Vous êtes sur la page 1sur 7

Running head: SELF REFLECTION FOR HEALING ENVIRONMENTS

Self-Reflection for Healing Environments


Melissa Ritchey
University of Arizona

SELF REFLECTION

In the last eight weeks we have learned the principles of integrative nursing and the role of the
nurse in creating an optimal healing environment (OHE). An OHE is defined as the social,
psychological, spiritual, physical and behavioral components of healthcare that support healing and
the achievement of wholeness (Lincoln & Johnson, p.183, 2009). My interpretation of an OHE is
one that is created around the patients needs as it related to their physical, emotional and spiritual
well-being. An optimal healing environment can be created in any place to encourage wellness.
I currently work at a large not for profit community hospital. The hospital is mainly all on one
floor, this was done to preserve the view of the mountains. Each room has a large window that faces
a patio, they were designed to allow natural sunlight in each room and allow patients, families and
staff to visit the patios. Our hospital follows the Lean philosophy which empowers our staff and our
patients to make the changes that are necessary to safely and efficiently care for our patients.
Our hospital is focused on our patients experience and we are introducing complementary and
alternative therapies throughout the hospital. In pediatrics we have fish tanks and we offer pet
therapy. In the Intensive Care Unit we have a harpist at the nurses station. The area that is
struggling with creating an OHE is the Emergency Department (ED). They face challenges, such as
the lack of windows in rooms and the fast turnover. The ED is working on providing music therapy
by playing classical music through the speakers. One area we strive to improve on is promoting selfcare. Our nursing strategic plan for the next five years focuses on education and support for our
nurses in an effort to create an organization that encourages the nurses to care for themselves.
In creating an OHE, nurses must take into consideration the six principles that provide a
Foundation for integrative nursing. First the nurse must assess the patients needs as they relate to the
whole of their situation, also known as whole systems healing (Koithan, 2014). This principle not
only refers to the patients mind, body, spirit, but also to their environment of care. Whole systems
healing is a comprehensive approach to focus on all the factors that are contributing to the disease
process (Flanders, 2009). It is our responsibility as nurses to create a healing environment free of

SELF REFLECTION

harm for our patients. Our hospital has many initiatives for hand hygiene and policies on cleaners
that can be used to avoid chemicals that can cause harm to the patient in the hospital environment. It
is critical that the environment of care reduces the risk of additional disease.
The second principle is capacity for health and well-being. Health and wellbeing is an
emergent property of the whole person/whole system (Koithan, p.9, 2014). Watsons theory is that
health is an organization of mind, body and spirit that occurs when one is seeking a connection
between themselves and universal consciousness (Koithan, 2014). The relationship between caring
and peace is related to attitude, intentionality and consciousness of positive emotions (Watson, 2014).
I am often involved in speaking to the family during a difficult situation. I offer a spiritual counselor,
I have found that prayer is an example of energetic healing. I am facilitating the healing of others
through peace and love, love being the highest level of consciousness (Watson, 2014).
The third principle is nature as healing and restorative. Watson states that nature is essential to
our self-care and self-knowledge (Koithan, 2014). Exposure to nature is therapeutic for patients with
both physical and mental illnesses, including plants, gardens, and sunlight (McCaffrey, Hanson, &
McCaffrey, 2010). Studies have shown that outdoor gardens have decreased the sense of loneliness
and depression (McCaffrey, Hanson, & McCaffrey, 2010). Personally I seek out nature for
relaxation. I spend about half an hour each night outside watering plants while I enjoy the fresh air
and the beautiful stars in the sky. This helps me unwind at the end of the night which helps decrease
my stress level, in turn it helps me sleep better at night so that I am reenergized each and every day.
The fourth principle person-centered and relationship based care is focused on a caring and
healing environment for the patient. This model compromises three crucial relationships: the
relationship with the patient and family, self, and with co-workers (Woolley et al., 2012). My
experience with relationship based care involves hourly rounding and an interdisciplinary approach to
developing communication plans for the patients, such as turnaround times for labs and x-rays. Our
patient experience survey results have high scores for keeping the patient informed during their

SELF REFLECTION

wait. This initiative allows us to focus on involving the staff, improving the work environment and
implementing evidence based practice such as rounding into our patient care (Woolley et al., 2012).
The fifth principle is nursing practice that uses multiple, evidence-based therapeutic modalities.
Integrative nurses take into consideration both traditional and complementary therapies when
constructing a plan of care for their patients (Koithan, 2014). Integrative nurses consider evidence
based practice when choosing the right complementary therapy. Pet therapy is one that is used
frequently in the hospital setting and there is evidence based practice to support it. Animals have
long been associated with positive effects on patients (Rossetti, DeFabiis, & Belpedio, p.29, 2008).
Our hospital provides pet therapy daily which is a versatile non-invasive therapy.
The sixth principle focus on health and well being of recipient of care and providers is specific
to a caregiver. Integrative nurse leaders take into consideration the wellbeing of our employees
(Koithan, 2014). It also means that nurses must develop self-awareness and focus on their own
wellbeing (Koithan, 2014). The Transtheoretical model is crucial to consider when planning a
lifestyle change to promote self-care (Aufenthie, 2014). This course has helped me to assess my own
self care. I have planned time off to allow myself to reenergize. I also have noticed that the staff are
following my lead. I have also added a massage chair to our break room to promote self-care.
A nurse leaders role in facilitating an OHE supports a culture of healing aligned with the
organizations vision and mission. An integrative nurse leader enables healing by following
Nightingales directive to allow nature to assist in the healing process (Quinn, 2014). A leader must
be able to adapt to change, act on ideas and collaborate with others (Kreitzer, Flegan, & Roach,
2014). Leaders who exemplify whole-systems leadership have the knowledge, skills, and attitudes to
execute an effective solution to an intricate problem (Kreitzer, Flegan, & Roach, 2014).
I am currently working on designing our pediatric emergency departments lobby. Because we
are drawn to nature, the focus of the lobby is creating a connection to the natural environment

SELF REFLECTION

(Zborowsky & Kreitzer, 2014). The plan is for a fish tank on one side of the room and large prints of
nature scenes with an emphasis on bodies of water. I would like to install windows and sky lights to
allow for natural sunlight. In a study where an atrium was built as a lobby in a childrens hospital,
the children were surveyed and stated that they could see everything on the outside including the sky
and the trees which they enjoyed (Adams, Theodore, Goldenberg, McLaren & McKeever, 2009).
A complementary and alternative modality (CAM) appropriate for pediatric patients would be
laughter therapy. Laughter therapy is cost effective and easily accessible, it can be attuned for any
age group and is proven to have positive effects on depression, insomnia and sleep quality (Ko &
Youn, 2011). A CAM appropriate for teenagers is music therapy. One study showed that music
promoted positive emotional expressions and an increase in joy (Kim, Wigram, & Gold, 2009). Both
can be implemented with minimal staff training, we have a physician who provides laughter therapy
and could commit to 2-3 times a week on the unit. We could also buy a few portable radios that the
nurses would offer to our teen patients along with a selection of age appropriate compact discs.
As a leader the first strategy to promote the transformation for an OHE, is to go out to where
the work is done and observe and seek feedback from our patients and staff. It is important to get
them engaged so that when you arrive to the planning stage they are willing to participate. By doing
this the employee takes ownership and pride which helps sustain the new initiative. In developing an
OHE in our pediatric lobby I would first implement a pre assessment. I would include an assessment
of mood, whether happy, neutral or sad. I would also concentrate on the metric left without being
seen. The goal in creating an OHE in the lobby is to help decrease anxiety while waiting and create
an environment that promotes healing prior to seeing a provider. I would expect to see a decrease in
left without being seen patients and increase in statements of feeling happy while waiting in the
lobby. As a nurse leader it my responsibility to create a place as a healing environment
(Zborowsky & Kreitzer, 2014)

SELF REFLECTION

6
References

Adams, A., Theodore, D., Goldenberg, E., McLaren, C., & McKeever, P. (2009). Kids in the atrium:
comparing architectural intentions and childrens experiences in a pediatric hospital lobby.
Social Science & Medicine, 70, 658-667. http://dx.doi.org/doi:
10.1016/j.socscimed.2009.10.049
Aufenthie, J. (2014). Facilitating lifestyle choice and change. In M. J. Kreitzer, & M. Koithan (Eds.),
Integrative Nursing, pp.137-147). New York, NY: Oxford University Press
Flanders, J. G. (2009, April). Creating a healing environment: rationale and research overview.
Cleveland Clinic Journal of Medicine, 76, S66-S69. http://dx.doi.org/doi:
10.3949/ccjm.76.s2.13
Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of
children with autism in improvisational music therapy. Autism, 13, 389-409.
http://dx.doi.org/doi: 10.1177/136236139105660
Ko, H., & Youn, C. (2011). Effects of laughter therapy on depression, cognition and sleep among the
community-dwelling elderly. Geriatrics & Gerontology International, 11, 267-274.
http://dx.doi.org/doi: 10.1111/j.1447-0591.2010.00680.x
Koithan, M. (2014). Concepts and principles of integrative nursing. In M. J. Kreitzer, & M. Koithan
(Eds.), Integrative Nursing, pp.3-16). New York, NY: Oxford University Press
Kreitzer, M.J., Felgen, J. & Roach, P.A. (2014). Whole systems healing: a new leadership path. In
M. J. Kreitzer, & M. Koithan (Eds.), Integrative Nursing, pp.47-55). New York, NY: Oxford
University Press
Lincoln, V., & Johnson, M. (2009). Staff perceptions of a healing environment. Holistic Nurse
Practice, 23, 183-190.
McCaffrey, R., Hanson, C., & McCaffrey, W. (2010). Garden walking for depression. Holistic Nurse
Practice, 24, 252-259.

SELF REFLECTION

Quinn, F. (2014). The integrated nurse: way of the healer. In M. J. Kreitzer, & M. Koithan (Eds.),
Integrative Nursing, pp.33-46). New York, NY: Oxford University Press
Rossetti, J., DeFabiis, S., & Belpedio, C. (2008). Behavioral health staffs perceptions of pet-assisted
therapy: an exploration study. Journal of Psychosocial Nursing, 46, 29-33.
Watson, J. (2014). Integrative nursing caring science, human caring and peace. In M. J. Kreitzer, &
M. Koithan (Eds.),

Integrative Nursing, pp.101-108). New York, NY: Oxford University

Press
Woolley, J., Perkins, R., Laird, P., Palmer, J., Schitter, M. B., Tarter, K., ... Woolsey, M. (2012, MayJune). Relationship-base care: implementing a caring, healing environment. Medsurg Nursing,
21, 179-184.