Pain Matters: Megamorphosis pre-work at Youville
Submitted by Heather Mak, clinical nurse specialist, Residential Care
The final week of pre-work in preparation for the Megamorphosis was filled with experiential and reflective work around the importance of understanding the pain experience in the people we serve and in each other. Heather Mak, clinical nurse specialist, and Joesph Sun, nurse educator, led the week’s participatory activities that engaged staff in discussions about their own pain, how pain might show up in the people we serve and how all of us have a role in working towards supporting people to be as comfortable and relaxed as possible.
In one of the exercises, Heather had half of the group leave the room and place beans in their shoes, then walk back into the room where the unsuspecting other staff had to understand what was happening for those with their shoes full of beans (causing discomfort and downright pain) through non-verbal language only. Despite the laughter, key learnings included how hard it was to experience pain - if only for a few minutes - as well as how frustrating it was to be unable to tell your coworkers to hurry up and take off your shoes! As caregivers, staff explained that people with dementia change over time; even if a resident was able to tell you about their pain a few months ago, today the words may no longer be there. Many staff shared that knowing their residents helps to identify when they are uncomfortable.
Although at work we tend to think of pain as confined to the people we serve, many of us experience pain. The second day was spent reflecting on our own pain experiences, how it impacts us and what brings us relief. It was powerful to learn about the wide variety of approaches even within our small group. A few people were clear that medications were a necessity, however many more used a soothing environment, aromatherapy, pressure, heat or cold as their first steps. Is there an opportunity to find out what works for the people we serve, and what we can offer?
On Wednesday, the team gathered to see what the day would bring. Joseph Sun led an Island Exercise designed to understand the impact of choice and control in decision making. Joseph explained that we had recently moved in to the “No Pain Home”. Drawing on the two previous days’ experiences, the group listed the five key approaches that caregivers needed to know about us was ensure we remained pain-free. Once each participant captured their pain reduction plan, they passed it to the person on their right who was then directed to cross out three items - these approaches would not be offered at the ‘No Pain Home”. When the lists were returned to the writer and they saw the two approaches left, the group erupted into feelings that ranged from irritation to anger to sadness. “Why did you cross that out?” “How come you didn’t ask me?” “Don’t you know that a dark environment is important?” and in a few cases “You knew what I needed!” When we are not able to provide all the interventions that a person would like, how do we connect with the people we serve to be certain that the pain interventions that we can provide are the most important ones for that person?
Our final gathering encouraged us to draw on the conversations and observations throughout the week, by asking the question, “How can we bring comfort and joy to the people we serve?” After a lively discussion that we captured on a flip chart, we were amazed that only one entry focused on pain medications! We had more than 40 other ideas and it is amazing to see how much we can do to improve comfort. Staff then chose one of these new approaches to try during the Megamorphosis weeks and wrote it on two postcards: one card was placed on a poster for display, and the second was kept as a personal reminder.
Throughout the week, this vibrant group representing all disciplines and including students and residents, gathered twice a day to engage in activities designed to deepen our understanding of our ability to promote comfort and joy. Many laughs were had and the participants left with a sense of purpose and confidence.
The Megamorphosis began the following week on February 14 and marks a two-week high intensity culture transformation that will bring residential care one step closer to our vision. The vision’s foundational areas of focus are: emotional connections matter most and residents direct each moment, while at the sometime creating a vibrant and engaging home.
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