Nurses as Healers: Good Work Environments

January 25, 2016December 23, 2017 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

I remember when I became a new nurse 21 years ago, and a friend asked me what I did at the hospital when I worked those long 12 hour night shifts. His thoughts were that the patients were asleep, so it was probably a job where you hung out and drank coffee, occasionally checking in on a patient. I remember walking him through what I usually did on a 12 hour 7pm- 7 am night shift, including most of the tasks and requirements of the job from receiving report at the start of the shift to giving report at the end of the shift. I made sure to include that if- when I got a break, it was usually around 2am or 3am when I was finally “caught up enough” to take some 20-30 minutes to nourish and hydrate myself.

As I thought of this telling of what nurses do some 20 years later, I wondered if I included what nurses are really charged with doing, which is supporting the healing of those we care for. Did I focus on all of the tasks and duties I would complete during that 12 hour shift, or did I also include the time spent rubbing backs, holding hands, saying prayers, educating, and supporting patients and their loved ones? Did I include the story about the time I had to call a deaf woman and tell her husband had passed after she left for the evening? Or the time when the family asked me to increase the morphine drip rate because “the doctor said she would be dead before the morning and we are ready for her to be gone”? What about the man with ALS being kept alive on a ventilator and feeding tube who lay lonely in his bed, unable to verbally communicate, and went for weeks at a time without a single visitor?

I believe that as nurses we need to educate the public not just on all of the technical skills we do each day to support patients’ receiving good medical care, but also on the healing aspects of our unique work as nurses: on how we were likely “called” to be a nurse because we want to make a difference, the skills we have developed that support us in creating caring-healing environments for patients, and the rewards of being able to support others through their healing process. I think we should be making it clear to the public as well that we are committed to our own health and healing, knowing that we can’t support others through health challenges if we are not also dealing with these challenges ourselves. And as nurses, we need to support one another in our own healing process, role-modeling what self-care and stress management look like in action.

A recent study research from www.mountainmiraclesmidwifery.com/, showed that supporting nursing and creating “good nursing environments”, with adequate nurse staffing, leads to better long term patient outcomes, with fewer deaths one-month post surgery (http://mobile.reuters.com/article/idUSKCN0UZ2XL). It pays for hospitals to invest in having enough nurses, in treating those nurses well, and supporting nurses in what we have been called to do: create healing environments that support patients toward their greatest health potential. Healthcare facilities need to be moved to support nurses in managing their stress and enacting self-care in order to potentiate the healing of the patients these facilities serve. Good staffing is just the beginning of creating “good nursing environments”: nurses should be empowered to begin dialog with their employers regarding what a healthy and good work environment for nurses looks like in consideration of the healing work that nurses do.

Nursing as Practical Magic

November 1, 2015 / Wendy Marks, DNS, ANP-BC / 4 Comments

Nursing is a practical magic that creates internal and external environments to promote health or a peaceful death through acts that generate transformation. Ancient wisdoms and civilizations create rituals to honor life’s milestones and seasonal changes.

Samhain (pronounced sow-een) is known as the ancient Celtic festival of the dead. Celebrated on the 1^st day of November, Samhain is a time of introspection, and remembrance of the ancestors.

How do you remember and honor your ancestors?

Wise women throughout the ages, healers, and witches honor the turning of the wheel of life, the seasons, and the rhythms of the natural universe.

Connecting with the moon, stars, plants, animals, self and spirit they give thanks and set intentions to create healing and the life they dream of.

Consider the symbols and talisman of Halloween. One may see that the Broom symbolizes clearing of the old to make way for new; the Owl for wisdom; the Cat for mystery of the unknown; Ghosts for notions of the other world; and Bats for transformation.

As nurses, we inherently make connections with and for our patients and families. We tap into the power of the universe, as we embrace it we realize there’s a little witch in all of us.

Magic isn’t just spells and potions; its symbols and talisman that have whatever meaning you assign to them. What are the symbols and rituals that hold meaning for you?

Healers use their powers to conjure and create by setting intentions and connecting with the inherent energies of their environments.

The nursing metaparadigm (nurse, person, health, environment) viewed through the Unitary Transformative paradigm conjures an integration of multiple ways of knowing, being and becoming.

As we honor our nursing ancestor Florence Nightengale, we hear her say:

“All disease is a reparative process…an effort to remedy a process of poisoning or decay…I use the word nursing for want of a better. It has been limited to the administration of medicines and applications of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and diet…”

How do you conjure your environment for healing? How do you create the environment for your patients to heal? What ritual, symbols and talismans and intentions do you use in your self healing and work?

As we connect to our ancestors today, let us begin to reclaim our providence and power as nurse healers.

Listen to you heart, hear the beat of the drum, the drum of your heart as it connects with the hearts of the others and the universe; conjuring, gathering and sending out powers of healing and love to self and universe.

On this day we honor the ancestors, the ancient wisdoms, where we have been and the gifts we have been given.

See the vibrant colors of the Autumn; red, yellow, orange, and brown. Smell the earthly aromas of patchouli, sandalwood, musk, spice and copal. Hear the rustle of leaves as they fall and fly.

Let your nursing be a practical magic. Conjure a spell and send your intentions off on the winds, allowing the vibrant leaves of red, orange and yellow carry your wishes of health and healing to the earth, animals and humans.

Reference

Nightingale, F. (1859). Notes of Nursing; What is it and What it is not. Barnes & Noble (2003): New York, NY (pp 1-2).

The Nursing Manifesto: Aligning action toward living nursing as caring science and wholeness

November 30, 2014December 2, 2014 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

“Organizations are not changing because people in organizations are not changing” (Cowling, Chinn, & Hagedorn, 2000).

The Nursing Manifesto provides us within the profession a beacon of light and hope toward creating change; it provides a map of sorts leading toward the manifestation of Nursing Qua Nursing. It calls for us to grow, change, and evolve into our professional caring autonomy.

My doctoral dissertation looked at Nursing’s Living Legend, Dr. Jean Watson’s Theory of Human Caring and how it could be explicated through relating it to other areas of academic disciplines: chaos theory, partnership theory, and transpersonal psychology were all used to support the concepts in Watson’s theory. My overall conclusion after many pages of theoretical writing was that nurses need to be on a journey of self-care and reflection in order to enact the human caring experience that Watson calls for.

“We believe that our journeys to enact this manifesto will certainly require a reuniting of the inner and outer life, accepting our wholeness and owning our freedom – a wholeness and freedom that will strengthen our outer capacity to love and serve” (Cowling, Chinn, & Hagedorn, 2000).

How can one love and serve in their capacity as a nurse? Several years after completing my dissertation, I was given the opportunity to develop an RN-BSN curriculum from a caring- holistic-integral science perspective at the University of Maine at Augusta. The recently accredited program emphasizes self-care and reflection, while students also have the opportunity to explore holistic modalities for use on their own healing paths and to share with others as well. The creation of this curriculum was an act of love and it continues to be a path of service toward the nurses we care for in our program.

For several years, I had a dream of bringing Jean to our students and faculty. Eventually we were able to partner with our local hospital Maine General Medical Center and bring Jean not only to our students, but to nurses and nursing students from around the state of Maine. After a year of planning by a committee of 10 empowered nurses, we were able to bring over 400 nurses together to spend a day with Jean, learning about her theory.

The Augusta, Maine civic center was transformed by the planning committee nurses to be a healing space; special lighting was used, break time music was geared toward songs that support healing, plants were brought in, and intentions were set by the planning committee for healing space and caring science to emerge. The lunch meal and morning and afternoon fruit offerings were also geared toward support the health of the participants.

Dr. Watson spoke for many hours throughout the day about her transpersonal caring healing moment, the challenges we as nurses face in the current medical-cure based healthcare system, and the 10 Caritas Processes that support the nurse in creating the caring moment. Participants were encouraged to ask questions and share their own experiences with caring and healing. The whole day aligned with the Nurse Manifesto process, in that Dr. Watson focused on Nursing Qua Nursing and how we can move toward a caring science reality of nursing: “It is our firm conviction that there is a body of knowledge that is specific, if not unique, to nursing’s concerns and interests. We think that this knowledge is grounded in appreciation of wholeness, concern for human well being, and ways in which we accommodate healing through the art and science of nursing” (Cowling, Chinn, & Hagedorn, 2000).

Additionally she spoke extensively about the broken healthcare system, which has morphed into an illness system, or as the nurse manifesto noted, “general subjugation of spiritual consciousness to the economics of health care” and “the long-standing ideology (acquired consciousness) of nurses being subservient to other interests, and not encouraged to be deeply committed to their own healing work” (Cowling, Chinn, & Hagedorn, 2000).

Of great importance throughout the day was the emphasis on Watson’s first caritas process ™: Embrace altruistic values and Practice loving kindness with self and others. The other 9 caritas process revolve around the nurse’s efforts toward enacting the first caritas process, which begins with the nurse learning to care for themselves through self care, or acting in love towards oneself.

Students provided us with feedback after the event, and they stated that the most profound experiences were being able to meet Dr. Jean Watson, and also experiencing the transpersonal caring moment through a listening experience. During this experience, the participants first centered themselves in order to speak or listen from the heart; and then in pairs, they had the opportunity to practice being present and listening without saying a word, as well as reversing the experience and speaking for several minutes from the heart. The students found this to be profound and they realized what it means to be truly present with another person in a caring- heart centered experience. Many nurses do not have the skills or experience in this area, so this is something we must continue to foster in our nursing curricula and healthcare settings. My hope is that the nurses who experienced this event will have experienced some change within themselves that will help foster the change needed in the healthcare system. Love, serve, remember….

I am grateful to also have had media coverage of the event. Media coverage for nurses is of great importance, moving us out of the shadows and away from the invisible nature of our work. The front page of the Kennebec Journal on November 17 read, “Love is What Heals” and included a picture of Dr. Watson at the podium. Additionally, the event was covered by the local TV station, and that can be viewed here: http://www.foxbangor.com/news/local-news/6994-doctor-redefines-practice-of-nursing.html This media coverage is important, because as we know nurses tend to be invisible in the media, our presence often over-ridden by the medical-cure based system. We need to continue to find ways to shine our own unique light of love and healing.

Reference:

Cowling, W. R., Chinn, P. L., & Hagedorn, S. (2000, April 30, 2009). A Nursing Manifesto: A Call to Conscience and Action. Retrieved from http://www.nursemanifest.com/manifesto_num.htm

Nurses’ Day Eve

May 5, 2014 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 1 Comment

It is the eve of our special day

Can we honor nurses’ caring in a new found way?

Can we as a profession unite?

Centering and shining our healing light.

It’s our own day emerging from here, nurses’ day eve

Supporting one another, let’s believe:

That all nurses can earn a superior pay

That love and caring will rule the day

That hope and healing reign supreme

That we soon shall realize Nightingale’s dream

That we shine the light in any places remaining dark

That each nurse may leave her or his healing mark

That nursing education moves fully toward caring science

That we remain cohesive and united, growing our reliance

Yes, the field of nursing is moving out of oppression

Journeying forward to our own art, science, and caring expression.

With great thanks to the many nurses actively striving to create transformative change, innovations, and holistic-caring practices; keep striving, keep healing, and share your love and light!

What are nurses saying?

December 19, 2013 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 6 Comments

I have been intrigued lately with what nurses are saying in public arenas and how it reflects our practices. Many nurses blog or journal about their work, and while some of it serves to accurately portray the workplace issues we face, some of it may also be damaging to our profession and our image, serving to keep us stuck and in need of emancipation versus moving us toward freedom and autonomy as a profession.

Take the following blog post, created by a nurse known only as Brownie3, which seems at first glance to portray some of the issues we face as nursing. http://brownie83.hubpages.com/hub/10-Things-Nurses-Dont-Want-You-to-Know

Despite it’s title of “10 Things Nurses Don’t Want You to Know”, the blog reflects a keen desire to begin to inform and partner with patients, creating a venue for discussing with the public what nurses do. Why is it that we would perhaps not want our patients to know our profession and our challenges better? In many ways the blog clearly reflects the face of modern nurse as somewhat distanced and harried, un-empowered, and it provides background for why we must act in a reductionistic manner with our patients; we simply have too many demands, too much stress to “perform”, and legal constraints, such as on the use of patient names. The issues with pain medication and the nurse’s desire for the patient’s to be “sincere” in their needs reads very judgmental. However, my greatest concern is that the blog fails to portray what I believe we charged with as nurses: to provide caring, non-judgmental, presence at the bedside that supports the patient’s healing journey. There is no inkling of the idea that the nurse is there to share the journey and no clue to the idea that nurses are guided in their decisions by nursing theory and evidence based practices. Of course, as one of my colleagues pointed out, this is just one person’s experience, but when the statements are broadly placed to all of nursing, it becomes a concern for all of us professionally.

The next entry I looked at this week was from an intensive care nurse who wrote the blog as a fairly new graduate nurse. Diary of an Intensive Care Nurse begins to reflect the many troublesome issues nurses face in providing care in the highly technological world of the ICU: http://nypost.com/2012/12/09/diary-of-an-intensive-care-nurse/

While Nurse McConnell makes a clear portrayal of the issues in ICU around the country, there is something lacking here. One thing missing is the use of evidence to back up some of these statements; for instance there is some great evidence out there about what harm the ICU does, but it is not included here and in some ways the personal experience, while very valuable, could be better validated with use of data. Also, there is a lack of a solution; while the nurse calls for change in ICU settings, what and how that change might be is unclear. Again, there is plenty of evidence to suggest earlier palliative care and use of hospice at end of life greatly change end of life outcomes, and many more patients are opting for these services. My thought is that perhaps the writer is not yet keenly aware that these options exist and we should be striving toward greater use of these options for all people, or incorporating some of these more holistic and caring approaches into ICU type care.

While we want all nurses to have a voice, we also need to support one another in developing the best ways to express our concerns for the profession, and our plans for creating change. One thing I think is for certain: as nurses, we all should ideally support greater levels of education for our nurses, so that every nurses understands how evidence and theory drive practice, they each grasp the ethical implications of their practices, and they all can be supported in meeting their true call to nursing. The greatest joy in our profession is in the supporting of each patient’s healing capacity across the lifespan and through the death experience.