The Narrative Initiative

On the last day of the Gathering of Kindness Week Dr Lorraine Dickey, Neonatologist from The Narrative Initiative outlined her journey to explain the importance of

Understanding the story – focusing on care and compassion through narrative.

Lorraine is the founder and CEO of The Narrative Initiative and an Advanced Narrative Facilitator as well as being a neonatologist with experience leading a large Neonatal Intensive Care Unit in the USA.

She established The Narrative Kindness Project after she had a catastrophic ski accident and experienced the healthcare system as a patient. Her recovery was slow and arduous with three years of rehabilitation. After she was told she would never work as a physician again because of the traumatic brain injury she did an MBA in Health Care Management.

“She had the privilege of returning to the profession of medicine in 2004 though returning with a vastly different perspective… Armed with the new philosophy of Patient and Family- Centered Care she embarked on leading changes that truly matter to patients, their families, and healthcare staff.”

Health professionals don’t get special care when they’re sick – they have varied experiences like the general public. She changed direction and promoted self-care in the profession after getting burnt out with her new career and developing breast cancer.

She had to personally invest in the culture of self-care! Not necessarily just to be kinder to herself but to understand how it happens.

“Lorraine works to bring people in health care together to address staff-identified barriers to providing high-quality health care experiences for patients, their families, and healthcare staff using research-based, published, facilitated narrative techniques.”

Some topics include:

• resiliency,
• the wounded healer,
• compassion fatigue,
• professionalism,
• dignity therapy
• principles of Patient- and Family-Centered Care.

Enhancing listening and communication skills through the use of personal story

In 2013, Lorraine entered a second Fellowship in Hospice & Palliative Medicine and now cares for babies and children with serious illness or life-limiting conditions, also their families, facilitating the alignment of parental goals of care and medical goals of care while also providing complex pain & symptom management.

“ It is critical to know what brings a person joy, both as a patient and as a parent. Family-centered care is honored when medical therapies match and enhance the goals a parent has for their child while helping them make decisions under the most difficult of circumstances. Physicians and other healthcare clinicians need to understand that providing therapies that match parental values and family culture IS providing good medical care. Practicing with this philosophy in mind supports what we as physicians got into this profession to do: Help someone do what they cannot do for themselves.”

Dr Lorraine Dickey

In 75 minutes we were given a taste of what is normally done at either a cafe workshop (12 participants) where people attend one or several sessions over a period of time or a half-day for larger groups with narratives focused around a topic of choice.

The experience of care triggers a powerful biological response in the patient… and emotional memories of care last a lifetime.

Lorraine wanted the forum to address the barriers to kindness and develop ways to overcome them. She talked about communication as perceived by the listener and drew a pie chart showing  absorption was

• 40% from the tone of voice
• 55% from non-verbal actions (stance etc)
• 5% verbal – the actual words spoken.

It is emotionally hard to fathom what is said if there is lack of tone and non-verbal indicators but to have people concentrate and remember what you are saying you must tone down actions and how you say it.

People are motivated to achieve certain needs and some needs take precedence over others.

Maslow’s hierarchy of needs is a motivational theory in psychology comprising a five-tier model of human needs, often depicted as hierarchical levels within a pyramid. 

In a hospital situation, if you need the toilet, are hungry or traumatised, these needs will affect your listening skills. Plus ‘a difficult patient’ may not have coping skills.

The same will go for professional needs – often staff are tired, hungry and stressed.

• Maslow shows emotion trumps logic every time.
• People must learn to treat each other with respect.

In a hospital, it may be as simple as staff sitting down beside the patient or family member, not standing over and facing them. Staying calm and asking how the person is doing and remembering to use their name.

You cannot reach people’s logic if they are in pain.  When a patient is in pain, self-actualisation is their logic. Kindness lives in the love/belonging space.

Clinicians sometimes need to act to put patient welfare first even although they may be tired, worried and stressed themselves: 

‘I will smile’                  ‘I will be open-minded’

People perceive acts of kindness differently.

You see someone in a wheelchair and you open the door for them, a natural instinctive courteous and kind act.

But what if the person in the wheelchair can open the door themselves or wants to exercise their independence? Instead, we should ask, ‘do you want me to open the door for you?’ or ‘would you like me to open the door?’

There are probably many kind acts of omission that are never recognised as such. For example, the doctor is ten minutes late and the patient doesn’t mention or complain about the lateness – and vice versa.

Efficient, effective communication happens when words and logic meet and both parties walk away understanding the same thing. We often don’t realise the collateral damage of our actions or our words.

The importance of writing

The act of writing makes us slow down. Writing gives form and shape to experiences that seem formless and shapeless, even chaotic. Writing helps us translate complex experiences into a form more easily grasped such as an obituary or eulogy.

While some participants are talented and accomplished writers it is important to note that these narrative sessions make use of informal writing.

• Informal writing is not designed to be correct, artistic or accomplished in any special way.
  Informal writing is designed to capture the writer’s honest reaction to a significant experience.

The simple act of reading this type of informal writing aloud, word for word, to an interested and informed audience can itself be a powerfully validating experience.

Write Read Renew

We were given three minutes to write a personal experience of a kind act: spoken or physical gesture. It could be from a professional experience with a patient, their family member or a colleague or a kind act of omission.

This kind act that was either particularly difficult or challenging or alternatively uplifting or inspiring must then be read without changes to the person sitting beside us.

I shared my story with Angela, a Charge Nurse at the Austin Hospital.

My 3 Minute recollection of an Act of Kindness – written without editing:

When my Mother was dying, a nurse suggested we bring a quilt from home my sister had made to brighten the starkness of the bed sheets. I thought that a very kind suggestion amidst the grief of my very big family (six siblings plus partners and children) and friends crowding the room.

In the trauma of Mum dying in hospital, she realised we would have preferred to have her at home and went out of her way to encourage us to replicate some of that familiarity. She had previously arranged a bed for me to stay 24 hours with Mum.

Angela wrote about her daughter having an unplanned emergency causing Angela to leave work for some time. When she returned to work, staff had left flowers, chocolates and a welcome back card with kind words of support. She had no idea how they valued her up until then.

Angela and I discussed our feelings and the incidents we had written about in closer detail, which transformed us from being total strangers sitting at a table together to human beings with empathy for each other.

Empathy is about understanding each other’s needs and not just smiling sympathetically. It is emotional and thrives on good communication.

Several people shared what they had written with the whole room. Our excellent facilitator, Lorraine pointed out specific use of language and wording plus the images and tone of the narratives, as well as encouraging further exploration of the story.

The experience similar to what we do in my writing workshops and classes, especially Life Stories & Legacies –

• encouraging the getting it all down first,
• the reading aloud,
• close listening skills,
• absorption of story
• understanding of what the writer wants the reader to take away
• what should be edited.
• or added!

It can be painful writing about harrowing or life-changing experiences, particularly when it comes to illness and grief, but often these difficult stories are the important ones to share. You still feel the loss and pain, but it can be a therapeutic release and also help to enlighten others.

A story shared about a young woman’s brother who died of brain cancer was very moving. Her mother did not speak English and the doctor didn’t speak her language but despite a sad outcome, their empathetic relationship eased the pain. She talked of brain cancer ‘winning and an earthly miracle not realistic.’

Lorraine noted that winning is everything in medicine and society doesn’t like losers and often the language we use reflects this attitude.

Everyone appreciated how difficult that personal story was to tell and felt privileged and moved. The young woman’s tone of voice quiet and natural, the simplicity of words and detailed imagery mesmerising. We listened.

The stories made us feel connected to each other – and this is how I feel in my writing classes when people share stories of their life.

Lorraine then drew two columns and in a quick-fire room participation, people said what they thought were barriers to kindness and methods to overcome these barriers.

Perceived barriers:

• not wanting to be kind, selfishness
• overwork, overtired, and stress
• ignorance and misunderstandings
• lack of humility and bad manners
• insecurity and task focused
• burn out
• vicarious trauma – disoriented
• busyness and lack time
• lack of training in how to respond
• not connecting and/or fear of connection
• inequity, and custom and practice
• fear of how it will be perceived
• pressure from being overwhelmed
• arrogance
• lack of a role model
• friendship – wanting to belong and seeking saviour in silence
• funding model – cut corners because of a shortage of time
• not being able to forgive
• the faker
• cultural differences
• not actively listening
• lack insight
• lack professional boundaries

Methods to overcome barriers:

• modelling
• be kind to staff
• value and acknowledge kind acts
• self-care
• be a role model
• celebrate the small stuff
• accept feedback
• value your people
• reward kindness
• pause and reflect
• educate and model
• value and celebrate difference
• forgive and learn

Lorraine pointed out there was a tiny origami crane among the flowers decorating each table and attendees could agree who takes it home – her act of kindness to us.

Angela asked if she could have it for her daughter and I said of course.

A small act of kindness at a critical point can have an unimaginable impact. Sometimes we need to be kind by breaking rules. Celebrate kind acts, not kind people, talk with, not to people.

What a wonderful day I had and I left with a challenge ringing in my ears:

Remeber to do something different – kindness to self and to the people around you. Bring joy and a giggle to life. 

Focus on what can be done, not what you can’t do.

What is Gathering of Kindness?

 Kindness matters.  There is a direct correlation between organisational negativity and staff wellbeing and effectiveness.  

 The Gathering of Kindness aims to redress this by building, nurturing and instilling a culture of kindness throughout the healthcare system.

 We bring together people from inside and outside the healthcare sector – actors, clinicians, artists, musicians and innovators – to imagine that kindness, trust and respect are the fundamental components of the healthcare system, and that bullying is unacceptable. We look for creative pathways to a more compassionate model of health care.

 This first public Gathering Of Kindness has encouraged the broadening of participation. I’ll pass on a challenge… Be kind and do random acts of kindness at home and at work.

Tuesday, November 13, 2018, is World Kindness Day

• Smile at strangers and do kind things for them.
• Give up your seat on the bus/train to someone else.
• Buy someone a coffee.
• Volunteer your time at the local op shop or some other charity.
• Leave a kind note for someone or send an uplifting message.
• Kindness should not only be reserved for our fellow human beings. Be kind to the animals and to the environment as well.
• If you have children in your life, teach them the virtue of kindness by practising it in your daily life.

It truly can be a wonderful world.