Nurses’ Professional Care and Power to Affect Change

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Introduction

Holistic care requires knowing oneself and the patient as well as a personal dedication to human service. It entails being caring and loving to bridge the gap between the caregiver and the recipient. For nurses, self-reflection on individual beliefs and cultural influences, as well as those of the patient, is important for optimal care delivery. In this paper, I reflect on my professional experiences and personal beliefs that influence my work as a nurse.

Models of Health and Healing

Existing paradigms in holistic health and healing fall into three historical periods, each defined with a specific model. In this paper, two frameworks – Era I and Era III – and their view of the human body are distinguished. Era I (1860-1950) encompasses the biomedical model that advances the reductionist view of the body (Santos & Lima-Basto, 2014). This mechanistic perspective considers bodily dysfunctions as an adverse outcome of pathogens or chemical imbalance; hence, it emphasizes on pharmacotherapy and surgery. The fundamental premise is that health and wellness are physical aspects. In contrast, Era III (the 1970s) is grounded in a multi-paradigmatic – mind, body, and spirit – model, which integrates conventional medicine with non-pharmacological therapies to improve patient outcomes (Koerner, 2011).

Thus, unlike in Era I where the body is seen as an objective entity, in Era III it is conceptualized as interactive-integrated component composed of the body, mind, and spirit. Alternative healing methods such as Ayurvedic practices and Traditional Chinese Medicine (TCM) resemble the Era III model. They conceptualize the body as a balanced five-element entity and believe that illness arises due to an imbalance between these components (Weil, 2004). Thus, Era III includes holistic, evidence-based medicine, which is a shift from the mechanistic approach used in Era I.

Models and Professional Presence

The foundations of my professional presence differ significantly from Era I notions about health-disease phenomena. My belief is that the body is a multi-dimensional entity, and as such, diseases require a multi-pronged approach. It comprises the physical part, mind, and spirit. These three elements operate in an integrated way and are interdependent. I also believe that the mind is not a physical entity like the brain. As such, it is not localized in the body but exhibits a ubiquitous existence as consciousness. On the other hand, the spirit is the entity animating the body and mind.

These ideas represent my comprehension of health and healing and they are markedly different from the fundamental assumptions of the Era I model. The first notable dissimilarity lies in how the mind is perceived. Era I considers the mind as a product of brain mechanisms that resides within the body (Santos & Lima-Basto, 2014). In contrast, I regard it as discrete entity or consciousness that is not physically confined. The mind and body are functionally interdependent. The second difference is that while Era I attributes health to the healing of bodily dysfunctions, I consider wholeness to be a result of the body-mind-spirit alignment. Therefore, patient care should incorporate non-pharmacologic, evidence-based therapies a precondition for wellness. Spiritual practices such as prayer and meditation as well as support from family should be incorporated into treatment to help reduce anxiety and improve physical and mental health outcomes (Carvalho et al., 2014).

Influence on Nursing Practice

In nursing practice, professional presence and mindfulness increase a nurse’s self-awareness of how his/her experiences and preconceptions may impact patient care delivery (Mendes, 2015). This approach helps address a conflict of beliefs and values in the course of duty. I have learned to use mindfulness practices – personal reflection and conversation – to understand my views and feelings and align them with those of the patient. The strategies also help me deal with work-related stress. My professional presence resonates with the Era III model. I hold the view that healing is not limited to interventions targeting physical dysfunctions, but it addresses other aspects of human nature, which include mental, spiritual, cultural, and social dimensions.

In my routine practice, I encounter with minor and complex cases. In such instances, I not only consider a patient’s physical condition but also his/her emotional, cultural, and spiritual factors that aggravate the situation. If healing were limited to physical wellness, then drugs and surgical procedures would be adequate. However, clinical empathy and compassion are required in patient-nurse encounters to provide care based on patient needs, feelings, and preferences (Reid & Koppel, 2015). In addition to preliminary physical assessments, I take note of the patient’s concerns to understand extraneous stressors related to the illness.

I once took care of a young man who presented with chest pains and had a history of meth use. Through our conversations, I was able to learn that he had relapsed to drug use due to marital problems. By applying mindfulness practice, I discovered that depression was the primary cause of his condition. Subsequently, I developed a multidisciplinary intervention that included cognitive therapy to help him cope with stress that is linked to heart problems, including hypertension and ischemia. Therefore, listening to the patient can help see the bigger picture and address emotional and spiritual issues underlying the illness. In my practice, I have also avoided medical errors by being mindful in the course of my professional work.

Personality Assessment Submission

The Keirsey Temperament Personality Test (KTPT) is a self-evaluation tool meant to assist takers to know their temperament. The four primary personality types include artisan, guardian, idealist, or rational (Rodriguez, Bartoloni, & Hendricson, 2017). The result from this test reveals that my personality is the artisan type. Rodriguez et al. (2017) artisans make up a significant proportion of the population (30-35%). They tend to exhibit optimism, boldness, and spontaneity. They are also creative leaders and excellent problem solvers and prefer to work with real-life events. Their major strength lies in their tactical skills and improvising ability. They are also agile and good at troubleshooting and using tools.

Test Result Analysis

As stated above, the KTPT results reveal my personality type is an artisan. This temperament comprises four general groups: promoters, crafters, performers, and composers (Keirsey, 2018). At a professional level, artisan type is largely in alignment with my personal characteristics. I tend to be tactical in approaching situations; I often develop flexible goals and priorities for every activity. As a promoter, I am always prepared for new clinical challenges, a trait that is consistent with the artisans’ characteristic of being bold and daring (Keirsey, 2018). I find routine work less exciting if there are strict requirements to stick to established procedures. I consider myself a troubleshooting leader who is receptive to change and new ideas meant to improve the outcomes of a process. I love variety and freedom to make clinical decisions and dislike working in highly structured, straightjacket environments.

Artisans are also said to be friendly and pleasant to those around them. According to Keirsey (2018), performers have a good sense of humor and are skilled entertainers. As a teenager, I enjoyed the thrill of competition in sports and class. As a performer, I am good at comforting anxious persons or patients dealing with discomfort or pain, which resonates well with my duties as a bedside nurse. Although most people may consider this work stressful, I find it exciting because each patient encounter is different.

At a personal level, the KTPT results are correct, as I tend to be optimistic and realistic. As an artisan, I have an impulsive ability to distinguish even the subtlest medical errors and avoid them before they occur. According to Keirsey (2018), the exceptional quality to recognize artistic differences in tone, flavor, etc., is characteristic of composers. I am also handy with equipment and machines. From my childhood to my professional role, I have always been a skillful user of machines and gadgets. Although the artisan type is a fair representation of my personal traits, I disagree with some aspects of the KTPT test. I am not a thrill-seeking individual nor do I crave for pleasure and stimulation; instead, I prefer doing things in a planned and tactical manner.

Preferences Alignment

The profile from the KTPT test aligns well with my relationships, pursuits, and career choices. My family often says I tend to be a pragmatic person who is driven by results, especially in times of crisis. My peers often reach out to me for help when faced with trouble or when they need to be energized to act. Being an outgoing person, I maintain healthy social relationships. Usually, I spend quality time with friends and family on lunch dates on weekends. Being a nurse, I am able to juggle between work and social life quite well. I believe in doing work and having fun at the same time.

The artisan profile aligns well with my favorite activities, which include excursions, nature walks, swimming, and bungee jumps, among others. I love exciting and thrilling outdoor adventures. In my career, I get along well with my colleagues because I like getting things done. When given targets, I am able to improvise and maneuver through challenges to achieve them. As a nurse, I dislike red tape procedures and I believe the end justifies the means. Nevertheless, I do follow practice guidelines and routines but I tend to be frustrated by rigid systems that discourage the use of evidence-based nursing interventions. I am receptive to change and new ways of doing things.

Potential Challenges or Barriers

Although I relate well with my colleagues, I can foresee some potential challenges when working with a person with a different personality type. Specifically, a likely barrier to successful work relationships with guardians is following procedures and principles. These people like following regulations and often play by the rules (Ketchem, 2016). Therefore, they are likely to resist change. My enhanced self-awareness of the guardian temperament would help avoid workplace conflict by involving such people in developing benchmarks or protocols for new interventions to improve patient care. They can make good team leaders of projects that strict adherence to rules, dedication, and timeliness to realize the set objectives.

Another potential challenge relates to working with idealists. According to Ketchem (2016), idealists value harmony and diplomacy and dislike tactics that belittle teamwork or collaboration. As an artisan, I would be inclined to highlighting how effective strategies helped my team realize its goals. However, for idealists, cooperation, diplomacy, and harmonious relationships are critical success factors, not tactics. They also emphasize the well-being of others, are less focused on goals, and value teamwork over competition. By being self-aware of the idealists’ emphasis on cooperation, I would collaborate with my co-workers and appreciate individual contributions to the realization of my goals.

Whole Person Goals

A mindfulness plan can shape personal and professional dimensions of a nurse’s life (Reid & Koppel, 2015). It focuses on four aspects of an individual’s whole person: physical, vital, mental, and spiritual. My specific goals for each of these bodies are described below.

Physical Goals

Over the past few months, I have gained some weight due to a sedentary lifestyle and diet. I tend to consume snacks and sugary drinks. My first physical goal is to adopt a healthier dietary plan that will involve reducing sugar and fat in my diet. I will watch what I eat and replace snacks with organic food. My second goal is to become more physically active by engaging in morning jogging to cut weight and remain fit.

Vital Rhythmic Goals

It is important to keep a healthy work-life balance. I have two goals for the vital rhythmic aspect of my whole person. First, I plan to practice relaxation to achieve a consistent cardiac rhythm and cope with work stress. I will use aerobic exercises and yoga to realize this goal. Second, I will ensure that I get adequate sleep daily to maintain a regular circadian rhythm.

Mental/emotional Goals

An emotional state refers to how one relates or copes with feelings that affect personal life (Reid & Koppel, 2015). Work-life pressures are critical stressors in my life. I plan to reduce stress and burnout through in-depth conversations with my family and co-workers and engaging in outdoor events during my weekend-offs. I readily become depressed when frustrated. I plan to keep a daily journal to help me in time management in order to avoid such frustrations.

Biographical/spiritual Goals

Spiritual well-being is fundamental to physical and emotional wellness. Spirituality is perhaps the most important dimension in my life. My first spiritual goal as a practicing Christian is to attend church regularly by taking offs on Sundays. I will be able to strengthen my relationship with God and expand my beliefs about divine healing. My second goal is to become a member of a local bible study group to learn more about Scripture.

Achievement of Goals

Concerning my physical goals, I will seek family/peer support to attain them. To realize my goal of adopting good eating habits, I will involve a dietician to develop for me a dietary plan that will help me decrease sugar and fat intake. I will also replace snacks with healthier meals at home. I plan to achieve my second goal of increasing my physical activity by exercising at a gym at least three times a week and jogging every morning.

To realize my vital rhythmic goals, I will seek to establish a work-life balance. I will engage in routine aerobics and yoga to achieve my goal of relaxation after a busy day. These strategies will be useful in maintaining a normal cardiac rhythm during anxious or stressful moments. I will complete my household chores on time to ensure that I go to bed by nine. This schedule will help me achieve my goal of maintaining a circadian rhythm through adequate sleep.

I plan to achieve my emotional goals by seeking family/peer support. I will talk to a family member or colleague whenever I feel gloomy or depressed for encouragement. Additionally, being an artisan, I will participate in fun-filled activities and social events to combat stress. I will achieve my second goal of avoiding frustrations by keeping a journal in which I record my tasks and reflections on my feelings.

As aforementioned, I will achieve my first spiritual aim by visiting our church on Sundays with family and friends. I will plan to pass by the church at least twice weekly for morning prayers and participate in the Holy Communion. The aim is to strengthen my spirituality. To achieve my second goal, I will seek for a bible study group in the neighborhood and attend their evening meetings.

I will adjust to the changing whole person by improving my emotional and mental abilities. Through my current degree program, I hope to integrate mindfulness practice into my professional and personal life. The technique will help grow my self-awareness of my changing physical, mental, and spiritual aspects. Further, I will require the support of my family and peers to realize these goals.

Best Practices

Optimal healing environments (OHEs) are clinical settings that promote healing centered on patient/family experiences (Sakallaris, MacAllister, Voss, Smith, & Jonas, 2015). The Samueli Institute uses the OHE framework to provide holistic care to patients. One institution that has achieved an OHE environment is Iowa’s Grinnell Regional Medical Center (GRMC). The hospital uses massage therapy before surgical procedures to stimulate healing intention (internal environment) in the patient. The interpersonal component is achieved through social and professional interactions (Sakallaris et al., 2015). GRMC’s staff uses healing touch to promote mind-body-spirit integration and teach patients HeartMath breathing method to achieve relaxation (Grinnell Regional Medical Center, 2017). The hospital supports healthy lifestyles and patient-centered care (behavioral environment) through its family care services and calm places within the facility. Lastly, GRMC has an outdoor healing garden, a meditation room, and a bird aviary that optimize the patient’s external environment.

Another OHE facility is Montefiore hospital. Personalization of a patient’s room is allowed and inpatient television focusing on circadian rhythm-based content is provided to achieve comfort and healing intention – internal environment (Montefiore Medical Center, 2018). The interpersonal element includes a comfortable room for family visits and interactions. The facility’s Silent Hospitals Help Healing (SHHH) initiative helps reduce disruptions to create a positive behavioral environment. The hospital’s external element entails soothing colors, artwork, calm surroundings, aquariums, and high-quality air (Montefiore Medical Center, 2018).

Professional Presence Promotion

My current healthcare setting requires improvements to make it an OHE setting. I will apply self-awareness and insights into OHEs to create such a therapeutic environment. First, the emergency waiting area is dimly lit and always busy. A good improvement of this section may include providing pleasant colors and natural light and training staff on noise control. The aim is to reduce environmental stressors and promote healing. A second change will be offering inpatients age-relevant healthy magazines or educational television content on circadian rhythm. Further, a redesign of the hospital may be necessary to ensure that inpatients have a good view of the outside from the wards.

Conclusion

Through this self-reflective paper, I have learned the significance of self-awareness and mindfulness in my personal and professional life. As a mindful nurse, I can control my attitudes and beliefs to ensure optimal care delivery and create optimal healing environments. Further, by understanding my personality and that of others around me, I can avoid conflicts and build good relationships.

References

Carvalho, C. C., Chaves, E. L., Iunes, D. H., Simao, T. P., Grasselli, C. M., & Braga, C. G. (2014). Effectiveness of prayer in reducing anxiety in cancer patients. Revista da Escola de Enfermagem da USP, 48(4), 176-184. Web.

Grinnell Regional Medical Center [GRMC]. (2017). Optimal healing. Web.

Keirsey. (2018).Portrait of an artisan. Web.

Ketchem, S. (2016). Nurses’ professional caring presence and the power to affect change. Nursing for Women’s Health, 20(2), 125-128. Web.

Koerner, J. G. (2011). Healing presence: The essence of nursing (2nd ed.). New York, NY: Springer Publishing Company.

Mendes, A. (2015). The role of nurses’ and patients’ beliefs in nursing care. British Journal of Nursing, 24(6), 345-352. Web.

Montefiore Medical Center. (2018).Creating a healing hospital environment. Web.

Reid, P., & Koppel, P. (2015). Cultivating mindfulness to enhance nursing practice. American Journal of Nursing, 115(6), 48-55. Web.

Rodriguez, K. D., Bartoloni, J. A., & Hendricson, W. D. (2017). Is dental students’ clinical productivity associated with their personality profile? Journal of Dental Education, 81(12), 1436-1443. Web.

Sakallaris, B. R., MacAllister, L., Voss, M., Smith, K., & Jonas, W. B. (2015). Optimal healing environments. Global Advances in Health and Medicine, 4(3), 40-45. Web.

Santos, M. I., & Lima-Basto, M. (2014). A multiparadigmatic model for a holistic nursing.International Journal of Caring Sciences, 7(3), 781-792. Web.

Weil, A. T. (2004). Health and healing: The philosophy of integrative medicine and optimum health. Boston, MA: Mariner Books.

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