind participants of the activities they have undertaken.

. 2 Pick out any highlights, referring to materials that participants have produced and which you have displayed.

. 3 Hand out the Background Reading paper for participants to take away, pointing out any references and resources for this module, should they wish to explore the theme in more depth.

See Part 2: Guidance for Facilitators for further guidance.

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Action Planning

See Part 2: Guidance for Facilitators and Part 5: Additional Resources for information and guidance on action planning. Below is a suggested action planning exercise.

Exercise 6.7

Module 6|Valuing Yourself

Learning outcome

Materials

Making changes

Process:

Reflection and sharing in pairs

45 minutes
At the end of this exercise participants should be able to:

✔ identify ways of improving their self-care.
G Pre-prepared flipchart containing the following heading

and two questions:

Making a change to enhance your self-care:
– Why is this important to you?
– What does this change you have chosen give you?

G Paper and pens
G Flipchart and marker pens

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Facilitating the exercise

This exercise is in three parts. Lead each one as follows: Part A: Identifying a self-care goal (20 minutes)

1 Give out paper and pens to all participants and invite them to begin by working on their own:

❝Consider for a moment that you have been advised that you need radically to change your lifestyle as a matter of importance and urgency (this could be because of illness or change in circumstances) in order to improve your self-care.

Write a list of all the things that you always wanted to do and which would enhance your self-care.What is really important to you? It may be something you would like to happen, achieve or develop a skill in.Write as many as you like without letting any obstacles come into your mind.

Once you have written them down, choose one and imagine what it would be like in as much detail as you can: the feeling, the sights, sounds and tastes.❞

Allow about 5 minutes for participants to think this through and write their lists.

2 Now ask them to work in pairs as follows (display your pre-prepared flipchart):

❝Choose a partner and share one of the things you have chosen. Your par tner’s job is to listen, then ask two questions: ‘Why is this impor tant to you?’ and, ‘What does this change you have chosen give you?’ After a few minutes, change over. (If you have time, choose another item from your list, and repeat the questioning).❞

Allow 15 minutes for this stage of the exercise

Part B: Giving something up (5 minutes)
Invite participants to work individually again, as follows:

❝To make room for any changes we may need to give something up, or let go of an attitude. Make another list of all the things that are not important to you or you dislike doing.After you have made your list, choose several you could give up to allow space and time for you to achieve your new goal.❞

Allow 5 minutes.

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Feedback 10 minutes

Part C: Identifying obstacles and resources (10 minutes) 1 Ask participants to work in pairs again as follows:

❝With your partner again, share your ideas and discuss whether there are other things that may stop you achieving your goal, for example, time, money, skills, or lack of determination. Also consider all the resources that can help you achieve your goal, such as new skills, space, money and courage.❞

2 Allow a couple of minutes to ask participants to briefly share the following before moving into feedback:

❝Finish by imagining that you have achieved your goal.What would you do or say, how would you feel? Tell your par tner.❞

1 Divide a piece of flipchart paper into two columns, headed Suggested changes and Method.Ask each pair to feed back to the main group, first recording suggestions and then discussing what methods might be used to implement them.

2 Ask participants which part of the exercise they found easiest to do – what sort of blocks or issues did they face?

3 Finally, close the exercise by asking everyone to close their eyes for one minute and imagine that they have achieved their goal.

Be alert to the fact this exercise could raise serious issues around unhappiness at work or in relationships.These may have to be acknowledged and, after the session, help may need to be given to individuals to access appropriate sources of support. However, it may also be an opportunity to demonstrate a caring, supportive environment within the group.This will depend on whether it is appropriate for the group to support the individual beyond the session, and on the experience of the facilitator.

This action planning session could also be used to extend Exercise 6.5 by asking participants to choose one thing that they could change to improve their level of personal support in the next two weeks, and to develop an action plan for achieving this change.

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Helpful hints

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Evaluation

10 minutes

Materials

G Copies of evaluation pro forma (if being used) G Pens

Guidance notes

Run though your planned evaluation activity (see Part 2: Guidance for Facilitators and Part 5:Additional Resources for information and guidance on evaluation).

As an alternative or additional activity, you may also want to give out a more formal evaluation form at this point for participants to complete now or return by a given date.

Remember to plan in some time as soon as possible after the session to complete your own evaluation of how you think the session went.

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Closure

Exercise 6.8

Module 6|Valuing Yourself

Learning outcome

Materials

Facilitating the exercise

Four seasons

Process:

Visualisation

10 minutes
At the end of this exercise participants should be able to:

✔ experience the process of change and self-renewal through visualisation.

G CD track no. 18 Four seasons (or relaxing background music) G CD player/tape recorder (optional)
G Paper and coloured pencils/pens

1 Invite people to sit comfortably and relax. Encourage participants to sit upright, their hands held loosely in their laps, legs uncrossed and feet placed firmly on the floor.

2 Play CD track no. 18 Four seasons, or read the following text to the group (read slowly and clearly in a gentle voice, pausing at ellipses (…) and playing background music if you wish).

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❝Sit comfortably and relax.Take a few deep breaths. Close your eyes and concentrate on the sensation of your breath in your body… the feeling inside your nose as the air enters you… the difference in the feeling of the air leaving your body… the feeling of your muscles and lungs moving to pull in the air, and moving to expel it.

Imagine that you are a plant or tree somewhere in the world. What are you? And where would you be? See yourself as that plant and how it would feel… see your shape, your size and your foliage.What is the landscape around you like?

It is the beginning of autumn. Look around you at the scene, the colours, the smell… are there other plants and trees? What is the soil like and the landscape?

As time passes you are preparing for winter, you are retreating into yourself. What do you do? What happens to you at this time? It is a time for letting go of parts of yourself… your foliage… your flowers… your shape…What is happening to the landscape around you, the weather… the colours… the smell…?

Time passes… winter approaches… it is cold. It is a time for pulling your energy back into your core.You are withdrawing into yourself… it is the right time for retreat… for conservation. What are the strengths that you have deep inside yourself…? What keeps you going…? What strengths sustain you…?

After some time you notice another change; it begins to gets warmer and the sun stays longer in the sky. Gentle showers moisten the soil around you. Spring has come… It is a time for renewal… time for the energy to rise within you and for you to bring forth new growth… How are you changing…? What is the nature of your new growth…? How is it fed…? What changes do you notice in the landscape around you – the soil, the sky…? Look at your flowers, watch them unfold.

Time passes… the sun is getting hotter, the days deliciously long. It is full summer… a time of abundance and fruitfulness… Look at your fruits… they are beginning to ripen… within them they carry the seeds of next year… Let your fruits fall to the ground to enrich the earth around you.

Time passes again, and the long days of summer begin to shorten. You are at full strength, but you begin to prepare for autumn and approaching winter.There is some time to go, but what is the landscape around you like and how do you fit into it? How does it feel?

Feedback (optional)

Reflect back on the changes you have gone through; autumn, winter, spring, and summer, and now back to autumn… You accept change as a natural part of your life and know that you are able to nurture and renew yourself.

In your own time, open your eyes and sit quietly with the images.❞

Involve participants in a general feedback on the visualisation and how it made them feel.

If there is extra time, you can invite participants to draw how they saw the scene, either in one of the seasons or in all of the seasons. Invite them to share their drawings with the rest of the group.

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Follow-on/homework Exercise 6.9

Learning outcomes

Materials

Facilitating the exercise

The roles we play

Process:

Reflection and sharing in pairs

45 minutes
At the end of this exercise participants should be able to:

✔ ✔

1 2

identify the qualities they express in their different roles consider whether they are more than the sum of their roles.

Worksheet 6.9 The roles we play (2 sheets)

Invite participants to find a partner.

Give out Worksheet 6.9 The roles we play (2 sheets) and ask participants to complete the worksheet in their pairs.You may want to give participants the choice of doing this on their own initially, before sharing with a partner, or for each person to ask their partner the questions and fill in their answers on the worksheet.

Encourage participants to be spontaneous in their responses, rather than spending too much time considering their replies (see Helpful hints below).

Allow 30 minutes in total, prompting partners to swap roles after 15 minutes if they are using the question/answer approach.

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Feedback 15 minutes

Helpful hints

Ask each pair to join with another pair to briefly discuss whether individuals felt they were the sum of their roles or whether they discovered a ‘Me’ as well (see Background Reading paper). If time, this discussion could be continued in a group feedback session.

Here are some example responses you can draw on:

Module 6|Valuing Yourself

What am I like…

at work?
at home?
as a brother/sister? as a son/daughter? as a parent?
as a partner/spouse? as a work colleague?

efficient, submissive, cheerful, bossy easy-going, lazy, assertive
open, intolerant, humorous
critical, respectful

responsible, strict, supportive relaxed, argumentative, kind supportive, co-operative, competitive

What am I like when I am…

angry? sad? happy? anxious?

What was I like…

as a child? at school?

sulk, rage
blame others, withdraw sing/hum, playful, forgiving indecisive, jittery

trusting, enthusiastic loner, extrovert

What do I feel passionately about?

injustice, football, the environment, my family

What motivates me?

inner inspiration, my husband/mother/friends/colleagues, desire to do my job well

What am I like when I am quiet?

find peace, mind races

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Exercise 6.10

Learning outcome

Materials

Facilitating the exercise

Who am I?

Process:

Meditation

15 minutes
At the end of this exercise participants should be able to:

✔ experience their identity at a deeper level using meditation. G CD track no. 19 Who am I? (or relaxing background music)

G CD player/tape recorder (optional)

1 Invite people to sit comfortably and relax. Encourage participants to sit upright, their hands held loosely in their laps, legs uncrossed and feet placed firmly on the floor.

2 Play CD track no. 19 Who am I? or read the following text to the group (read slowly and clearly in a gentle voice, pausing at ellipses (…) and playing background music if you wish).

❝Sit quietly and relax.Take a few deep breaths and turn your focus onto your thoughts…

Who am I…? Am I just this body…? When I look into a mirror, what am I looking at…? Is that me…? Is there more to me than my physical image? My body is very real. I can touch it. I am aware of each part of it, even with my eyes closed.

Is this who I am…? As I think about these questions, I begin to get an idea of where I am. Somewhere inside my head is me. I’m not just my face, or my mouth or my eyes, I am something more than these things.

Who am I…? Am I my thoughts? Am I the one who is thinking, the one who is questioning…?

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Feedback (optional)

Now, sitting in this very quiet moment with no-one else looking at me, no-one else telling me who or what I am, I spend a few moments enjoying myself, getting used to my qualities… and getting to know how I think and feel… It’s a nice feeling, I can be me… I don’t have to please anyone, I don’t have to attract anyone’s attention to me. I don’t have to do what other people expect of me, just be who I am.

I like me. The more I get to know myself, the more I can be myself when there are others around, and that feels good. The more I appreciate who I am, the easier it is to appreciate who others are. Each one of us is a unique being. Each one of us is worthy of being alive.

Now, very gently, I remember again that I am sitting inside this body, in this room, and I know who I am.

In your own time move your hands and feet and look around the room.❞

You may wish to leave the group in silence for a while or ask for some brief comments.

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Exercise 6.11

Learning outcome

Materials

Facilitating the exercise

Creating happiness

Process:

Visualisation

30 minutes
At the end of this exercise participants should be able to:

✔ consider their current level of happiness and experience moving towards an increased level of happiness.

G Length of rope or cord if you are leading the ‘active’ version of this exercise

G Pebbles or coloured beads (optional)

This exercise can take the form of a visualisation only, or involve participants more actively (in which case, see additional guidance in brackets below):

Take the whole exercise slowly, allowing time for participants to reflect on, and feel each stage.

1 Ask participants to sit quietly before guiding them through the exercise as follows:

❝Imagine you are in a field or large space outdoors and there is a long rope across the field.❞

(If you are leading an active exercise, use a rope and lay it out across the room. Additionally, you can mark the rope in sections 1, 10, 20, 30 etc up to 100 using a marker pen, or put numbered pieces of paper next to it representing these points.)

❝One end of the rope represents misery and the other happiness. There is a scale of 1 to 100 between each end of the rope.❞

(One person in the group could stand at one end of the rope acting ‘misery’ and another at the other end demonstrating’ happiness’.)

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Feedback 15 minutes

Helpful hints

❝Sit quietly for several minutes and check out how you feel right now. Sit and reflect at all levels where would you place yourself on the rope. Give yourself a score.

Go and stand in that place alongside or next to others. How does that feel? Stay there for several minutes.

Now think about where you would like to be to experience happiness.

Next, move to where you would like to be on the rope scale. How does that feel? What number are you?

Finally, try and see if you can move up to 100.This represents complete happiness.What is that like? If you find that difficult, ask yourself what is it that is holding you back.❞

Allow up to 15 minutes to guide participants through the various stages of the exercise before feedback.

Invite participants to get into small groups of 2 or 3 and share their experiences for the remaining time, in particular:

G Where did they place themselves on the rope scale and what, if anything, held them back from moving further up the scale?

For 100 (ie complete happiness) you could apply a label like Nirvana, Heaven, Eden, or whatever seems appropriate for your group.

Most people will place themselves somewhere between 50 and 70 and move up to between 80 and 90.

Be prepared for the fact that the question,‘What held you back?’ may bring up some challenging issues. Examples are: ‘Don’t feel worthy’;‘Fear’;‘What is there left to achieve?’;‘No-one is 100.’

Use some quiet time at the end to connect with how it feels to be at the 100 end.

You may wish to give each person a pebble or coloured beads so that they can remind themselves of the good feeling (happiness) when they go about their daily business and come across difficult experiences.

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Worksheet 6.2

Design your healing space

Visualise a space where you could create a restful area for yourself – a place where you can go to rest, reflect and recharge.This could be a room, a part of a room, or a sheltered space within a garden.

. 1 For each of the questions below, make brief notes to help you build up your image.
Where is your space?
What would you enjoy looking at?
(eg: pictures/photos, plants, special objects, view through window)
What would you enjoy smelling?
(eg: scented candle, fresh air, flowers)
What would you enjoy touching?
(eg: fabrics, pet stroking, comfortable chair, grass under your feet)
What would you enjoy listening to?
(eg: music, radio talkshow, silence, birdsong, running water)
How would you ensure privacy?
(eg: ‘Do not disturb’ sign, screening from other, agreement with others)
What would you clear out of your space? What would you enjoy doing there?

. 2 Now try to represent your space, using the art and craft materials and pictures available.

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Worksheet 6.4 Part A

Exploring self-confidence

Attitudes

Module 6|Valuing Yourself

What is the attitude of a self-confident person towards…

Column 1

Column 2

Being in a crisis

Success

Obstacles

Work

Colleagues

Patients

Friends

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Worksheet 6.4 Part B

Exploring self-confidence

Values

Name two values a self- confident person would have in dealing with the following…

Column 1

Column 2

A dominating manager

A difficult family member

Making a mistake

Junior colleagues

A complaining patient

A rebellious child

Anxious relatives of a patient

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Worksheet 6.4 Part C

Exploring self-confidence

What are your three main qualities of self-confidence?

What three qualities of self-confidence would you wish to develop more?

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Module 6|Valuing Yourself

Worksheet 6.5

Sources of support

. 1 List the person you would choose to turn to for support in the following circumstances:
Making a mistake at work:
A row with your partner/best friend:
Following an accident in your car:
A death in the family:
To chat to when feeling low:
To tell a secret to:
If you had been diagnosed with a serious illness: A dispute with a colleague at work:
A patient that has upset you emotionally:

. 2 Where are the gaps in your support?

. 3 How could you fill these gaps?

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Worksheet 6.9

The roles we play

Apply some simple adjectives to yourself below, to describe your positive and negative qualities in the following relationships and circumstances:

1 What am I like…

at work?
at home?
as a brother/sister? as a son/daughter? as a parent?
as a partner/spouse? as a work colleague?

2 WhatamIlikewhenIam…

angry? sad? happy? anxious?

3 What was I like…

as a child? at school?

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Worksheet 6.9 (continued)

The roles we play
4 What do I feel passionately about?

5 What motivates me?

6 What am I like when I am quiet?

Now discuss in your group whether you are the sum of your roles, or whether there is a ‘Me’ as well.

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Background Reading

Why Spirituality in Healthcare?

As modern conventional medicine becomes more reductionist in its approach, and there is an increasing concern with new techniques and pharmaceuticals to manage disease, the challenge is to bring human values (spirituality) to the centre of healthcare, while maintaining high standards in healthcare delivery.

Integrating spirituality is a development of the holistic approach. It becomes more urgent at the beginning of the 21st century as we appreciate there is more to healthcare than treating illness; there is also a need for deep healing at all levels of our being, and that includes healing society and the environment.

Spiritual care is an area that needs to be developed, not only in terms of patients’ needs, but also for healthcare practitioners themselves. It can be said that every illness has a spiritual dimension and at some level, every patient, regardless of the illness, is confronted by questions of meaning, existence and belief: ‘Why me?’ ‘Why now?’ ‘Is this fair?’ These questions are transpersonal in nature, that is, they make us look inward to get our bearings, to interpret what is happening to us in relation to the world out there.

Purpose of module

During our training we learn about the normal and abnormal functioning of the body, the influence of the mind and emotions on illness, and the social and cultural factors that affect health. However, there is something more than all these elements combined; something deeper, personal, yet collective. It remains central to the healing process – it can be called the spiritual aspect of health and healing.

Introduction to the Spirituality in Healthcare module

This module can be run separately exploring what is spiritual care within healthcare, or as a way of drawing together all the modules of the Values in Healthcare programme.

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Exploring spirituality can best begin by considering what are the qualities of a person that demonstrate spirituality and then recognising that we have these same qualities in each one of us. Spirituality is known through experience, and recalling these memories can be inspiring. When we return to the question of what is health and healing, and what part spirituality plays in healthcare, we can begin to focus on spiritual care at work and experience spirituality in our own life.

Themes of Exercises

A spiritual person (7.1)

Generally we think of a ‘spiritual person’ as someone with very special qualities that we admire and respect. When we reflect on what these qualities are, acceptance, kindness, patience, tolerance and generosity are some of the words that come to mind. It is who the person is, as much as what they have achieved, that makes them spiritual. They act as an ‘inspiration’ and something we ‘aspire to.’

Recognising such people and their qualities helps us to recognise the very same values in ourselves. It tells us that, just like the people we admire, we are special too.

Experiencing wonder (7.2)

Wonder is a feeling of awe; it is a moment where surprise is mingled with admiration and curiosity. The experience of wonder is discovering something outside in the world that resonates with something inside our own being. It may be experiencing the stillness in a wood that connects with an inner stillness, or looking at the stars at night that opens us to the vastness of outer space which, in turn, reminds us of the limitlessness of our own inner space. That feeling of awe and beauty can equally occur in response to something small like a butterfly wing or a pattern on a shell. Whatever arouses wonder in us is personal and deep; it is a spiritual experience.

Wonder is:

G telling it in a whispered voice with reverence G gasping at beauty as if seen for the first time G time standing still
G making a space for peace

G surprise in what is already there G joy, mystery, magic.

Such experiences are perhaps more common than we give credit for, and recounting them generally makes us feel good.

What is ‘health’ and ‘healing’? (7.3)

‘What is healing?’ and ‘What is health?’ are questions we ask at the beginning of our studies of healthcare, and questions we should return to throughout our professional career.

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The words ‘health’ and ‘healing’ are closely linked, and deal with concepts that can be quite difficult to pin down. On a purely physical level it is easy to understand healing. A skin wound, for example, reunites to form part of the whole again. The body does this naturally if the wound is clean and the person is well nourished, rested and not stressed. We may also be familiar with the concepts of emotional and mental healing; but what of holistic healing that includes the spiritual aspect?

Consider this example: a young, unemployed man has an argument with his parents; he then goes out to a football match where he gets into a fight and receives a head wound; the police are called and he goes to hospital to have his cut stitched. He has a wounded body, a confused mind and a spirit in turmoil. In addition, his family are worried and hurt, there are financial, legal and employment issues, and on the broadest level, disruption to society.

What is it that needs mending? Healing can be at any and all of these levels, but healing at a spiritual level occurs when lessons are learned and insights are gained. In the example, as the young man lets go of his anger and finds some peace, deep healing begins. As he changes and grows, so his family and society will be healed.

What is ‘spirit’ and ‘spirituality’? (7.4)

Spirit

The word ‘spirit’ is a commonly used word that carries a multiplicity of meanings from the sacred to profane. It is one word that is sure to create many misunderstandings and reveal some prejudices. Although the context will help to clarify its particular meaning, we still cannot be sure of what somebody means by this word, unless we know them well.

‘Spirit’ implies more than emotional and psychological well-being. It implies a sense of self (who we are); of presence (how we interact with other people); and consciousness (how we bear ourselves, how we treat ourselves, how open we are to our own feelings and those of others) – a sense of our whole selves.

Spirit can mean the ‘essence’ of something – as in the essence of a problem, or the essence of someone – as in his or her essential nature. This may provide a link to the concept of soul where the essence of a person is their soul. Discussion of ‘soul’ may lead people to consider their ideas and experience of the essence of everything or ‘God.’

Note: The term ‘spiritualism’ can cause confusion when discussing the word ‘spirit’. In the UK it refers to a religious practice that communicates with departed spirits in order to bring comfort to the church members and reassure them that their dead loved ones exist in spirit form. A similar spirit communication can be observed in different forms in many cultures around the world where spirits are seen as ‘wise advisers’.

Spirituality

One definition of ‘spirituality’ is ‘looking inwards to discover our true identity’. Although the definition is simple, it is deep and profound. The ‘looking inwards’ is discovering who we are, what our values are and what gives meaning and purpose to our lives. Our ‘true identity’ is our essence; some would say it is experienced as peaceful and it is expressed as compassion.

Other definitions of ‘spirituality’ include:

G being in touch with something/some being greater than myself G being truly human, expressing my inner values
G that which gives meaning and purpose
G mystery, beyond description

G the aspect that seeks balance and wholeness.

Spirituality is also a journey, a journey of self-discovery, which not only leads inward but ultimately outward to the realisation of the connection we have with all human beings and an experience of a something greater than ourselves.

Note on religion and spirituality

It is important to distinguish between spirituality and religion, as the two are not necessarily synonymous. A person can be spiritual and not be religious, and another can be religious and not spiritual.

A working definition of religion might be: ‘a belief system associated with ritual, a dogma (settled opinion), based on teachings of a leader with divine inspiration’.

In many countries today, people no longer have formal religious practice in their lives. However, most people have some belief, or sense of it – such as a broad and non-specific ‘belief in God’, even if they do not ally themselves to any particular religious beliefs and practices.

What is ‘spiritual care’? (7.5, 7.8)

‘Spiritual’ is a word that is being increasingly used in the context of health and healthcare, and so when we do talk about ‘spiritual care’ we need to be clear what we mean.

We can witness people practising spiritual care many times throughout the day. They may be listening attentively to a patient, smiling at them, or simply touching them gently; all these are forms of giving spiritual care. Patients know and appreciate when they are receiving such care and value it more than many of the things that are done for them on a physical level.

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Times of crisis in healthcare are common and it is then that people turn for help when facing inner turmoil. They may be faced with a serious illness or living with a disability and asking, ‘Why me?’ and, ‘Why now?’, ‘What will happen?’ and, ‘Will anyone care?’ They may have strong feelings of anger, guilt and grief.

However, when spiritual care is included as part of a holistic approach it does not receive the same attention in clinical practice and education as other aspects of care, such as the physical, psychological or social. This may be because some practitioners have a limited view of their role and may miss what concerns patients most; their loss of sense of self and the meaning of what is happening to them inside as well as outside, in other words their spiritual concerns.

Inner sanctuary (7.6, 7.10)

Throughout history, churches and temples have been seen as safe and sacred spaces – sanctuaries from the dangers and pressures of the world. They have provided a quiet place to rest, reflect and recuperate. Using a visualisation, we can create a safe space in our own mind so we can experience that feeling of calm and can practise it anywhere and at any time.

It can also be useful to spend time contemplating how our own spiritual qualities can be healing.

Meeting the spiritual needs of patients and practitioners (7.7)

When a patient is experiencing illness they will have certain physical needs and often social, emotional and psychological needs as well. Expressing their spiritual needs can be more difficult as it is a private and sensitive area. They may be struggling to make sense of the situation that challenges their values, beliefs and faith and be asking the ‘Why me? Why now?’ type of questions.

We all want healthcare practitioners to be competent and also to be caring. ‘Competency’ is about accurate diagnosis and appropriate treatment to include prescribing medications, surgery and physical therapies. It can also include good communication skills, ‘talking therapies’ and working well in teams. To be ‘caring’, which broadly means being respectful, kind and compassionate, is a spiritual practice and something central to good healthcare. So patients have personal spiritual needs and a need for their carers to be caring.

Personal needs:

G deeper, unspoken needs, that they may not be ready to face but are nonetheless there, such as feeling through their illness or situation that their values, beliefs, faith or self identity are being challenged

G unfinished business with others and a need to express anger, release fear and guilt, and seek reconciliation and forgiveness

G a belief that illness may hold meaning and purpose in life and has the potential to be transformative.

Needs for carers to:
G be compassionate and act with kindness G be reassuring and optimistic

G listen – the listening should have that quality of attention and lack of judgement necessary for a person who may be sharing their beliefs, fears, hopes, dreams, suffering and despair

G be curious about their family, culture, beliefs and practices and their concerns about their present illness and future health

G be able to relate to them at times out of the professional role as a human being

G be aware that they may be suffering on more than a physical level, with doubts about beliefs and relationships, feelings of rejection, loneliness, and being let down.

Of course, healthcare practitioners will have their own spiritual needs that will often be triggered by their patients’ needs. So meeting their needs and patients’ needs are two sides of the same coin – they cannot be separated. By addressing their needs, the practitioner benefits and so do their patients.

The Values in Healthcare programme sets out to address the spiritual needs of healthcare practitioners through all seven of its modules, helping them in identifying their personal values, being peaceful, being positive, practising compassion, co-operating with colleagues, practising self-care and developing self-esteem. The programme enables this spiritual exploration through the development of spiritual learning tools – meditation, visualisation, reflection, listening, appreciation, creativity and play.

Assessing spiritual needs (7.9)

When assessing spiritual needs, should we ask questions in the same way as we assess patients’ physical, psychological and social needs and record our findings in their medical records? And if we do, how does this information affect the management
of the patient, and how do we evaluate what we are doing?

Perhaps more important than the actual questions is the attitude of healthcare practitioners themselves when conducting such an assessment; that they should be sensitive, respectful and patient. They should be expert listeners.

In carrying out an assessment, we should perhaps be asking general open-ended questions with some follow-up specific questions such as those in Handout 7.9.

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While assessment of spiritual needs might seem most relevant in the context of the dying patient, spiritual care can be considered as part of any illness and indeed, any patient encounter. Assessing such needs should be part of providing good, holistic care for all.

The place of ritual in healthcare (7.11)

An example of a simple ritual or ceremony is saying a few words before a meal. It can be called a grace, a prayer, a blessing or an expression of gratitude. Some may say it is a pointless habit, others a religious practice important to their faith.

A ritual marks an event by enabling us to do the following: we stop what we are doing, we pause, we may make a connection to something greater than ourselves, and we repeat words or actions which recognise the moment. What gives the act its meaning and power is the intention we give to doing it.

Some rituals are repetitive habits and, as such, are meaningless, but if we imbibe meaning and perform them with awareness they enrich our lives. There are many things we do out of habit from the moment we get up until we go to bed; cleaning our teeth, eating breakfast, arranging our desk at work, starting conversations, folding sheets back, washing our hands. All are habits but only become a meaningful act, that is, a ritual, when we pause and give them meaning and perform them with awareness.

A ceremony is a ritual usually performed in groups, either as a much-repeated, familiar practice, or as something intuitive and of-the-moment. It can be something simple like lighting a candle in memory of a person, which as a symbol can carry profound thoughts and feelings. There are many accepted ceremonies around changes in our lives which serve to honour profound changes such as birth, marriage and death, and these will vary tremendously between cultures.

A ceremony becomes a custom through practice or habit, or it can be prescribed by a religion. The importance lies in the intention behind the act, which is strengthened by its repetition and pattern. Some of these customs are performed in a very conscious way and others are less conscious.

There are many rituals, ceremonies and customs associated with illness and healthcare practice which we may or may not practise with intention, but for all of us it is important to be aware of what these customs are, as they can help to bring meaning to our work and enhance patient care.

Healing through illness (7.12)

Illness provides us with an often unwanted, but nevertheless valuable, opportunity to reflect on the meaning of our lives and on our own spiritual ‘journey’. We may wonder ‘Why me?’ and begin to re-appraise what is important, as our needs and priorities depart from those which formerly shaped our day-to-day lives. The future may seem less certain and we may take up or return to spiritual practice in order to find comfort and meaning to what is happening to us. Taking time to describe an illness we have suffered, or one from a patient’s perspective, can help us to gain valuable insights into the way in which we live and work, our values, and our own spirituality.

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The Facilitator’s Guide to Module 7

Session I: Exploring spirituality and healing

Aims

G To consider the qualities of a spiritual person and our own special qualities

G To explore an inner sense of spirituality through meditation

G To explore the meanings of ‘health’, ‘healing’, ‘spirit’ and ‘spirituality’ through sharing, discussion and reflection

G To relate definitions of ‘spirituality’ to a healthcare context Process

Participants begin by working in pairs to explore the qualities of ‘a spiritual person’ and through this, to recognise their own special qualities. They then form small groups to share their own, individual recollections of feeling a sense of ‘wonder’ as a spiritual experience. After a movement exercise and break, the next exercises provide opportunities for participants to reflect first on the meanings of ‘health and healing’, then on ‘spirit and spirituality’. From this basis they begin to explore spiritual care in a health context, first by reflecting on what it means to them and when they have witnessed it. A final meditation guides participants into visualising a safe inner space or ‘sanctuary’ as part of their own spiritual care.

Session II: Spiritual care in practice

Aims

G To explore and define spiritual needs and spiritual care in a healthcare context G To consider how spiritual care might be provided to patients and practitioners G To consider ways in which the spiritual needs of patients might be assessed

Process

This session explores the idea of providing spiritual care for patients as an important component of their overall healthcare. Time is spent in reflection, sharing and discussion of spiritual needs and ways of providing spiritual care, both in relation to patients and to practitioners themselves. Action planning focuses on considering ways in which the spiritual needs of patients might be assessed, giving participants an opportunity to design a set of questions for this purpose. A final meditation helps everyone to see themselves as a natural source of healing which can be shared if they wish. Follow-on exercises explore the place of ritual in healthcare and healing through illness.

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Programme/plan for Module 7

Spirituality in Healthcare

Module 7|Spirituality in Healthcare

Introduction 30 minutes SESSION I Exploring spirituality and healing

Exercise 7.1 A spiritual person 30 minutes

Exercise 7.2 Experiencing wonder 20 minutes

Movement exercise 5 minutes Break 20 minutes

Exercise 7.3 What is ‘health and ‘healing’? 30 minutes

Exercise 7.4 What is ‘spirit’ and ‘spirituality’? 20 minutes

Exercise 7.5 What is ‘spiritual care’? 30 minutes

Exercise 7.6

Lunch break

SESSION 11

Exercise 7.7

Inner sanctuary 10 minutes

Spiritual care in practice

Meeting the spiritual needs of
patients and practitioners 50 minutes

Exercise 7.8 Reflection on spiritual care 5 minutes

Movement exercise 5 minutes Break 15 minutes

Session review 10 minutes

Action planning

Exercise 7.9 Assessing spiritual needs 30 minutes

Evaluation 10 minutes

Closure

Exercise 7.10 Healing meditation 10 minutes

Total time 5 hours 30 mins

Follow-on/homework

Exercise 7.11 The place of ritual in healthcare 40 minutes

Exercise 7.12 Healing through illness Optional

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Materials

G Paper and pens
G Flipchart and marker pens
G CD player/tape recorder (optional)

Session I

G Handout 7.3 Definitions of health and healing
G Handout 7.4 What is ‘spirit’?
G CD track no. 20 Inner sanctuary (or relaxing background music)

Session II

G Handout 7.9 Questions to assess spiritual needs
G CD track no. 21 Healing meditation (or relaxing background

music)

Preparation

. 2 Familiarise yourself with the main learning tools which are being used in the session (see Part 4: Spiritual Tools).

. 3 Read through the session guidelines and look at the suggested session programme which will incorporate:

G Session introduction G Exercises
G Movement breaks
G Breaks

G Session review G Action planning G Evaluation
G Closure

4 Photocopy any handouts and exercise sheets, and make sure that you have any other equipment listed under Materials.

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Introducing the Module

30 minutes
Run through your planned introductory session which may include:

Quiet time
Introductions/optional warm-up exercise Overview of session
G Theme of session
G Aims and learning outcomes
G Programme/plan for the session
G Practical considerations
G Any questions

Setting the tone

G Ground rules/principles G Participants’ expectations

Review of last session/homework
See Part 2: Guidance for Facilitators for further guidance on introducing

the session.

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The Exercises

Session I: Exploring spirituality and healing

Exercise 7.1

Learning outcomes

Materials

Facilitating the exercise

A spiritual person

Process:

Reflection

30 minutes
At the end of this exercise participants should be able to:

✔ define the qualities of a spiritual person ✔ describe their own special qualities.

G Paper and pens
G Flipchart and marker pens

The exercise is in two parts.
Part A: Qualities of a spiritual person (10 minutes)

1 Ask participants to form pairs and lead them as follows:

❝Spend a few moments on your own thinking of someone you know that you consider is ‘spiritual’. They may be a friend or colleague. If you cannot think of anyone, choose a historical or public figure you admire.❞

Allow a minute or two before moving on.

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Feedback 5 minutes

2 Now invite participants to work in their pairs:

❝Try to describe to your partner what qualities that person has, or give examples of the sort of things they do and say that make them spiritual.

Discuss this person with your partner for a few minutes, and then change over and discuss the person they have been thinking of.❞

Allow up to 10 minutes, prompting participants to change over halfway through.

Bring the group back together for a brief feedback, asking for one or two examples of a spiritual person from the group.

Discuss:

G What is it about a spiritual person that makes them spiritual? G What are their qualities and actions?

Make two lists on the flipchart, one with the names of the spiritual person and the other list alongside, with their special qualities.

The two lists work well during feedback and discussion, especially when participants describe friends as well as famous people.

Part B:Your own special qualities (10 minutes)

After collecting all the ‘data’ on spiritual people, move on to the second part of the exercise, inviting participants to reflect on their own qualities (this is covered more fully in Module 1 Values, Session I: Inner values):

❝Again in the same pairs, share with your partner what your special qualities are, and how you express them.❞

Allow up to 10 minutes, prompting partners to change over halfway through.

In the main group, invite each person to choose one of their partner’s qualities and in turn, say this aloud to the group, for example, ‘This is John and he is patient.’ ‘This is Kathy and she is kind.’

Module 7|Spirituality in Healthcare

Helpful hints

Feedback 5 minutes

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Exercise 7.2

Learning outcome

Facilitating the exercise

Experiencing wonder

Process:

Reflection and appreciation

20 minutes
At the end of this exercise participants should be able to:

✔ describe an experience of wonder (as a spiritual experience). 1 Invite participants to form groups of three or four and lead

the exercise as follows:

❝Sit in silence for two minutes and individually reflect on a special moment of wonder you have experienced, for example, in nature – walking in woods, on a mountain or watching a sunset. It may have been when you were with someone or alone.

Was there a time, however briefly, when you felt truly at one with everything? Or when you were so absorbed in a task that you seemed in a different space? Or when everything went just right?❞

Allow two minutes.

2 Next, invite participants to share, within their groups, some examples of their experiences of wonder.

Allow up to 10 minutes.

Encourage participants to share some of their moments of wonder with the larger group.

Often it is best that stories are left without comment. Instead, encourage participants to share the feelings that reliving and telling these experiences aroused.

Feedback 5 minutes

Helpful hints

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Point out the following:

G while each one is personal, everyone has these kinds of experiences

G it makes us feel good to remember them
G each experience is a gift we already have which cannot be

bought or sold

G there are probably many more moments of wonder we have experienced but have forgotten.

In the healthcare context, it can be useful to encourage patients with chronic or terminal illness to remember these kinds of experiences in their life.

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Movement exercise Z 5 minutes

Break

20 minutes

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Exercise 7.3

Module 7|Spirituality in Healthcare

Learning outcomes

Materials

Facilitating the exercise

What is ‘health’ and ‘healing’?

Process:

Reflection and sharing

30 minutes
At the end of this exercise participants should be able to:

✔ clarify what the words ‘health’ and ‘healing’ mean to them ✔ provide definitions in relation to their own work and to

healthcare in general.

G Handout 7.3 Definitions of health and healing G Paper and pens
G Flipchart and marker pen

1 Provide participants with paper and pens and invite them to find a partner.

2 Ask everyone to sit quietly for a moment and work on their own, as follows:

❝Think about what the words ‘health’ and ‘healing’ mean to you. Write down some of the meanings for the word ‘health’, and

then do the same for the word ‘healing’.
Now try and formulate a definition for ‘health’ and a definition

for ‘healing’.❞
Allow up to 5 minutes for this.

3 Now ask participants to work in their pairs and to share their meanings and definitions.

Allow 5 minutes

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Feedback 10 minutes

Helpful hints

4 Invite each pair to team up with another pair and to agree on a few definitions.

Allow up to 10 minutes.

Ask one person from each group of four to read out their definitions. Put their answers on a flipchart sheet for display during the rest of the session.

You may wish to add to the list by drawing on some of the definitions included in Handout 7.3 Definitions of health and healing.

It may be helpful to invite groups to work on a specific definition for their particular work/team/department, and a more general one for healthcare.

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Exercise 7.4

Module 7|Spirituality in Healthcare

Learning outcomes

Materials

Facilitating the exercise

What is ‘spirit’ and ‘spirituality’?

Process:

Creativity

20 minutes
At the end of this exercise participants should be able to:

✔ describe the many meanings of the word ‘spirit’
✔ provide a definition for the word ‘spirituality’ which might be

relevant to a healthcare context.

G Handout 7.4 What is ‘spirit’? G Paper and pens
G Flipchart and marker pen

1 Lead the exercise as follows:
❝Sit quietly for a minute and think of the word ‘spirit’.

Write the word ‘spirit’ in the centre of a piece of paper.

Think of as many meanings of ‘spirit’ as you can and write or draw them around the central word. Draw lines that connect these various meanings to it. (You will end up with a spider diagram, with the word ‘spirit’ being the body and its legs joining to the words or pictures, its feet.You may get more than eight legs!).❞

Allow a few minutes before asking participants to add a simple definition of the word ‘spirituality’ to their sheet of paper.

Allow a further few minutes and check that everyone is finished before proceeding to feedback.

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Feedback 10–15 minutes

1 In turn, ask everyone to read out a word or convey a visual image for the word ‘spirit’ and write/draw them on the flipchart.

2 Next, ask everyone for a simple definition of the word ‘spirituality’ and write these on the flipchart.

3 Ask if anyone has any more meanings they would like to add to either list.

4 Spend any remaining time considering how the word ‘spirituality’ can be used in a healthcare or medical context.

Encourage participants to be creative in their spider diagrams, jotting down thoughts and using quick ‘doodles’, rather than spending time on detailed definitions or drawings. Refer to Handout 7.4 What is ‘spirit’? for examples of ‘spirit’ words which can be added into the discussion.

It is helpful to emphasise the concept of spirituality at this point as ‘looking inward and learning about ourselves’. A more detailed suggestion can be found in the background paper.

The ensuing discussion may be wide-ranging, covering areas such as religion, the soul and spirituality, but it is helpful to seek to give it a healthcare or medical context. For example, it is often at times of crisis, such as life-threatening illness or being given a terminal prognosis, that patients may begin to reflect on the spiritual aspect of their situation.

Helpful hints

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Exercise 7.5

Module 7|Spirituality in Healthcare

Learning outcomes

Materials

Facilitating the exercise

What is ‘spiritual care’?

Process:

Reflection and sharing in pairs

30 minutes
At the end of this exercise participants should be able to:

✔ provide definitions of spiritual care
✔ give examples of spiritual care in clinical practice.

G Paper and pens

G Flipchart and marker pens

G Prepared flipchart sheet with the following questions written on it (allow space under each for noting responses during the feedback session):

– ‘What does spiritual care mean to you?’ – ‘When have you witnessed it?’

1 Ask participants to choose a partner to work with and to sit with them.

2 Lead the exercise as follows:
❝Reflect individually for a few moments on the following questions

(refer to the prepared flipcharts):
– ‘What does spiritual care mean to you?’ – ‘When have you witnessed it?’❞

Allow up to 5 minutes before moving on to the next step.

3 Invite participants to discuss their thoughts with a partner, sharing their descriptions of spiritual care and examples of when they have witnessed it. Ask them to note down their descriptions and examples together.

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Feedback 15 minutes

Helpful hints

Allow about 10 minutes for this stage before moving into feedback.

Gather people’s comments/answers to the two questions, summarising and grouping these on the flipchart sheet under the two questions. Facilitate a discussion on what spiritual care is.

The concept of spiritual care being part of normal clinical/ healthcare practice may be new to many participants and the questions are intended to encourage discussion and exploration.

The key to providing spiritual care is understanding that it is not what you do, but rather how you come across, ie how you are. Examples of spiritual skills include being peaceful, positive, practising compassion, co-operating with colleagues, and self-care. See the Background Reading paper for further information which may be useful to this discussion.

This initial exploration of spiritual care is quite short but will continue in Session II.

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Exercise 7.6

Module 7|Spirituality in Healthcare

Learning outcome

Materials

Facilitating the exercise

Inner sanctuary

Process:

Meditation

10 minutes
At the end of this exercise participants should be able to:

✔ visualise a safe inner space as part of their own spiritual care. G CD track no. 20 Inner sanctuary (or relaxing background music)

G CD player/tape recorder (optional)
1 Introduce the visualisation using the following note:

❝This visualisation exercise is intended to create a safe space in your own imagination, as an element of your own spiritual care.❞

. 2 Invite people to sit comfortably and relax. Encourage participants to sit upright, their hands held loosely in their laps, legs uncrossed and feet placed firmly on the floor.

. 3 Play CD track no. 20 Inner sanctuary, or read the following text to the group. Read slowly and clearly in a gentle voice, pausing at ellipses (…), and play background music if you wish.

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❝Sit comfortably and relax.Take a few deep breaths and turn your attention inwards.You are going to create a sanctuary… your own special place where you will feel safe.

In your imagination, choose a scene in nature that you particularly like… by the sea… in the mountains… by a lake… or in a wood… it can be a place you know or you can create it as you would like it.

It is peaceful… and very beautiful. It is your ideal place… completely safe and secure… your own special place.

What does it look like…? Are there trees and flowers…? Do you notice any animals…? Are there any smells and sounds…?

Now create a building – a place where you can stay in complete safety, which no one else can enter…What does the building look like…? Use whatever materials you like… be as lavish and creative as you like… Is it made of wood or stone…? What shape is the roof…? Where are the doors and windows…? Now see it set in a garden.

See yourself walking up to this building set in your perfect scene, and enter it… What is it like inside…? Remember, this is your sanctuary, where everything is to your liking… Choose the furnishings for your comfort… choose the lighting and colours… make it really special. Make it a place where you feel really at home… where you feel peaceful and positive about yourself and the world…

Your sanctuary has a special atmosphere that seems to wash over you and make you feel good from the inside… absorb that atmosphere for a few minutes (pause for 30 seconds).

Now it is time to leave… have a last look around your place and take in the feeling of familiarity and happiness… then step out through the door to admire the view and the perfect setting of your house… breathe that in and feel a sense of contentment. You are leaving only temporarily, as it is a place you can revisit

at any time.

And now in your own time, slowly come back to the room.

Deepen your breathing… become aware of your chair and your Yfeet on the floor. Open your eyes… rub your hands together…

and have a stretch.❞ Lunch break

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Module 7|Spirituality in Healthcare

Session II: Spiritual care in practice

Exercise 7.7

Learning outcomes

Materials

Facilitating the exercise

Meeting the spiritual needs of patients and practitioners

Process:

Creativity and sharing in small groups

50 minutes
At the end of this exercise participants should be able to:

✔ identify the spiritual needs of patients and practitioners ✔ develop ideas for meeting the spiritual needs of patients

and practitioners. G Paper and pens

G Flipchart and marker pens

Briefly summarise the exercises in Session I, referring to the Background Reading paper and how they can now inform this exercise on considering spiritual needs.

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Part A: Discussion in pairs (20 minutes)

1 Invite participants to work in pairs for this part of the exercise. The first step can be done as a sharing, or telling a story, or as a role play:

❝Relate a situation from the patient’s perspective of their experience of illness. What were their spiritual needs? What did they value besides physical care? (You can use your own experience of illness if you wish).❞

Allow up to 10 minutes for this, before moving on to the next step.

2 Invite participants to now consider the practitioner attending the patient.What spiritual needs might they have, as a practitioner, in the same situation? For example, some of the things patients say or do may affect and challenge them.They may find that they become emotionally involved or are asked questions to which they have no answer.

Allow a further 10 minutes for this step before moving on to Part B.

Part B:Working in small groups (15 minutes)

1 Invite each pair to join up with another pair to form a group of 4, and to undertake the following task, writing up the 2 headings on a flipchart:

❝Share some of the spiritual needs you identified in Part A of this exercise. Begin to consider specific suggestions for meeting these, under the headings ‘Patients’ needs’ and ‘Practitioners’ needs’. What are the skills and tools needed by practitioners and by

Feedback 15 minutes

the team? What facilities and environments are needed? Imagine there are no restrictions on resources. Note down any ideas.❞

Allow up to 15 minutes for this part of the exercise.

In the main group, ask each group to report back, showing what they have written on their flipchart paper under the two headings: ‘Meeting patients’ spiritual needs’ and ‘Meeting practitioners’ spiritual needs’.

Compare the two lists – in what ways are they similar and in what ways do they differ?

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Helpful hints

3 Spend the remaining time inviting good practice ideas for spiritual care that are particular to participants’ areas of work, and general guidelines for spiritual care within healthcare practice. Record these on a flipchart, identifying some which might lead to achievable actions.

Keep the flipchart notes from Session I on display for participants to refer back to during this exercise.

Encourage participants to be creative in their thinking about ways of meeting spiritual needs.

Many of the ideas raised may be explored further in other Values in Healthcare modules, such as finding a place to be quiet (see Module 2 Peace), making time to listen to patients (see Module 4 Compassion) and getting together as a team to talk about giving support (see Module 5 Co-operation).

The final discussion and record of ideas for good practice can be returned to and developed further during the Action Planning part of this module.

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Exercise 7.8

Reflection on spiritual care

Process:

Reflection

5 minutes
At the end of this exercise participants should be able to:

✔ further clarify their understanding of spiritual care.
G Optional CD player/tape recorder and relaxing background

music

This brief reflection can be conducted in silence or accompanied by relaxing background music.

1 Ask participants to sit comfortably in their chairs and guide them into a short reflection, as follows:

❝Spend 5 minutes on your own, reflecting on what you have been discussing. What have you learned about spiritual care…? What feelings have been aroused in you…? What has inspired you…?❞

Z 5 minutes Break

15 minutes
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Learning outcome

Materials

Facilitating the exercise

Movement exercise

Session Review

10 minutes Guidance notes

. 1 Briefly review the session by displaying the session aims, learning outcomes and session programme. Remind participants of the activities they have undertaken.

. 2 Pick out any highlights, referring to materials that participants have produced and which you have displayed.

. 3 Hand out the Background Reading paper for participants to take away, pointing out any references and resources for this module, should they wish to explore the theme in more depth.

See Part 2: Guidance for Facilitators for further guidance.

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Action Planning

See Part 2: Guidance for Facilitators and Part 5: Additional Resources for information and guidance on action planning. Below is a suggested action planning exercise.

Alternatively, this action planning session could extend the following exercise, drawing on the ideas and flipcharts generated:

Exercise 7.7: Meeting the spiritual needs of patients and practitioners. For example:

G an action plan for improving spiritual care of patients who are dying G developing guidelines for meeting the spiritual needs of patients and

practitioners.

Exercise 7.9

Learning outcomes

Materials

Assessing spiritual needs

Process:

Creativity and sharing in small groups

30 minutes
At the end of this exercise participants should be able to:

✔ ✔

G G

design a set of questions to assess patients’ spiritual needs

consider issues of confidentiality and the place of spiritual needs assessment in their own healthcare setting.

Handout 7.9 Questions to assess spiritual needs Paper and pens

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Facilitating the exercise

This exercise explores how practitioners might assess patients’ spiritual needs in the same way as their physical, psychological and social needs.

1 Ask participants to work on their own initially:

❝Working on your own with pen and paper, think of some questions which could be used to assess the spiritual beliefs of patients and which you could ask in your own area of work in order to improve their spiritual and overall care.

Try to produce a set of questions you might wish to ask patients in order to make an assessment of their spiritual beliefs and which could be recorded in their notes.❞

Allow 5–10 minutes before moving on to the next step.

2 Invite participants to form groups of 3 or 4 and work together as follows:

❝In your small group, share your questions and choose 3 which you feel would be most helpful as part of an assessment of patients’ spiritual beliefs. How would finding out the answers to these questions help to improve the quality of spiritual and overall care which could be provided to the patient?❞

Allow a further 10 minutes for this part of the exercise.

Spend the remaining time sharing answers within the main group. Discuss how patients’ responses might be used to improve the quality of their spiritual and overall care.

You may also wish to consider the following:

G Should we ask about a patient’s religion?

G Confidentiality issues – should we be recording patients’ responses to our questions in the notes for everyone to see?

If you have time, you might wish to invite participants to consider whether and how spiritual needs should be assessed within their own healthcare settings.

You may need to distinguish between religious questions and broader spiritual questions concerning belief, bearing in mind that, often, patients’ and practitioners’ views may differ (see Handout 7.9 Questions to assess spiritual needs – some of these example questions could be written up on a flipchart for reference during the feedback session).

Module 7|Spirituality in Healthcare

Feedback 10–15minutes

Helpful hints

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The key point about using these questions is to ask them at an appropriate moment and with the right intention.The intention is not to quiz or test the patient for an answer, but to create a ‘safe place’ in which they can explore these issues, if they wish. It is about the practitioner being genuine and sensitive.

Module 7|Spirituality in Healthcare

Evaluation

10 minutes Materials

G Copies of evaluation pro forma (if being used) G Pens

Guidance notes

Run though your planned evaluation activity (see Part 2: Guidance for Facilitators and Part 5:Additional Resources for information and guidance on evaluation).

As an alternative or additional activity, you may also want to give out a more formal evaluation form at this point for participants to complete now or return by a given date.

Remember to plan in some time as soon as possible after the session to complete your own evaluation of how you think the session went.

Module 7|Spirituality in Healthcare

Closure

G What notion of spiritual care did you have before this module or course? G Have those ideas changed?
G What does spiritual care mean to you now?

Exercise 7.10

Learning outcome

Materials

Facilitating the exercise

Healing meditation

Process:

Meditation

5–10 minutes
At the end of this exercise participants should be able to:

✔

G G

1 2

experience themselves as a source of healing energy which can be shared if they wish.

CD track no. 21 Healing meditation (or relaxing background music)

CD player/tape recorder (optional) Paper and pens

Ask the group to sit comfortably in their chairs.

Play CD track no. 21 Healing meditation or read the following text, playing background music if you wish.The text needs to be spoken slowly and clearly, pausing at ellipses (…).

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❝Sit comfortably and relax… allow any tension in the muscles of your neck and shoulders to soften… take a deep breath in… then breathe out with a sigh. Either close your eyes or if you wish, keep them open and focus on a point in front of you.

Bring your attention to the rhythm of your breathing for a few moments… observe your breathing settle down into its own natural rhythm… experience calm come into your body and with it your thoughts slow down…Watch your thoughts and do not become entangled in them… allow them to drift past… as you become peaceful.

Feel that deep peace… and experience it as a point concentrated in the centre of your forehead… like a point of light… a deep peacefulness emits from this point of light… a point symbolic of your spirit or soul… Visualise this peaceful light emitting rays of tranquillity… rays of peace and light. Experience the energy of this light as relaxing and very peaceful.

Now move your attention to a space outside of your body… where there is another point of light, a point that is like an ocean of peace… an ocean of tranquillity… an ocean of love… Make a connection between yourself and that ocean… so that the light and energy from it flows to you, entering through your face and eyes… … spreading out to fill every cell of your body with soft healing energy… Hold that image of the soft healing light coming from this infinite ocean of love and filling you with the same energy. You feel restored… replenished… healed.

Stay with that experience for a bit… then feel that same soft healing energy radiate from you… from your forehead… to your heart… to the people next to you… then fill the whole room… and stay connected to that ocean of peace and light… you feel the room is full of love… light… peacefulness…

Imagine there is a globe of the earth suspended in the centre of the room, a couple of feet off the floor… and imagine that your peaceful, healing energy concentrates in the centre of the room… surrounding it and all the people on the ear th… You remain aware of being a peaceful, soft light… connected to an infinite resource of peace, love and light… your healing thoughts and energy are surrounding the globe… This healing energy flows gently between you and the world… …

Stay with that a bit longer… then in your own time, become aware that you are sitting on your chair in this room… with your feet on the floor… Deepen your breathing, open your eyes and have a stretch…❞

Module 7|Spirituality in Healthcare

Helpful hints You could invite participants to write down some words which capture what they felt.

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Follow-on/homework Exercise 7.11

Module 7|Spirituality in Healthcare

Learning outcomes

Materials

Facilitating the exercise

The place of ritual in healthcare

Process:

Reflection and sharing in pairs and small groups

40 minutes
At the end of this exercise participants should be able to:

✔ give examples of rituals in medical or healthcare
✔ identify ways in which rituals can enhance the quality of

spiritual care.
G Flipchart and marker pens

G Flipchart with discussion questions written up for each part of the exercise (see below).

Introduce this exercise with examples of some rituals and ceremonies in everyday life and how some of these are part of customs around birth, marriage and death. Refer to the Background Reading paper for further information.

Begin by asking participants to find a partner or small group to work with.The discussion is in three parts:

Module 7|Spirituality in Healthcare

Part A:What makes a ‘good’ funeral? (10 minutes)
1 Invite everyone to spend the first few minutes reflecting on

their own, as follows:

❝Reflect on a funeral you have attended and think of a part of the ceremony that you had good feelings about.❞

2 Next, ask pairs/small groups to take it in turns to share how they felt and what it was about the ceremony that made them feel good, before considering the question:

G What makes a ‘good’ funeral?

3 Ask each pair/small group to contribute one or two of their ideas to the main group before moving on to the next part of the exercise.

After 10 minutes, move on to the next part of the exercise. Part B: How do rituals help? (10 minutes)

. 1 Ask each pair/small group to choose a simple situation at work where they have observed that there is a tradition or special way of dealing with an event or issue, for example, a staff meeting, a member of staff’s birthday, or how they say goodbye to a patient.

. 2 Invite them to discuss the following questions:

G Is this ritual or tradition helpful to yourself and others

involved? In what ways?

G How could it be improved or changed so that it is more helpful?

Allow 10 minutes before moving on to the next part of the exercise.

Part C: A significant situation (10 minutes)

. 1 Ask each pair/small group to identify a significant situation which occurs in their workplace, for example, a death, breaking bad news.

. 2 Invite them to discuss the following questions:

G What currently happens to mark or recognise that situation? G How could this be improved through ritual?

Allow a further 10 minutes for this stage before moving into feedback.

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Feedback 10 minutes

Helpful hints

1 Invite the groups to share some of their examples.
2 Spend the rest of the time considering this following question:

G What do these traditions/rituals add to your work and to the quality of spiritual care?

Make notes on a flipchart.

It is best to choose a simple ritual first before tackling the bigger ones around death, such as laying out a body.

The discussion may lead from a personal, particular ritual to more general cultural and religious rituals around birth, illness and death. It may be an opportunity to encourage participants to research the subject by reading, visiting religious sites and conducting interviews with staff and patients which could be written up as a project, or which they could present back to the group or their work team.

Further time could be given to developing action plans for introducing or improving rituals around specific events in the work place, as a way of enhancing spiritual care.

Module 7|Spirituality in Healthcare

Exercise 7.12:

Learning outcome

Materials

Facilitating the exercise

Healing through illness

Process:

Reflection

Optional
At the end of this exercise participants should be able to:

✔ understand illness as more than a clinical challenge, through exploring it as a meaningful experience.

G Paper and pens

Participants should work individually on the following topics (this could be done as part of a follow-on session, or in their own time as homework, to be discussed in a later session).

Choice of topics: Personal view

❝Describe an illness you have suffered and how you felt through each stage.What helped you recover and what did you learn from the experience?❞

Memorable case

❝Describe a patient that gave you an insight into the way you work. What did you learn?❞

The patient’s story

❝Write from the patient’s perspective how they might record their care, either as a personal descriptive statement, a poem, a letter or a journal entry.❞

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Handout 7.3

Definitions of health and healing

Health:

… sound in body, mind or spirit

… balance (harmony) of body, mind and spirit

… a state of well-being

… a feeling of being positive and full of energy

… ‘a state of complete physical, mental and social well being’ (WHO, 1947)

… ‘being confident and positive and able to deal with life’s ups and downs’ (Our Healthier Nation, Green Paper, 1998)

… ‘absence of disease and prevention of death’ (Our Healthier Nation, White Paper, 1999)
Healing:
to make whole
to make healthy
to promote well-being
to cure
to restore to soundness
to bring into balance
to offer love
to act as a channel of healing energy to bring peace and dignity
to discover meaning

Module 7|Spirituality in Healthcare

Handout7.4

What is ‘spirit’?

Real meaning (the spirit of…)

Soul

Sprite, fairy creature

Ghost

Essence

Character, eg courage, ver ve

Spirit

Pulling together, eg team spirit

A being that exists without a body

God, supreme being

Breath of wind

Solution of alcohol

Way of acting
(with spirit)

Handout 7.9

Questions to assess spiritual needs

Questions about values and beliefs:

General

What spiritual or religious practices are useful to you? What would help you to express these?

Specific

Have you a religious or spiritual practice that may affect your healthcare?
Do you have any dietary needs associated with your practice?
Do you pray or meditate?
Are there any pieces of music, poems, books or objects that provide you with meaning or comfort? Are there areas in your religious or spiritual beliefs or practice that you find difficult?

Questions about sense of self:

Do you have a hero/heroine that inspires you?
Do you have any strong beliefs?
Do you have a special place which is safe and comforting to you?

Questions about meaning of life and illness:

General

Why do you think you became ill?

Specific

What does this illness mean to you?
How do you see the future?
What do you think might help you on the road to recovery?
If you were to describe your life as a journey, how would you do that?

Module 7|Spirituality in Healthcare

Part 4: Spiritual Tools Contents

. 1 Introduction…………………………………………………….377

. 2 Meditation ……………………………………………………..379

. 3 Visualisation…………………………………………………….383

. 4 Reflection……………………………………………………….386

. 5 Listening………………………………………………………..389

. 6 Appreciation…………………………………………………….392

. 7 Creativity……………………………………………………….395

. 8 Play …………………………………………………………….397

Introduction

In the healthcare professions, there are many different methods used to teach the skills and the art of each discipline. Traditionally, formal lectures, personal study, tutorials and practical experience are used alongside apprenticeship learning.

Values in Healthcare, however, seeks to add a ‘spiritual’ dimension to the range of learning opportunities available to people involved in the practice of medicine and related disciplines, recognising that ultimately the relationship between practitioner and patient is a relationship between two human beings. This spiritual approach is an essential element of the programme, not only in the way that it focuses on our inner selves and the impact our thoughts, feelings, beliefs and values have on our practice, but also in the way it is delivered to participants.

The sessions that form the core of the Values in Healthcare programme consist mainly of participative exercises. These exercises encourage self-exploration and self- discovery and are designed to help people (a) understand that they have within them the capacity to bring more to their work than the knowledge and skills acquired through their formal training and their professional practice, and (b) identify ways in which the use of ‘spiritual tools’ can enhance their practice and everyday lives.

Most of the exercises in the sessions use one or more of the following seven spiritual tools:

G meditation G visualisation G reflection
G listening
G appreciation G creativity
G play.

The following story illustrates why we must keep our tools sharp:

Once upon a time, a very strong woodcutter asked for a job working for a
timber merchant, and he got it. The pay was really good and so were the working conditions. For that reason, the woodcutter was determined to do his best.

Part 4|Spiritual Tools

His boss gave him an axe and showed him the area where he was supposed to work. The first day, the woodcutter brought back 18 trees.

‘Congratulations’, the boss said. ‘Carry on that way!’

Very motivated by the boss’s words, the woodcutter tried harder the next day, but he could bring back only 15 trees. The third day he tried even harder, but could bring back just 10 trees. Day after day, he brought fewer and fewer trees.

‘I must be losing my strength’, the woodcutter thought. He went to the boss and apologized, saying that he could not understand what was going on.

‘When was the last time you sharpened your axe?’, the boss asked.

‘Sharpen? I had no time to sharpen my axe. I have been very busy trying to cut more trees for you.’

Ref: Covey, S. R. (1989) Seven Habits of Highly Effective People. New York: Simon and Schuster.

While the axe is the tool the woodcutter needs to keep sharp to do his job well, the seven spiritual tools are the tools we need to keep ‘sharp’ if we are to explore our inner selves and bring our insights to our practice.

We sometimes get so busy that we don’t take time to ‘sharpen the axe’. There’s nothing wrong with activity and hard work, but should we be so busy that we neglect the truly important things in life, like relaxing, taking time to reflect and to be creative? If we don’t take time to develop or sharpen our spiritual tools then we will become dull and lose our effectiveness in working and living.

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Meditation

What is it?

Meditation is both an ancient art and a modern-day skill. There are many meditation techniques and methods from various philosophies and disciplines, but the essence of all of them is to quieten and focus the mind.

Whatever we think about influences how we feel; we use the understanding of this connection as the method of creating positive feelings in meditation. In fact, the word meditation itself has the Latin root meditare – to think or ponder. With meditation it is possible to direct thoughts to a desired state of feeling, such as being peaceful, contented, silent in the mind, calm, light, happy, more accepting or less angry.

In the Values in Healthcare programme of learning, the tool of meditation is used as a method of directing the mind so that a peaceful or positive state of awareness results. Some of the meditations use visualisations or time for reflection as part of the process, so there is some overlap with the other tools.

Why should we do it?

Meditation is perhaps the most important tool to help us develop our spiritual skills. It produces a wide range of effects on the mind, such as improved capacity to concentrate and increased clarity of thinking which, in turn, simplify decision-making. It also improves health and general well-being, reducing anxiety, stress, pain, and depressive or obsessive thoughts. It is useful in clearing out the mind at the end of the day, for relaxing and improving sleep.

On a deeper level, meditation is a journey of rediscovery of our inner selves, in particular the good about ourselves. This discovery of inner strength can be especially useful at times of crisis or illness. As the power to become calm and to experience deep peace within us develops, we become able to allow this calming and healing energy to reach the body as well as the mind. By connecting to this inner peace, we are then able to become more effective in working with our patients’ suffering and distress. This includes helping them face terminal illness and the fears that attend the process of dying.

Meditation helps keep us peaceful and positive and therefore, less susceptible to being unduly influenced or overwhelmed in difficult situations. Inner peace is the key to developing a more positive attitude towards ourselves. It strengthens us psychologically, bringing about an enhanced sense of well-being and meaning to life. Our sense of self-worth shifts from being dependent on what others think of us and on our status and roles, and rests instead on the experience of our own goodness and

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inner quiet. We draw on our inner strengths and so become more self-reliant, creative and fulfilled. Importantly, these foundations of self-respect are tangible and enduring, not artificial or temporary.

Often we are caught up in everyday distractions and demands, preoccupied with what we are doing. Consequently we are seldom in touch with that deep sense we have of ourselves as spiritual beings. The more we meditate, the more our sense of identity gently shifts to that part of us which is more stable, lasting and clear, the part of us that we know to be our true selves.

Meditation can also be a practice which connects us with a source of higher energy, which we may call the ‘universal spirit’ or ‘supreme being’. In fact, the quest to know or connect to the highest spiritual energy comes as a consequence of recognising the depth of our own inner being. The qualities of this energy are often described as ‘an ocean of peace’, ‘unconditional, pure love’, and ‘light, joy and strength’. Through meditation and for some, through prayer, it is possible to connect to this light and to experience these qualities within our inner being.

A few of the exercises in this text refer to this supreme energy. It is a matter of choice for you and your group how you identify and label this ‘source’ and whether you wish to experiment with the opportunities provided.

How is it done?

The most effective methods of meditation are those that also offer a clear under- standing of how the mind operates, that is, how thoughts arise and can be managed in the mind. This understanding allows us to choose what and how we wish to think and so brings the energy of thought under our conscious control. It is not necessary to attempt to blank or suppress the mind in meditation. In fact, many methods of meditation suggest particular themes or concepts to focus the mind. The Values in Healthcare approach encourages the creation of positive thoughts to harness our natural power to think.

Thoughts arise from many external sources – it is natural to begin to think about what we see or what we hear. We tend to react involuntarily to the stimuli we receive through our senses. Thoughts also arise from past memories stored within us. To lift us out of the involuntary turmoil that such thoughts often create, it is vital to focus on something positive and uplifting. The most powerful focus for meditation is the self and, in particular, the peaceful, positive qualities and goodness at the core of the self, which is our inner being. For example, by thinking deeply about our original nature as beings of peace, love and wisdom, we begin to experience those qualities which may have been latent or hidden. The thoughts we create of the self as a positive and peaceful being move us towards the calm and silent centre of our conscious self.

A powerful sense of wonder accompanies the discovery of that peaceful place within. It takes time to explore this. With practice, this inner peaceful world will become familiar, like a sanctuary, a safe home or retreat.

This inner space is not a place of passive emptiness. Rather, it is a place filled with treasure. Here, it is not necessary to battle with negative thoughts or feelings. In fact it is easier, and preferable, to simply stand back and refocus on inner peace or to actively replace negativity with positive and powerful thoughts. This method also naturally enables us to let go of negative feelings and to allow very positive feelings such as love, peace and happiness to grow.

Meditation is something you can do at any time, in any circumstances, preferably sitting upright in a comfortable position on a chair or on the floor. It may take time to gain control over your thoughts, and to feel at ease with this practice. Through it, it is possible to become the master of your mind and to develop a very positive attitude towards yourself and as a consequence, to others around you.

All the modules in the Values in Healthcare programme include opportunities to practise short meditations. In particular, the series of exercises in Module 2 Peace is a useful progressive introduction to meditation practice. Module 3 Positivity develops the theme of positivity further.

Simple meditation exercise

We know our thoughts can in an instant take us anywhere, from the hustle and bustle of a busy street to a secluded beach where waves gently ebb and flow upon the shore. Here we feel an atmosphere of peace. When we think of people we love, such thoughts create a positive feeling in the mind. So, the thoughts we think create feelings in us. This principle underlies the experience of meditation.

During meditation we can feel the inner quiet and stillness filling us with strength. We may become aware of the pure love within and realise that peace, love and strength are part of our nature. These qualities belong to everyone. By always being busy in activity we forget that these qualities are deep and natural; only we lose the ability to find them. Meditation reminds us how to regain them.

By thinking of ourselves as peaceful beings, we can learn to take ourselves to a very peaceful place. In this peaceful place, we may experience a sense of connection with the universal supreme energy.

This is a simple meditation exercise. Either play the CD track no. 22 Simple meditation or speak these thoughts to yourself, pausing at ellipses (…) to allow yourself time for reflection.

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❝ Sitting comfortably I begin to withdraw my attention from the outer world, the world of my senses, and gently focus my attention within…I can create thoughts of peace… ‘I am a peaceful being’ … and peaceful feelings follow… I become immersed in a feeling of peace and my thoughts gradually slow down… My mind begins to become quiet… The quiet feeling in my mind grows… I become more aware of the silence that lies behind all the usual chatter of my thoughts… In this silence I begin to experience a deep sense of peace… peaceful thoughts arise… As I focus on my inner self I begin to feel very relaxed and light… I am just flowing peaceful energy… I am very still… floating away… like a tiny star in a sea of peace… Waves of peace wash over me and through me…

This feeling leads me to a very peaceful place… This place is like a beautiful, silent room where I can just slow down, be myself and be free… This is a very special room because it has no walls, ceiling or floor… it is just light and peace… This is my home where there is no fear, just peace… my inner sanctuary… As I become comfortable reaching here with my thoughts, I may become aware of a tranquil presence… a benevolent, loving presence that is filling me with beautiful feelings and refreshing my tired thoughts… I come to know this supreme energy as my friend… a constant source of comfort and strength in an ever-changing world… This being emanates peace, love and bliss… I enjoy basking in these qualities… Slowly I return, just like a feather floating gently to the ground.❞

In conclusion

By observing the thoughts in our minds we come to realise that they are the energy that takes us into an experience. By creating positive thoughts we can lead ourselves naturally into an experience of peace, inner strength and love. Peace is something we can create within our own minds. With practice, we realise this process can change the quality of our lives, our relationships, our behaviour and the way we experience the world. We understand ourselves to be peaceful beings and also know we have constant access to a dimension of silence where we can find the supreme source of all positive qualities. It is this source that fills us and helps us on this journey of self-discovery.

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Visualisation

Visualisation is simply using our mind to create images. It is when the mind creates positive images that visualisation becomes a useful spiritual tool.

Often the images we have in our mind are of past negative experiences or fantasies of our desires which can cause us unhappiness or frustration. We dwell on past failures and neglect the many times when things have gone well. Equally, we may be preoccupied with unrealistic ideas of things that we think may make us happy, such as more money or more success. However, we do have the choice to stop such thoughts and direct our thoughts in a positive way.

It is not easy changing what may be a lifetime habit where we have been taught to think in a certain way. It is our thoughts accompanied by feelings that form the basis of our beliefs and actions. Our thoughts are the one thing we do have control over and can change despite any outside influence. Using visualisation positively helps us guide our thoughts and feelings in new, helpful directions. This will affect our feelings and actions. But do remember we have control over our own thoughts.

With our mind we can travel wherever and whenever we like. For example, if you think of your living room or a beach you have visited recently you soon get a picture of it. If you close your eyes you can conjure up the sounds, smells and sights that accompany the image. Using visualisation, we have instant access to many memories; focusing on the positive ones can make us feel good inside. We can also create new places where we can feel relaxed, safe and content.

To get an idea of the power of visualisation try this brief exercise:

❝Close your eyes briefly… and imagine you see a bright yellow lemon in front of you… With a knife cut the lemon in half… and bite into one half… Now open your eyes… Did you see the lemon and did your mouth water and your cheeks pull in with the bitterness?❞

Most people do, and it shows how the mind can create pictures that are so real that they have a physical effect on the body.

Many of the guided visualisation exercises not only create an environment where we will feel good, but clear a space to allow deeper aspects of ourselves to be expressed.

Guided visualisation

The visualisation exercises enable us to find that place within ourselves where we can deeply relax and begin to experience ourselves. They often take the form of a journey or creating a special place.

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While the Values in Healthcare pack includes some specific visualisation exercises within the sessions, you should also feel free to draw on your own creativity and intuition in guiding and developing visualisations. Here are some useful guidelines:

G talk in a relaxed and gentle voice
G play soft background music
G use appropriate images covering sight, sound, touch, smells and atmosphere G use symbolic images
G allow some quiet time once the scene has been created.

Images

Keep the description general to allow people to create their own pictures. Choose a range of images, as individuals will differ in which senses are dominant, eg some people may be more tactile than visual:

G sights – set the basic scene, colours, structures
G sounds – wind rustling in trees, water trickling
G smells – flowers, special aromas
G touch – feeling the sun or breeze on the skin, sand or grass under the feet G atmosphere – peaceful, calm, safe.

Symbols

Symbols are metaphors that have various levels of meaning and, although different people will have their own interpretation, the following are generally accepted. You need to be aware that individuals may have negative associations with some of the suggested imagery, so your words should offer suggestions, rather than paint the picture for them.

G G G G G G G G G G

Gates and doorways – openings and new opportunities (any gate opened should be closed on returning).

Hills and mountains – expanse and strength of nature, challenges of ascent. Forests – in contact with nature, absorbing images.
Water – flow of life, crossing a sea or lake, a deep stillness, a river moving on. Sky – openness and freedom.

Staircases – for raising consciousness or contacting deeper unconscious. Landscapes – open spaces to explore, views of past and future.
Trees – links between above and below.
Bridge – a crossing over.

Rainbows – something magical.
Stones – a resting place (or an obstacle).

Colours

Colours are like images and symbols; we will all have our own personal associations, but there are also some more general associations when used in visualisation. These are suggested below. In addition, different shades of a colour can have their own meanings, for example, crimson red can mean anger, whereas rustic red can mean earth and home.

G Gold – protection.
G Green – balance, harmony, love.
G Orange – energy.
G Red/brown – earth, physical, survival. G Rose – unconditional love.
G Blue/indigo – intuition, inspiration. G Silver – clearing and cleansing.
G Sky blue – communication, uplift.
G Violet/purple – spiritual.
G Yellow – joy, clarity, happiness.

Some of the visualisation exercises and CD tracks in the Values in Healthcare pack will provide opportunities for participants to experience particular colours.

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Reflection

‘Reflective practice’ is learning from past experience. In healthcare it is a well- established method of evaluating concerns with the aim of improving clinical practice. It is a useful discipline to create a structure that reviews our professional progress.

Rather than analysing past concerns, the spiritual approach to reflection is to take
a more detached view of the situation. This involves standing back and looking at ourselves from outside so we can examine our own emotional reactions and feelings. It is a way of moving into a place of calm and peacefulness so we can observe what has happened. In this way we can begin to understand that our own feelings of anger, anxiety and attachment are something that can be released. We can then focus on what went right and the positive contributions we made. The aim of this type of reflection is to strengthen self-esteem by learning from mistakes, observing our feelings and building on positive experiences.

Reflection, either as ‘reflective practice’ or as a spiritual tool, requires commitment in terms of effort and time. To do it we need to be convinced it is worthwhile. At an ‘outer’ level we can observe whether good practice will follow from reflective practice, and at an inner level we can observe whether reflection allows us to feel more at ease with ourselves. Both will boost self-esteem, reduce stress and give us contentment in our work and life. Deep reflection leads to being able to stay stable and calm as an observer of a situation and not become emotionally involved ourselves.

This is not to deny that reflection will force us to face up to some issues that have stirred up inner negative emotional responses. One suggestion to deal with this is
to record the events and feelings in a daily journal; rather than dwelling on failures, record what you have learned from the experience. Reflecting on one event each day would give us 365 useful lessons a year! Besides working on your own, it is important to have a support network to help deal with difficult issues and to share your feelings with colleagues, friends or a partner.

When using reflection exercises in the sessions you will ask participants to reflect on questions on their own first, then to share in pairs, and then feed back to the main group. This allows them to explore their own feelings and responses first, then to expand on that with a partner, perhaps at a more personal level. The main group feedback should encourage reflection on the process, but allow time to share personal experiences, if people wish.

Examples of general reflective questions are:

What went well?
What was important to me over the last day or week?

Examples of more specific reflective questions:

Where was I successful over the last 24 hours or week? What made me feel content today?

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Exercise

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Learning outcome

Facilitating the exercise

Reflecting on important events of the day

30 minutes
At the end of this exercise participants should be able to:

✔ understand how to use reflection as a spiritual tool.
1 Ask participants to spend a few minutes thinking about the

following question and writing down their responses:

❝What has been important to you in the last 24 hours?

It can be any aspect of your life, a work situation, a conversation or something that you feel good about – a thought, idea or action.❞

It is important to remind participants that as well as useful and interesting experiences, they can also include more challenging situations.

Allow 5 minutes before moving on to the next step.

2 Now ask participants to think about a second question and write down their responses:

❝How can you apply what you have learned from your experience?

What is the next step for you to take?❞ Allow 5 minutes.

3 Ask participants to share what they have written with a partner. Allow 5 minutes.

4 Invite each pair to team up with another pair and share their main points.

Allow 5 minutes before moving into feedback.

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Feedback 10 minutes

Helpful hints

Share any interesting insights about the process with the main group and discuss the usefulness of the process of reflection.

It may be helpful to point out that the exercise shows that different things are important to different people, and that there are many ways of applying ideas. For example, people may have reflected on specific topics, like deciding to smile more at work, or more general topics, like how to bring more peace into work.

Reflection is a good tool to encourage as a ‘spiritual practice’ and should be woven into the learning practice. It can also be part of a continuous professional development programme.

If there are specific learning points that arise out of the reflective exercise it may be useful to ask two additional questions:

What else would you like to know? How are you going to discover it?

They may wish to find out more about practising silence and may therefore need to find some guides in the form of a self-help book or teacher.

When Values in Healthcare modules are run as a series on a weekly basis, the facilitator can use reflection as a learning tool to link each session. At the start of each session you could ask what was learned from the last session and how it was applied in practice over the week.This emphasises reflection as a learning tool.

Another way of using reflection as a learning tool is to ask par- ticipants what they feel are their learning needs at the beginning of a session.This encourages a cycle of identifying needs, putting that into practice, reflection on practice, applying what has been learned, and moving on to the next cycle. Everyone may have different learning needs, so adopting this approach can help people keep focused on what is important to them.

In general you can use two simple questions:

What do you wish to learn from this session? How can you apply it?

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Listening

There is nothing wrong with a good chat with a friend or an exchange with a stranger. It is all part of our rich social fabric of communicating and building relationships. Interpersonal exchange is complex because the meaning is conveyed not only through words but also the tone of voice, facial expression and body posture. These vary enormously from culture to culture and even within cultures.

In healthcare, some practitioners feel that we need to have a cool detachment towards patients in order to make sound judgements, or we can end up emotionally ‘washed out’. This may be true for doctors and others in specific situations, for example, when making critical diagnoses, but is not appropriate for most other circumstances. Perhaps the most important aspect of any communication is how we listen. Deep listening is healing and relieves suffering. Such listening is dependent on the listener finding peacefulness within, giving their full attention and having an open heart. As the listening becomes deeper it occurs at a spiritual level, and this is why we call such listening a spiritual tool. In time, it is possible to switch from analytical thinking, for example when considering symptoms and planning treatment, to listening deeply, which is healing for both the giver and the recipient.

To be a good listener we need to be inwardly peaceful. This can be achieved by practising ways of calming the mind. The Values in Healthcare programme includes meditation and visualisation exercises designed to help participants find inner peace (see Module 2: Peace). A few moments’ quiet before talking with a patient allows you mentally to release your thoughts and emotions and to come into the present.

When listening to people as part of our practice, we need to remain calm to enable us to listen deeply. This is done by adopting an easy posture, breathing regularly and maintaining peaceful thoughts, so an atmosphere of tranquillity is built up. This will help neutralise some of the strong feelings that may come up for us as patients tell their story, and will protect us from reacting to anxiety and anger.

Giving your full attention

Deep listening is achieved when we are able to give our full attention to the other without distraction and we can keep focused on them. It is good practice at all levels to allow a person to tell their story in their own words and at their own pace. We get a truer picture of their problems and the simple act of telling their story and being listened to is, in itself, therapeutic.

A very practical aspect is not to interrupt someone speaking. It may sound easy but how often do we interrupt? When taking a medical history we will wish to clarify a point, or stop them from wandering off the subject. However, it is still best to give patients uninterrupted space and time.

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We have all experienced that listening to someone tell a story can be boring and our mind wanders, or tries to make connections with our own experiences. However, in order to develop listening as a spiritual tool we do have to listen with our full attention. It is inevitable that patients’ stories will conjure up images and associations, but with practice we can bring our mind back on track and be fully with the person again. For example, when in conversation, we often use what we are being told to trigger our own contribution to the conversation. What somebody says may remind us of a similar experience of our own that either causes us to interrupt them before they have finished so that we can share our experience, or distracts us so that we do not listen properly. Worse still, we may simply not be interested in what is being said and try to change the subject, or simply ‘switch off’. In the ‘rough and tumble’ of lively conversation among friends, such patterns are normal. However, in a healthcare setting, people are communicating information that may be critical to their well-being.

Listening to the story

Patients have come to tell their story and have the right to be listened to. They may have a well-rehearsed story and have told their story many times before. For others the story will be unframed and it will be the first occasion they have told it in this way. Then you are in the privileged position of hearing a story for the first time and the words that emerge out of the person’s feelings will have a rawness and freshness to them. They will reveal much of the person’s personality, their social and cultural background, and their deepest feelings. They need to be heard with respect, which means without being interrupted.

Being quiet

Deeper listening is more than not interrupting and holding back from asking questions and making comments; it is also about not making noises, encouraging
or otherwise, that may seem judgmental, for example, the soft ‘Mmm’ or the exclamation ‘Ohh’ may be said in a tone which implies disapproval or surprise. Facial expression and postures can also been seen as judgmental and so will inhibit the person from telling their story as they would wish. Some people may say that being completely quiet may be interpreted by the speaker as disinterest in the listener, and many of us may have difficulty with the idea of not making encouraging noises. Nevertheless, experiment with it and observe whether or not the quality of communication improves.

Being curious

Being curious is the key to encouraging someone, so when appropriate make gentle open-ended enquiries to reassure them about your interest. (See Module 4: Compassion, Exercise 4.5 Compassionate listening).

Listening with your heart

Sitting with someone when you feel peaceful, and having an attitude of compassion, is healing for them and yourself, and is a valuable element of deep listening. To do this, imagine that your heart is open to the person you are communicating with. This means having an open posture and a receptive and calm expression. Let your attitude be one of gentle kindness. Looking directly into the person’s eyes is ideal, but you will have to be sensitive so as not to embarrass them. Generate a feeling of compassion within so that an atmosphere of tolerance, gentleness and love is created.

In summary, there are three things to remember when using listening as a spiritual tool:

G be peaceful
G be attentive
G listen with your heart.

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Appreciation

Perhaps in all lines of work, but especially in healthcare, we are taught to be critical in the way that we appraise our work. We try to provide optimum treatment by avoiding mistakes or errors that could have harmful consequences or be potentially life-threatening. Healthcare practitioners are taught to be careful and cautious and to develop a critical attitude. While this is wholly appropriate for many situations involving technical aspects of medical care, it is not the best approach with many aspects of healthcare which are essentially people-focused. If we have a critical attitude, this affects not only the way we give or deliver patient care, but the way we interact with colleagues and the way we live our personal lives. We can become negative about the way others handle situations or become negative about ourselves. We can then become hyper-critical, hyper-vigilant, anxious and defensive, leading to an outlook of hopelessness.

However, it seems that having poor self-esteem or being negative, especially about ourselves, can become more comfortable for us than appreciating what we are, what skills we have and what we do. In fact, professionals may view positive thinking as self-deception and even some of our treatments, for example, psychological therapies, prefer to focus on what is not right in order to find a solution.

The value of appreciation

The tool of appreciation is included in this workbook because of the strong impact appreciation has on individuals and organisations. This impact shows that people are healthier and happier when at least twice as much appreciation than devaluation is in their lives. They also work better and more effectively with colleagues to carry out their work when they acknowledge and value each others’ strengths and different points of view. The body of research that demonstrates the power of appreciation includes studies on the effects of joy and positive emotions, psychological therapies that build on a person’s exceptional moments to move forward and practices that build on the best of the past in an organisation to develop even more effective results in the future.

Appreciation has been used very effectively in healthcare in the UK, North America and Asia. Because it is so powerful, it is introduced into many of the exercises for individuals to practise and use for their personal lives, as well as groups of individuals to use in their teams, department, or whole organisation.

By applying appreciation to ourselves first, we can understand and experience its impact first hand. We can then think about applying it to our patients and colleagues. Appreciating another involves the qualities of valuing, respecting and empathy. When drawing on these values it becomes a spiritual tool. Such appreciation is facilitated by a genuine regard for the individual’s unique qualities beyond their roles and status.

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In order to develop the tool of appreciation, we have drawn on two major sources: the Living Values Educational Program (LVEP) and a process termed Appreciative Inquiry (AI).

Living Values Educational Program (LVEP)

LVEP, run in conjunction with UNICEF, has been operating throughout the world for the past ten years. It won the 2002 Teacher’s Choice Award and is a practical guidebook for teachers, parents and students to explore 12 particular human values in some depth. It includes educational activities that promote self-esteem, emotional intelligence and creative expression in children of all ages. Students enjoy it and teachers report decreased classroom disruption and an increase in motivation in their students. True acknowledgement, encouragement, recognition, support and praise are part of this educational approach. The LVEP treats appreciation as a skill, and looks at the three principles of being sincere, being specific and linking praise to a value or quality.

Ref:LivingValues:An Educational Program.Florida:Health Communications.For further details on LVEP, see website: http://www.livingvalues.net

Appreciative Inquiry (AI)

Appreciative Inquiry (AI) was developed in the late 1980s by David Cooperrider and Suresh Srivastra, at Case Western Reserve University in Cleveland, Ohio in the United States. The approach, emphasising appreciative questions in organisational settings, grew out of an awareness that problem-focused questions were effective for only a short period of time. Longer lasting change with better service and work practices happened when there was a combination of appreciation and inquiry.

The following summary table outlines the difference in taking a deficit-based and a strength-based approach to looking at services or practice and making changes.

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Problem solving approach

Identify problem

Analyse causes

Brainstorm and analyse

Develop action plans

Metaphor: organisation is a problem to be solved

Strength-based approach

Discover and appreciate the best of what is Envision possible solutions
Co-create what should be
Deliver and sustain what will be

Metaphor: organisation is a mystery to be embraced

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Appreciative enquiry has two important elements, valuing and inquiry. Some definitions of each are given below:

Valuing

G The act of recognising the best in people and the world around us.

G Affirming past and present strengths, successes and potentials.

G To perceive those things that give life (health, vitality and excellence) to living systems.

G To increase in value eg economy or property appreciating in value.

Synonyms: valuing, prizing, esteeming and honouring.

Inquiry

G The act of exploration and discovery.
G To ask questions: to be open to seeing new potentials and possibilities.

Synonyms: discovery, search, study and systematic exploration

AI looks at individuals, organisations or groups from the perspective of valuing what works best, drawing on existing skills and shared values to develop a shared future, rather than focusing on the problem and apportioning blame. AI assumes that in every team, group or society, something works, and the task for the group is to embrace this. AI sustains and encourages innovation through dialogue and sharing, asking questions that allow people to draw on past successes and to envision how they would like the future to be.

Ref: Cooperrider, D. L. (2000) Positive Image, Positive Action:The Affirmative Basis of Organizing. In: Appreciative Inquiry: Rethinking Human Organization Toward a Positive Theory of Change (Eds Cooperrrider, Soresnsen, Whitney and Yaeger). Champaign IL: Stipes Publishing Co.

This chapter is also available on the following website: http://www.stipes.com/aichap2.htm Appreciation is a major theme in Module 3: Positivity and the approach is

described in more detail in Handout 3.6 Appreciating others.

For further references and resources on appreciation and appreciative inquiry see Part 5: Additional Resources.

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Creativity

Creativity is a tool located in the right side of your brain as opposed to the left side, where the tools of logic and reason reside. Many healthcare professionals are ‘left- sided’ by inclination and their training reinforces this. However, this does not mean that we cannot use both sides of our brain and use all the tools available to us. It is good for us to be challenged to use a part of the brain that we are not so used to using, and it can certainly provide some useful insights.

Rarely does a big idea, for example, a new song or a great invention, come into our heads as a complete package in an instant. While they might seem like gifts that arrive from somewhere outside ourselves, creative ideas are often the product of working on problems over a long period of time, where work at a ‘deeper’ level than conscious thinking has been going on.

More commonly, elements of ideas come when we give them space to appear and a chance to develop. This is why having quiet times helps to still the mind and allow ideas to emerge. Equally, when we are taken up totally with something else, a solution to a problem may appear. Sometimes when we are under pressure and drop preconceptions about our own abilities, ideas may begin to flow.

Working in groups towards a common goal, when normal roles are laid aside, can be very creative. Ideas are bounced off each other and the group seems to move beyond the sum of its parts. Some of the exercises use this creative process to explore ways of generating and sharing ideas, and arriving at solutions to problems.

In these exercises we have often used drawing as a creative method because it is easy to practise and only requires coloured pencils and paper. Most people may not have done much drawing since childhood and it is important for them to set aside any feelings that they ‘can’t draw’. The idea is to move away from left-brain, logical thinking and tap into a more creative and intuitive mode which can help us to access our feelings and ideas. We are not looking for technical accuracy, clear meanings or pre-planning in the drawings, but a spontaneous representation of ideas and feelings as shapes, colours, etc. – whatever comes onto the page.

Another form of creative artwork used in some of the exercises is collage. This only requires a collection of old magazines, scissors and glue, although you can add other materials if you wish, for example, pieces of fabric, card shapes, glitter, string etc. Again, collage is something people may not have done since childhood, but it can provide an effective means of creating new ideas or a shared vision within a team. Collage allows representation of form and texture and can incorporate words as well as pictures. Other forms of creative art work could include working with clay or sand, making models or sculptures.

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Some of the creative exercises in the modules use mime, drama and poetry to explore issues and come up with solutions. Again, these tools free people from their usual ways of problem-solving, enabling them to experience feelings and ideas through movement or creative use of words.

There are an unlimited number of ways to be creative and we would encourage facilitators to experiment and develop the creative exercises. This may require some risk-taking, but in general, participants will appreciate the opportunity to explore new ways of working together.

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Play

Fun and laughter is essential to balance some of the serious discussion and deep reflection involved in some of the exercises. The quality of play opens people’s hearts and brings groups together.

Being playful is being spontaneous and carefree, with a willingness to risk getting it wrong; it is a good way of letting go of barriers and overcoming difficulties. Play brings a ‘lightness’ to the proceedings, encouraging tolerance in our listening and softness in our judgements. It helps to create a balance between maintaining respect and concern and having an easy way with others.

Playful people are like the ‘wise fool’, having an easiness with success and failure alike, in themselves and others. They have an inner smile and a childlike twinkle in their eye as they laugh at their own foolishness.

Playing simple games is something many of us feel inhibited about, because we have a fear of appearing foolish. However, when we do participate, it can be a moving experience. It helps us to connect with others at a deeper level beyond normal conversation and discussion. When we have fun in a group we can drop our roles and pretences and ‘just be ourselves’. A natural easiness becomes apparent when we are detached from the ‘ego personality’ and our inner joyful nature shines through. The inherent quality we have to smile and laugh is released.

Many of the exercises in the sessions are playful in themselves, particularly the warm-up exercises, movement exercises and closure exercises.

For exercises that are playful in nature, facilitators should use the following guidelines:

G Encourage participants to adopt an attitude that is accepting and easy.

G Encourage participants to have no expectations, and so to be free of frustrations.

G Encourage participants to approach playful exercises with a frame of mind that is clear of any immediate concern or task.

G Use an intuitive rather than intellectual activity.
G Encourage people to participate in the exercises with lightness.

References and resources

Ideas for further reading on the spiritual tools can be found in Part 5: Additional Resources.

Part 5: Additional Resources Contents

. 1 Warm-up Exercises………………………………………………399

. 2 Setting-the-tone Activities……………………………………….405

. 3 Movement Exercises …………………………………………….409

. 4 Closures ………………………………………………………..421

. 5 Personal Development and Action Plans …………………………426

. 6 Evaluation ………………………………………………………434

. 7 Meditation CD Track List……………………………………….441

. 8 References and Resources………………………………………..442

Warm-up Exercises

Every group that meets for the first time, or has regrouped with new members, should introduce themselves in some way as part of the overall session introduction. In addition to exchanging names, a warm-up activity helps to lighten the atmosphere and encourages everyone to relax in each others company. It helps participants feel involved and sets the style and tone for the session.

For more information on introducing the session, including warm-ups, see Part 2 Guidance for Facilitators Section 10.

Exercise 1.1

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Learning outcome

Facilitating introductions

General introductions

Introductions at the beginning of a session or course can be done either with people introducing themselves in turn, while sitting in a circle, or each person walking around the room exchanging information with one person at a time, until they have met everyone.

5 minutes
At the end of this exercise participants should be able to:

✔ identify the names of, and some personal information about, most members of the group.

Use the following text, or your own style if you are experienced in facilitating groups.

❝Introduce yourself to the others in the group by choosing three facts about yourself, for example, your name, where you come from, and your favourite food (or star sign).❞

Alternatives you may like to try include:
G name, where you were born and are now living
G name and what attracted you to the seminar/session

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Helpful hints

G name and something positive that has happened to you in the last week

G name, and a quality you like about yourself
G name, what animal you would like to be and what quality you

like about it
G name and what you wish to learn from the session G name and something interesting about yourself.

Introductions in the sessions can be done either with people introducing themselves in turn, as a round while sitting in a circle, or each person walking around the room exchanging information with one person at a time, until they have met everyone.

As a general rule for small groups of up to eight, each person
can spend a few minutes saying something about themselves. For larger groups it is better to keep introductions brief, for example, only names if in a round, or ask participants to share in pairs.

Choosing specific questions for the introductions has the advantage of being brief and giving everyone equal time.

Exercise 1.2

Learning outcomes

Facilitating fun exercises for groups

Fun exercises for groups

Typically 5–10 minutes
At the end of this exercise participants should be able to:

✔ express themselves comfortably within the group ✔ play a part in establishing a group identity.

You may choose to use one of the following exercises as part of Introducing the session, where a group has come together for the first time, or where relationships within an existing group need to be refreshed.

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Remembering names

This is a good way of remembering everyone’s name even with a large group.

This game starts with one person stating their name,‘My name is …’.The next person states her/his name and introduces the previous person again,‘My name is … and this is my friend called …’.

The person next to them then says their name and the names of the two previous people in the circle.This is then repeated right round the whole circle.

As the list of names to be remembered gets longer, people inevitably forget some but are helped by others, and so a group spirit develops. It is expected that the facilitator will be last and get the names right for the whole group!

Throwing cushions

You need a cushion.After everyone introduces themselves by name, start the game by throwing a cushion at someone in the group and at the same time saying their name.

The person receiving the cushion throws it to someone else, saying their name.

Continue in this way until everyone seems to know everyone else’s name.

Silent gestures

This game may seem a bit daunting at first but it is a sure way to warm people up.

Ask participants to stand in a circle. One person in turn should take a step into the centre and introduce themselves with a sweeping gesture movement of their choice.The rest of the group then repeats their name and gesture.

Go round the circle until everyone has had a turn.

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Exercise 1.3

Learning outcome

Facilitating exercises involving pairs

Sharing in pairs

Typically 5–10 minutes
After any of the following exercises, participants should be able to:

✔ work comfortably together in pairs, in order to share information, discuss thoughts and explore ideas with their partner.

Exercises involving working in pairs start with choosing a partner. This can be done in a number of ways:

G ask participants to choose anyone they like to be their partner in the group

G ask participants to choose someone they do not know to be their partner

G ask participants to stand up and walk slowly around the room making eye contact with everyone, and choose someone they feel drawn to. (They will need to check out that this is OK with their chosen partner.)

G divide the group into two and allocate a number to each participant 1, 2, 3 etc within each group. People with the same numbers make a pair

G ask participants to stand in a circle and place their hands in the centre, so they all touch and grasp a hand.

Sharing with a partner provides everyone with a friendly contact and helps them feel safe and more at ease.

Strictly speaking, the exercises in this section are preparatory exercises rather than warm-up exercises. Many of the sessions involve working together in pairs and some time may be needed to allow the participants to get to know their partner. Often it is an opportunity for people to air their current concerns.

The following exercises are designed to help participants to get to know each other and enable them to become comfortable

Helpful hints

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with sharing information and expressing their thoughts and ideas with partners.

Animal identification

Explain to participants that this exercise is a way we can reveal aspects of ourselves.

Lead the exercise as follows, reminding participants when it is time to swap over.

❝Think of an animal you identify closely with. It can be a domestic animal, a wild one or an imaginary one.Take a minute or so.

Now each take it in turns describe your animal to your partner without naming it, using the ‘I’ statement to describe it. If it is a cat you may say, ‘I am independent and curious; I like to keep clean and have my meals on time; I don’t like to be disturbed when sleeping’.

After 3–5 minutes change over.❞ Pictures like me

You will need a selection of pictures, for example, postcards or pictures cut out from magazines.

Spread the pictures out on the floor or a table top and explain to participants that this exercise gives us some insight as to how we may feel at the present moment.

Lead the exercise as follows, reminding participants when it is time to swap over:

❝Look at all the pictures and each choose one which reflects exactly how you feel right now.This has to be decided quickly using the intuition, not the intellect. Take it in turns to share with your partner why you chose a particular picture.

Change after 3 minutes.❞ Interviews

Prepare a list of questions on a sheet for participants to ask each other and respond with ‘yes’ or ‘no’ answers. Questions could include things like:

Do you like curries? Do you have a pet? Do you like gardening?

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Do you play tennis?
Do you find it easy to get up in the morning? Do you ride a bike?
Did you come a long way today?

Make copies for all the participants, with space to write answers.

Explain to participants that the purpose of this exercise is to have some fun and meet new people!

Lead the exercise as follows:

❝Go around the room with your sheet of paper, stop people, ask them one of the questions to which they should answer ‘yes’ or no’ and get them to sign their name.

Try to get as many signatures as you can.
When all the questions are ticked and completed, we will stop

the game.❞ Allow 5–10 minutes.

Imagination

This exercise focuses on the use of intuition and our perceptions of others.

❝Sit for a few minutes quietly facing your partner.Try to find an inner calm and peacefulness so your mind becomes blank.

Now one person should say something about the other using statements beginning with ‘I imagine…’ for example, ‘I imagine that you like horse riding and watching horror movies’ or, ‘I imagine that you like to travel and that you enjoy red wine’.

After 5 minutes change over, then sit and compare which information you have discovered correctly.❞

A variation of this is for partners to hold hands, with eyes closed, and try to read something about each other.

Setting-the-tone Activities

Take any group of people and you will find differences: beliefs, opinions, personalities, reasons for being part of the group, interests, family structure, cultural background, education, accent, age, appearance… the list goes on for as long as you want to pursue it.

Working together as a group, therefore, will inevitably expose some of these differences. Mostly, they will be absorbed within the group dynamics and will not compromise the group’s ability to achieve its goals; indeed, many of the differences will be sources of amusement, admiration, respect and wonder.

However, there may be differences that have the potential to cause conflict within the group. It is important, therefore, that a tone is set which allows individuals to feel valued within the group, no matter what differences may be exposed.

Working in groups involves people revealing aspects of themselves that would normally remain private property in some other settings, for example, at work. It is important, therefore, that a level of trust is established within the group in order that people can feel comfortable about their revelations, or behaviour within the group, and that consequently, they are able to make an effective contribution to the group’s activities.

For more information on setting the tone, see Part 2 Guidance for Facilitators Section 10.

Exercise 2.1

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Learning outcome

Materials

Working together

10 minutes
At the end of this exercise participants should be able to:

✔ apply principles of working as part of a group that enable differences to be acknowledged and trust to be established.

G Flipchart and pen

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Facilitating the exercise

Introduce the exercise as follows:

❝You will be working together today in a group and also in pairs. Think about what you consider to be important in this type of session.

What are the principles that should guide how we all work together? Get into pairs (or threes) and share with your partner(s) what

you think is important when working in this type of session.❞ Allow 3–5 minutes.

Ask for examples of what people said and write them up on
a flipchart.These can be used to form a set of principles or guidelines for the group to work to during the session.You may wish to display the guidelines on the previous page for the g roup to add items they think are important to their own list.

Initially, you may need to take a lead in establishing the group’s principles as, at this early stage, the group will still be finding its feet. If necessary, give examples such as, honesty, listening, respect and care for others.

Point out that participants have a responsibility to make the session a success as much as the facilitator.

Feedback

Helpful hints

Exercise 2.2

What do you want to get

out of this session today?

This exercise gives you something to refer to at the end of the session to check whether participants’ expectations were met.

It may also be an opportunity to highlight that they have some responsibility for making the day a success for themselves and others.

10 minutes

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Learning outcome

Materials

Facilitating the exercise

Feedback

Helpful hints

At the end of this exercise participants should be able to:
✔ identify their own and others’ expectations of the session.

G Flipchart and marker pens

Ask participants to get into pairs and introduce the exercise as follows:

❝Think about what you want to get out of this session today and how this can best be achieved. Discuss this with your partner.❞

Allow 3–5 minutes.
Ask for examples from the group and put them onto a flipchart.

An alternative question could be,‘How do you want to feel at the end of the session?’

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Exercise 2.3

Learning outcome

Materials

Treasure chest

5 minutes
At the end of this exercise participants should be able to:

✔ be aware of their own and others’ expectations of the session. G Flipchart and pen

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Facilitating the exercise

Draw a rectangle on flipchart and call it a treasure chest.Ask people what they want out of the day; examples could be, to feel more relaxed, have fun, learn something about the subject. Put these aspirations, or treasures, for the day into the treasure chest by writing them in the rectangle on the flipchart.This can then be referred back to at the end of the day.

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Movement Exercises

Many of the exercises in the sessions involve sitting, sharing in pairs or groups, or practising being still through meditation and visualisation. The following exercises are designed to get people moving in order to prevent stagnation and to get energy moving in the body and mind. They are playful in nature and should be conducted in this spirit. Some of the exercises are simple stretches, whereas others use imagery to help integrate the experience into the body.

Learning outcomes

After these exercises participants should be able to:
G feel energised and ready to move on to the next part of the session.

Facilitating movement exercises

In preparation for any movement exercises, handbags, briefcases and notebooks should be cleared away to the perimeter of the room; chairs should be moved back to create as much empty space as possible.

When facilitating these exercises you need to establish a relaxed, non-competitive atmosphere. There is no right or wrong way of following the instructions and you will probably need to say so. Everyone should work within the limits of their own body; they should feel stretched comfortably and painlessly by the end of each exercise. If anyone has an injury or health condition, they will need to make their own judgement about whether to participate in a particular movement. However, make it clear to all participants that anyone who finds a movement uncomfortable or painful should stop immediately.

Introduce your chosen movement exercise as follows:

❝ This is a simple, enjoyable exercise which you should do in a way that is comfortable for you. If there is pain there is no gain; if there is stress and strain there is no gain. Use your mind as an observer of your own interior physical experience.

Don’t get caught up in observing others; you can shut your eyes if
you want to and focus on your own physical experience.There is no competition to be won. Each of you will have your own way of moving. Be mindful of your bodily sensations as you carry out the exercise.❞

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Helpful hints

Introduce the exercise through doing it yourself as you describe it.

Talk participants through the exercise as they are doing it.

Let the slower members of the class dictate your pace.

Keep guiding them verbally through the movement until the fundamentals have been grasped, then let them pursue it in their own time.

Prepare to bring the exercise to an end by making it clear that they are carrying out the final cycle of movement before they finish.

Movement exercise 3.1 Stretch

This is good to do if people have been sitting for more than 20 minutes. Lead the exercise as follows:

❝Stand up and have a stretch and yawn. Interlock the fingers of both hands together, then turn them round and stretch your arms above the head. Go up on your toes, move locked hands slowly to each side, feeling the stretch to your arms and spine. Let out an ‘Ahh’ as in a deep yawn or sigh as you bring the arms back down and release the fingers.❞

Repeat a few times.

Movement e xercise 3.2 Shimmering

This exercise can help to release any tension out of the body. It can be undertaken in 1–2 minutes, or you can allow them to go on for a few minutes longer.

It can be used to create positive experiences in the body.

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Helpful hints

Facilitate the exercise using the following words:

❝Find a space and stand with your feet about the same distance apart as your shoulders.

Feel yourself in your body, relax and gently shift your weight so that you feel balanced.

Feel light and free as you do the following shimmering movements.

Let one arm hang loose and shake it, as if you are gently shaking a bell, paying attention to your arm as it moves. Start fairly fast, then reduce it to a gentler shimmer. Repeat on the other side, starting fast and then reducing the speed so that it is a more comfor table shimmer. Again, pay attention to the moving arm.

Now standing on one leg, imagine you are gently shaking off a sock on the other foot. Pay attention to your foot as it moves. Next, point your foot back and shake off a slipper, again paying attention to your moving foot.

Repeat each movement with the other foot.

Now swing your arms from side to side, slowly as if you had an over-size jumper on and the sleeves were hanging out… let your arms flap freely.

Finally, loosely throw one arm upwards and out over your head in a gesture of openness and freedom… Repeat with the other arm.❞

You can add some verbal prompts while participants are shimmering, like, ‘Let go of all the tension,’ ‘Release all negativity’, or be more specific,‘Let go of feelings of guilt’,‘Let go of that person that annoys you’.You can encourage people to make a noise as they move by giving an example yourself.

The exercise can be done to fast music, so that as participants begin to move their whole bodies they can end up dancing.

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Movement exercise 3.3 Pummelling

This is a wake-up, energising exercise. Facilitate the exercise using the following words:

❝Tap on your legs with closed fists, starting at your feet and working up your legs on the outside, tap up one leg then the other. Now move up your sides, back, shoulders, neck and head. Gently tap your face with finger tips, then the front of your neck. With closed fists tap your chest, abdomen and down the inside of your legs to your feet.This can be repeated several times.

As a variation, the exercise can be accompanied by the sounds ‘HO…’,‘HA…’,‘HE…’,‘HEY…,in turn.

Movement exercise 3.4 Breathing and bending

Check whether any of the participants has back problems and if so, advise them not to participate in this exercise, or, if they feel they are able, to do it very slowly and gently. Facilitate the exercise using the following words:

❝Stand with feet placed the same width apart as the width of your shoulders.Take a breath in as you lift both arms above your head… stretch back if comfortable… then breathe out as you flop forward in the direction of your feet… into a bending forwards position.

Relax… hold it there for one breath in and out… allow your arms to feel heavy and release the tension from your shoulders. When you are ready, take a deep easy breath in as you uncurl slowly into an upright position and stretch upwards with your arms above your head… stretch… then breathe out and bend forwards again with the ‘out’ breath to relax.

Do four bends and stretches in your own time. As you breathe in, take in light and energy… and as you breath out, let go of tension.When you have finished give your arms a shake.❞

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Helpful hints Other exercises which focus on breathing include Exercise 2.2 Muscle relaxation and breathing in Module 2: Peace.

Movement exercise 3.5 Standing postures

The following movement exercises are all based on the standing posture described below.You can select one or more of these exercises; try them out yourself so you are familiar with the ones you wish to use.

First, lead participants into the standing posture as follows:

❝Stand up in a space on your own. Place your feet apart the same width as your shoulders with your toes pointing forward. Bend your knees slightly so you feel firmly in contact with the ground with your weight evenly spread. Move your weight from foot to foot so you get a sense of being balanced… Your spine should be straight, so imagine a string attached to the top of your head pulling you gently upwards… Drop and relax your shoulders… look straight ahead. Allow your arms to hang loosely by your side.❞

Now participants are ready to undertake any of the following movement exercises:

Arm swinging

❝Gently begin to swing your arms… let your hands feel really heavy. Gently and rhythmically swing back and forward… allow your knees to bend as you swing at your own rate. Extend your swing so when your hand comes back it slaps your opposite shoulder… you should now be slapping each shoulder… do this at least twenty times… Then relax and stand for a minute.❞

Seaweed in a current

❝Imagine you are a piece of seaweed moving with the current and you are firmly rooted to the seabed. Gently move with the current… feel yourself being moved softly from side to side… sway with the water… in your own rhythm… gently, softly… feel free…❞

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Bent-arms stretch (to regulate all organs)

❝Bring your arms above your head, bend the elbows outwards and rest the backs of your hands on your head, palms facing up and fingertips touching. Now on the out-breath push your arms up, keeping the palms facing the sky and finger tips touching… as though you are supporting a plank of wood. Relax on the in- breath as you bring your hands down to rest on the top of your head, still with your fingertips touching. Repeat at your own rate of breathing, slowly pushing up as you feel the stretch… hold it… one… two… then relax and bend your arms back to your head, keeping your palms facing upwards. Repeat this ten times.❞

Unwinding

Lead this exercise as follows:

❝Find some space in the room and stand apart. Bend your knees so they are soft… let the weight of the head lead it down towards the floor, with your arms loosely hanging down… hands hanging from the end of the arms (if it is not comfortable to touch the floor that is fine). Feel the weight of your blood in your finger-tips as it is pulled towards gravity… keep your knees soft… feel your weight hanging down from the pelvis towards the centre of the earth, towards the centre of gravity… feel the space between your vertebrae increase. Curl slowly back up from the base of the spine to the top of the head… feel your head is light like a helium balloon, floating on the top of the spine as if a string were attaching your head to the heavens… imagine that you are completely healed… …❞

Punching (to build strength)

The instructions below sound complicated but participants should easily grasp the idea if you demonstrate the movement for them.

❝Make your hands into fists facing upwards (with your thumb under the fingers) and hold them at your waist. Now turn one fist over (facing downwards) pushing it forward like a punch and pulling the other fist back as far as it can go (facing upwards). Now pull back the forward fist and change it over from facing down to facing up as it comes back. At the same time, do the opposite with the other hand.

Do the movement slowly but with force, pushing forward on the out breath and breathing in as you change over. See it less as a punch but more as pulling a strong elastic cord as the fists pull apart. Repeat ten times, then relax.❞

Relaxing bounce

❝Have the knees well bent. Place your wrists on the hollow of your back by the kidneys so the hands are floppy. As you breathe in… bounce for a count of five… then breathe out… and bounce for five. Bounce as loosely as you can, breathing in for five… and breathing out for five.❞

Repeat for two minutes.

Fighting posture

❝From the standing posture, place one foot in front of the other by about two feet with both feet extending forwards. Make sure you are comfortable.Your knees should be bent so you can rock slowly back and forward.You should feel the centre of your gravity just below your navel and you should feel really secure on the ground… so it would be difficult for someone to push you over.

Experiment with your movement by swaying back and forward… test up and down… and side to side… remembering to feel as stable on the ground as possible. Slow it down. Change over with the other foot leading… and move back and forward, up and down, side to side.❞

Movement exercise 3.6 Pairs and group

movements

Following a partner

Ask participants to face a partner and describe the posture they should adopt with these words:

❝From a standing posture, place one foot in front of the other by about two feet, with both feet extending forwards. Make sure you are comfortable.Your knees should be bent so you can rock slowly back and forward.You should feel the centre of your gravity just below your navel and you should feel really secure on the ground… so it would be difficult for someone to push you over.❞

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Explain the exercise as follows:

❝One person, the leader, puts their hand out, palm down and their partner lightly places their hand on top.The leader slowly moves their hand in a circle and their partner follows this movement.

Do this with eyes closed… and move your weight so you feel well connected to the ground.You can go up and down as well as back and forward and side to side. Go very slowly… then change the speed.The partner has to be aware of the leader’s movement.❞

After several minutes ask people to change roles.

Standing from sitting

Ask participants to form pairs with another person of similar height and to sit together on the floor, back to back.With backs pressed firmly against each other, each pair should now find a way of standing up, using each other as a support.

Sitting on each other’s knees

Ask participants to form a line facing in one direction, so that each person is facing the back of the person ahead.The person at the front of the line should now sit lightly on the bent knees of the person behind.This person, in turn, should sit on the knees of the person behind, and so on, all the way down the line. This needs to be done quite quickly!

Massage

This can be done in pairs, or with a large group, in which case participants should form a circle facing in one direction so that each person massages the back of the person in front of them and at the same time, receives a massage from the person standing behind. Remind participants to ask permission first.

Facilitate the exercise using the following words:

❝Start by gently massaging the shoulder of your partner… around the neck… across the shoulders… and down the back. Check with them if they wish it to be lighter and firmer. Spend 2–3 minutes doing this.

Now, try gently pummelling with closed fists… then sides of hands… then open hands… and then lightly with fingertips.❞

If people are working in pairs, ask them to change roles and repeat the exercise.

Movement exercise 3.7
Long muscle relaxation

Movement can occur on a subtle level within the body and can provide a route to deep relaxation and stillness.This muscle relaxation exercise aims to enhance understanding of our experience of tension and relaxation (an alternative muscle relaxation and breathing exercise can be found in Module 2: Peace Exercise 2.2). By repeatedly tensing and then relaxing each area of the body, we become aware of the relativity of

tension and relaxation and the feeling it has in different areas. We also need to be aware that in day to day life one of the most common tricks we play on ourselves is to accept the extra tension we hold in our body as normal. It may be normal because it is there so frequently, but it is not normal in terms
of correct ways of managing our bodies.

There are several reasons why a muscle needs to hold tension:

G to hold the body upright against gravity
G to hold the body in shape, ie good posture
G to perform movement of the body, eg walk, touch things G to manipulate our environment, eg lift objects.

To do these things well, the body has an internal adjustment system that will allow some muscles to loosen while others tighten.

We need to relax, or decrease the excess tension, to enable the blood (carrying new food and carrying away cell waste) to flow easily through the muscles and the surrounding tissues.

So tension and relaxation are relative concepts and as we develop our skills in relaxation we may find that we are able to reach a more relaxed state.

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Learning outcomes

Materials

Throughout this relaxation session, practise abdominal breathing, that is moving your abdomen and not just your ribs when you breathe in.All muscle contractions should be isolated to the area described and as far as possible allow the rest of the body to relax.

20 minutes
At the end of this exercise participants should be able to:

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✔ ✔

experience a relaxed and peaceful state through the use of muscle tension and relaxation

understand the effects of tension and relaxation on the body, thoughts and emotions.

CD track no. 23 Long muscle relaxation (or relaxing background music)

CD player/tape recorder (optional)

Ask participants to sit comfortably on their chairs, feet placed firmly on the ground and hands held loosely in their laps.

Play CD track no. 23 Long muscle relaxation. Alternatively, you can speak the following commentary, playing background music if you wish. Speak in a clear, gentle voice, pausing at ellipses (…) to allow participants to focus on the experience.

❝Sit with your legs uncrossed and remove your shoes. Place your hands on your lap. Remove your glasses and close your eyes if you wish.

Throughout this relaxation session, practise abdominal breathing, that is moving your abdomen and not just your chest when you breathe in. All muscle contractions should be isolated to the area described and as far as possible allow the rest of your body to relax.

Start by focusing on your breath… be aware of its pattern…

With each in-breath: allow your abdomen to rise.

On the out-breath: allow your abdomen to fall.

Be aware of your breathing pattern and allow the breathing to become slower and deeper, but do not force it.

Now focus your attention on your feet… curl your toes hard… feel the tension… and relax… Curl your toes hard again… feel the tension… and relax. Notice the difference.

Point your toes down away from you so your calf muscles become tense… feel that tension… then relax… Point your toes down again… feel that tension… then relax. Be aware of the difference.

Bend your feet up towards your knees, stretching the calf muscles, feel that tension… and then relax… Bend your feet up towards your knees again… feel that tension… and then relax… Note the difference.

Bend your knees and hold your knees together, making your legs solid and tense… hold it… and relax… Bend your knees and hold your knees together again… and let go… Be aware that your legs are now more relaxed. Appreciate the difference in the feelings in your legs.

Bring your attention to your pelvis.Tighten your buttocks so you rise from the chair… feel the tension… and relax… Tighten your buttocks again… and relax.

Now focus on your back – arch your back and feel the tension and then relax… Arch again… and relax.

Bring your attention to your abdomen – tighten your tummy muscles so your chest moves closer to your hips – hold that tension and feel it… and relax… Tighten your tummy muscles again… and relax.

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Helpful hints

Be aware that the lower half of your body is relaxing deeper and deeper.

Focus on your breathing…

Now focus on your hands… make your fists tight… and feel the tension… and then relax… Tense again… feel it… then relax… Spread your fingers out and arch them back… and relax… Span you fingers out again… and relax your hands…

Bend your elbows and wrists… hold tight… and relax… Bend your elbows and wrists again… hold tight… and relax… Straighten your arms … hold… and relax… repeat that… and relax. Feel the relaxation in your arms and hands.

Now be aware of your shoulders and neck where we often hold our tension. Press your shoulder blades together… hold… and relax… Repeat… and relax… Round your shoulders bringing them forward around your chest… hold … and relax… Repeat… and relax… Lift your shoulders up towards your ears… feel that tension… and relax. Lift your shoulders towards your ears again… hold… and relax… Pull your arms down your side to your hips… hold… and then relax… Pull your shoulders down… hold… and relax.

Focus on your face… tighten your mouth and eyes very tight… hold… relax… Repeat… relax… Now tighten your scalp by pulling up your eyebrows and pulling back your ears… very tight… and relax… Repeat… and relax…

Feel your body very light and relaxed… Check your breathing is light and easy…

With your mind, travel over your body and check it is all relaxed. You can repeat some exercises to increase the relaxation…

Stay in this relaxed state for a few minutes and enjoy the feeling. Allow the body to adjust and accept this relaxed state as normal. Allow the body’s own healing energy to emerge.

When you are ready to move, first tighten your hands and feet and get up slowly and gently.❞

3 Allow time for participants to stand up and gently walk around. You may wish to invite their comments on the experience and its effects on their bodies, emotions and thoughts.

Do not undertake this exercise at the very end of a session. Caution: Do not drive or operate machinery immediately.

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Closures

The facilitator should give some consideration to how the session could end. Some form of simple ritual, possibly related to the theme of the module, to bring the session to a close gives everyone a feeling of completion.

You may already have some ideas, and creating your own closure for the day is often the best plan. Choose something that you are comfortable with, then assess its suitability for the group.

Closure activities can take many forms and emphasise different aspects of reaching the end of intensive group activity. They can be simple, or involve more complex exercises. They can express or focus on:

G Appreciation: valuing or celebrating the experience

G Farewell-goodbye: helping participants to go their separate ways

G Reflection and integration: thinking about what has been experienced or learned

G Action and pledges: identifying ways of applying the experience and learning beyond the session.

The type of closure will depend on the facilitator’s experience, the module and the participants. Listed below are some suggestions for closure activity from which you can choose. In addition, the modules each contain examples of closure activity which have been found to be particularly appropriate for their theme.

Closure 4.1

Appreciations

Focus: Appreciation

Form a circle and ask each participant in turn to answer one of the following questions without comment or feedback. Give participants the option of writing down their response and handing it in to you.

G What have you learned or gained from the session? G What will you take away?
G What have you appreciated, or not, from the session?

Part 5|Additional Resources

Closure 4.2

Candle rituals

Focus: Appreciation; reflection and integration; farewell-goodbye

Lighting a candle at the beginning of the session and blowing it out at the end is a simple form of ritual.As with any ritual it is the ‘intention’ concerning the action that gives it meaning.

Pass a candle around the group, inviting each participant to hold it for a few seconds before passing it back to you to blow it out.

While they hold the candle, you could invite participants to comment, if they wish, on what they appreciated (or not) about the day.

There are many variations, such as everyone in the group standing in a ‘group hug’ and blowing out the candle together. While standing around the candle, invite each person to say what they wish to take away from the session or simply send good wishes to someone.

Closure 4.3

Woollen web

Focus: Appreciation; farewell-goodbye

You will need a ball of wool made up of different coloured lengths of wool knotted together.

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1 2 3

Start by passing the ball of wool to one participant while holding the end of the thread.

Ask this person to hold onto the thread at one point and pass the ball of wool onto another person, anywhere in the circle.

Prompt everyone to pass the ball around in this way until everyone is holding the thread at different points, forming an interconnected web.

4 Cut the web between each ‘holding point’, so that everyone has a symbolic piece of thread to take away and remind them of the day.

This closure can be done in silence, or as each member receives the ball they can say what they have appreciated about the session.

Closure 4.4

Goodbye

Focus: Farewell-goodbye; reflection and integration; appreciation

Form a circle with everyone facing inwards. Lead everyone through the closure as follows:

Reflect on the day: what have you learned, appreciated, shared?

Turn and face outward. Look to the journey home; see yourself at your place of work
and at home over the next few days.

Turn back again to face inward, look around and say goodbye. Turn and leave the room.

Closure 4.5

A positive centre

Focus: Reflection and integration Guide participants as follows:

❝We will close now with a few minutes contemplation. Sit at ease and allow the mind to quieten down. As you become quiet, focus your attention within as though you are turning inwards… Imagine that you are gently moving to a centre of yourself where there is silence and joy and real positivity… a centre filled with cheerful thoughts, attitudes and feelings… a centre of happiness and learning. Here, reflect for a moment on insights or realisations you have gained or regained today… …

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After one minute: In this quietness, absorb your learning from today before leaving the room.❞

Closure 4.6

Untying the knot Focus: Integration; farewell-goodbye

. 1 Ask participants to stand in a circle with hands held out in front of them.

. 2 Invite them to hold another person’s hand, anywhere in the circle, until all hands
are held.This should ‘tie’ everyone into a knot.

. 3 Next, ask the group to attempt to unravel the knot without releasing hands.This will require turning, twisting, ducking under arms etc.

. 4 When the group has ‘unravelled’ as much as they can, invite them to say goodbye to each other as they each release the others’ hands.

Closure 4.7

Drawing

Focus: Reflection and integration

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2 3

Give participants pieces of paper and provide a range of coloured pens or pencils.

Ask them to do a drawing that represents the day.

Invite participants to place their drawing in the centre of the group, put it on a pin board or simply take it home.

Closure 4.8

Pledge card Focus: Action and pledges

1 Give each participant a small coloured card and ask them to do the following:

❝Write down one thing on a card that you pledge to do in the next week. An example may be something that is positive, peaceful or compassionate. It could be more than one, an action at home, work, or for yourself.❞

2 Invite participants to place their card in the centre of group, put it on a pin board, or simply read it out and/or take it home.

Closure 4.9

Letter to self Focus: Action and pledges

. 1 Give each participant a piece of paper or card and an envelope.

. 2 Ask them to write a pledge to themselves (see 4.8 Pledge card above), adding some phrase/s of encouragement, and place it in a self-addressed envelope.

. 3 Post the letters to participants in 4–6 weeks’ time.

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Personal Development and Action Plans

There is an increasing emphasis on lifelong learning and continuous professional development in healthcare today. With this, comes the need for training courses to build in opportunities to capture the learning which has taken place in a systematic way, in order that it can be linked to any or all of the following:

G the individual’s existing learning and experience
G the individual’s current job and responsibilities
G the individual’s career development and future work G the current or future needs of the organisation.

With the pace of change in organisations and roles, individuals must take more responsibility for their continuing development and learning, so that they can demonstrate that they are equipped to meet changing demands.

The following tools (individual learning logs and portfolios) may be useful to introduce at the end of the Values in Healthcare course, in order to help individuals record their learning and relate it to their own practice and development. These tools can be adapted or photocopied as they are. It may be that similar tools already exist within participants’ organisations, in which case they may wish to use these. Whatever tools are used, the recording of learning which has taken place can usefully be brought into the ongoing process of identifying, planning and meeting individual development needs, a process which is increasingly shared between the individual and their manager.

Individual learning log

A learning log is a simple way of encouraging reflection and learning from the training experience, including:

G a brief description of the learning event
G a summary of the main learning points
G specific plans for using the learning in practice.

The learning log provides a logical sequence for reflection and recording. A sample log which could be used is shown on page 427. If participants are undergoing several modules, they might be encouraged to complete a separate log for each, and later, to collate the main points into one log at the end of the course.

426

Values in Healthcare Learning log

Name……………………………………………………………………………. Job title………………………………………………………………………….. Organisation……………………………………………………………………..

Module or session/s attended: ……………………………………………………………. Date …………….. ……………………………………………………………. Date ……………..

Key learning points: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

How this experience connects with other learning: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Plan to use the learning in my practice/future work: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

New learning needs identified from the session/s: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Other points to note: ………………………………………………………………………………….. …………………………………………………………………………………..

Signed……………………………………………………….Date ……………..

Adapted with kind permission from Pickles,T. (1999) Toolkit for Trainers.Techniques for training and learning. Brighton: Pavilion Publishing.

Module 1|Values

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Learning portfolios

Learning portfolios involve creating a folder of evidence to demonstrate the training and learning which the individual has undertaken. Portfolios help people to take responsibility for the content and format of their own learning and development, and are becoming increasingly important as a means of providing employers and training providers with a rounded picture. Many professionals in healthcare and related fields are now required to create and maintain such records, and may already be using a particular format to do this.

Whatever the format used, it is the content and process which is important. Portfolios require time for reflective thinking before, during and after the training. Values in Healthcare sessions build in rich opportunities for individuals to reflect on their own development and practice, both during the exercises themselves, and as part of the action planning which is designed to help translate learning into their practical work. (See also Action Plans on page 430.) The outcome of these reflec- tions can be captured in learning logs, development plans and action plans, all of which can be incorporated into a portfolio.

An important starting point is to establish a plan for what learning needs have been identified from the training, and how these might be met, in the form of a professional development plan. A pro forma for this is shown on page 429.

If you are working alongside individuals who are completing these plans, encourage them to consider a broad range of further learning and development opportunities, rather than focusing on training courses alone. These might include:

G G G G G G G

coaching/mentoring from a colleague or manager in-house team training sessions or team away-days self-study or distance learning
research or project work

secondments qualifying/vocational training post-qualifying training.

Values in Healthcare Professional development plan

Learning needs identified from the session/s: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Plans and opportunities for these learning needs: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Sources of support required to implement plans: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Anticipated timescale for implementing plans: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Other considerations: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Signed……………………………………………………….Date …………….. Date to review plan……………………………………………………………..

Adapted with kind permission from Pickles,T. (1999) Toolkit for Trainers.Techniques for training and learning. Brighton: Pavilion Publishing.

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Action plans

Thoughts about how learning and insights might be applied will occur at different times during a module: at the end of a particular exercise, during a break, within a feedback discussion, and sometimes that final resolve as part of a closure exercise. The inclusion of an action planning exercise within each module allows participants to focus specifically on the application of learning; the following tools are intended to help participants identify clearly how this will be achieved.

Guidance on using action plans as part of the Values in Healthcare training programme can be found in Part 2: Guidance for Facilitators. It is helpful to
use a pro forma for this purpose, with headings or prompt questions to assist the formulation of individual or team plans. Suggested pro formas for individual and team action plans are included on pages 432 and 433 and can be amended or photocopied as they are. The individual plan can be used for participants to consider changes they might wish to make in their personal lives, as well as their work practice.

Before participants focus on the sheets themselves, it is helpful to allow time for reflection at the end of a module or session, during which participants can consider how the material, experiences and insights might be applied to their personal and/or working lives. With this in mind, each module incorporates an optional action planning exercise designed to prompt and guide this process. Alternatively, individuals, groups or teams may opt to undertake action planning around an issue or need which they want to address back in their personal lives or work settings.

Encourage participants to make their intended actions SMART, ie specific, measurable, action-orientated, realistic and timed, so that they will know when they achieve them. Remind them of the value of setting a date for reviewing their action plan, and adjusting it in the light of changing circumstances, achievements gained or problems encountered.

An interesting alternative to formalised action planning for individuals is to give each person a blank memo sheet and envelope towards the end of the course. Ask them to address the memo to themselves, and to write down ideas and plans for how they intend to use the course learning in their work or personal lives. When finished, each person puts their memo into their self-addressed envelope and hands it to the facilitator, who will post it in two months time as an ‘unexpected’ reminder. This works on the premise that commitment can often slip without a prompt further down the line.

Another approach, where individuals are working in the same service or organisation, is for individuals to decide on a specific action they will take (or change in their day- to-day practice) and write it on a shared flipchart sheet, signing it with their name.

430

The resulting ‘corporate’ pledge to action can be typed up and circulated after the course. This sharing and valuing of individual commitments will clearly demonstrate that everyone has some area of influence and can make a difference, whatever their position within the organisation.

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Values in Healthcare Individual action plan

Name…………………………………………………………………………….

Job title…………………………………………………………………………..

Organisation……………………………………………………………………..

Module or session/s attended: ……………………………………………………………. Date ……………..

My main reasons for participating in this training were: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

The main learning points for me were: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

What I have learned or discovered connects with: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

The things which I now plan to start doing, or do more of, are: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

The things which I now plan to stop doing, or do less of, are: ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Other action points arising from this training are ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

I plan to review these action points on…………………………………………. Signed……………………………………………………….Date ……………..

Adapted with kind permission from Pickles,T. (1999) Toolkit for Trainers.Techniques for training and learning. Brighton: Pavilion Publishing.

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Values in Healthcare Team action plan

Team members………………………………………………………………….. Session attended:

……………………………………………………………… Date……………. Main learning outcomes for the team:

………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Three key issues in our work we would like to address:
1 ………………………………………………………………………………… 2 ………………………………………………………………………………… 3 …………………………………………………………………………………

Plan of action:

Action to be taken

Who by

Target date

Issue 1:

Issue 2:

Issue 3:

Date to review plan……………………………………………………………..

Adapted with kind permission from Pickles,T. (1999) Toolkit for Trainers.Techniques for training and learning. Brighton: Pavilion Publishing.

Part 5|Additional Resources

Evaluation
Evaluation considerations and approaches relevant to the Values in Healthcare

training programme are discussed in detail in Part 2: Guidance for Facilitators.

While opportunities for informal feedback are built into each exercise, the evaluation session at the end of the training event provides a broader form of feedback about the whole. The main benefits of any evaluation activity include:

G encouraging participants to assess the training, in terms of content, process and other features

G providing opportunities for participants to evaluate their learning (including relevance and usefulness to their personal lives/professional practice), and identify further learning needs and action

G assisting the facilitator in planning the next stage of the training, or in adjusting the training for future groups based on feedback about what has worked/not worked (in terms of both content and process)

G re-affirming the value of the programme for ongoing use.

Pre-prepared evaluation forms provide one way of structuring and gathering information in written form from all participants at the end of, or following, a module or session. Findings can be readily collated and summarised into an evaluation report which can be passed to other interested parties, for example, the organisation which commissioned the training, or the training provider.

Requesting certain information about the participants themselves can be very helpful in designing or amending the training for other, similar groups, eg asking for participants’ job titles or their initial objectives for attending the training.

Rating scales can help to minimise the amount of work required on the part of the participant, while providing the facilitator with a clear ‘feel’ of the overall reactions to the various elements of the training and highlighting any problem areas. However, respondents should also be encouraged to provide additional comments to qualify, illustrate or expand upon their ratings.

Evaluation forms can be completed at the end of a module or session, before participants leave (ensuring a high rate of return, but without the opportunity for reflection), or sent to participants following the course (after the emotional reactions to the session have subsided, but running the risk of a low rate of return and diminishing memory!). Time to complete the forms and the length of the form are further factors in determining whether responses are rushed and impressionistic, or more considered and therefore, more valuable.

434

Two different styles of evaluation form are included on pages 436–439 and page 440. The one entitled Evaluation form provides structured responses concerning the main features of the course. The Feedback sheet is designed to capture more subjective information concerning participants’ feeling and reactions to the whole event. These forms can be amended or photocopied, as they are for participants to complete.

Pickles,T. (1999) Toolkit for Trainers.Techniques for training and learning. Brighton: Pavilion Publishing.

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Values in Healthcare Evaluation form

Your views about this training are valued.We aim to improve its effectiveness by learning from the experience of every person who undertakes it. Please take a few minutes to reflect on the training and complete this form.

Name……………………………………………………………………………. Job title………………………………………………………………………….. Organisation…………………………………………………………………….. Facilitator…………………………………………………………………………

Module or session/s attended: ……………………………………………………………… Date…………….

1 Objectives

What were your objectives in attending this event? ………………………………………………………………………………….. ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

To what extent do you think each of these objectives has been met? ………………………………………………………………………………….. ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

To what extent did the session meet its stated aims? ………………………………………………………………………………….. ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

What aspects of the training would you highlight as being particularly effective or useful?

………………………………………………………………………………….. ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

2 Content and presentation

Please rate the following features of the training, adding any additional comments in the spaces provided:

Content of training

Relevance to your work

Training style/exercises

Very good

Good Satisfactory Poor

3 2 1

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Pacing 4321

Facilitation 4321

Support materials provided 4321

Additional comments on course content and presentation:

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3 Practical arrangements

Please rate the following features of the training, adding any additional comments in the spaces provided:

Very good

Pre-course administration 4

Prior information about the training 4

Good Satisfactory Poor

3 2 1

Venue 4321

Lunch and refreshments 4 3 2 1

Additional comments on practical arrangements:

4 Putting learning into practice

How will you put your new learning into practice in your current work? ………………………………………………………………………………….. ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

What impact will the session have on your team/service (and how)? ………………………………………………………………………………….. ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

5 Improvements

How might aspects of the session be changed or improved? ………………………………………………………………………………….. ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Any additional comments about the session: ………………………………………………………………………………….. ………………………………………………………………………………….. ………………………………………………………………………………….. …………………………………………………………………………………..

Date completed………………………………………………………………….

Many thanks for your feedback. Please return the form to:

Part 5|Additional Resources

Values in Healthcare Feedback sheet
Your views about this training are valued.We aim to improve its effectiveness by learning from the experience of

every person who undertakes it. Please take a few minutes to reflect on the training and complete this form.

Name …………………………………………………………………………………………… Job title ……………………………………… Organisation………………………………….. Facilitator ………………………………………………………………………………………..

Module or session/s attended: …………………………………………………………………………. Date ………………..

Please circle or add other words as appropriate

What I enjoyed about this training was:

clear learning outcomes presentation venue materials/handouts learning activities pace

action planning chance to reflect

What I did not enjoy was:

food style

meeting people

venue learning activities action planning pace food materials/handouts

style
unclear learning outcomes presentation

The main benefits to me were: ………………………………………………………………………………………………….. ………………………………………………………………………………………………….. …………………………………………………………………………………………………..

Other things I would like to say are: ………………………………………………………………………………………………….. ………………………………………………………………………………………………….. …………………………………………………………………………………………………..

My overall view of the event is:

mediocre stimulating challenging poor thought-provoking engaging irrelevant calming

alright excellent boring fine

Please write on the back of this sheet if you need additional space for your comments.Thank you for completing this feedback sheet, which will help to improve future training courses.

Adapted with kind permission from Pickles,T. (1999) Toolkit for Trainers.Techniques for training and learning. Brighton: Pavilion Publishing.

Meditation CD track list

Tracks 12–23 in the text correspond to tracks 1–12 on CD 2

Part 5|Additional Resources

Track

Title

Module

CD 1

Experiencing personal values

CD 1

Rekindle the dream

CD 1

Practising peace through muscle relaxation and breathing

CD 1

Practising peace through becoming silent

CD 1

A peaceful day at work

CD 1

A peaceful anchor

CD 1

Inspired to be me!

CD 1

S.O.S

CD 1

Tuning into positive thoughts

CD 1

Meditation on compassion

CD 1

Breathing out anger

CD 2 (1)

Standing like a tree

CD 2 (2)

Forgiveness

CD 2 (3)

Inner values of co-operation

CD 2 (4)

A co-operative workplace

CD 2 (5)

Being cared for

CD 2 (6)

Cleansing colours

CD 2 (7)

Four seasons

CD 2 (8)

Who am I?

CD 2 (9)

Inner sanctuary

CD 2 (10)

Healing meditation

CD 2 (11)

Simple meditation

Part 4

CD 2 (12)

Long Muscle relaxation

Part 5

The text for each meditation commentary can be found in the modules or part of the pack in the table above.

Part 5|Additional Resources

References and resources

Participants may be interested in extending their knowledge and experience in some of the areas that have been covered in the modules. Facilitators need to have thought about possible local resources provided by their professional organisations, employers and community. They may also need to think about support and counselling services and ways in which the group can be self-supportive if there is an interest from the group. Others may wish to study some of the areas in an informal way or as part of their ongoing education and we have provided a reading list for each module and a more general list. There are also some useful websites to refer to for further information and our own website will be updated regularly.

References and resources

Part 1: Introduction

Appleton, K., House, A. & Dowell, A. (1998) A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds. British Journal of General Practice 48 1059–63.

Bakker,A., Killmer, C., Siegrist, J. & Schaufeli,W. (2000) Effort-reward imbalance and burnout amongst nurses. J Adv Nursing 31 884–91.

Bradshaw, A. (1997) Teaching spiritual care to nurses: an alternative approach. International Journal of Palliative Nursing 3 (1) 51–57.

Brahma Kumaris World Spiritual University (1995) Living Values: A Guidebook. London: Brahma Kumaris World Spiritual University.

British Medical Association (1994) Core Values for the Medical Profession in the 21st Century (Published report). London: British Medical Association.

Brom, B. (1995) Holism: definition and principles. International Journal of Alternative and Complementary Medicine 13 (4) 14–17.

Brown, C. K. (1998) The Integration of Healing and Spirituality into Healthcare. Journal of Interprofessional Care 12 (4).

Brown C. K. (2003) Low morale and burnout: is the solution to teach a values based approach? Complementary Therapies in Nursing and Midwifery 9 (2) 57–61.

Cooperrider,D.,Sorensen,J.P.,Whitney,D.&Yaeger,T.(2000) Appreciative Inquiry:Rethinking Human Organization Toward a Positive Theory of Change. Champaign: Stipes Publishing.

Cooperrider, D.,Whitney, D. & Stavros, J. (2003) Appreciative Inquiry (AI) Handbook. Bedford Heights: Lakeshore Communications Inc.

Department of Health (1994) Core Values for the Medical Profession in the 21st Century (Published report). London: British Medical Association.

Department of Health (2003) NHS Chaplaincy: Meeting the religious and spiritual needs of patients and staff. London: Department of Health.

442

Draper, P. & McSherry, W. (2002) A critical review of spirituality and spiritual assessment. Journal of Advanced Nursing 39 (1) 1–2.

Duffy, M. & Griffin, E. (2000) Facilitating Groups in Primary Care, a manual for team members. Abingdon: Radcliffe Medical Press.

Firth-Cozens, J. (1999) Stress in health professionals: psychological and organizational causes and interventions. London:Wiley.

Firth-Cozens,J.(2003) Doctors,theirwellbeingandtheirstress.BritishMedicalJournal326670–1. Gill-Kozul, C., Kirpalani, J. & Panjabi, M. (1995) Living Values: a guidebook. London: Brahma Kumaris

World Spiritual University.
Hawes Clever, L. (1999) A call to renew. British Medical Journal 319 1587–1588.
Heron, J. (1999) The Complete Facilitator’s Handbook. London: Kogan Page.
Johnstone, C. (1999) Strategies to prevent burnout. British Medical Journal 318 7192.
Kellehear, A. (2000) Spirituality and palliative care: a model of needs. Palliative Medicine 14 149–155.

Maslach, C. (1993) Burnout: a multidimensional perspective. In: W. Schaufeli, C. Maslach and T. Marek (Eds) Professional Burnout: Recent Developments in Theory and Research 19–32. New York:Taylor & Francis.

Maslach,C.&Schaufeli,W.B.(1993)In:W.Schaufeli,C.MaslachandT. Marek(Eds)Professional Burnout: Recent Developments in Theory and Research 1–16. New York:Taylor & Francis.

McGinn, C. & Hewitt, R. (1995) Wisboroughs – Make a new start with a fresh view of life. Sturminster Newton: Wessex Aquarian Publications.

McWhinney, I. R. (1998) Core values in a changing world. British Medical Journal 316 1807–1809. Pendleton, J. & King, J. (2002) Values and leadership. British Medical Journal 325 1352–55.

Peterson, E. A. & Nelson, K. (1987) How to meet your clients’ spiritual needs. Journal of Psychosocial Nursing 25 34–39.

Pickles, T. (1999) Toolkit for Trainers. Brighton: Pavilion Publishing.

Pietroni, P. (1986) Holistic Living. London: J.M. Dent & Sons.

Pines, A. & Aronson, E. (1988) Career burnout: causes and cure. New York:The Free Press.

Smith, R. (2001) Why are doctors so unhappy? Editorial. British Medical Journal 322 1073–1074.

Swinton, J. (2001) Spirituality and Mental Health Care. London: Jessica Kingsley.

Tillman, D. (2000) Living Values: An Educational Program (Series). Deerfield Beach: Health Communications Inc. (For further details on LVEP, see website: http://www.livingvalues.net)

Yamey, G. (2001) Promoting well being among doctors. British Medical Journal 252 232–253. Part 2: Guidance for Facilitators

Brockbank, A. & McGill, I. (1998) Facilitating Reflective Learning in Higher Education. Buckingham: Open University Press.

Duffy, M. & Griffin, E. (2000) Facilitating Groups in Primary Care, a manual for team members. Abingdon: Radcliffe Medical Press.

Part 5|Additional Resources

444

Hawkins, P. & Shohet, R. (2000) Supervision in the Helping Professions. Buckingham: Open University Press.

Heron, J. (1999) The Complete Facilitator’s Handbook. London: Kogan Page. Pickles, T. (1999) Toolkit for Trainers. Brighton: Pavilion Publishing.

Movement

Dennison, P. E. & Dennisin, G. E. (1994) Brain Gym.Ventura: Edu-Kinesthetics Inc. Jarmey, C. (2003) The Theory and Practice of Taiji. Qigong, UK: Lotus Publishing.

Sift, J. M. (1990) Educational Kinesiology: Empowering Students and Athlete Through Movement. ERIC document Reproduction Service No ED 320891.

Part 3: The Modules

Values

Eyre, R. (1995) Don’t Just Do Something Sit There! New York: Simon & Schuster (Trade Division). Gill-Kozul, C., Kirpalani, J. & Panjabi, M. (1995) Living Values: a guidebook. London: Brahma Kumaris

World Spiritual University.
McWhinney, I. R. (1998) British Medical Journal 316 1807–1809.

Peace

de Mello, A. (1984) Sadhana A Way to God. New York: Doubleday.
George, M. (1998) Learn to Relax. London: Duncan Baird Publishers.
George, M. (2000) Discover Inner Peace. London: Duncan Baird Publishers Ltd. Hanh,T. N. (1991) Peace is Every Step. London: Rider Books.
Linn, D. (1995) Sacred Space. New York: Ballantine.

Positivity

Arbinger Institute (2002) Leadership and Self Deception. San Francisco: Berrett-Koehler.

Goodman, M. (1997) Making Your Mind Your Best Friend (Audio tape). London: Bkpublications.

Jeffers, S. (1987) Feel the Fear and Do It Anyway.Toronto: Random House.

Robbins, A. (1995) Notes from a Friend : A Quick and Simple Guide to Taking Control of Your Life. New York: Simon & Schuster.

Royal College of Nursing (2001) Managing your stress: A guide for nurses. London: Royal College of Nursing.

Utterback, J. (1996) Mastering the Dynamics of Innovation.Watertown: Harvard Business School Press.

Compassion

Braybrooke, M. (2003) 1000 World Prayers. New Alresford: O Books.
Carter-Scott, C. (1998) If Life is a Game these are the Rules. Llandeilo: Cygnus Books.

Cole, R. (2002) Mission of Love: A Physician’s Spiritual Journey Toward a Life Beyond. Berkeley: Celestial Arts.

Dixon, M. & Sweeney, K. (2000) The Human Effect in Medicine. Abingdon: Radcliffe Medical Press.

Dowrick, S. (1997) Forgiveness and Other Acts of Love. London:The Women’s Press Ltd.

Dowrick, S. (2000) The Universal Heart. New York:Viking Press.

Gill-Kozul, C., Kirpalani, J. & Panjabi, M. (1995) Living Values: a guidebook. London: Brahma Kumaris World Spiritual University.

Hanh,T. N. (2001) Anger: Buddhist Wisdom for Cooling the Flames. London: Rider. Holden, M. (2003) Boundless Love. London: Rider.

Kornfield, J. (1993) A Path with Heart : A Guide Through the Perils and Promises of Spiritual Life. New York: Bantam Books.

Pines, A. & Aronson, E. (1988) Career burnout: causes and cure. New York:The Free Press. Snow, C. (1990) I’m Dying to Take Care of You. Deerfield Beach: Health Communications.

Co-operation

Collins, J. (2001) Good to Great: Why Some Companies Make the Leap…and Others Don’t. New York: HarperBusiness.

Collins, J. & Porras, J. (1994) Built to Last: Successful Habits of Visionary Companies. New York: HarperCollins.

Gill-Kozul, C., Kirpalani, J. & Panjabi, M. (1995) Living Values: a guidebook. London: Brahma Kumaris World Spiritual University.

Gratton, L. (2003) The Democratic Enterprise: Liberating Your Business with Freedom, Flexibility and Commitment. Financial Times Prentice Hall.

Levering, R. (2000) A Great Place to Work. San Francisco: Great Place to Work®, Institute, Inc. Payne,V. (2001) The Team-Building Workshop. New York: American Management Association. Scott-Morgan, P. (1994) The Unwritten Rules of the Game. McGraw-Hill Trade.

Valuing Yourself

Braybrooke, M. (2003) 1000 World Prayers. New Alresford: O Books.
Dass, R. and Gorman, P. (1985) How can I help? Emotional support and spiritual inspiration for

those that care for others. New York: Alfred A. Knopf, Inc.
Field, L. (2001) Creating Self Esteem. London: Random House UK Distribution.

Firth-Cozens, J. (1999) In: J. Firth-Cozens (Ed) Stress in health professionals: psychological and organizational causes and interventions. London:Wiley.

Greener, M. (2002) The Which? Guide to Managing Stress. London: Penguin. Hay, L. L. (1999) You can Heal Your Life. Carlsbad: Hay House.

McGinn, C. & Hewitt, R. (1995) Wisboroughs – Make a new start with a fresh view of life. Sturminster Newton: Wessex Aquarian Publications.

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Parsons, R. (2002) The Heart of Success. London: Hodder & Stoughton General.
Salinsky, J. & Sackin, P. (2000) What are you feeling, Doctor? Abingdon: Radcliffe Medical Press.

Tolle, E. (2001) The Power of Now: A Guide to Spiritual Enlightenment. London: Hodder and Stoughton.

White,T.(1995) BeYour OwnTherapist.San Francisco:Purple Paradox Press.

Spirituality in Healthcare

Brown, C. K. (1998) Optimum Healing. London: Rider Books. Caddy, E. (1996) Opening Doors Within. Forres: Findhorn Press.

Cobb, M. (2001) The Dying Soul: Spiritual Care at the End of Life. Buckingham: Open University Press.

Cobb, M. & Robshaw,V. (Eds.) (1998) The Spiritual Challenge of Health Care. London: Churchill Livingstone.

Janis, S. (2000) Spirituality for Dummies. London: John Wiley. Jewell, A. E. (1999) Spirituality and Ageing. London: Jessica Kingsley.

Koenig, H. G., McCullough, M. E. & Larson, D. B. (2000) Handbook of Religion and Health. Oxford: Oxford University Press.

Orchard, H. (2001) Spirituality in Healthcare Contexts. London: Jessica Kingsley Publishers. Page, C. R. (2000) Frontiers of Health: From Healing to Wholeness. Saffron Walden:The CW

Daniel Company Ltd.
Rinpoche, S. (1998) The Tibetan Book of Living and Dying. London: Rider.

Robinson, S., Kendrick, K. & Brown, A. (2003) Spirituality and the Practice of Healthcare. Basingstoke: Palgrave Macmillan.

Siegel, B. S. (1988) Love, Medicine and Miracles. London: Arrow.

Stoter, D. (1995) Spiritual Aspects of Health Care. London: Mosby.

Swinton, J. (2001) Spirituality and Mental Health Care. London: Jessica Kingsley.

Vaughan, F. (1995) Shadows of the Sacred: Seeing Through Spiritual Illusions. Wheaton: Quest Books.

Walsh, R. (2000) Essential Spirituality:The 7 Central Practices to Awaken Heart and Mind. London: John Wiley & Sons.

Part 4: Spiritual Tools

Covey, S. R. (1989) Seven Habits of Highly Effective People. New York: Simon and Schuster.

Meditation

Austin, J. H. (1999) Zen and the Brain:Toward an Understanding of Meditation and Consciousness. Cambridge: MIT Press.

Bodian, S. (1999) Meditation for Dummies. Foster City: IDG Books World Wide Inc. George, M. (2004) In the Light of Meditation. New Alresford: O Books.

Hendlin, S. J. (1989) The Discriminating Mind. London: Unwin Hyman Limited.
Kabat-Zinn, J. (1994) Wherever You Go There You Are: mindfulness meditation in ever yday life.

New York: Hyperion.
LeShan, L. (1984) How to Meditate:A Guide to Self Discovery.Toronto: Bantam Books. Schiff, F. (1992) Food for Solitude. UK: Harper Collins.

Visualisation

Achterberg, J., Dossey, B. & Kolkmeir, L. (1994) Rituals of Healing. Using Imagery for Health and Wellness. New York: Bantam Books.

Dossey, L. (1993) Healing Words.The Power of Prayer and the Practice of Medicine. California: Harper.

Gawain, S. (2002) Creative Visualisation. Novato: New World Library.
Gawler, I. (1997) The Creative Power of Imagery: A Practical Guide to the Workings of Your Mind.

Hill of Content Pub Co Pty Ltd.
Morgan, G. (1986) Images of Organizations. London: Sage Publications.

Simonton, M. D. O. C. & Creighton, J. (1992) Getting Well Again:The Best-selling Classic About the Simontons’ Revolutionary Lifesaving Self-Awareness Techniques.Toronto: Bantam Books.

Reflection

Johns, C. & Freshwater, D. (1998) Transforming Nursing Through Reflective Practice. London: Blackwell Science.

Mezirow, J. & associates (1990) Fostering Critical reflection in Adulthood. San Francisco: Jossey-Bass Publishers.

Rolfe, G., Freshwater, D. & Jasper, M. (2001) Critical Reflection for Nursing and the Helping Professions. Basingstoke: Palgrave.

Schon, D. (1987) Educating the Reflective Practitioner. San Francisco: Jossey-Bass Publishers. Schon, D. (1991) The Reflective Practitioner. Aldershot: Arena.

Listening

Griffith, J. L. & Griffith, M. E. (2002) Encountering the Sacred in Psychotherapy: How to talk to people about their spiritual lives. London:The Guilford Press.

Guenther, M. (1992) Holy Listening:The Art of Spiritual Direction. Cambridge: Cowley Publications. White, M. (1997) Narratives of Therapists Lives. Adelaide: Dulwich Centre Publications.

Appreciation

Cooperrider,D.L.,Sorensen,P.F,Whitney,D.&Yaeger,T.F.(2000) Appreciative Inquiry:Rethinking Human Organization Toward a Positive Theory of Change. Champaign: Stipes Publishing.

Cooperrider, D. L. & Srivastva, S. (1990) Appreciative Management and Leadership:The Power of Positive Thought and Action in Organizations. San Francisco: Jossey-Bass Inc.

Cooperrider, D. L., Srivastva, S. & Associates (1990) In: Appreciative Management and Leadership. San Francisco: Jossey-Bass.

Cooperrider, D. L.,Whitney, D. & Stavros, J. M. (2003) Appreciative Inquiry (AI) Handbook. Bedford Heights: Lakeshore Communications, Inc.

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Torres, C. B. (2001) The Appreciative Facilitator. Maryville: Mobile Team Challenge.
Whitney, D., Cooperrider, D. L., Trosten-Bloom, A. & Kaplin, B. S. (2002) In: Encyclopedia of Positive

Questions. Bedford Heights: Lakeshore Communications.
Whitney, D. & Trosten-Bloom, A. (2003) A Practical Guide to Positive Change. San Francisco:

Berrett-Koehler.

Creativity

Edwards, B. (2000) Drawing on the right side of the brain. London: Souvenir Press.

Fritz, R. (1989) The Path of Least Resistance. New York: Fawcett Books.

Kelley,T. (2003) The Art of Innovation. New York: Doubleday.

Senge, P. (1994) The Fifth Discipline Fieldbook: Strategies and Tools for Building a Learning Organisation. New York: Bantam Doubleday Dell Publishing Group.

Play

Adams, P. & Mylander, M. (1998) Gesundheit! Rochester: Healing Arts Press.
Blatner, A. & Blatner, A. (1997) The Art of Play: Helping Adults Reclaim Imagination and Spontaneity.

New York: Brunner/Routledge.

Platts, D. E. (1996) Playful Self-discovery. Findhorn: Findhorn Press.

White,T.(1995) BeYour OwnTherapist.San Francisco:Purple Paradox Press.

Williamson, B. (1993) Playful Activities for Powerful Presentations. Duluth, MN: Whole Person Associates.

General

Canfield, J. & Hansen, M.V. (2000) Chicken Soup for the Soul. London: Random House.

Capra, F. (1982) The Turning Point: Science Society and the Rising Culture. Toronto: Bantam Books.

Carson,V. B. (1989) Spiritual Dimensions of Nursing Practice. Philadelphia:W. B. Saunders Co.

Dossey, B. M. (1996) Core Curriculum for Holistic Nursing. Gaithersberg, Maryland: Aspen.

Dowrick, S. (2000) The Universal Heart. New York:Viking Press.

Foundation for Inner Peace (1999) A Course in Miracles. London: Penguin.

Kornfield, J. (2000) After the Ecstacy, the Laundry. New York: Bantam Books.

Krieger, D. (1981) In: Foundations for Holistic Health Nursing Practice. Philadelphia: J. B. Lippincott and Co.

Levin, M. (2000) Spiritual Intelligence. London: Hodder & Stoughton.
Levine, S. (1988) Who Dies? An investigation of conscious living and conscious dying. Bath: Gateway

Books.
Levine, S. (1989) Healing into Life and Death. Bath: Gateway Books. Marks, L. (1991) Living with Vision. London: Coventure, Ltd. Moore,T. (1994) Care of the Soul, Harper Perennial, New York. Pietroni, P. (1986) Holistic Living. London: J.M. Dent & Sons.

Townsend, E. (1997) Enabling Occupation: An Occupational Therapy Perspective. Ottawa: CAOT Publications ACE.

Wright, S. G. & Sayre-Adams, J. (2001) Sacred Space – Right relationship, spirituality and health care. Edinburgh: Churchill Livingstone.

Useful Websites

General

The British Holistic Medical Association http://www.bhma.org

Facilitation

Global Facilitators Network is a resource for all sorts of resources http://www.globalfn.org

Barbara Frederickson’s article on Cultivating Positive Emotions to Optimize Health and Well-Being can be found at http://journals.apa.org/prevention/volume3/pre0030001a.html

Movement

Shaolin Temple Health Nourishing 6 Qigong Exercises http://www.shourinji.net (click on ‘English’ and then ‘nourishing exercises’)

Educational Kinesiology (UK) Foundation Website – The official site for Brain Gym® and Educational Kinesiology in the UK
http://www.braingym.org.uk/

Modules

Peace/stress management

Relax7.com is your very own place to find the methods and means to help you relax during turbulent times and take with you into your daily life – Mike George. http://www.relax7.com

This site by Pratrick Whiteside explores happiness and gives support and resources for people to develop their happiness.
http://www.happinesssite.com

The Sacred Space Foundation provides peaceful rest, retreat and recuperation facilities for those who have become exhausted, burned out and stressed in their work. Our focus is on the helping professionals, primarily healthcare practitioners, such as nurses and doctors, but we do not exclude others who may come to us for help. http://www.sacredspace.org.uk

Positive thinking/appreciation

Using the New Positive Psychology to Realize Your Potential for Lasting Fulfilment http://www.authentichappiness.org

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Mind Tools outlines important life and career skills in easy to understand language. http://www.mindtools.com

Appreciative Inquiry websites http://www.aradford.co.uk http://www.aipractitioner.com http://www.appreciative-inquiry.org

Compassion and forgiveness

A View on Buddhism – Love and forgiveness meditations http://buddhism.kalachakranet.org/Meditations/love_forgiveness_meditation.html

Co-operation/team work

Great Place to Work Institute is dedicated to building a better society by helping companies transform their workplaces. Our work is based on the major findings of more than 20 years of research – that trust between managers and employees is the primary defining characteristic of the best workplaces. We offer services and tools to help companies build trust and become more effective organisations. http://www.greatplacetowork.com

Spirituality

Spirituality in nursing practice http://www.ihpnet.org/nrs4.htm

Spirituality and Psychiatry Special Interest Group at the Royal College of Psychiatrists http://www.rcpsych.ac.uk/spirit

Spiritual Tools

Meditation

Brahma Kumaris World Spiritual University is an international resource for meditation, positive thinking and stress management and much more. http://www.bkwsu.com
http://www.bkwsu.org.uk

bkpublications.com http://www.meditationsociety.com/ http://www.learningmeditation.com/ http://www.meditationcenter.com

Play

Maya Talisman Frost, Drawing on Creativity: How to Trick Your Brain on http://www.massageyourmind.com

Listening

Public Conversations Project aims to foster a more inclusive, empathic and collaborative society by promoting constructive conversations and relationships among those who have differing values, world views, and positions about divisive public issues.

http://www.publicconversations.org

Reflection

The Reflective Practitioner: Foundation of Teamwork & Leadership http://www.css.edu/users/dswenson/web/TWAssoc/reflectivepractitioner.html

The sites shows how teachers use reflective practice to develop professionally. http://www.edutech.nodak.edu/dls/html/reflective.html

Creativity

The Creativity Portal promotes the exploration and expression of personal creativity through free learning, arts, crafts, writing and other creative activities. You’ll find our site chock-full of how-to resources, inspiring articles, downloadable projects, fun and humour, and motivation to be creative!

http://www.creativity-portal.com

Drawing On Creativity: How To Trick Your Brain, by Maya Talisman Frost Feb 22, 2004
http://www.expertmagazine.com/artman/publish/article_417.shtml

Part 5|Additional Resources

Values in Healthcare: a spiritual approach

Acceptance

Values in Healthcare: a spiritual approach

Appreciation

Values in Healthcare: a spiritual approach

Balance

Values in Healthcare: a spiritual approach

Benevolence

Values in Healthcare: a spiritual approach

Centredness

Values in Healthcare: a spiritual approach

Clarity

Values in Healthcare: a spiritual approach

Commitment

Values in Healthcare: a spiritual approach

Compassion

Values in Healthcare: a spiritual approach

Co-operation

Values in Healthcare: a spiritual approach

Courage

Values in Healthcare: a spiritual approach

Creativity

Values in Healthcare: a spiritual approach

Dependability

Values in Healthcare: a spiritual approach

Dignity

Values in Healthcare: a spiritual approach

Enthusiasm

Values in Healthcare: a spiritual approach

Flexibility

Values in Healthcare: a spiritual approach

Forgiveness

Values in Healthcare: a spiritual approach

Generosity

Values in Healthcare: a spiritual approach

Gratitude

Values in Healthcare: a spiritual approach

Honesty

Values in Healthcare: a spiritual approach

Hope

Values in Healthcare: a spiritual approach

Humility

Values in Healthcare: a spiritual approach

Humour

Values in Healthcare: a spiritual approach

Integrity

Values in Healthcare: a spiritual approach

Kindness

Values in Healthcare: a spiritual approach

Listening

Values in Healthcare: a spiritual approach

Love

Values in Healthcare: a spiritual approach

Loyalty

Values in Healthcare: a spiritual approach

Openness

Values in Healthcare: a spiritual approach

Optimism

Values in Healthcare: a spiritual approach

Patience

Values in Healthcare: a spiritual approach

Peace

Values in Healthcare: a spiritual approach

Positivity

Values in Healthcare: a spiritual approach

Practicality

Values in Healthcare: a spiritual approach

Reflection

Values in Healthcare: a spiritual approach

Respect

Values in Healthcare: a spiritual approach

Responsibility

Values in healthcare: a spiritual approach

Simplicity

Values in healthcare: a spiritual approach

Tolerance

Values in Healthcare: a spiritual approach

Trust

Values in Healthcare: a spiritual approach

Wisdom

? : an introductory paper ………………………2