GROUP MAGIC

MONDAY MUSINGS: Everything I've learnt as a group facilitator...

This year I designed a nurse-led 8 week programme for my day hospice patients. It’s been my blood sweat and tears as of November last year – but it’s something I have become proud of.

This week we delivered the final session to our second cohort and we are now half way through our third group.

Whilst some might say my job is ‘easier’ now – my patients are more ‘well’, I don’t deal with the acute issues I did as a hospital palliative care CNS, and I no longer work weekends or the dreaded nights. There is less need to fight fires and no real ‘emergencies’ – the pace therefore could be described as ‘calmer’ or ‘slower’. But with that slower pace comes new avenues, new challenges, and new learning.

As a hospital CNS I did lots of teaching – to other Nurses, ward teams, Resident Doctors and Consultants. I therefore wasn’t daunted by creating presentations and standing up in front of people – sometimes far more senior than me – and teaching them something about my specialty. I received a good response and feedback, and this made space for my confidence to grow. I would love to get a clinical teaching qualification at some point and be able to do more teaching.

Despite my previous experience in teaching and presenting, group facilitation is a different kettle of fish. I thought that experience would serve me well, and of course it has, but I quickly came to realise teaching a group of ‘lay people’ is very different. Teaching for professionals is time limited – usually in a lunch break, or part of something that they have to do. They listen, they absorb, and some will ask questions, but not all. Then they leave and you mostly don’t see them again, and then you do it over again to a new set of professionals a few weeks later. Your slides are prepared, you know more than them about the subject you are delivering, so you know they will learn something. Often this teaching also selfishly hugely helped me, because it made my job easier, when the professionals that I worked alongside had the knowledge to deliver the right care to patients without my input, or my requests on a patients behalf.

When delivering to a group of patients, I still have my slides prepared, but I’ve learnt they are often adapted, amended, switched or changed. They all still learn something, but it’s not always what they want to hear. What they learn is always so deeply personal to them – not just another dimension to their career. Some won’t ask questions – instead ALL will ask questions, and they will have multiple different perspectives, and tolerances to the answers they may receive. I will see them again, and I will hope they continue to return.

I had a conversation with a social worker last weekend, and in that conversation, it dawned on me further that actually I may not have really been equipped for this role as a group facilitator. I have lots of experience in palliative care, patient care, particularly within this specialty, and my teaching/presenting experience. I was confident that was enough, and don’t get me wrong, I’m not out of my depth and have delivered this content with confidence and with good response, but I realised there is a lot more to it than standing in front of a group and asking them to listen. I had no training for this and it has so far been self taught. I have done it, and survived it and luckily nothing has gone wrong, but I realise now that I had a lot to learn.

The learning for me personally has been rich, and insightful, and actually wonderful. There have been challenging times, and moments where I have felt either lost, or that I have got it wrong. But there have also been incredible moments where I am entirely sure I have got it right - and no training could teach you those moments, interactions or reactions. No healthcare professional I’ve taught before could allow me to see the difference I can truly make, or the way I can make someone feel, or give them the ability to see something in themselves that they have lost somewhere along the way.

And my goodness, groups are not for everyone. As an introvert – group work and discussions are probably not for me at all. Sharing my woes with strangers fills me with dread. The prospect of having to find my voice in a group of potential extroverts feels anxiety inducing rather than helpful or insightful for me. However, what I have seen and learnt in the last 16 weeks has made me feel differently about that and how helpful group work can actually be. Other peoples experience may be the helping hand you need, but I also recognise it could be unhelpful and triggering at the same time.

Magic can be created in a group that works - and that’s a very special thing to have nurtured and have the opportunity to witness and be a part of.

So, here’s everything I have learnt and a newbie group facilitator for palliative care patients:

CONTENT:

You will never know your content truly works until you begin delivering it – You may think you have thought of and covered everything, but you will tweak, adapt, add and subtract from even your proudest work. Delivery requires confidence, passion, and true understanding of your subject. People will ask questions, and you will need to know the answer.

DYNAMIC:

You never know what kind of group you will get and how they will connect. You are mixing and blending potentially juxtaposing personalities, values, and experiences. Being mindful of that - having the ability to steer into or away from certain directions is key.

CONNECTION:

The people you least expect to form connections may just form a better connection than you could ever imagine. If your group wants to remain in contact after the group completes, you have nurtured a group who can go on to offer support and value to each other beyond completion.

BALANCE:

Balance becomes your biggest ally. Finding the right balance in your content – to offer listening, discussion and active participation. Also ensuring balance within the participation – there will always be those more dominant and those who are reluctant, ensuring everyone has a voice but also doesn’t feel pressured to speak is a balance that requires fine tuning.

INCLUSION:

Encouraging inclusive participation by ensuring all participants feel respected, valued, heard and comfortable. Creating a safe space and slowly building and nurturing trust within the group is key to ensuring everyone gets the best value from the content and discussions.

TIME:

Time will run away with you some days, and some days you will need ways to fill space when there is too much time – the content is the same but the way each group receives it and engages with it will be different. Leaving space for adaptation allows for gaps or overspill in time. Balancing meaningful discussion with completing the planned agenda can be challenging, especially when topics generate extensive debate.

SATISFACTION:

Participants will enjoy differing aspects of your content. Not everyone will enjoy everything, and managing expectations and encouraging active participation with reluctant participants can be hard. Participants may be resistant to new ideas, activities, or decisions, making it harder to achieve group goals. Reaching decisions that satisfy everyone can be difficult when participants have differing priorities or perspectives. Getting feedback from participants is key to ensure you are meeting your objectives and that you are continually learning and have opportunities to re-evaluate and further develop.

TRIGGERS:

My participants are vulnerable and at times lost. In creating ways to build their confidence, they first must sit with what has made their confidence diminish. There will be times when emotions will come to the surface. People cry, and if I’m honest, at times I want to cry with them. Building trust and a safe environment allows these releases which can be very powerful. Having capacity to deal with unexpected emotions is important to factor in – if someone needs to leave or be supported it’s important the show can go on for the rest of the group.

LEARN:

Whilst you are essentially the ‘teacher’ - what you learn and gain from each experience is invaluable. Whilst you may feel repetitive in your delivery of the same content to different groups – they will each offer their own perspective and way of accepting and engaging with your content. You will learn what works, what triggers, what resonates, and what is misunderstood or even avoided.

SELF CARE:

Group facilitation can be challenging and emotionally draining. The stories you hear, the distress you see, the things you learn, and the experiences you have alongside your participants are huge and impactful. Time to process, to reflect and debrief after groups is so important. Supporting yourself alongside your group is the only way to continue the legacy of what you have created and what you know has the potential to be so valuable to someone else.