PROFESSIONAL PRESCENCE AND INFLUENCE

Western Governments University

January 12, 2016

PROFESSIONAL PRESENCE

What does it mean to be human, and how do we as nurses provide care to our patients? According to Jean Watson “The future of nursing is tied back to Nightingales sense of calling guided by a sense of commitment and covenantal ethic of human service; cherishing our phenomena, our subject matter and those we serve. It is when we include caring and love in our work and our life we discover and affirm that nursing, like teaching is more than just a job but a life giving and life receiving career for a lifetime of growth and learning” (Watson, J. 1978). There have been many different individual thoughts and theories on what it means to be human and how to provide a healing presence. According to Koerner “western medicine traditionally conceptualized the body as a grand machine controlled by the brain and central nervous system” (Koerner, J.G. 2011). In a sense a living computer! “Physiologic and psychologic behaviors were considered dependent on structure and hardware of the brain and body” (Koerner, J.G. 2011). Healthcare and how we take care of people have changed over the years with the different advancements in medicine and psychology. Health and healing is not only seen as physical but also includes mind, spirit and biopsychosocial including cultural factors. These aspects helped shape the different modalities of how we take care of patients. Larry Dossey has described three different models of health and healing. Era I according to Dossey is the Mechanical Era, in this Era health and healing was considered to be more physical in nature. Healers believed that a person’s health was determined by physical factors. Era II not only was health and healing influenced by physical aspects but also by feeling and emotions (Dossey. L. nd). An example of this is too much stress. We now know that too much stress can cause increased blood pressure predisposing people to heart disease, diabetes and stroke. The newest and most recent of Larry Dossey’s Eras is Era III which took shape in the 1990’s. Era III is considered the body, mind, spirit and biopsychosocial model. In this model Dossey explains that healing is not only on a physical level but a conscious level. Dossey states “Consciousness is not confined to an individual body, an individual mind may affect not just their body but also other people around them” (Dossey,L. nd). The Eastern models of TCM (Traditional Chinese Medicine) and the Ayurvedic beliefs about being human and caring for people are similar to Dossey’s theories. These theories underlying belief in how to provide care are the body is made of 5 elements and disease is caused when there is an imbalance between the elements (“Traditional Chinese Medicine: In Depth & What is the Philosophy of Ayurvedic Medicine, nd). There are many different styles in the way a presents a caring presence to their patients, such as a nurse’s personality, and mindfulness practice to the way they provide a healing environment. As a nurse the caring model that I can relate to most is Dossey Era III. I believe that health and healing is not just about the physical aspect but involves the person as a whole. Healing involves not only physical, mind, body, spirit and cultural factors; but also involves patients and family involvement in their own care. Being in the emergency department I see many different aspects of human nature. The emergency department I work in is busy it deals not only with minor medical treatments, more invasive medical treatments, traumas, and death but also manages and holds psychiatric patients, ETOH patients, homeless patients and Drug addicted patients. In order to be an effective nurse I can’t look at just their physical ailments but also their mental and spiritual suffering. If in the healthcare field physical ailments were the only cure patients would be just treated with medicine and surgery. When I take care of patients I treat them as a whole person. In my nursing along with doing a preliminary assessment labs and vitals. I just listen to my patient concerns and be empathetic to them and their family. “Clinical Empathy involves an ability to understand the patient’s situation, perspective and feelings” (Mercer, S.W. & Reynolds, W.J. 2002). By practicing my nursing in this way I can learn what my patients’ needs are and be proactive in their care. I recently took care of a young native American man with chest pain. He was young, but had relapsed from meth. While drawing his labs, doing an initial assessment, and EKG to address his physical needs. I was having a conversation with him During the course of our conversation he explained to me that he has used meth after being clean and sober for a year. He then went on to explain all the other stressors that were going on in his life. He was recently separated from his wife and she was in North Dakota and he came out to Washington to find himself. He was also busy helping out as a member of his church with the local youth group trying to help the kids stay out of trouble. Now he felt depressed because he let himself down and felt like he let other people down as well. In this nursing situation not only did I have to assess the physical factors of his health, but also social, emotional, spiritual and biopsychosocial. Stress can cause cardiovascular problems, such as hypertension, stroke and coronary artery disease. Fortunately for this patient his chest pain was related to anxiety and not physical disease. If he would have been treated for physical needs his underlying cause of his chest pain, his emotional and spiritual needs would not have been met. By treating his underlying needs listening to him and arranging resources for him such as social work. I was able to help him relieve some of the stressors and help his chest pain resolve. According to Jon-Kabat-Zinn “Mindfulness means paying attention in a particular way; on purpose, in the present moment & non-judgmentally” (Zinn, J.K. nd.).
During my 12-hour shift at work he was just one of the many patients I saw. In the emergency department there is a large volume of patients and quick turn arounds it’s hard to stay mindful. When I’m mindful in my patient care it’s easier to see the whole picture of my patient and also possibly catch errors and clarify orders. A good example of this is catching med errors before they occur. I had a pediatric patient in one of my rooms with new onset seizures. The patient was also experiencing nausea and vomiting. The physician had written an order for 4mg Zofran IV to be administered. I questioned the order because of the age of the patient and weight and had pharmacy recheck the dose. The patient was only supposed to receive 2.3 mg IV. This med error was averted because I was being mindful when I was at work. Being in the ED there can be several different distractions throughout the day. You feel like you’re being pulled in different directions. When I’m distracted it feels like I have given inadequate care to my patients. It also makes me feel like I have been inadequate as a nurse. Charting and remembering what to chart becomes difficult. My goal throughout the day is always stay mindful and give my patients adequate care to the best of my ability and knowledge.

PERSONALITY PREFRENCES Personality can be defined as the set of emotional qualities, ways of behaving and complex characteristics that distinguish and individual (“Plagiarism,” 2016).

Custom Keirsey Temperament Report for: Kenna | 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.Establishing and following a familiar daily routine is critical to your well-being. In your ideal job, you and your coworkers would all share information so that everyone could remain "on the same page” as projects move forward. Because you genuinely care about the people you work with, your colleagues and your customers appreciate your unassuming kindness. (Kiersey, D. nd). | |

According to the Kiersey temperament Sorter My temperament is considered to be a Guardian. A Guardian makes up to 40-45 % of the population with 50% being women and 57% being nurses. According to the assessment all Guardians share core characteristics such as making loyal mates and responsible parents, Guardians have a natural talent in managing goods and services and use their skills to keep things running smoothly, Guardians are considered dependable, down to earth and reliable. Most Guardians have fun with friends but know duties and responsibility come first. In their careers Guardians are meticulous about schedules, follow proper procedures and have a difficult time with change or winging it. Guardians normally cooperate with other people and generally care about the people they work with. From reading this profile I have to say I agree with most of the profile. I feel I’m a responsible parent and devoted mother and wife. My family sometimes says I keep the house together which means that sometimes responsibilities and household work comes before having fun. When I do get out and have fun I have a few close friends that I like to spend time with. Normally on a weekend off, or once a month me and my girlfriends set up a lunch date. Being nurses we all have varying schedules, but are able to rework our schedules in order to ensure that we have the same weekends off. In my career I pride myself in working well with my coworkers to get the work done, I don’t like being behind and generally like to stay on task. I treat everyone I know how I, myself would want to be treated. I also try not to complain, although there are times that I do especially when I feel like I’m falling behind in my tasks at work. I ‘am also cautious about change but not opposed to it. Most recently at my job a new nursing director was hired I was nervous about it because the department seemed to be running smoothly with the prior director. After having a discussion with the new director I realized the plans that she wanted to put in place for the department were good plans and would benefit the department in the long run. Even though I work well with all of my coworkers, I could see a potential challenge working with an Artisan. As a person who likes to stay on task, follow the rules and get facts before making a decision or jumping in blindly at work there may be challenges. Artisans like to blaze their own trails and sometimes bend the rules to accomplish their goals. Artisans also like to seek out adventure and show a constant hunger for stimulation. By being self- aware of an Artisans temperament instead of it causing conflict I could use it as an advantage when working as a team. In certain circumstances action is required more than following rules. Artisans are quick in making decisions and carrying out decisions. Artisan may want to have an assignment with more complex patients. By knowing this working with an Artisan may be beneficial in that they will be more eager and willing to help out more with complex patients. By being self- aware it will be enable me to have less conflicts at work and collaborate with my co-workers. Mindfulness Practice Generalized distractions, stress and anxiety can interfere with being mindful in my job and home life. My goal is to develop a mindfulness practice plan that will help me to decrease distractions stress and anxiety. For my mindfulness plan to be effective and accomplish my goals I have to make sure my plan has attainable. My plan will address the four different aspects of being mindful including the physical, emotional spiritual and vital/rhythmic. Physical- I’m currently slightly overweight at 153 pounds and being 5ft 4in. I recently had surgery and have been physically inactive for the past 2 months. I don’t believe the holidays helped out also due to all the delicious food there was to eat. My goal for the physical aspect in my life is to improve my diet by decreasing food high in sugar and fat. Along with watching what I eat I also plan to become more active by walking my dog for 1.5 mile or trying to do either an hour on my elliptical or stationary bike in order to lose at 10 pounds.Emotional-I live in Washington state so on gloomy days I find I become easily depressed. My plan for decreasing my depression is by using imagery on the gloomy days remembering times with my family or friends that were enjoyable. I also plan to spend an hour reading a book every day. When I read it helps me to relax and keep my mind busy. Spiritual-This is probably the most important aspect for me to work on for years I have struggled with my faith. My spirituality goal is becoming closer to God and knowing the there is a higher power. How I would like to accomplish this goal is by going to church on the Sundays I have off from work (every other Sunday) or as my schedule allows. I would also like to become more involved in my church by either volunteering or joining a bible study group. Vital Rhythmic-For the vital rhythmic aspect of my life my goal is to become more relaxed and have increased energy at work. Being a busy mom, working full time and going to school full time can take a toll on my body causing me to have a decrease in energy. I plan to relax at work by practicing meditation and breathing exercises during my 15 minute breaks. To also increase my energy at I plan to get at least 8 hours of sleep. I believe I can accomplish this by practicing more time management in my life. On the days that I work I need to have my meals prepared ahead of time so when I get home I don’t have to spend time cooking. I also need to have my stuff set out the night before so I’m not rushing in the morning looking for things. I believe if I’m able to accomplish all of these goals the changes in my life will be for the better. I will feel better about myself, be less distracted, and less stressed. I will be able to perform more efficiently at work because I will have more energy, by treating my body better by eating right, getting enough sleep and generally knowing who I’ am.Healing EnvironmentsThe Samueli institute believes an optimal healing environment by focuses on the patient as a whole. “All aspects of a patient experience physical, emotional, spiritual, behavioral and environmental are optimized to support and stimulate healing” (Optimal Healing Environments nd). The framework for the optimal healing environment are broken down into 4 domains. The internal which provides the healing intention and personal wholeness. The interpersonal environment that provides a healing relationship through social and professional interactions. Behavioral environment which is the physical aspect by practicing and encouraging a healthy lifestyle, and patient focused and family center care to promote healing and prevent illness. The last domain is the external environment in which care is optimized by a patients’ external surroundings done through the use of art, architecture colors and designs to foster wellness and recovery. Most healthcare institutions goals are to achieve optimal healing environments. Some institutions practice portions of one or two of the domains for optimal healing environments. Few institutions have achieved an optimal healing environment. Kadlec Regional Medical Center in Richland Washington follows the Planetree design. Kadlec’s goal for their patients is to make everyone’s patient experience less stressful and more healthful by creating a healing environment and not treating patients by just their diseases or procedures. They do this in practice by treating the patient as a whole person. Examples of how Kadlec Regional Medical Center provides an internal healing environment is by providing massage therapy to their inpatients, and aroma therapy to promote relaxation. Kadlec provides interpersonal environment by providing unlimited visiting hours to family and friends and making them feel welcome. Kadlec promotes behavioral environment by involving family and friends in the patients plan of care. Kadlec Regional Medical Center has on campus and outdoor garden area that provides and external environment to their patients where they can go and optimize wellness and recovery. Another way Kadlec Regional Medical Center provides and external environment is they provide their patients with entertainment and music (Kadlec, nd). Not only is Kadlec Regional Medical Center an optimal healing environment in Washington state. Another Facility that provides an optimal healing environment is Seattle Childrens Hospital. Seattle Childrens Hospital is considered a Magnet hospital meaning they have the highest standards for their nurses. Seattle childrens hospitals motto is to provide hope, care and cure for patients and family. They do this by meeting the emotional, physical and developmental needs of the patient and their families. They collaborate with physician and specialties to provide patient and family centered care. Seattle Childrens Hospital provides an internal environment by providing a program called Child Life. The program allows families and patients to relieve tension and fears so they can feel more in control of their feelings. Seattle Childrens Hospital supports an interpersonal environment by providing onsite counselors and interpreter services for deaf, hard of hearing non English speaking patients and their families. This will enable families and patients to be partners in their care by bridging the gaps of communication difficulties. Seattle Childrens hospital provides a behavioral environment by providing their patients and community helpful information about preventing illness and maintaining health. They do this on their online website magazine called Good Growing. The magazine provides tips to parents about preventing accidents in the home, providing home care treatment for such things like the common cold and general advice for good practices when raising children. Seattle Childrens hospital not only provides an external environment by their use of colors and fun art but also by helping families arrange places to stay, transportation and providing them with neighborhood resources which can be arranged through their guest service department (Seattle Childrens Hospital, nd).The facility I work in is an older facility that needs improvements in order to be considered an optimal healing environment. In the emergency waiting area it is not bright, cheerful or colorful. The space sometimes seems confining because it is very busy, not inviting or family friendly. A nice change that I would like to see in the waiting area is providing a more family friendly area that would show that we as a facility care about our patients. I think it would be easy to do this by offering magazines for patients to read while their waiting or providing children coloring or activity books while their waiting. On occasions patients sometimes wait 3 hours or more. Rounding on patients more in the waiting room and updating them about their wait time. Putting these changes in place may help to cut down on our patient numbers of leaving without being seen. Another change that I think would be instrumental in improving our facility is private rooms in the emergency department. Right now we have rooms that house two or sometimes three patients and are separated by curtains. When the patients are speaking with their physician the patient in the curtain next to them can hear what the patient is saying, there is no privacy. In the near future our facility is supposed to be remodeled and hopefully some of these issues will be addressed.Conclusion In conclusion what I learned most from this course is self-knowledge about me as a professional and the things I can accomplish. I learned what it means for me to be a more mindful nurse in my nursing practice in order to take better care of myself so I can provide better care to my patients. By learning what my personality is and how it will help me in my career going forward. I also learned that even though my facility is not and optimal healing environment there are a few things I can do as a nurse to make it more inviting to patients. I believe like Jean Watson summed it up “that when we include caring and love to our work and our life that we discover and affirm that nursing, like teaching is more than just a job but a life giving and life receiving career for a lifetime of growth and learning” (Watson, J. 1978). ReferencesDossey, L. MD (nd) A Conversation about the Future of Medicine Retrieved from http://www.dosseydossey.comKoerner, J.G. Healing Presence: The Essence of Nursing. (eds 2.) (2011). Danvers, MA: Springer Publishing Co.Kadlec (nd). Kadlec.org Retrieved from http://www.kadlec.org/PlanetreeKiersey, D (nd). Kiersey Temperament Sorter II. Retrieved from http://www.kiersey.comMercer, S.W. & Reynolds, W.J. (2002, Oct) Empathy & Quality of Care. Retrieved from http://www.ncbi.nlm.nih.govOptimal Healing Environments (n.d.) Retrieved from http://www,Samueliinstitute.org/research-areas/optimal-healing-environments/ohe-framework/internalSeattle Childrens Hospital.org (n d). Retrieved from http://www.SeattleChildrensHospital.orgTraditional Chines Medicine (n.d.) Retrieved from http://www.nccih.nih.govWatson, J. Theory of Human Caring (1978). Retrieved from http://www.watsonscaringscience.orgWhat is the Philosophy of Ayurvedic (n.d). Retrieved from http://www.takingcharge.csh.umn.eduZinn, J.K. What Does Mindfulness Involve. (n.d.). Retrieved from http://www.mindfulnet.org | |