Episode Summary
In this episode of Palliative Talks, host Kath Murray sits down with Nadine Valk—an experienced palliative care leader, coach, and mindfulness educator. Nadine reflects on her 30-years experience, emphasizing the importance of compassion, presence, and team cohesion in supporting those with life-limiting illness. Together, they discuss how reframing “difficult conversations” as “tender conversations” opens space for meaningful connection, the essential role of personal support workers, and the power of curiosity and active listening in transforming care.
Episode Guest
Nadine is a full-time coach based in Ottawa, specializing in working with health care teams to trasform care in a practical way. With over 30 years of experience in health, community and palliative care – including role as Director of Education for Hospice Palliative Care Ontario and Executive Director of the Champlain Hospice Palliative care Program – she brings extensive expertise to her practice.
Nadine hold a master’s degree in public administration with a focus on health policy. She is a certified Integral Professional Coach (TM) with additional training in team coaching, facilitation and implementation science.
Visit Nadine’s website here.
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Transcript
00:00:10 (Kath Murray): Nadine Valk, good to see you. Good to be with you.
00:00:14 (Nadine Valk): It’s so good to see you too, Kath.
00:00:17 (Kath): How are you doing today?
00:00:19 (Nadine): I’m doing well.
00:00:20 (Kath): Good
00:00:20 (Nadine): You?
00:00:21 (Kath): Yeah, I am good. Let me start with introducing you. Nadine has over 30 years of experience in health, community and palliative care, including director of education for Hospice Palliative Care Ontario, and executive director of the Champlain Hospice Palliative Care Program. And I think it was when you were working for HPCO that I first came to know you. Very excitedly, you transformed yourself, then into a professional coach, and you’re specializing in working with health care teams to transform care in a practical way. Very exciting. Nadine is also director of the University of Toronto’s Mindfulness Informed End of Life Care program, and holds a Master’s degree in public administration with a focus on health policy. Nadine, I know that you bring with you compassion and understanding, creating a supportive space for meaningful change in how we care for ourselves and for each other. Exciting to have you join us for this podcast series. Palliative Talks a palliative care podcast. My name is Kath Murray. I’m a hospice palliative care nurse, educator, author and co-founder of Life and Death Matters. Great to be together again and to get to talk today specifically about integrating a palliative approach to care. So we’re going to start with the million dollar question. How do you define- what is a palliative approach to care?
00:01:48 (Nadine): There are some key elements to palliative approach to care. So it is a focus on holistic care, that is very person centred, and prioritizes quality of life. And that’s done with a team, an interdisciplinary team, and the earlier you can introduce a palliative approach to care, the better. So those are the main elements that- that really person centred quality of life focused care.
00:02:23 (Kath): Lovely, lovely, lovely. I like to use my very simple definition which- which is right in line with yours, which is that integrating a palliative approach is integrating the principles and practices of hospice and palliative care for people with any life limiting serious illness early in the disease trajectory and across all care settings. And- and those principles and- those principles of palliative care that you’ve mentioned, person centred, the person and the family being the unit of care family, of course, defined by the individual. The quality of life is the priority and earlier. So, those are beautiful principles. I want you to think back over your years in palliative care. Do those principles make providing care easier or harder? And in which ways?
00:03:19 (Nadine): That’s a great question. I think people often fear that talking about palliative care makes it harder, but I think having a palliative approach makes it easier. Because, if you’re focusing on- on the living piece, it can take the fear out of it. There’s a huge difference between asking somebody, “what does a good day look like to you?” And, “how can we help you have more of those?” To, “Do you want or don’t want CPR?” and, “which level of care would you like should something happen in the future?” But if we have a palliative approach, and lean into questions to get at, “what matters most to you?” “What’s important to you?” “Do you have any worries or concerns that I could help address?” Then you can have a very different conversation that builds trust and relationship, makes all future conversations much easier.
00:04:32 (Nadine): We- we hesitate to talk about it because we’re focused so much on the dying part, that we forget the living part.
00:04:43 (Kath): You know, it’s funny how some- often we talk about those as being difficult conversations and we- we talk about it like everybody, nobody wants to talk about those- those conversations. And yet you hear someone like Mahoganie Hines, and I think you and I too, and many of us, we kind of like those difficult conversations and leaning into- leaning into those areas that are so, so sweet, so sacred, so tender.
00:05:11 (Nadine): You’re using some of my favourite words there, and that makes me think of -of Kathryn Mannix’s wonderful book called Listen, where she talks about transforming and- and reframing it from tough to tender conversations. Or instead of thinking about it is a difficult conversation, you know, compassionate conversation, and then all the sacred places that you can get to with that,
00:05:35 (Kath): I agree with you also that, in some ways, integrating a palliative approach is easier because it deals with reality. Doesn’t deal with some falsehood that life is just going to keep going and going and going and going.
00:05:50 (Nadine): That also makes me think of another wonderful resource from the Waiting Room Revolution. So that wonderful podcast in the book Hope for the Best, Plan for the Rest, which is geared towards, you know, it’s meant as a resource for people living with a life limiting illness. But there’s so much wisdom in there for caregivers, for health care providers, because it’s about exactly that. How do you walk those two roads? You can’t have hope unless it’s grounded in realistic information. So, how do you maintain hope, and recognize that hope changes and transforms along the journey, but grounded in really practical planning that’s going to support you in decision making so that you’re not having to do it in crisis.
00:06:40 (Kath): And if you do end up in a crisis, then when you’re through the crisis on the other side, then let’s do a review. Let’s talk about that. Let’s revisit what just happened. Your specialty now is in helping people make change. What other suggestions do you have to make it easier to integrate a palliative approach?
00:07:02 (Nadine): I think I don’t know if this is one of the ways that makes it easier to integrate a palliative approach, but I think one of the ways a palliative approach to care can make providing that care easier is because it’s an approach. It’s not another task. So you’re not adding anything to your to do list. You’re looking at what you’re already doing. And how can I make this just a little bit better? How can I foster more connection? What’s a question I can ask here? How can I get curious about how I can support this person? And then that means everybody can do it. So you can understand and see how everybody has a role to play in offering a palliative approach to care. And it can be so empowering, especially for for folks in roles like personal support worker, community support worker, whatever you call that marvelous group of people who often are the ones spending the most time with that resident, or with that family. They’re the ones that first notice changes. They’re the ones that hear the stories. They’re the ones that really know that individual. And so they’re the ones that can really transform care.
00:08:25 (Kath): And what are your- what are your tips? What are your recommendations for helping to grow the cohesiveness of a team so that the PSW’s are full members of the team?
00:08:38 (Nadine): I think education is always helpful, but education with a plan. So that you’re coming together with what you’ve learned and identifying opportunities for everybody to practice and recognizing everybody’s contribution and everybody understanding each other’s role in providing that. So working with a long term care home recently, looking at, “how can we do this better?” Supporting residents and families at end of life. And they’ve decided to have quick huddles with all team members who need to know what’s going on so they can all get on the same page, and then go and make their own plans that they need to within their discipline and scope of practice. But, it’s a coming together, hearing everybody’s voice about “what do you think would be most helpful?” So creating those opportunities for the team to- to share what they know, because everybody has a lot of a lot to offer.
00:09:44 (Kath): One of my favourite stories of a personal support worker being honoured in the team, was told, I think it was the Ontario Long-Term Care Association conference, and they were giving an award for a PSW. And the story that was told went went like this, that there was a woman who was a resident in the home and her husband died, and she had dementia, and staff were unsure how she would take this information and how she would be able to hold it. And so they asked the PSW, who knew her the best, if the PSW would break that news to her. And I am assuming that they did a good job of helping to prepare the PSW and discussing what might go well, what might not, what things to use if, you know, different approaches. And then the PSW went in and there was just a description I have in my mind, whether it was shared or not, of this PSW just in a very tender way, telling this wife that her spouse had died.And- and I- I love that. A couple things, one is that she had such a good relationship with this resident. Another one is that the team realized that she had a good relationship, and the team recognized the skills that this personal support worker had, and called on her to use those skills, and supervised her and supported her in the process. And to me, that’s just that’s marvellous. And- and how do we- how do we help personal support workers to be able to magnify those relationships, and help to magnify their skills?
00:11:33 (Nadine): Yeah, there’s- there’s so much to unpack there. And go back to, helping people realize that this is something that everybody can integrate. And, cultivating practices that help support you to be really, really present in the care that you’re providing. Being mindful. And my- my favourite definition of mindfulness is around paying attention on purpose without judgment. So again, it’s something that everybody can do regardless of role. But there’s such a powerful difference in the care that you can provide when you cross the threshold of a room, knowing that, yes, there are things that you have to get done. And how can I do this in a way that recognizes the relationship first? I think you know Ruth Richardson as well. Wonderful friend, palliative care nurse. And I remember having a conversation with her about something similar, and she was saying in nursing school that they’re, you know, they’re taught many things. One of them is, you know, you don’t leave somebody in a wet bed. You know, you- you address that right away. She said but, “Nadine, we leave these people in a wet bed of emotions all the time.” You see something and we’re like, “oh, I don’t know if I want to deal with that now. I’m just going to take care of this.” So I think going back to your question about what can PSW’s do to- to kind of amplify or enhance their role? Anybody, in fact, is that paying attention on purpose? And what can I do in this moment to make that just- make this- everything just a little bit better or to- to foster that connection, that relationship and then do the things that I have to do.
But just taking that moment.
00:14:00 (Kath): As nurses, we- we tend to love to fix things and so when I think of Ruth and the wet bed of emotions, I think the first thing, wouldn’t it be great if we could help dry up that bed of emotions? But that’s not our job. Sometimes, it’s to join them in that sea of emotion, and to be with them, and be present. And isn’t it wonderful to think, you know, you can call it integrating a palliative approach. You can call it active listening. You can call it being present. You know, so many different names. You can call it the best of dementia care. You can call it whatever you like, but it’s definitely- it’s the best of the best of care.
00:14:37 (Nadine): Yes
00:14:38 (Kath): and the ability to just go and be with someone.
00:14:41 (Nadine): Yes.
00:14:42 (Kath): Yeah.
00:14:44 (Nadine): I- there’s a- a framework that we use in asset based community development. We talk about like the fixing, which is a very human thing to want to fix and problem solve, especially if it’s something uncomfortable. So we spend a lot of time doing things to people, or for people. And we want to try and shift into doing things with people, or creating the circumstances for them to do it by themselves.
00:15:13 (Kath): So what does that make you think of?
00:15:16 (Nadine): It makes me think of exactly what you were saying about the importance of being with, to acknowledge how somebody is feeling- just even that active in and of itself, for ourselves, but also for other people, like acknowledging emotions.
00:15:36 (Kath): Yeah.
00:15:38 (Nadine): That sounds really hard. Do you want to talk about it? Even if it’s just- it doesn’t have to be for a long time. But it just- again it builds trust, and connection, and relationship.
00:15:50 (Kath): I think of those things that can take lots of time, but I also think of just that ability to respond. Be it, to touch, to touch a shoulder, to touch a face, to touch a hand, to acknowledge, to even to go down in, in size, down to sit next to or squat next to someone and say, I hear you. And that is huge.
00:16:18 (Nadine): Yeah.
00:16:19 (Kath): But that is a big question. That is a big emotion. And, we’re here for you. I really like the idea that every member of the team needs to respond. It doesn’t mean that we need to have the answers. We just need to respond, you know? So, one of the small things that I think can have a big impact is also encouraging questions.
00:16:41 (Nadine): Yes.
00:16:42 (Kath): You know, the research shows that people assume that if something big is happening ,that the health care team will tell them.
00:16:50 (Nadine) Yeah, yeah, absolutely. (Kath): And tell them in a way that they’ll hear it.
00:16:53 (Nadine): Yeah. And to trust your gut on that when you notice, like, oh, like, I just saw a facial expression that that communicated worry. They didn’t verbalize the worry, but there’s something there. Maybe I could ask a question. “You know, you seem concerned about something. Is there anything you want to talk about?”
00:17:14 (Kath): Yeah. Pretty special. Pretty special. You mentioned earlier about mindfulness. Can you talk about ways that the individual team members, staff as a larger community and the organization with their policies – Can you share ideas on how, the organization can in particular practice mindfulness?
00:17:38 (Nadine): So if you go back to thinking about mindfulness as paying attention on purpose without judgment, and that paying attention, starting first with yourself. So, that you’re- you’re checking, you know, “what is the energy I’m bringing with me into the room?” And acknowledge that, “okay, I’ve been feeling a little frazzled, but I’m going to take a- take a moment, take a pause, breathe.” “What’s my intention as I go into the room?” “What’s the attitude I want to bring with me?” “How can I help make this just a little bit better?” So that pause so you can be fully present not only helps you take care of yourself, but it helps you provide the kind of care that you want. And then for teams and organizations, well, and for individuals to look at opportunities to just sprinkle it in everywhere you can throughout your day. It doesn’t have to be a long, you know, you don’t have to find a cushion somewhere and sit down and meditate for half an hour. It is cultivating like a threshold, practice pausing and checking in. It is taking a moment as you wash your hands after a bathroom break, to just feel the water on your hands, and smell the soap, and take a few deep breaths. And every time you do that, you’re sending the message to yourself that, “I’m taking care of myself.” “I’m pausing and slowing down.” “Then what do I need to do next?” But it’s creating those little pockets of rest so that you can show up in the way that you want to. And so, you can create those pockets in team huddles and at team meetings, and you can model that, and create- create the space for that so that you’re all checking in with each other as well. And acknowledging, you know, “oh, today is a really hard day. I might need some extra support.”
00:19:56 (Kath): I love that, “pockets of rest.” And I- I think also, as you talk of pause, how many people have identified just pausing in between people. Whether that’s a deep breath, whether that’s, like you say, washing hands. Nadine. Thank you. We are going to be doing another podcast with you also where we are going to talk about coaching and integrating a palliative approach and how do we bring some of those ideas into practice and how we change practice. So we’re going to leave some of those for- for later. I’m going to take with me that idea of a “pocket of rest.” And- and Ruth’s piece on “don’t leave somebody in a wet bed, but don’t leave them also in a wet bed of emotions.” I could just hear Ruth saying that. So those are- those are a couple of the things that I think I’ll take with me. What- what will you take with you from today? What’s one practical thing that you’ve thought about today?
00:21:06 (Nadine): I think there’s something for me around recognizing that you are the best medicine you can offer. It’s all about the relationship, and that connection. And so in that you have a lot of ability to transform the care. And isn’t that incredible? That you are the best gift you can bring? And then, on the other hand, how do we get out of the way when we need to be invisible? Which is such a huge skill as well. And one that often PSW’s are asked to- to do that. Be present, and yet somehow become a fly on the wall. Or even better, just melt into the wall. Whether that’s when we’re helping to toilet someone, or whether that’s in witnessing those sacred moments with family at the bedside. And how do we provide whatever support it is that we are needed for there in that moment? And yet, how do we also just kind of be as small as possible so that they have their space?
00:22:21 (Nadine): Yeah, yeah. So- and then it all comes right back to the- the mindfulness piece and paying attention on what is needed in this moment? And how do I be present in this space in a way that really honours someone’s dignity?
00:22:37 (Kath): Lovely. Nadine, thank you. And a reminder to our listeners that this, and the other podcasts, are part of the podcast series, Palliative Talks, a palliative care podcast. And part of the Hospice Palliative Care Ontario Education Programming. Please go to HPCO.ca And have a look at the resources, not only the podcast, but a full range of other education opportunities. Nadine, thank you and I look forward to our next visit. When we get to talk about specifically ways to integrate, and- and how to make change happen.
00:23:18 (Nadine): Thank you, Kath.
00:23:19 (Kath): Thanks, Nadine.
