Presence and Influence

Western Governors University

“Being human means being whole physically, mentally, emotionally and

spiritually” (Koerner, 2011). I believe that these are important aspects that contribute to

our life as human beings. As a nurse, part of our professional presence is to be able to

understand other people by putting ourselves in their situations. When we understand,

value and respect others, we are able to provide the healing that they need.

A1. Differences Between Two Models of Health and Healing

Larry Dossey, a medical theorist and physician, developed a theory of health and

healing which incorporates three different eras in healthcare. In 1800s, Era I medicine

considered consciousness a mechanical entity like the physical brain (Dossey, 1996).

This era looks at the body and the mind as purely physical, as purely pursuing the blind

laws of nature. The therapies that shake out of that approach are medications, surgery,

radiation and so on (Dossey, 1996). Era II, which is known as the “mind-body medicine,

emerged in the 19thcentury, when scientists began to understand what is known today as

the mind-body connection. In Era II, consciousness is believed to have an influence on i

individual health (Dossey, 1996). Era III medicine adds a spiritual dimension to health,

according to Dossey, and captures the idea that consciousness can extend beyond the

body. Dossey uses the term “non-locality” to express the notion of an expansive

consciousness (Dossey,1996).

The two eras that interest me the most are Era I and Era II. Era I believed that all

illness has a physical solution, such as medications, physical manipulation, or surgery.

This era demonstrates that the mind and body are exclusively physical in nature. On the

other hand, Era II demonstrates that disease has “psychosomatic” aspects that emotions

and feelings can influence the body’s function (Dossey, 1996). Era II interests me because a person’s perspective and attitude influences the healing process. When one has

positive viewpoint, the outcome will be positive and vice versa.

A2. Models and Professional Presence

My first few months as a registered nurse, my practice was based on policies and

procedures. I would go home late because everything I performed was by the book.

When my patients complained of pain, I would give them medication without thinking

what could be causing this pain. This align to Era I because every illness has a

physical solution such as medications.

After being a nurse for two years, I believe that my practice has merged from era

I to era II. Era II is the connection between the mind-and-body, our emotions and

feelings can impact the body’s function. An example would be when I check my

patient’s blood sugar level. The result would be in the high 200’s to 300 mg/dl, and my

patient would tell me that they barely ate and at home he or she would usually be in the

100-150 mg/dl. In my mind, I would just think it’s the hospital food that is causing their

blood sugar level to increase. As this situation arise more often I begin to question and

realize that being in a hospital is very stressful because they have family and financial

issues to think about and have no control of. Being stress can increase blood sugar level

and this is the cause of their hospital hyperglycemia episode. A similar situation would

be when a patient becomes hypertensive in the hospital with no history of hypertension.

When a person is stress about his or her situation or environmental situation, it can

negatively affect our body system because our mind and body influence one another.

A3. Influence in Nursing Practice

My nursing practice is influenced by era II, the mind-body connection. I have only been a

nurse for two years and I have seen the powerful connections between the mind and body

on my patients. As a nurse, I try to put myself in their situations. Working at the largest

acute hospital in Nevada, I have seen many patients readmitted at the hospitals for the

same diagnosis. An example would be patients admitted with hyperglycemia. Most

people don’t realize that being stress increases a person’s blood sugar. At times, I am

guilty of not being mindful of stress factors that may affect my patient’s blood sugar

level. When taking my patient’s history during admission, I would have patient who

would tell me that they have lost their jobs , recently divorce, or who just lost their

house. Going through difficult situations in their life has put stress in their body and

affected their body systems. Nurses and other healthcare workers need to be mindful of

our patient’s situations and environment because the mind plays a role on our

health.

B1: Personality Assessment Submission

Custom Keirsey Temperament Report for: Carla Buison | Your Keirsey Temperament Sorter Results indicates that your personality type is that of the Guardians (SJ's) are the cornerstone of society, for they are the temperament given to serving and preserving our most important social institutions. Guardians have natural talent in managing goods and services--from supervision to maintenance and supply and they use all their skills to keep things running smoothly in their families, communities, schools, churches, hospitals, and businesses. Guardians can have a lot of fun with their friends, but they are quite serious about their duties and responsibilities. Guardians take pride in being dependable and trustworthy; if there's a job to be done, they can be counted on to put their shoulder to the wheel. Guardians also believe in law and order, and sometimes worry that respect for authority, even a fundamental sense of right and wrong, is being lost. Perhaps this is why Guardians honor customs and traditions so strongly -- they are familiar patterns that help bring stability to our modern, fast-paced world. Practical and down-to-earth, Guardians believe in following the rules and cooperating with others. They are not very comfortable winging it or blazing new trails; working steadily within the system is the Guardian way, for in the long run loyalty, discipline, and teamwork get the job done right. Guardians are meticulous about schedules and have a sharp eye for proper procedures. They are cautious about change, even though they know that change can be healthy for an institution. Better to go slowly, they say, and look before you leap. Guardians make up as much as 40 to 45 percent of the population, and a good thing, because they usually end up doing all the indispensable but thankless jobs everyone else takes for granted. On the job, you seem to innately understand how to create smooth, working processes in your environment. You can excel at directing others to fulfill their duties. In your ideal workplace, you and your colleagues would know what is expected of you and be predictably rewarded for meeting these expectations (Keirsey, 1998). |

B2. Test Result Analysis Keirsey Temperament Theory has four basic temperament in which each

temperament has its own unique qualities and shortcomings, strengths and challenges.

First “as concrete cooperators, Guardians speak mostly of their duties and

responsibilities, of what they can keep an eye on and take good care of, and they're

careful to obey the laws, follow the rules, and respect the rights of others.” (Keirsey,

1998). Second temperament “as abstract cooperators, Idealists speak mostly of what

they hope for and imagine might be possible for people, and they want to act in good

conscience, always trying to reach their goals without compromising their personal code

of ethic.” (Keirsey, 1998). Third temperament “as concrete utilitarians, Artisans speak

mostly about what they see right in front of them, about what they can get their hands on,

and they will do whatever works, whatever gives them a quick, effective payoff, even if

they have to bend the rules” (Keirsey 1998). Fourth temperament “as abstract

utilitarians, rationals speak mostly of what new problems intrigue them and what new

solutions they envision, and always pragmatic, they act as efficiently as possible to

achieve their objectives, ignoring arbitrary rules and conventions if need be” (Keirsey,

1998). Based on the Keirsey Temperament survey, I believe that the description of a

guardian matches my personality. At the current hospital that I work for, I am known to

be easily approached and friendly. But at the same time, I know that my priority are my

patients. On a daily basis, it is my responsibility that I provide the care that my patients

need and deserve. I am the type of nurse who will prioritize patient care over paperwork.

Like the description of guardians, I am never comfortable about taking shortcuts because

it jeopardizes my patient’s life. My performance as a nurse is within the standard of

practice that is safe and effective.

B2a. Preference and Alignment

The guarding temperament aligns with my personal relationship, activities, and

my career choice in so many ways. My number one priority in my life is my family. My

personal relationship with my family matters most and I am the type of person who will

do everything to keep my family together. I’ll sacrifice my own happiness in order to

provide for my family. Guardians “use all their skills to keep things running smoothly in

their families” (Keirsey, 1998). “Guardians can have a lot of fun with their friends, but

they are quite serious about their duties and responsibilities” (Keirsey, 1998). Although I

want to travel to different countries with my friends, I know at this point I have a goal to

reach. During my undergraduate, I promised my parents that I would buy them a house

after a couple of years of working. I am still determined to reach that goal, and at this

point I am willing to sacrifice traveling. Like any guardian, I pride myself on being

dependable, helpful and hardworking. When I told my friends and relatives that I wanted

to become a nurse, their opinion was I was going to waste my time and fail at my career

goals. As many of us are aware, choosing nursing as a career can be a gamble pathway

because no one can be a hundred percent sure that they will get into the nursing program.

But I am very hardworking and determine that I will achieve my dream career regardless

of the challenges that I will encounter. From the start, I know that this career will give

my family and I financial stability and enhance to become a future leader to the

community.

B2b. Potential Challenges or Barriers

I believe that I am a complete opposite of the artisan temperament. “Artisans

want to be where the action is; they seek out adventure and show a constant hunger for

pleasure and stimulation” (Kerisey, 1998). In my perspective, artisans are people who

don’t think about the consequence of their actions in the long run. As a guardian, I

believe that the actions I take will impact me in the future. I believe in the guardian’s

description “working steadily within the system is the Guardian way, for in the long run

loyalty, discipline, and teamwork get the job done right”(Keirsey, 1998). I am very

discipline and loyal with my decisions, especially when my future and career is involved.

“Artisan seem right at home with tools, instruments, and vehicles of all kinds, and

their actions are usually aimed at getting them where they want to go, and as quickly as

possible” (Keirsey, 1998). Although I consider myself as technology literate, I am not as

a quick learner as artisans. It takes time and practice for me before I become comfortable

with using tools and instruments.

C1a. Whole Person Goals

Physical: 1. To have a healthy body 2. To be more fit
Mental:
1. To feel better about myself
2. To not hold grudges

Spirtual:
1. To go to church more often
2. To be thankful for everything that God has blessed me with

Vital/Rhytmic: 1. To get 8 hours of sleep each night 2. Balance family, work, school

C1b. Achievement of Goals

Physical:

1. I will eat more vegetables and fruits with my meals, and cut down on my meat. I

will also eat more home cook meals rather than eating at restaurants.

2. I will include at least 30 minutes to an hour of exercise in my daily schedule.

I will use the stairs whenever possible instead of taking the elevator.

Mental:

1. I will think more positive about myself and feel proud on the things that I have

achieved. I have always believed in the quote “ Train your mind to see the good

in everything. There is always something to be grateful for.”

2. I will forgive those who has hurt me emotionally. I will live my life without any

hatred.

Spirtual:

1. I will take Sundays off from work so I can attend masses Sundays.

2. I will not only pray for the things that I hope that will happen but rather also

pray for the things that God has blessed me with.

Vital/Rhytmic:

1. I will set myself a bedtime each night. I will try to get home from work as

soon as I can so I can sleep my scheduled bedtime.

2. My family is currently living in California. I will go back home at least once a

month so I can spend time with them. I will not pickup extra days of work so I

can have more time for school and my family.

D1. Best Practices

The Samueli Institute has identified a framework that promotes the highest

level of healing, Optimal Healing Environments. According to this framework, a

healthcare institution must contain four elements to be considered an optimal healing

environment (Samuel Institute, 2013).

The four elements are:

* Internal Environment * Interpersonal Environment * Behavioral Environment * External Environment Internal environments:

Healing intention and personal wellness are the two components of internal

environments. Healing intentions are expectations, hope, understanding and beliefs.

Personal wellness includes mind, body, spirit and energy. At Enloe Medical Center is committed to providing a nurturing environment where patients are surrounded by caring staff and supported by opportunities and resources that promote healing of the body, mind and spirit (Enloe, 2007). The mission of Enloe Medical Center is to improve the quality of your life through patient-centered care. Stamford Hospital is committed to personalizing, humanizing, and demystifying the healthcare experience for patients and their families. Stamford’s approach to patient- centered care is holistic and encourages healing in all dimensions—body, mind, and spirit (Stamford, 2004). Interpersonal environments:

Healing relationship and healing organization are the two components of

interpersonal environments. Healing relationships include communication, compassion,

social support, and empathy. Healing organizations includes mission, leadership,

teamwork and technology. Enloe Medical Center created a “Patient-centered care

retreats for staff which all employees are provided with an eight-hour training to help all

enloe employees with an understanding of Planetree and its techniques. Retreats

introduced caregivers to the tools for nurturing and healing, building on their strong

caring qualities.

Stamford Hospital created a patient and family partnership council. The council

continues “to be comprised of those who have utilized Stamford Hospital and are

enthusiastic in helping the hospital improve our patient experience and philosophy of

patient-centered care” (Stamford, 2004). The hospital believes that when they work

together as a team, it improves everyone’s satisfaction.

Behavioral environments:

Healthy lifestyles and integrative care are the two components of behavioral

environments. Healthy lifestyle includes diet, exercise, addiction and management.

Integrative care includes family centered, patient centered and cultural sensitive. Enloe

Medical Center value the ideal that everyone within the organization is a caregiver and

fully engaged in creating a culture of service. Enloe Medical Center provides classes

such as pre-diabetes class, healthy hearts and stress reduction.

Stamford hospital believes in a supportive, caring environment for patients,

families and staff is essential to providing quality care. Stamford hospital offer Patient

Directed Visitation, where patients choose who can visit and when, as well as a Care

Partner Resource Center for family members (Stamford, 2004).

External environments

Healing spaces and Ecological sustainability are two components of external

environments. For Enloe Medical Center, a calm, quiet place is the ideal for the healing

process. To help manage noise, Enloe Hospital eliminated routine overhead paging.

Enloe Hospital also encouraged quiet time by dimming the lights for a period of time

each day on our inpatient units. This concept is to help create a quieter environment

where patients can get more health-restoring sleep while in the hospital (Enloe, 2007). Stamford hospital created healing environments that are warm and welcoming

with design that focuses on comfort and removing barriers between patient and staff.

Stamford offers the care channel (channel 49) to help patients relax. At 8 pm. Stamford

hospital dim their lights, lower voices, and close doors for quiet time to help induce

sleep and healing (Stamford, 2004).

D2. Professional Presence Promotion

I currently work at Sunrise Hospital Medical Center in Las Vegas, Nevada.

Sunrise Hospital is the largest acute care in Las Vegas Nevada. Although Sunrise

Hospital does not incorporate many of the aspects of the optimal healing environments, I

believe that the hospital will reach the goal of becoming a magnet hospital. Each nursing

station of the hospital has a call light answer and has a designated secretary who will

answer and rely the message to the nurses and certified nursing assistants. This is one

method that they are using to improve their patient satisfaction. Recently, Sunrise Hospital has also stopped paging every “codes” in the hospital unless it is a “code” that

rapid response team has not attended to in the next five minutes. Rather than paging

overhead, the hospital now provides cellphones, which every charge nurse and rapid

response team has to be aware of “codes” in the hospital. Sunrise hospital offers classes

to patient and families such as diabetes class, ways to prevent stroke, and healthy living

classes each month.

Sunrise Hospital is on the process of becoming a part of the magnet hospital

system. From eliminating overhead paging, remodeling the cafeteria and rooms, and

providing free classes to families and patients, Sunrise hospital is determined to improve

patient’s satisfaction to provide optimal healing.

References

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Planetree - Healing Environment - Enloe Medical Center - Chico, CA. (2007). Retrieved

January 09, 2016, from http://www.enloe.org/about-us/planetree/healing-

environment

Keirsey Temperament Website –Overview of the Four Temperaments. (1998).

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http://www.keirsey.com/4temps/overview_temperaments.asp

Koerner, J. (2011). Healing Presence, The Essence of Nursing. New York: Springer

Publishing Company.

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http://samueliinstitute.org/

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