Abstract
By Lura L. Pethtel M.Ed. and John D. Engel Ph.D. Oxford: Radcliffe Publishing, 2010, 148 pages, $25.00.
The Palliative Care and Hospice Caregiver's Workbook is a useful educational training resource that explores the emotional and spiritual aspects of care for the dying. The training was developed as a method to prepare new hospice or palliative care volunteers for the challenges of work with dying people. The curriculum, 16 sessions of 3 hours each, is designed for a trainer to use with a small group of learners. The workbook includes spaces for participants to write in directly, both during sessions and in preparation for future sessions. Though the workbook outlines a majority of the curriculum, a free trainer's guide is available online with additional information and recommendations for facilitators.
With the exception of the first unit, which begins with an overview, the sessions follow the same general structure. They open with a short quieting exercise or meditation designed to promote relaxation and mindfulness. Then participants share comments from their journal notes about the previous session. Each unit includes several activities to explore the unit's theme, which can take the form of discussion, skill-building exercises, creative activities, and reflection. The units close with time for journaling and assignments to prepare for the next session. All units contain an outline with full descriptions of all activities, including necessary materials and expected time requirements. The text is easy to read and contains thought-provoking quotations and ample references to support further exploration of each topic.
Unit 1, entitled “Getting Started,” is a one-session introduction to the course. After a course overview, participants introduce a partner to the group using a brief biosketch. To familiarize learners with the field's philosophy and goals, the group then reads aloud an essay about the history of hospice and palliative medicine. Then the class participates in a readers' theater adaptation of The Death of Ivan Ilyich, which catalyzes thinking and discussion about the experience of dying from the dying person's perspective both in this and in future sessions.
Unit 2, “Understanding the Caregiver's Self,” provides an opportunity for learners to reflect on their own reactions to death, as well as thinking about how another's experiences might be similar or different than one's own. This unit occurs over six sessions: “Reflecting on Death,” “Mindfulness,” “Self-Knowledge,” “Spiritual Knowledge,” “The Whole: Body-Mind-Spirit,” and “Facing Death.” Activities include creating a list of needs of a dying person, listening with mindful presence, self-exploration about what brings the learner to working with dying people, creation and presentation of a physical model of one's own spirituality, and a group exercise about “death sitting in the empty chair.”
The goal of Unit 3 is “Understanding Ourselves in Service of the Dying Person,” which attempts to create a framework of the social, religious, personal, and cultural constructs that impact the relationship between dying person and caregiver. During the three sessions that make up this unit, participants create a “Caregivers' Code of Ethics,” hear from representatives of different faith backgrounds about the rituals and beliefs about death in their religion, and consider the impact of concrete and abstract losses on them as individuals.
Unit 4, “Ways of Helping the Dying Person,” focuses on building concrete skills to aid and deepen caregiving for both the caregiver and the dying person. The five sessions include teaching about communication, compassionate presence, the barriers created by assumptions, the power of narrative, and creative activities that can help a dying person find meaning in suffering. Unit 5 includes a single session about “Honoring the Caregiver,” which introduces and explores the importance of self-care.
Pethtel and Engel have created a remarkably rich curriculum, one that fully embraces the challenging task of preparing individuals for the emotional challenges and the concrete skills of working with dying persons. While they created the curriculum to train hospice and palliative care volunteers, as they aptly note in the introduction, many of the activities would be equally beneficial for a professional audience. Many of the exercises are both inventive and evocative, setting the stage for intentional self-reflection and significant growth. Participants in their course are fortunate to benefit from the thoughtful and meticulous work of master teachers. Readers of their workbook will find a wealth of new ideas to teach difficult material.