by Terry Chase, MA, ND, RN
Patient & Family Education Coordinator
Craig Hosptial
I work in a healthcare setting where rehabilitating the patient in the areas of physical function, mental focus and attitudinal shifts are all part of the process of returning to life after a catastrophic spinal cord injury. I see Dialogue Education (DE) as a well-formed process to support the shifting of power back to the patient and family who find themselves in a situation where power and self-determination can be altered by circumstance. I see Dialogue Education (DE) as a well-formed process to support the shifting of power back to the patient and family... As a person enters the healthcare system, power is subverted from the patient by the stripping away of personal clothing, pre-determined food choices and treatments aimed at healing yet oftentimes done in the HC provider’s time frame. As Arthur Frank relates in his book, “At The Will of The Body” (1991) about the loss of personal power while dealing with the healthcare system: life turns to beige. It is difficult to accept the realities of what physicians can do for you without subordinating yourself to their power. The power is real, but it need not be total. You can find the places for yourself in the cracks. To me DE is one of the ways to expose the cracks and invite the power of the person to come forward while going through the rigors of the rehabilitation process. The use of DE in 1:1 teaching, group experiences and the teachable moment offer an opportunity for dialogue in the moment. This dialogue provides the opportunity for the patient to have a voice and to hear their own power and experience their contribution to the situation just by being present and acknowledged as a human being.
Spinal cord injury can leave a person with little or no use of limbs, an inability or reduced ability to breathe without mechanical support and altered elimination systems requiring attendant care for even life’s most basic and private functions. In essence these patients are learning to deal with a body that no longer works like before injury. The use of one’s body in the world is altered on levels never imagined or considered. A person’s sense of self can be rocked to very core and shake even the highest levels of self-confidence. Through the process of rehabilitation and the opportunity to learn new ways of moving about in the world through one’s own power or with specialized equipment, the person with this injury can make great gains and find their way in the world again.
Specifically I use the principles of DE in my group classes for patients who have experienced a spinal cord injury. The most valuable tools of DE I have leanred and utilize on a daily basis are the Four A's: Anchor, Add, Apply, and Away. The most valuable tools of DE I have learned and utilize on a daily basis are the Four A’s: Anchor, Add, Apply and Away.At the beginning of each class “Anchor” by asking about what they know, what have they thought about so far about the topic? This acknowledges their presence, their ability to learn though daily experience and to anchor that they know something already. “Add” some information by chunking new information into small pieces and avoiding bowling them over with too many facts. I use many visual aids and props, to illuminate concepts that are difficult to grasp only through words. “Apply” is through what is happening now for them. How can they put this information to work in the moment or make a plan for use in the very near future, like at lunchtime or during evening personal care routines? The patients leave the class with a sense of “Away” that they can use this information or practices in their directing care or performing personal care routines that are scheduled everyday.
I see the value and benefits of Dialogue Education to shift the balance of power back to the patients as an important step in their progress through rehabilitation. The goal of rehab is get patient back to life, to work, to family, and to full functioning as a contributing member of society. Through day-to-day attention of opening a space for dialogue and acknowledging the patient as a person this goal will be achieved.
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