Nurses and Global Peace

This blog posting will be a bit different from others I have written, but I believe the NurseManifest page is a place where we can open our hearts and souls to the essence of nursing, which is healing, caring, love, and compassion. In a world seemingly torn asunder from fear, violence, and anger, nurses are called forth to support healing on a local and global level. The call comes from something beyond ourselves, and if you stop and listen closely, I believe you will hear that calling. You are a nurse and there is a reason you were drawn to nursing: to support healing through loving kindness and caring.

A few nights before the recent violence spread around the world, from Beruit to Paris, I lay in bed cuddling my 7 year old daughter close. Every night I am blessed to be able to spend some time reading to my daughters and cuddling as they drift off to dreamland. For a few moments that evening, I found myself floating in a space where I felt like the mother of the universe was whispering to me, not in words, but through a deep felt intuitive process. I knew the goodness, the light, and the powerful strength of peace as they came through clearly to me, carrying with them the message that the mother of all, the earth as a complex system, will heal itself. After the moment of certainty passed, I was left with the usual feelings of uncertainty: how will the good and the light prevail in these times of darkness? Who will help make this happen? What is my role in this process?

Then tragedy struck, and violence and war continue to grow. The feelings of uncertainty have not dissipated, so I sit with those, but I also do remain strongly rooted in the belief that as nurses, we can support global peace and healing through our own efforts of creating local peace and healing. And that local peace starts at the place closest to us all, right from our hearts.

As we practice our own healing, creating our own peace and loving-healing processes, we can begin to spread that healing, peace, and love to others. A practice I try and do daily is called loving kindness meditation. I feel on many levels this practice is about my own healing and self-care so that I can be a better nurse, wife, and mother… and it is also about bringing that healing into the world.

I start with focusing on myself, in my heart space, and intending for myself healing through the following words:

May I know peace, joy, love, and ease. May my heart be full. May I be safe, healthy, and happy.

I than send this intention to the loved ones in my life, wishing them all love, peace, ease, happiness, health, and safety: family, friends, pets, students, and colleagues. As the circle of intention spreads outward, I send the intention and feelings of love and peace out to my “enemies” and challengers, and I end with the whole planet, with every being being sent the intention of peace, love, and healing.  The process takes  5-10 minutes.

As nurses supporting healing, we can think and act both locally and globally. Imagine if every nurse sent out an intention, a prayer, a positive thought for healing and peace for the entire mother earth and all of the beings living here. Consciousness studies show that our thoughts and intentions impact our environment and reality.  I think of Jean Watson’s call for us to practice loving kindness and  Martha Rogers’ concept of Unitary Beings. We can reflect the patterns before us, we can create shifts in consciousness to support healing.

Despite the medical system’s over-emphasis on technology-cure-illness management, I still believe that nurses are truly called toward the healing that all beings are capable of experiencing. If you have been called to be a nurse, can you return to that calling, can you spare a few moments to consider the global situation, and what you can do as a nurse to support healing from the truly local level (yourself) and on to the global level?

I would love to hear from nurses and how they are supporting peace and healing around the globe. The call has been made, how will you answer?


peace-signs-clip-art-peace-signs-clip-art-10h call has been made… how will you respond?



Futile Care: Alive and Well in America

Contribution by Carey S. Clark, PhD, RN, AHN-BC

I recently supported a dear friend of many years who was faced with caring for her terminally ill husband. We were part of a small group of fast friends, having all gone to the same college, and we spent many years afterwards celebrating life and adventuring together. In many ways, this special couple had been family to me over the years.

One challenge for me as a nurse was being 3000 miles away and relying on text and cell phone calls to assess my friend’s status and prognosis. While I was fairly certain that once he was put on the ventilator, given his complex medical situation,he had numerous ailments that were too complex to be treated at home one of which was leaky gut. Not even a nurse coming to the home would have been able to give him the care he required. He would not be successfully extubated and go on to be discharged, the medical staff were not clearly communicating this to my friend who was trying, despite her grief and stress, to make the right decisions for her husband.

The conversations I had with my friend ran deep, and the main challenge was supporting her in getting the prognosis clearly from the various providers; my biggest questions for her to answer to help support my assessment were why is he still on the ventilator, what is the prognosis, and what did he want medically at the end of life? It turns out he wanted all medical-technical interventions possible if there was hope for his recovery and some quality of life; but what was not being conveyed clearly here was the hope of recovery issue.

After several days of the husband being on the ventilator, my friend was able to listen to the renal team discussing her husband’s care, and it became clear to her that he was not being “cured” or healed, rather they were prolonging his inevitable death. The hospitalist was in a little bit of opposition to the renal team, with the hospitalist wanting to continue care, play wait and see for a little while longer. My friend recently reflected that the hospitalist was okay with simply keeping her husband alive, with no apparent concern for his quality of life. Finally, when my friend’s husband became septic a few days after intubation, when the full team finally confirmed that the prognosis was extremely poor, she was able to make the decision to remove the life support. He passed away peacefully shortly thereafter.

Unfortunately, this scenario of futile care and over-use of technology at end of life is repeated over and over again, on a daily basis, in nearly every hospital in America. While we know that technology use can save lives, we also know of the pain and suffering it can cause. For instance, Johns Hopkins recently reported that fully 30% of people intubated in the ICU setting suffer from PTSD post extubation. When people state that they want everything done for them if there is still hope, we need to consider that folks may really not know what they are consenting to, the suffering that technology in futile care cases can create, or the improbability of recovery after undergoing a full code scenario in the hospital. Their knowledge and experience with end of life technologies is often limited to what they see on TV or in the movies, the heroic efforts, the beautiful deaths, the rapidly unfolding peaceful or positive conclusions that bare little resemblance to the reality of end of life care.

As healthcare providers, nurses and doctors do know. Most doctors clearly do not want aggressive technologies used for themselves, and yet they need more training on clearly communicating when care is overly-aggressive or clearly futile; the following article clearly summarizes the research with doctor’s preferences around technology at end of life and the sort of training both doctors and nurses need to do to support better end of  life care. 

As Dr. Angelo Volandes in his Boston Globe Opinion article stated, we need a complete overhaul of end of life care in this country. “I have heard patients and families demand that we “do everything,” to prolong their life, but in many cases they, unfortunately, have little idea what “everything” means because no one has explained their options clearly. Sometimes, patients and families don’t want to face death. But more often, the problem lies with the medical profession. The principal reason we have gotten death so wrong is because doctors fail to have meaningful discussions with patients and their families about how to live life’s final chapter.” (Read the full article here:

Unfortunately, it remains true today that approximately 60% of the population in America will die in the hospital, even as we know 80% of folks would prefer to die at home. Meanwhile, the media generally continues to portray death inaccurately. In our culture the general public has little to no opportunity or incentive to educate themselves around death, and yet it is where we are all headed. Although it may be “easy” or “correct” for nurses to go along with doctor’s orders and provide futile care day after day, at what point do we decide to do our care differently, to step fully into our role as the patient advocate? Although we can’t divulge specific prognosis, we can discuss the limitations of technology. We can sit with families and discuss the reality of the care provided, and we can encourage them to have those conversations with the doctors: “What is the plan of care, what is the likely outcome, is the technology use just prolonging life without hope of recovery, is the technology use painful or likely to cause PTSD, what will life be like if my loved one does survive, are they suffering from the use of this technology, and what about quality of life now and into the future?”.

Why can’t we just include a list like this as a guide for doctors and nurses in facilitating their communication process, to really strive for educating families, patients, and decision makers around end of life care and futility? Why do we assume that folks really know what it means to “do everything”? We can become more comfortable with the types of conversations families need to have as they approach end of life, particularly if we spend the time to be reflective about our own future death experience and the deaths we have witnessed both professionally and personally. We can think about how different death seems when it is our loved ones facing this transition, and how we perhaps at times distance ourselves from the death of our patients. We can consider how in the last 100-150 years death in America has been removed from the public view, from the home and places of comfort, from the natural progression of life, and consider how death has become institutionalized in our hospitals. We can consider the healthcare costs around end of life care and how that impacts available resources and compounds the amount of money we continue to spend on healthcare. We can think about the nurse’s role around supporting healing at end of life, and what we want that to look like for our profession and those we serve. We can look more closely at our own end of life fears and concerns that make it challenging to care for those hospitalized at end of life.

I am currently teaching a thanatology (study of death and dying) course for nurses that I designed in way to support students to go deeply in their reflective process around death and dying, to explore the holistic needs of the dying, and to delve into the body of evidence around the science and politics of death and dying. While the course is challenging for students on many levels, it is also transforming their nursing practice, touching them deeply on a personal level, and helping them to advocate for others at end of life. I remain hopeful that someday every healthcare provider from MD to RN to Social Worker will have the opportunity to take a thanatology course like this and that out culture will eventually strive to start death education at earlier stages in life, moving toward acceptance that this life is impermanent, and that it is perfectly okay, natural, and normal to die; that one can indeed refuse treatments and technology regardless of age; that living well leads to a positive death experience. There is a new movie available that aligns with this purpose, called Death Makes Life Possible. I highly suggest using this movie as a tool to support discussions around end of life and open up to the possibilities of “transforming fear into inspiration”:

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

“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: 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.

JW_front page


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


Composing a Life Work: Why Creativity Matters in Nursing

The following is a guest blog by Jennifer (Jen) Reich PhD, MA, RN, NC-BC Nurse Coach, Poet, Storyteller. 

Once upon a time, I wrote a story called The Healer (2011). The premise of the story is a little boy from a difficult upbringing who encounters a magical being on his way to collect sea glass. He is collecting the glass to make a mosaic for his mother. With the help of his friend, he collects enough to make one for his school as well. He grows up to be an artist, creating mosaics for his community, nursing homes, and hospitals. When he is an old man, he meets his magical friend once more. She tells him he has been a great healer and will be welcomed into her tribe. At first he doesn’t understand. She explains that since he has followed his passion and created his mosaics with love, his art has brought great healing. Love, she tells him, is always healing.

I have written poetry and stories for as long as I can remember. Often I think in poetry, and it has always been a way to help me process information and feelings, to find my voice. I started playing the trombone in elementary school and music became another outlet for me. However, it wasn’t until I began working as a psychiatric tech in nursing school that I discovered how powerful the arts were to help those suffering give voice to their experience. I also realized how important poetry and writing were for me to give voice to my own experience as student nurse and tech.

As a new nurse, I learned from mentors that though a cure is not always possible, there is always potential for healing (Dossey, 2013). Most nurses have experienced the death of a patient or client and know it is part of their work. So how do nurses cope with these sorrows? Some use self-reflection and self-care strategies while others may engage in self-negating behaviors as a way to manage their stress and pain. Sometimes, it’s a little of both. The Nurse Manifest Document Introduction (1a, 2009) states: “We call forth the written and spoken voice of nursing to be claimed and reclaimed. We seek to inspire the fullest expression of the heart of nursing through individual and collective acts. We believe there are profound possibilities in claiming our individual and professional sovereignty.” As caring professionals, nurses need to have creative outlets not only to cope and de-stress, but perhaps most importantly, to find our individual and collective voice.

Very recently, we saw an excellent example of nurses claiming their voices. It began with an instance of nurse blaming in the Dallas nurses who contracted Ebola. In the case of both nurses, before the whole story was out, fault was transferred to them (Goodwin, 2014). However, colleagues in nursing would not allow this to go unnoticed and without consequence. Nurses from organizations such as National Nurses United, stood together collectively to voice their opposition and support their sisters in nursing. Petitions were generated and spread through media outlets. Individual nurses shared their personal and professional experiences through stories shared on blogs and Facebook and Twitter feeds across the Internet. These stories went beyond the nursing community and to the public where the compassion and professionalism of nurses could be seen and heard.

Despite this inspiring display of community and support, we still hear old adages such as “Nurses Eat their Young,” or concerns that nurses are the worst when it comes to taking care of themselves. Remember in The Healer story the boy learned that engaging in his work with great love and passion brought healing to others. When we don’t take time to care for our mind, body and spirit we deny ourselves the balance and harmony we seek for our students or those in our care. Creativity is a path to touching and bringing forth the inner knowing and wisdom to what we best need to reignite our passion. For example, when I do creative self-care workshops, participants will often tell me they haven’t painted, written stories or poems, or danced since before they were in nursing school, or even as far back as childhood. Having this creative release often gives them the courage to voice what has been long held within. There is very little teaching involved on my part, they already know how to be creative. My role is to provide encouragement and help them surrender to the creative process without judgment and/or critique.

There are journals dedicated to evidence-based research on the healing effects of the creative arts in patient/client populations. Music and arts-based therapists do amazing work with arts-based interventions in individuals, groups, and communities. However, there is limited research on why creativity is necessary for the wellbeing of nurses and healthcare professionals. Further, we often don’t often reflect on how the creative arts enhance our nursing practice. One example I share is from a hospice patient I met years ago. He had been a sax player and jazz musician. We spent a little time before each assessment chatting about jazz. I was able to have a volunteer get him a CD player to listen to his music. There was a reciprocal healing process as our connection through music contributed to a sense of greater well-being on both of our parts. In addition, it opened up space for me to understand his concerns and care needs.

When we are engaged in the creative process, we are fully present. This, in turn, teaches us presence. We are so longing for presence in this world. Though more and more coffee shops pop up, most of them have a drive-thru with lines wrapping around the building. We have bigger banks and lenders, and more often than not, we aren’t able to talk to a real person. We cannot explain to an automated system that the reason we missed a bill payment for example, is that we were caring for a sick parent or child. We need creative soul-utions, not just automated systems in our daily lives, and we need these in nursing and healthcare.

I had the privilege of interviewing 13 experienced RN’s on the concept of ‘story’ as part of my dissertation work. When I sent out my recruitment flyer, I received responses immediately and could not interview everyone interested. I realized from this experience that nurses want to be heard! We need to create more spaces to share our stories, to make art together, write poems, listen to music, to dance. Whether our nursing work is on the front lines in direct care, or as teachers, coaches and/or advocates, we must reignite our love for our calling and create individually and collectively a new paradigm for healing. For though there is no cure for all of the problems facing our healthcare system and the world, when we give voice to our life and work though creativity, healing is always possible~


Cowling, W. R., Chinn, P. L., & Hagedorn, S,. (2000). A Nursing Manifesto: A Call to Conscience and Action. Retrieved:

Dossey, B.M. (2013) In B.M. Dossey & L. Keegan (Eds.) C. Barrere & M. Blaszko Helming (Assc Eds.) Holistic nursing: A handbook for practice (6th ed) (pp. 247 – 260). Burlington, MA: Jones and Bartlett Publishers

Goodwin, W. (October 24, 2014). Was CDC Too Quick To Blame Dallas Nurses In Care Of Ebola Patient? National Public Radio (NPR) Retrieved:

Reich, J. (2011). The Healer. Retrieved:

Jennifer Reich PhD, MA, RN, NC-BC is a nurse coach, poet, and storyteller. She received her PhD in Nursing from The University of Arizona in 2011 and is adjunct faculty in the College of Nursing.  In addition to nursing, her background also includes degrees in Exercise Science:(Gerontology Specialization) and English/Theatre (minor) and training and practice in Mindfulness Based Stress Reduction, Reiki, Health Appraisal and Meditation. She has incorporated these diverse experiences to design wellness programs and teach self-care strategies to nurses and caregivers throughout the country.

You can find Jen @  and Jen wishes to thank Jackie Levin RN, MS, AHN-BC, CHTP for her review of the blog.


Nurses’ Day Eve

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!