On the nurse manifest project and creating change


I had the pleasure yesterday of presenting the NURSE #65X89 story to holistic nurses at the American Holistic Nurses Association.

We started the workshop with a brief grounding and centering exercise and moved on toward my reading the story. Then the participants had an opportunity to dialogue about the story and its meaning, and we then beagn some goal setting around creating the future of holistic nursing, one that exemplifies the values of the Nurse Manifesto, and also supports the vision of how nurse Jane in the story lives holistic nursing. For some participants, very concrete goals that were measurable emerged; for others what may have emerged was the need to do self care and find ways to let things go so that they can begin to realize holism and healing for themselves. As I have blogged about previously, it is a must that we have our own self-care in place if we are going to be able to create change in systems and the science of psychoneuroimmunology supports this need.

Meanwhile, the idea arose for us to perhaps collect more nurses’ stories, to do another round of Rogerian Narrative Inquiry Analysis on the stories of nurses, but I wonder about what differences may have emerged over the last 11 years. I suppose my concern is that the stories will continue to be reflective of the struggles of nurses and nursing toward emancipation, and I wonder if the new patterns emerging would be any different then the patterns we identified those years ago? Or perhaps the story of nursing is declining even further, and maybe I need to realize that perhaps this part of the chaotic change process, part of the bifurcation where a new pattern may emerge.

My intention from here is to stay in touch with these amazing holistic nurses, create ways to continue to communicate about their goals, use social media to stay connected, to share our light as we head back toward the institutions where darkness may seem to still rule and oppress our desires for healing and holism.

However, I wouldn’t be doing this work if I didn’t believe that a shift is possible, that light shall reign supremer, that healing is emerging… and so let’s all shift together.

Becoming the Transformed Nurse


“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.

International Human Caring Conference: Part I


I think that those of us interested in creating change need to find ways to gather, to heal ourselves, and to support one another in and through the change process. It is a blessing when we as professional nurses can be with other professionals of like mind and like goals.  I was privileged to attend the International Human Caring Conference in Philadelphia, PA this week. There were dozens of trade show displays and booths, of variou new and old non-profits aiming to better the world. As always, the key note speakers were amazing and inspiring: Dr. Jean Watson and Sigridur Halldorsdottir.

Dr. Watson focused on the heart space and unitary patterns, how we are all interconnected and how our own thoughts, intentions, and heart spaces can impact the greater field. Though these are not new concepts for Dr. Watson to express (many of them are mentioned in her 1999 publication Post Modern Nursing and Beyond), there seems to be a growing body of evidence to confirm that the transpersonal human caring states and states of personal peace that come from a heart centered space are able to create a greater unitary space and pattern of healing. Human caring therefore becomes about a unitary place of peaceful connectedness. This concept is confirmed by the fields of quantum theory, the unitary world view, caring science, and the ethics of belonging. Our true power as nurses and healers comes from taking action from a place of an evolving higher vibration consciousness and human caring – peace intentionality. Watson emphasized in her presentation the idea that love and peace are the highest level of unitary consciousness, and it is by dropping into heart space, and enacting our heart ways of being, that we can manifest peace and healing in meaningful ways.

Universal, Unitary Heart

Many people may read this and wonder just how to interact within the heart space; they may assume that it takes great practice and effort to relate to others from a heart space. Watson (1999) did however remind us that we have this power within us already; it is not so much about learning or adding in something, it’s about getting in touch with and remembering who we are- spiritual beings, interconnected from our roots. I like to remember that we all came from our star dust origins.

Some simple techniques to enter into the heart space may include closing your eyes, setting an intentionality for caring, communicating, and healing from the heart. Next, one may start from closing the eyes, focusing on the breath moving in and out of the nostrils. Next take the minds’ intention, by focusing on the “third eye” space or the space between the brows, and from there internally-visually dropping one’s attention into the heart space. Notice how it feels to dwell from this space and intend to be in this space throughout the day. Send the love you feel for and from yourself out to your loved ones, family, friends, pets, colleagues, administrators, your challengers, and the world. This can be done in 1-2 minutes, and one can remember/ return to this practice throughout the day; always returning to the heart space which is the core of our being.

For nurses this should be good news. In a just a few steps, you can begin to create the sort of caring-healing practices that make our work worthwhile and meaningful. Additionally, consider that the more one practices self-care and healing techniques, the easier and more natural it becomes to enter into the heart space. Practices such as yoga, Reiki, meditation, contemplative prayer, and tai chi can help one become familiar with the heart space, and prepared to enter it more easily. Taking good care of one’s being through diet, exercise, and sleep are basic health factors that also enable us to better relate to others from the heart. Within the heart space, nurses can generate peace and wellness for self, others, and all beings of the world. From this place of peace, we can create change within our profession, as we strive to support nursing in our emancipatory process.

Examining the Nurse Manifesto: Identifying with the Past and Future


Now, seeking meaningful avenues for action, we choose to identify ourselves with the heritage and future of nurses. From nursing history we have learned the fullness of our own potential as nurses, the strength of nurses, the effect of nurses in communities and to individuals. We have seen our own common self interest, and common oppression. Having found these authentic bonds as nurses, we realize we can rely on each other as we seek conscience-based action to shape a new future for nursing and for health care (Cowling, Chinn, & Hagedorn, 2000, paragraph 4).

This is another excerpt form the Nurse Manifesto, a document that calls us as nurses to create avenues of change for the future of the profession. As I reflect upon this excerpt, and our identity as a profession. Where did we come from and where are we headed? How can history inform the future of our profession, and how is it we can come together to create meaningful change?

Nurses Honor the Past By Wearing Caps For A Day

In 2002, I wrote an article about the nursing shortage and how in some respects, the profession has created our oppressive cycle by not coming together to empower ourselves and take control of future and our practices (Clark, 2002). Perhaps reflective of the greater culture, we tend to enact lateral violence, and repeat actions that keep us divided over our differences versus united in the quest to provide the greatest healing opportunities for our patients. We see that our own oppression grows, as we widen the gaps between administration/ managers and practicing nurses, and the dominance of nurse educators over students. Focusing on our differences, creating small factions, failing to care for ourselves, not committing to being lifelong learners, and spreading ourselves thin all contribute to our professional oppression and keep us from focusing on our common goals.

I believe that we can each start right where we are at. The first step is caring for yourself that you may also better for care for others, patients and colleagues alike. Creating work environments of healing and caring is a common goal we can share and explore together on the local level. We can commit to creating a consciousness for change in nursing and healthcare.

As the over-arching professional organization, it would be wonderful if the American Nurses Association could begin to bring us together on a national level. It seems the state nursing associations on many levels are more likely to create local action, but they also need assistance in gaining participation and increasing membership numbers. In my small state of Maine at our statewide meeting last year a quorum was not established as there simply were not enough members present to meet that mark.

I imagine a professional world where each donate some of our time every year toward taking action on the local-statewide level, whether that is writing a letter to congressional representatives, or serving our larger communities, or perhaps sharing our expertise about the human experience. I have served on the local school board, where I helped to foster much-needed changes in the kitchen and the nutritional program, and now I serve on the early education advisory council in my town, where I share and learn about childhood development and teaching and evaluation skills. Churches are another great place to provide healing services and demonstrate your expertise as a nurse. Serving in communities helps us to unit with the community and our patients; this unification process can also foster change as we grow our partnerships and empower communities and individuals toward creating the healthcare system of the future.

One great way to come together is to join a specialty nurses association and attend their conference. I have found great comfort, support, and enthusiasm in the American Holistic Nurses Association; it is rejuvenating to leave the conference and begin to take action based on what was learned there. I have found that the AHNA has a great commitment to changing the future of the nursing profession, and empowering nurses on a meaningful manner.

Lastly, how do we empower the future nurses to realize the potential of our profession? They must understand the path that nursing has traveled, the change process, self-care, and their potential contribution to the unveiling of the new paradigm of healing in our future.

Nurses in the Future

References:

Clark, C. S. (2002). The nursing shortage as a community transformational opportunity. Advances in Nursing Science, 25(1), 18-31.

Cowling, R., Chinn, P.L., & Hagedorn, S. (2000). The Nurse Manifesto.
Retrieved August 12, 2011 from
http://www.nursemanifest.com.