Author: Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN

Dreaming in nursing

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 3 Comments

I woke up at 0430 this morning with my heart pounding. Occasionally this happens, I have a “nightmare” about nursing.

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In this particular dream, I was working a night shift and at the end of the shift I was chatting with the nurses. I was getting ready for report, and I couldn’t remember seeing any of my patients; no names, no faces, no recollection at all. I began to feel anxious and I asked one of my fellow nurses, “Gee I hope I finished my charting” and she replied, “No I don’t think you closed out your charts.”

In a panic I ran to the charts. Of course in the dream they were not electronic, they were huge paper charts, perhaps as big as they could be about 6 inches thick, with hand written notes. I was trying to decipher the handwriting and figure out what was going on with a particular patient. As I read through the chart I realized I had not assessed this patient. I must have slept through entire shift. How could that be? Clearly from the diagnosis this patient would have needed pain medication, turning, toileting, and so on. Who was caring for this patient? I had nothing to chart and I realized that I would, at this last hour, have to go and check on all of my patients, assess them, check their meds, and then chart. My 5-year-old daughter arrived in the dream and wanted to play and I had to tell her no.

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Somehow, I woke up and had to convince myself it was just a dream, nobody was harmed, I was safe in my bed. For the record, I haven’t work the floor since the late 1990’s, though I worked as a hospice nurse and taught clinical in the hospital until 2005. Around that time, I finished my PhD, and began to focus on just honing my skills as an educator while I had two babies and raised them into young children.

I have this type of dream several times a year. I suppose I could do a dream analysis, look for the Jungian archetypes, or focus on my own life-anxiety and how it is related to my work. But I am really wondering about here is the dreams that nurses have: the good, the bad, the sleep time dreams, and the awakened dreams.

What is it that our hearts desire in our practice? What are we “dreaming of” in nursing practice and education… and how do we get there? Do we find reward in a broken healthcare system and as the largest providers of healthcare in the nation, how do we take back our practices of caring and compassion? How do we partner with others to create change? How can we use the Nurse Manifesto created by Peggy Chinn, Richard Cowling, and Sue Hagedorn to our benefit?

I would love to hear nurses’ stories about what they desire. I myself wrote a story about what nurses experiencing versus what we desire and you can read about that here: https://nursemanifest.com/research_reports/2002_study/nurse65x89.htm

This story was recently published in Creative Nursing journal. I am also presenting this story and supporting nurses in creating a personal plan of action at the American Holistic Nurses Association Annual Conference in Virginia Beach, VA this June. I hope to see you there!

Becoming the Transformed Nurse

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

“Nursing worldwide has been so confined and controlled by external material, physical reality, found within Westernized medicine and institutions, that it has almost lost it own heritage and purposive existence. It has been so consumed by the modern demand for technological competencies it now is faced with having to restore the under-developed ‘ontological competencies’ so essential to nursing’s maturity and survival as a distinct caring-healing profession” Jean Watson, 2002, p. 2.

How do we come back to the heart of nursing as healing, where so many of us wish to dwell and practice nursing? I ask myself this question frequently and I wonder about the challenges that we face as nurses and educators in supporting one another to create caring-healing spaces. Dr. Watson (2002) called for us to do this by healing our relationship(s) with self and others, creating meaning around our own concerns related to profound and compassionate caring and healing practices in nursing as service, gaining deeper understandings of and thereby transforming our own and other’s suffering, and accepting impermanence and the cycle of life.

This statement makes sense to me, but I also understand that nurses who have not been exposed to Watson’s theory, or who struggle to understand the deep implications of healing and personal evolution, may not grasp the call that Dr. Watson is making here. To simplify this statement a bit, I believe that she is calling for us to be each on our own healing and caring journey; walking into our own suffering, and continually working toward healing ourselves, helps create in each of us a greater capacity for caring for others and remaining compassionate at the bedside.

If we became nurses because we felt called to nursing, we can come back to that original calling and work toward Nightingale’s model of nursing as a spiritual-sacred healing practice. As Watson (2002) reminded us, when we are on the healing path ourselves, we can strive to be fully present with the patient through creating a caring-healing space. In this space, we reflect healing and enact transpersonal caring in such a way that our work as nurses becomes the most rewarding part of our lives, as we connect deeply with another human being and recognize our interconnection with all.

Part of my own healing process has included a journey into yoga practice and yoga teaching. Interestingly, even as I have encountered great healing for myself with yoga, I also find great healing for others and myself when I share the process of teaching yoga. This sort of mutual healing space that is created in a yoga class, is the same sort of space that many nurses are striving for in their caring work.  One of the challenges then becomes how to create the time and space within your practice to connect deeply with your patients, to hold with them a space for healing, and to bring true meaning to your healing work as a nurse?

Unfortunately, there is a perpetuated myth that transpersonal or deep caring- healing takes too much time and is usually left for last after all of the technical demands of the nurse are met, once the charting has been done, once the patient has been stabilized, and so on. I posit here that with practice and with work on one’s own personal caring- healing journey, the nurse can strive for learning to create a caring-healing sustainable practice with everything she does for patients.

Being present to patients and briefly breathing for a minute to set an intention for caring healing spaces does not take more time, though it may take practice, commitment, and reminders for the nurse to return to that healing space again and again and again throughout her busy day. Managing one’s stress and practicing healing for oneself are also the keys to learning to create caring at the bedside on a regular basis, and that may take more time out of one’s personal life, however if one is committed to nursing from a caring-healing space, then that time is an investment for oneself and a requisite to enacting a caring- healing practice.

And nurses may ask “why?”… why bother to create these spaces when it is not valued by the larger demands on the nurse, and takes a personal effort that is likely not always recognized or rewarded? My thoughts on this are:

  • If we are not supporting healing we are not nurses, we are technicians. If we lose our value of caring in nursing; we become heartless and our value to society at large diminishes or or is distinguished completely.
  • Patients, and their resultant expression of satisfaction, demand a healing presence.
  • One way to ensure the nurse has a long and fruitful nursing career, and does not burn out or become ill from stress of the job, is to for the nurse to enact a sustainable caring-healing bedside practice, that is deeply related to her own personal healing journey.
  • Because much much of what is going on in hospitals currently is ethically unsound, as damage is done to patients on a regular basis in the hospital environment and unfortunately nurses may also be subject to, or become an aspect of, said damaging environment.

I would like to expand a bit more on this last aspect. According to the New England Journal of Medicine, we now know that patients are leaving the hospital setting with what is being called post hospitalization syndrome, which is basically another term for PTSD related to hospitalization (Krumhloz, 2013). Indeed hospitalization for injury also increases one’s risk for depression and PTSD (Zatsik et al, 2008).

This sort of evidence should be generating questions for nurses, ranging from how they might be contributing to patients’ stress, to how they might be impacted by an environment known for stress induction, to how they are supporting the creation of caring-healing environments to counteract this stress.

Ethically, as purveyors of healing, we are obligated to examine our nursing practices with more depth and determine how we are going to create and be the change that our patients and the world are calling us toward.

“As nurses and nursing enter into this transpersonal aspect of our work, as we are re-patterned  so is our environment, our systems, and our culture. We then, individually and collectively, become the transformed nurse; we become the ethos and culture of caring and healing, living out our timeless heritage and most extant caring ethic, theories and philosophies in our lives, and our work” (Watson, 2002, p. 7).

References:

Krumholz, H.M. (2013). Post hospital syndrome: An acquired transient condition of generalized risk. New England Journal of Medicine, 368, 100-102.

Watson, J. (2002). Nursing: Seeking it’s source and survival (editorial). ICU and Nursing Web Journal,9, 2-7.

Zatsik, et al. (2008). A national US study of post traumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury. Annals of Surgery, 248, 429-37.

The nursing revolution will not be televised: Part III, the work of consciousness evolution

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / Leave a comment

If you are following these postings, you may have begun to wonder, ” well how can I, an everyday nurse, take on the enormity of changing myself; I have always been this way, these are engrained patterns, and I don’t know how to change”. I have outlined a few steps here, though the reader is encouraged to also discover their own healing path.

I. Start looking at the basics of your human needs.

Most nurses have some exposure to Maslow’s Hierarchy of Needs, and the more we learn about psychoneuroimmunology (PNI), the more we know the importance of  laying the foundation of good health behaviors in order to achieve “self-actualization” or consciousness evolution; we can also use this model to begin to visualize that as we move toward your own growth, healing, and self-actualization experiences, we can then prepare to support others (ie our patients and our colleagues) to do the same. From a PNI perspective, if the base of the hierarchy is not addressed, we will be in a physiological chronically stressed state, leading to not only feeling bad and functioning poorly, but also toward an inflammation state and a genetic-chromosomal expression that leads to illness and disease.

Many nurses need to start with attending to the basic physiological needs. As research has shown that most nurses get an average of only 6 hours of sleep before any given shift, for many nurses, this will be the way to begin: first, learn to honor your sleep in order to best care for your own PNI and set the stage for consciousness evolution. Additionally, with erratic schedules and nurses’ long 12 hour shifts, diet and exercise habits that are proven to support a strong PNI, personal stress resilience, and consciousness evolution, may be missing and this useful information is never readily available for the people in need.

As one begins to build a strong physiological basis for themselves, they are better prepared to address the safety needs stage of Maslow’s hierarchy: I believe this is of great importance to nurses, because on a daily basis, our safety issues and boundaries are pushed by our patients, patients’ family members, colleagues, and administrators alike. However, if we don not have our own basic physiological needs met, we may not progress toward addressing our safety needs and moving into a space where work group relations can be addressed and managed.

Nurses may choose to work with a wellness counselor, support group, or health-nurse coach to begin to manage and create a healthy lifestyle. We need to recognize that these habits are hard to create, but with continued support, we can create lasting healthy lifestyle behaviors.

II. Look to the Literature: Self-help and self-care tools abound

In the curriculum I have enacted in the RN- BSN program I have developed, it has become clear that nurses need specific tools to undertake the self-care and healing journey. Luckily, one does not have to look far to find these tools. Some recommendations I feel comfortable making to nurses, educators, student nurses , and whole groups of nurses looking to share this work together include:

Cheryl Richardson’s (2012) The Art of Extreme Self-Care: Transform Your Life One Month at a Time. In this book, individuals and/ or groups can work together to reflect and create real change in their lives. This particular book walks the reader through affirmations, to creating healing space, and learning to set limits with the “absolute no” process.

Another great work to support nurse’s on their healing journey and consciousness evolution process is Joan Borysenko’s (2012) Fried: Why You Burn Out and How to Revive. In this book, Dr. Borysenko, a pioneer in the research that emerged from Harvard’s Mind Body Institute, shares her own burn out scenarios and a step-by-step reflective process to help readers revive by examining their childhood roots of burnout, personality traits that may predispose us to burnout, and the revival process needed to move beyond burnout.

Creating work groups or informal groups that can share this healing process may be helpful, though certainly one can also work through this process on their own.

For those looking for what I might call a deeper journey toward the state of evolutionary consciousness a text entitled Integral Life Practice: A 21st Century Blueprint for Physical Health, Emotional Balance, Mental Clarity, and Spiritual Awakening (2008, Ken Wilber et al) may prove to be a challenging and useful endeavor. This book walks one through the lived process of addressing psychological shadow issues, while also focusing on the mind-body-spirit processes needed to support evolutionary consciousness growth.

III. Seek out counseling

As most nurses know, we want to support the healing of others through caring, which is the heart of nursing practice. But if this task becomes one of control and co-dependence, our workplaces may even morph into lateral violence as we reenact the patterns of our dysfunctional family’s and painful childhood experiences. Through work with the right counselor, we may find that we are able to identify these patterns, observe them, heal them, accept them, and detach from them as we create new ways of being. At this juncture, we then create new patterns for coping. Additionally, tools such as EMDR can help one to create new neural pathways of peace and well-being to attend to when life is stressful, rather than continuing to enter into old habits of fight or flight ad the ensuing dysfunctional behaviors that tend to dictate our reactions in unhealthy manners.

IV. Evolve your consciousness: The ancient tools

For many centuries, people have searched for ways to relief their suffering and find ways to grow spiritually and evolve their consciousness. We are only now coming to the point where we can link these endeavors to the PNI response; organizations such as the Harvard’s Benson- Henry Institute for Mind-Body Medicine, UCLA’s Mindfulness Awareness Research Center and the Center for Neurobiology of Stress, and The Institute of Noetic Sciences have taken the lead in this area.
Working toward mindfulness, using tools such as meditation and yoga help us to evolve our consciousness toward higher states and recognize our unity with others and the universe at large. Mindfulness means paying attention in a particular way, on  purpose, in a present way, while remaining non-judgmental and non-evaluative toward both the inner and outer environments. The video below from UCSF’s Osher Center provides a clear background on this process which directly relates to managing stress and evolving.

I would love to hear your thoughts and experiences around this process of personal consciousness evolution and the power it may have to transform our lives and realize our healing-caring nursing practices.

The (nursing) revolution will not be televised: Part II

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 4 Comments

“If we do not change direction, we are likely to end up exactly where we are headed”- Chinese Proverb.

In one of my previous postings, I mentioned that the nursing revolution would not be televised; in other words, our own revolution begins with an evolution of consciousness about nursing and our practices. I do believe, just as our esteemed nursing theorists Jean Watson has stated time and again, that caring is the essence of nursing practice, and yet we have continued as nurses to generally practice in institutions and organizations that do not know how to value and support the caring- healing capacities of nurses, despite the fact that our patients make clear time and again are of the utmost importance along their healing journey.

We are each, as individuals and nurses, in need of awakening to our own personal path of caring and healing. If we are to be able to share caring and healing with others on a meaningful basis, we have to be on a caring-healing journey for ourselves individually and collectively.

In order to create change in our profession and move toward greater acceptance of caring-healing nursing practices, the change needs to come from within each of us. I have some students who state things along the lines of, “What is the use? I can change myself and yet this will not effect the institution where I work”. And this is where they are wrong. I have seen time and again nurses who move toward changing their consciousness and engaging in their own self-care and healing endeavors, and they then go on to create meaningful changes in their lives and their practices. Others find the courage and strength through self-reflective practices  and increasing stress resilience to realize that they are serving a dysfunctional system and they opt to leave their place of employment. By increasing our personal stress resilience and creating new brain pathways, we can open up to creative solutions to workplace problems and we can walk into our own issues instead of running from them or remaining stagnant.

Stress resilience helps us to create a personal revolution toward peace, ease, and well being. The following is a video by Joan Boryenseko on transformational experiences of healing, awakening, and consciousness evolution. Here she walks into the process of witnessing our emotions and the process of witnessing, forgiveness, and grief.

As we undertake the revolutionary steps of transformation to change our personal and nursing consciousness toward peace, we will notice a reduction in aggression and an increase in compassion, caring, love, and tolerance- the qualities needed to support the creation of healing environments in our healthcare systems and facilities. As our personal and professional consciousness evolves and shifts, we begin to move toward a better understanding of the unity of all human beings and species and even to the larger cosmos.

So what prevents us from taking the steps toward personal and professional revolution through consciousness transformation? Below is a video by Eckhart Tolle that briefly described the movement toward consciousness transformation and moving beyond fear.

I am open to hearing your thoughts here and in the next installation, I will present ideas on the steps toward walking into peaceful revolution and transformation in part III.

The (nursing) revolution will not be televised: Part I

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 3 Comments

Nursing is in need of a revolution. A revolution of thought and a revolution of how nursing is learned and practiced. Now seems to be a “good” chaotic moment in time and history for the revolution to begin and perhaps to expand: as our healthcare systems become less well funded, less well-staffed, and as more and more of the population (in theory) begins to seek healthcare due to “Affordable Care Act”, the stage for change and growth have been set. I do predict that some major changes are ahead for nurses and our roles in healthcare, and if we as a profession and as individuals do not create our own revolution in nursing, the revolution will be dictated to us by others.

Dovetailing on my last post about nursing and the media, I feel confident in stating that the nursing revolution will not be televised. The following is video-recording of Gil Scott Heron’s work on the revolution not being televised:

What Gil Scott Heron really meant he explains here:

We as nurses can learn a great deal from this song and the revolution of the civil rights movement to begin to plan how we each can and must forge a plan to change our minds, our consciousness, to move toward the right page, and find the right note as Mr. Heron encourages us to do. Each of us has within us the power to create the environment and practices of nursing that best serve our patients, our colleagues, and ourselves on this human journey of life, healing, and love.

And it begins within; we cannot televise the changes in our consciousness that we create, but we can begin our own efforts focused on healing and creating stress resilience practices that support us in moving toward others, instead of remaining in fight-or- flight mode and running from ourselves and others. We can each create a personal brain bio-psycho-neuro-immunological (mind-body-spirit) revolution movement that can change the face of healthcare as we empower ourselves and others toward healing and supporting our evolution of consciousness personally and professionally.

In future postings, I will discuss a bit more about how this is possible and the amazing tools that we have at our disposal to make this revolution a reality.