Professional Presence and Influence: The Art of Nursing
Nicole R. Penkalski
Western Governor’s University
May 8, 2016

“A nurse who is totally present sees the subtle, perceives the whole, and co-creates with the person—and the health team—a creative response to the uniqueness of the situation,” (Koerner, 2011). Jean Watson’s Theory of Human Caring established a framework of core concepts that assists in understanding the concept of “being human”. Personalities, life experiences, and core values allow an individual to become a certain type of provider. Being aware of personality traits and how they impact us as individuals can help us to become more efficient providers of healing for the diverse population as it stands today. Fostering a healing environment that can encourage excellence for nursing practice that involves mindful presence can create greater outcomes for patients.
Models of Health and Healing
The history of nursing dates back centuries with different eras of health and healing that have led us to this moment in time and the way nursing is currently practiced. Although there are many types of health and healing, in the United States predominately conventional medicine is practiced. There are three Eras that require review to gather information and understanding that help to redefine how health and healing has arrived at its current form. The first Era is Era I which took foothold in the 1860’s and focused on biomedicine. Era II, which began in the 1950’s, focused on mind and body healing. Finally, we find ourselves in the current Era III which concentrates on body, mind, and spiritual healing, which also may be referred to as the bio/psycho/social model. Moving forward from one era to the next has allowed healthcare providers to reach a state of acceptance, awareness, and appreciation for the various modalities of healing therefore allowing the patient to become more of a participant in their own healthcare.
To allow for comparison between two Eras as they may relate to what it means to be human, a definition is necessary to establish what is meant by “being human”. Each individual may view “being human” as something different based on perspective, worldview, and life experiences. From an individual perspective, “being human” means a state of wholeness defined by not just the physical being, but the mental, emotional, and spiritual aspects of an individual.
Era I, Mechanical Model evolved in the 1860’s with a single focus on the health of a person being simply physical in nature. According to Koerner (2011), “health and illness were completely physical in nature.” This Mechanical Model is based on in scientific medical practice. The treatment and diagnosis of illness was solely related to physiological functioning which in turn took the “being human” aspect out of the equation. Emotional, social, and spiritual elements of and individual were not even considered. This model is simple and uses the laws of nature. The physician utilizes the tools available to fix the problem.
Era III, referred to as The Mind, Body, and Spirit or Bio/Psycho/Social Model began in the 1990’s and continues to forge itself into our clinical environments today. The evolution of the quantum physics paradigm, varying belief systems and different modalities has opened our eyes as professionals to the “wholeness” of a person. “In this rich multidimensional world, we can choose to treat the “whole person,” which includes the physical, emotional, mental, and spiritual aspects of our life, by inviting in the power of soul. The essence of soul consciousness influences the brain via the mind and touches all aspects of the person’s nature. In this approach to healing, we invite symptoms and suffering into our space as our guide,” (Koerner, 2011). Within this model it is obvious that “being human”, “professional presence”, and “mindfulness” are integrated to allow for accurate evaluation of illness and disease. Facilitating the management of all body elements with accurate evaluation and assessment will assist practitioners in determining the type of treatment and provide a healing environment that caters to needs other than physiologically required.
Models and Professional Presence
Professional presence is significant to the way we act and interact with patients, families, and interdisciplinary team members. Being mindful or present in the moment can help us to not only decrease internal anxiety, but grasp the situation with confidence, compassion, and empathy. “We can define mindfulness as a state of mind or mode of practice that permits the questioning of expectations, knowledge and the adequacy of routines in complex and not fully predictable social, technological, and physical settings, (Jordan, Messner, and Becker, 2009). Era I, The Mechanical Model did not require the display of empathy, compassion, or any other quality that would play to the key areas of the human psyche that may impact the physical body. The doctor was simply a mechanic and the nurse a technician to follow orders of routine. All things considered only physiological in nature.
A strong professional presence is very noticeable in my everyday practice. A vivid sense of control, confidence, and display of authentic character are obvious when I walk into a crisis situation or a simple conversation. The patient is a complicated intertwining of many aspects of life that may be all taking a toll on the patients physical well-being. I try to take into consideration in all my interactions that I may not know the totality of this individuals suffering, but it is my obligation provide a conscious effort to keep my mind open to all things. Listening to the patient and family to evaluate what their needs and concerns are at the time. Provide emotional support and social services if necessary. Carefully assess all the needs of this patient from physiological, to emotional, to psychosocial. I try to always be present in the moment and aware of my own consciousness.

Influence on Nursing Practice
“Nurses walk between two worlds, the material world of a scientist and the creative world of an artist. Our craft depends on a well-developed sense of aesthetics: if it does not “look right,” it is not functioning properly. The intuitive capacity of the nurse is the heart of the sentinel function at the bedside, which notes a subtle shift heralding a potential crisis. Early identification assures intervention with the least amount of effort to restore balance,” (Koerner, 2011). Professional presence simply guides my practice. There is no other way to describe the internal ethical, moral, dedicated compassion for life that I innately have as a birthright. Being professionally present requires that I am aware of things and situations that effect my thoughts, decisions, and choices. These qualities allow my nursing practice to be powerful in gaining the trust of my patients and families. The confidence that resonates when I enter a room, educate a patient and assume responsibility for something that reassures them provides for quality care and positives outcomes. “Mindfulness explicitly recognizes that the reflective process is not limited to cognition alone. Mindfulness practice perceives reality by liberating attachment to memories of the past and fantasies of the future, bringing the present moment clearly into focus beginning with grounding in present-moment body sensations,” (Sherwood and Horton-Deutsch, 2012). Nurses are challenged daily with situations that have the potential to curb decision making. Strong professional presence decreases the opportunity for situations to control my practice rather than my practice controlling the situation.

Personality Assessment and Analysis

According to this assessment, I am part of a large group in our society that attempts to preserve our societies traditions. As a part of this, being good at managing, following the rules, and keeping things running smoothly are qualities that I agree with completely. I always say, “things have a place and they should be in that place. Rules are made for a reason, unless there is substantial reason to break them, they should not be broken.” Respect for law, elders, order, and a dee respect for any authority have been engrained in me since childhood. Finding a solid environment with teamwork is essential to my character, if it is absent, by all means my dedication and loyalty will do what is necessary to bring this to the forefront. Procedural practices are to be adhered to strictly to create smooth running environments. These qualities tend to work extremely well with the environment that I have chosen to work in for my career choice. As a nurse, teamwork is essential for safety and quality outcomes.
There are times when varying personality types create a situation that may be dangerous unintentionally or not conducive to providing care for patients admitted to the hospital. I find it challenging to work with a partner that is self-focused. Some people have work ethics that entail individual, self-motivated tasking without consideration for the team. There are many people involved in the care of a patient therefore, working with a self-focused attitude will not work for long. I tend to see this quickly and by utilizing professional presence and mindfulness encourage a change indirectly to the other person’s behaviors. Again, this is how professional presence can bring forth a positive change. Another challenge for me is people that do not follow protocol. If you don’t agree with the protocol, don’t just do your own thing, do something about it. Takes steps to potentially get this procedure changed if you think it is not safe, effective, or time managed. When I see people doing this, I quickly and professionally bring it to their attention, yet give them options for appropriate behavior. Listening to the reasoning behind someone else’s behavior that may not be congruent with yours can potentially open a new thought process and procedure details.
The assessment gives light to the guardian liking to have fun with friends and being down to Earth. These personality traits run congruent with my lifestyle and the way I have been since childhood. A lover of the outdoors, I find peace in simple activities such as running and bike riding. Through these activities, I gain freedom of thought, assists in my weight loss goals, and brings me closer to the healthy and tone body that is so important as a reflection of practicing what I preach. Television has never been a focus in my life as I would rather participate in volunteer activities, such as feeding the homeless than to sit in the house. Involving family and friends in activities that help the community as a whole is a huge part of my life. As it stands, the assessment was completely accurate in defining me and my behaviors as a personality type. I don’t see challenges to my personality as wrong, just different and I am always open to others viewpoints. Whole Person Goals and Achievement
There are four aspects to be considered in relation to establishing a plan for mindfulness. The physical, vital/rhythmic, mental/emotional, and spiritual. According to Sherwood and Horton-Deutsh (2012), enhancing emotional intelligence helps a nurse in the performance of their practice. Establishing goals and having a plan to achieve those goals increases self-awareness.
Physical
The first goal of the physical aspect is to obtain a satisfactory amount of weight loss. Achieving this weight loss will improve my physical conditioning and stabilize my blood pressure possibly eliminating the hypertension. This goal has the potential to help me avoid a long standing family history of cardiac mortality. The plan to achieve this goal is two-fold. Initially, I have a plan to make a lifestyle change that involves healthy eating. Paired with my husband, I will begin a diet that will inevitably become a habit and not a chore. The second part of this plan is to increase activity and exercise that is beneficial for improved cardiac function and weight loss.
The second physical aspect goal is regular biking. Biking at least three times weekly for at least eight miles which is my current maximum distance. This activity will increase my stamina, energy, and strengthen muscles that will allow for physical challenges in my work environment on a daily basis. The first step to achieving this goal has already been completed and that was to go purchase the bike.

Vital/Rhythmic Establish good wake/sleep cycles. It is important in the everyday functioning of not just the body, but the mind to get good rest. Preparing a routine for wake/sleep cycles will allow for adequate sleep and increased energy levels upon waking. My plan is to schedule myself to go to sleep no later the 10pm and awaken by 6am daily. Peaceful sleep enhances the body which goes to show that environment does have effect on physiological health. Finding a balance between family, work, and education will be my second goal in this area. A balance of anything is self-explanatory. When things such as life, relationships, finances, etc. out of balance nothing good happens. My study plan was the first step in this goal achievement. I specified time for myself to study that would not interfere with my normal family time. Sure it is a struggle to balance so many of life’s tasks and personal goals, but with effort anything is possible. The other way to achieving this goal is not to work as much as I have been over the last few years. I plan to work my three shift weekly and that is it.
Mental/Emotional
The mental goal is and always will be is to continue to challenge myself with obtaining knowledge. I find satisfaction in pursuing knowledge. Without a continued pursuit of knowledge my mind feels like it’s in a lull. Attending WGU is one stop in my plan for educational attainment of a PhD eventually. I do not foresee any obstacles in achieving this goal. Another goal I have in this area is to share my feelings and emotions when they occur. There are many times that I hold in my thoughts, feelings, and emotions to my own dismay. Internalizing emotions can lead to self-infliction of anxiety which is well known to be bad for our health. My plan is to communicate my feeling and emotions more effectively. Open communication can help to resolve bad feelings rather than cause anxiety. At home, my family is always receptive to discussion, but I have in the past held back to avoid conflict. The plan is to take a few minutes to share how I feel rather than bottle emotions up.
Biographical/Spiritual
Refresh my moral foundation and belief systems. At times parts of life gets shoved in the closet due to the hustle and bustle of life. My goal is to bring these things to the forefront again. Remind my family about the values, morals, and beliefs that we as a family have held onto for so long. Things such as loyalty, practicing justice and fairness. Treat others as we want to be treated. When you have done these things for so long achieving the goal is generally a gentle reminder. Rebuild my foundation of spirituality. Spirit in my eyes comes from within. Spirituality is a deep intertwining of the things that make up you as an individual. For me, going to church is an effort with time management, but it is the goal to be achieved. I know for sure without a doubt that this brought balance to my life. I am absolutely sure this aspect is completely attainable. Best Practices “Samueli Institute defines healing as “a holistic, transformative process of repair and recovery in mind, body, and spirit resulting in positive change, finding meaning, and movement towards self-realization of wholeness, regardless of the presence or absence of disease. The OHE framework was designed to elevate healing and health creation to be as important as disease identification and cure. If strategically implemented, the tenets of the OHE framework serve to hardwire the commitment to person-centric practice and engagement of innate healing abilities into the culture of the organization. Several assumptions are foundational to the OHE framework,” (Sakallaris, MacAllister, Voss, Smith, & Jonas, 2015). The two healthcare facilities that I reflect on when I think of optimal healing environments are Scripps Memorial Hospital La Jolla a Level II Trauma Center and UCSF Medical Center in San Francisco. Scripps was the first hospital in San Diego to reach Magnet Status. That alone speaks to how patients feeling about the staff and environment. This is a 444 bed facility that boosts itself on a 43-acre lot. Scripps has not only provided a wide range of services to its community on a 24 -hour basis, but continually donates to the community. This hospital provides a number of wellness clinics, free support for cancer survivors and their families, classes on health promotion and a high standard of care. Externally, Scripps has established worldwide partnerships for improving healthcare internationally. The professionalism and compassion displayed by the staff is far above the bar. The interpersonal communications and teamwork is so apparent that it’s not surprising they have reach Magnet designation. UCSF Medical Center in San Francisco is the second of the two hospitals that I thought of immediately when posed with the concept of an optimal healing environment. This is a very large multi-building medical center that focuses on the community, research, and health promotion. The medical staff, scientist, and all other staff members are amazing. The hospital provides the community with a number of wellness clinics, classes to educate the community on healthy living as well as, chronic conditions, cancer awareness, survivor support, etc. The list of community programs provided by this hospital and its staff is numerous. UCSF also donated to many funds and partners with many external organizations to ensure services are provided to those underprivileged community members. I must reiterate the amazing teamwork and compassion I witnessed at this facility. Medical staff to nursing staff was the most astounding communication I have seen in a healthcare facility. Professional Presence Promotion Self-awareness not only gives you a clear perception of your own motivations, strengths, weaknesses, beliefs, thoughts, and personality. Self-awareness allows you to see how other people perceive you and your actions. Self-awareness allows you to see yourself as an individual separate from others and the environment, but at the same time allows you to see the effect on others. Self-awareness allows me to see what it is I can do as an individual to make the environment I currently work in great. How can a single individual take an experience and use it to influence others? That is exactly what has been discussed previously in professional presence. As a part of my current team, I share my experiences at other hospitals with my coworkers. Being a team player, communicating effectively, encouraging openness and compassion are just a few of the things I can do to help make a great environment conducive to optimal healing. Suggesting more community partnerships to my administrative team and hoping that they consider donating to volunteer causes in the future. My hospital does some of these things currently, but not on the level I witnessed at Scripps and UCSF. Behavior can be a detriment or positive attribute to the environment in a hospital. Encouraging professional presence will inspire others to become mindful and practice the art of nursing to the degree it should be.

References
Jordan, S., Messner, M., and Becker, A. Reflection and Mindfulness in Organizations: Rationales and Possibilities for Integration. Management Learning 2009; 40; 465
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Kiersey, D. Kiersey Temperament Sorter (KTS-II). Retrieved from http://www.Keirsey.com
Koerner, J. G. (2011). Healing Presence : The Essence of Nursing. New York: Springer Publishing Company.
Sakallaris, B. R., MacAllister, L., Voss, M., Smith, K., & Jonas, W. B. (2015). Optimal
Healing Environments. Global Advances in Health and Medicine, 4(3), 40–45. http://doi.org/10.7453/gahmj.2015.043
Sherwood, G. and Horton-Deutsch, S. Reflective Practice: Transforming Education and
Improving Outcomes. Indianapolis, IN, USA: Sigma Theta Tau International, 2012. ProQuest ebrary. Web. May 4, 2016. Copyright © 2012. Sigma Theta Tau International. All rights reserved.