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The Language We Live By
- 1. The Language We Live By. (Gergen 2009) Dr Lesley Choucri University of Salford
- 2. • ‘As we communicate with each other, we construct the world in which we live’ • ‘The realities we live in are outcomes of the conversations in which we are engaged’ • Gergen, K.J. (2009) An Invitation to Social Construction, Sage, London The Language We Live By
- 4. The Language We Live By • Picture • A Tapestry of Birth By Judy Chicago
- 5. The Language We Live By Action
- 6. • ‘You do get girls that just think they [babies] constantly suck’. • ‘I’ve seen girls hit postnatal depression with breast feeding’ • ‘We get a lot of girls calling and saying the baby’s been on the breast for 6hours’ • Furber, C. M. Thomson, A. M. (2010) The power of language: a secondary analysis of a qualitative study exploring English midwives’ support of mother’s baby-feeding practice. Midwifery 26, 232–240 •‘Girl’ • Dominating? • Disempowering? • Subservient? The Language We Live By Words
- 7. • Metaphor: • Kitzinger (1962 ): ‘The baby factory where women are treated as though they were so many fish on a slab’ • Rich (1977) ‘No more devastating image could have been invented for the bondage of women – sheeted, supine, drugged, her legs in stirrups • Atwood (1979): ‘they take the baby out with a fork like a pickle out of a pickle jar, they stick needles in you, you might as well be a dead pig’ The Language We Live By
- 8. • Metaphor • Scamell (2011)The swan effect in midwifery talk and practice: • ‘Us midwives: we are like swans swimming across a lake. On the top we look all serene and tranquil but under the water our little feet are flapping about like mad’. The Language We Live By
- 9. • Professor Ged Byrne Director of Education and Quality Health Education North West • http://nw.hee.nhs.uk/2014/04/28/geds-blog-on- the-six-small-cs/ The Language We Live By: ‘Intelligent Kindness’
- 10. Developing the Culture of Compassionate Care – Creating a Vision for Nurses, Midwives and Care-Givers 6Cs
- 11. Read this book!
- 12. The Language We Live By: Intelligent Kindness Have we lost the language that depicts the concept of kindness? Think in metaphor of kindness being the ‘glue’ of co-operation so that we can connect genuinely with the living humanity of another person (Ballatt & Campling 2010)
- 13. ‘An obligation to one’s kin born of our understanding of our connectedness and the natural expression of our attitudes and feelings arising from this connectedness’ (Ballatt and Campling 2010 p 10) • Much more than ‘compassion’ which is ‘suffering with’ or ‘pity’ The Language We Live By: ‘Intelligent Kindness’
- 14. Attentiveness Therapeutic Alliance Better outcomes Kinship Kindness The Language We Live By: ‘Intelligent Kindness’ A virtuous circle of positive language & action (Ballatt and Campling 2010 p 10) Attunement Trust
- 15. • To face the future bravely means using inner strength and energy to provide quality relationships. Billie Hunter and colleagues (2008) offer ideas about ‘the hidden threads in the tapestry of maternity care’. The Language We Live By Be Brave in Your Relationships
- 16. • A group of midwives in the North West were brave as they worked together with me to instigate practice change. This work informed my PhD and I present now an extract of their work which underpins the importance of the way we manage language and communication with an appreciative kindness. The Language We Live By: ‘Intelligent Kindness’(Ballatt and Campling 2010 p 10)
- 17. The Language We Live By • The Education and Practice Development Group created a safe, trusting atmosphere in which they took measured risks and even made mistakes and were able to see what happened.
- 18. • Work collaboratively with the Education and Practice Development Group (EPDG) in order to explore the developments occurring in practice through their work. • Facilitate the action of the EPDG through promoting a culture of inquiry in the practice setting. • Facilitate the midwives within a group meeting in order to help them achieve their projects • Use an action research approach to plan programmes of action in support of the Education and Practice Development Group The Language We Live By: An Appreciative Approach- Research Aims
- 19. • The ideas within Appreciative Inquiry are based upon the Social Constructionist idea that says our actions are shaped by past experience and that ‘what we take to be the world importantly depends upon how we approach it, and how we approach it depends on the social relationships of which we are a part’ (Gergen 2009:2). The Language We Live By: An Appreciative Approach
- 20. • The use of the affirmative language of Appreciative Inquiry called the ‘Positive Principle’ by Cooperrider and Whitney (2005:53) has a social bonding effect to better enable a sense of inspiration through camaraderie to create something new. • Cooperrider, D.L., Whitney, D. (2005) Appreciative Inquiry: A Positive Revolution in Change. Berrett-Koehler Publishers. CA. The Language We Live By Focus on achievement and what makes the group flourish
- 21. • How to ‘unleash a positive revolution of conversation…. to provide a community of support for innovative action. It all begins with the unconditional positive question’(Cooperrider & Whitney 1999) • Value the best of what is by focusing on the life giving aspects of the organisation to reduce the deficit vocabulary of negativity (Ludema et al 2006) The Language We Live By: An Appreciative Approach
- 22. What actions do you need to take What have you achieved so far in your role DISCOVERY Tell me what it is to be a practice development midwife The Language We Live By: An Appreciative Approach
- 23. • I have had a list of things to do since October. What have I done? I’ve explored what resources were in place I’ve made an action plan’ • ‘The situation is delicate as midwives are supposed to know and it’s not happening. Midwives will get upset, it needs sensitive handling-need to tell me what your training needs are because you can’t help women if you don’t have the skills yourself’ . The Language We Live By: Sam’s case study-The Baby Friendly Initiative
- 24. The proposal The Group Question & Reflection Commit to Act Commit to Learn Facilitate The Language We Live By: Sam’s case study using action learning approach
- 25. The proposal: A cohesive approach is required to infant feeding to work towards the BFI The Group: Critical friends who read, gave feedback upon the teaching package and care plans prior to delivery The question: What is required to provide staff with the correct standard of education to improve support for breast feeding women? Commit to act: Design teaching package Deliver teaching on mandatory days Design structured care plans Provide support in clinical practice Commit to learn: Read, critique & use BFI information. Undertake mentor module Facilitator: Provide 1-1 support, reflection, feedback, action plans Access to CPD portfolio Sam’s case study-The Baby Friendly Initiative
- 26. Sam’s case study: The Baby Friendly Initiative ‘Spiralling through turbulence’ Dancing with stones: critical creativity as methodology for human flourishing. Educational Action Research 18 (Titchen and McCormack 2010:539) -she felt like she was ‘torturing herself’ because her deep passion to improve practice was not felt by some midwives, She was seeking a ‘shared culture of competence’ (Heron and Reason 2008) and found it within the EPDG which had an attitude of inquiry which valued the body of work she was creating. This gave sustenance when times were hard and emotions were high, moreover the group offered critique and a forward plan of how to influence the feeding practices.
- 27. • Testimony from the group interview using appreciative interview style The Language We Live By Can Empower Us ‘Working to achieve goals & feeling of comradeship, so you don’t take things personally, you know its rigorous’ ‘It shows a journey of a piece of work-contacts, templates, who to send to. Can run faster as others have done it & tested the ground’ ‘You’re the expert & it will run & you provide the evidence for it- offers a form of autonomy that others may not achieve’
- 28. The Language We Live By: What was achieved? • Midwives with the knowledge and expertise to lead the way in developing practice • Full implementation of the UNICEF Baby Friendly Initiative • A collaborative diabetes service • A collaborative bereavement service • Guidelines to inform practice in smoking cessation and midwife prescribing of nicotine replacement therapies • Design and implementation of audit tools for post natal care • Teenagers receiving one to one maternity care from collaborative service. • Dissemination at local/national conferences
- 29. The Language We Live By: creating a collective positive principle EPDG Midwives became a collective Accomplished shared work Versatility helped them to adapt to changed environment Generated network of relationships Trusted each other to give & receive support Engaged collaboratively to achieve their goals of improving practice Were critical friends during design of e.g. guidelines or leaflets Backed each other up Were safe to take the risk of showing when they didn’t know without others undermining them: Intelligent Kindness
- 30. The Language We Live By Language matters: It binds us together for the good or ill of others in a shared kinship, our community of practice: Listen to her Affirm her Appreciate her Be Kind to her
- 31. • Leading the Way with Courage & Passion: A Success Story • ‘Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change we seek’ (Obama 2008) The Language We Live By: What was achieved?
- 32. • Leading the Way with Courage & Passion: A Success Story: ‘Yes We Can’ Obama 2008 The Language We Live By: What was achieved?
- 33. Thank you for listening l.p.choucri@salford.ac.uk
Editor's Notes
- Thankyou for inviting me to todays conference. For 41 years I have been a health care professional, 35 spent as a practising midwife. I feel proud and privileged to work within a midwifery community as a teacher, researcher, supervisor of midwives and manager of 2 teams-midwife and counselling lecturers. My subject area is of course midwifery, this continues to be my passion. The principles within my presentation are however transferable and I hope the ideas will be useful as tools to offer you to facilitate your own passion by enabling yourself and your teams to function well at the forefront of health care. I will explore language and its meanings and its application to my own Phd work where midwives were empowered to create positive change. This research offers a case study to promote woman centred values through a positive approach to change. This word cloud offers the positive language provided by midwives in one of our local maternity units of how they saw their role and it is a great starting point.
- Our experiences mirror the world, we have a mental picture of the world that we communicate to others through language. Language then gives you a picture of the world. Language depicts our world via the communities that we live in and we understand our world through our talk and relationships with others. Midwifery communities, through language, create their own culture and knowledge base for practice. As we relate together we grow rules about what is acceptable or not within that community of practice. So language is not just a word, it is a multilayered concept. Every day we use a combination of words, pictures actions and metaphor to define our midwifery world and how we go about living it. I am certain that you will argue that there are various types of midwifery communities or worlds and that all of them hold meaning for you as practitioners aiming to provide a high standard of care for women. I will give examples of each part of the model
- How does this image of birth affect you? What does this image make you feel? Do we have shared understandings of this tapestry?
- Midwifery Action in a picture. Does this depict your midwifery community? Language is the central plank through which we negotiate the reality of our world. Is the midwifery practice of your world anything like this? Should it be?
- What do these direct quotes tell us about the community of midwifery on display? We have the term ‘Girl’ as opposed to ‘woman’ We have disempowering comments about breast feeding
- A word is a metaphor when we take it out of one context of usage and place it within another. The body as a machine or a factory The uterus needs fixing There is failure to progress She becomes a piece of meat or a fish on a slab Powerlessness, the THEY attaches the blame to the institution which now has power over her We know that the organisation and personnel within it hold authority over matters of reality and right. These are old quotes, do they still hold resonance 40 and 50 years later? Hunter, L. (2006) Women give birth and pizzas are delivered: language and Western childbirth Paradigms, Journal of Midwifery and Women’s Health, 51, 119–24. Berg, M. (2005) A midwifery model of care for childbearing women at high risk: genuine caring in caring for the genuine, Journal of Perinatal Education, 14, 1, 9–21.
- The swan effect in midwifery talk and practice: a tension between normality and the language of risk. Ethnography Mandie Scamell Sociology of Health & Illness Vol. 33 No. 7 2011 ISSN 0141–9889, pp. 987–1001 ‘Routine surveillance in midwifery care in labour practice implicitly introduces uncertainty even in those situations where no deviation from the normal exists. Routine midwifery care during labour and birth is not so much about facilitating the normal as about hunting out the abnormal. This means that while midwives may purport to work within the paradigm of normality (Gould 2000), they have few resources or practical skills to police the boundaries of normality. The intrusion of the medical gaze into the lives of the well blurs the boundaries between the normal and the pathological’. The midwives’ understandings of birth appeared to be so confined by a preoccupation with surveillance that, in the interview context, they often found it difficult to imagine that normal birth existed without explicit reference to monitoring practices designed to hunt for the abnormal. In this research midwives struggled to articulate normal birth
- Ged Byrne asks us to consider 6 little cs and really consider how we create supportive relationships in our individual and team interactions
- The language I have depicted appears to have negative and uncaring components, an evidence base that appears to be undermining of what midwives do, an unkind principle. Are we too tired, over worked, hungry, dissatisfied, to really care about one another? Like an industry’ ‘Processes’ ‘organising’ ‘regulating’ ‘industrialising’ ‘Human beings have an enormous capacity for kindness, but also for destructiveness and violence’ Do midwives need to develop the 6 cs? About values and behaviours When they are performing at their best shared purpose promotes a culture of care, centred on the person Check out Roy Lilly's blog for his take on the Compassion agenda for the NHS, HE ASKS US TO CONSIDER a different approach of Intelligent Kindness
- Intelligent kindness emerges from a sense of common humanity, promotes sharing and effort on anothers behalf. When people are kind they want to do well for others, However when people are kind it brings risk of getting it wrong. So kindness is best when directed by intelligence Eg a midwife shows intelligent kindness when she is fully competent and skilled in her art and she understands how the relationship between herself and the woman matters to the best outcome. (Hodnett and colleagues)
- Kindness- warmth, and compassion breeds attentiveness Attentive kindness brings attunement of staff action to the patient experience Attuned actions bring reduced anxiety and trusting relationship to build an effective therapeutic relationship Such an alliance promotes better communication & cooperation. This experience brings better outcomes and satisfaction
- This paper reminds us that the evidence about the quality of relationship with caregivers is fundamental to a woman’s experience of childbirth. Indeed Hodnett in 2002 noted from 137 studies about women’s childbirth experiences that 2 key factors outweigh all other variables and they are the amount of support they received and the quality of the relationship with the midwife or care giver. Fears around childbirth are perpetuated in women due to negative caring encounters whilst fears around midwifery work are perpetuated through negative interactions between those who are providing care. Many maternity services are dominated by a machine like model which obstructs the formation of relationships in favour of getting through the work and completing the task on time see Choucri, L. (2012) Midwives and the time: a theoretical discourse and analysis. , Evidence Based Midwifery , 10(1), pp.1-15.
- We introduced an appreciative approach to change USING ACTION RESEARCH AND ACTION LEARNING This image depicts a team pulling together to achieve a goal in turbulent environment. As suitable metaphor to show you how a group of midwives created change!
- The EPDG are midwives with lead roles who have various projects within their roles Jane Mandatory in service training In post (interviewed) Anne Smoking Cessation Lead In post (interviewed) Diane Post natal Lead In post (interviewed) Sam Breast feeding Lead In post (interviewed) Heidi Diabetes Lead In post (interviewed) Alice Bereavement Lead Left to health visiting (interviewed) Lila Post natal Lead Left to health visiting (interviewed) Shelley Breast feeding Lead Left to health visiting (interviewed) Lisa Drug Liaison In post (not interviewed, joined after interviews took place) Angela Teenage pregnancy Lead In post (not interviewed, joined after interviews took place) Celia Antenatal Lead In post (not interviewed, joined after interviews took place) Leona Bereavement Lead In post (not interviewed, joined after interviews took place) Mavies National Vocational Qualifications Lead Post not now in action. (Interviewed, went on maternity leave)
- Discovery: Finding out what gives life to the organisation: Appreciating Dream: Imagine an ideal future: Envision results Design: Think of ways to make the ideal a reality: Co-construct Destiny: Implement the actions to make every effort for the ideal: Sustain
- Thus as we communicate with each other in a myriad of ways, and for the purpose of this study, through a group discussion, then a community of knowledge is grown.
- I conducted interviews with EPDG Positive topic chosen, positive strengthening questions that enabled her to consider what strengths she had, what was possible and to consider how to do it.
- Commentary Sam was acutely aware of the need to educate midwives so that they would understand the benefits of breast feeding, the hazards related to not breast feeding and the problems associated with breast feeding. She had a small package of information from Shelley the previous post holder. In her identification phase she saw that compliance with Baby Friendly Initiative (UNICEF) Step 2 (training) would improve compliance with all other steps and that providing clinical support and structured care pathways would be significant changes. She planned and acted through providing ward based clinical support and designed a training programme for all health care professionals which formed part of the mandatory in service study days. Alongside this she created breastfeeding support documentation, designed all the pathways from scratch and used the EPDG as critical friends before piloting their use. She negotiated with the Head of Midwifery who secured funding to send midwives on the Baby Friendly Breast Feeding module. Sam conducted audits throughout to assess compliance with her teaching and the 10 Steps. Women’s views were evaluated as was the staff response to training. This analysis phase ran with the education and training throughout the life of the project.
- 1 A proposal – where complex issues impact upon different parts of the organisation and which are not amenable to expert resolution, are selected and worked on. 2 The group - where the participants meet on equal terms to discuss the problems and progress. The group comprises of 6-8 people who care about the problems, know something about them and have authority to implement solutions. 3 Questions and a reflective process which when using Revans’ (1998) formula is Learning = Programmed Learning + Questions. Learning has occurred when Programmed Learning (current knowledge- in- use plus what is already known plus books, journals and other sources) has been added to questions for seeking further insights. 4 Commitment to action – action learning is based on the premise that learning does not occur until action is taken through implementation of ideas and solutions to the problem. 5 Commitment to learning – this means going beyond problem solving by enhancing knowledge with the capacity to undertake change. 6 The facilitator – Group benefit from the facilitator who adopts roles to suit the group needs for coordination, communication, coaching, observing behaviour and change strategies. The facilitation is seen as crucial in the early stages of action learning when the group is setting working norms.
- Progress was slow at first with staff non compliance with many elements of the project being of great concern. Sam used all her facilitation and change management skills throughout the years of the project. She worked through a series of goals with the EPDG, both to give support in the dark days of poor compliance and to celebrate and achieve success. Sam was acutely aware of the sensitivities around a lack of practice knowing regarding breast feeding in the field and the EPDG discussed this many times as she carried out teaching sessions and designed helpful tools to improve the education and skills of the midwives. At one point she felt like she was ‘torturing herself’ because her deep passion to improve practice was not felt by some midwives, (this was Shelley’s experience also). She was seeking a ‘shared culture of competence’ (Heron and Reason 2008) and found it within the EPDG which had an attitude of inquiry which valued the body of work she was creating. This gave sustenance when times were hard and emotions were high, moreover they offered critique and a forward plan of how to influence the feeding practices.
- Titchen and McCormack (2010:539) offer real insights into the nature of the interactions between Sam and the group and me as facilitator within their Human Flourishing model within the metaphor of ‘spiralling through turbulence’. We learned to enable all through turbulent times, facilitating some kind of opportunity to grow rather than accepting blockages. The group grew to realise that they had examples of success and they passed these on at every opportunity to avoid repeating old patterns of behaviour that didn’t work. Titchen, A., and McCormack, B. (2010) Dancing with stones: critical creativity as methodology for human flourishing. Educational Action Research 18 4 531-554.
- Empowered midwives who participated in redesigning their midwifery community through appreciative inquiry and more importantly taking a courageous approach to their work
- The EPDG team learning took place within the group inside an action learning approach which helped the group adapt to change and development, they learned their way out of things by using innovative thinking and creating tools for the job (Consider Sam who designed from scratch her learning resources, care plans, audit tool and Gannt charts). Learning how to do something when there are few existing resources to pull on has been named as an ‘adaptive challenge’ where the team co-constructs their own answer and is akin to Revans’ ‘comrades in adversity’ in action learning. In order for this to take place there has to be a consensus within the team that each member is safe to take the risk of showing ignorance or making a contribution so that there is no undermining of individuals