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5/18/2017

Laurie Schmiesing
Eira I. Klich-Heartt

1.Summarize the basic four fold view of man according


to anthroposophic nursing
The human being as physical body, etheric or life body, astral
or feeling/emotional body and spirit according to
anthroposophical nursing
2.Implement conscious choosing of a nursing gesture
in a case presentation
Present the polarity of enveloping and uprightness.
Review each of the gestures and how they relate to enveloping
or uprightness.
3.Apply the twelve nursing gestures to a personal
therapeutic use of self model.
Review nursing theories related to therapeutic use of self.
Discuss how the twelve nursing gestures relate to current
nursing practice including patient and nurse satisfaction.

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Anthroposophy – the study of the


wisdom of the human being – by
Rudolf Steiner
A nursing system developed
through anthroposophy in 1921
with Ita Wegman
Dovetails with anthroposophic
medicine
Acknowledges the whole human
being including spiritual realities.

Elements of Man Elements Qualities

Physical Earth Resting Solid state

Etheric/Life Body Water Flowing movement

Astral/soul Air Dynamic shaping

Ego/spirit Warmth Heat that transforms

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Fundamental pattern of knowing (Chinn & Kramer, 2011)

Chinn, P.L and Kraemer, M. (2014). 5

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Christoph von Dach Endingburgh, EP'16 7

Meeting
the person

Reflection
Reflection
With the Which gesture
person / the arises?
team

Implementa- Objectifica-
tion tion
Living the What are the
gesture in
working with
thoughts of
pt the team?

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Being Being
in with
relation self
Being present

Being Being
in social in
context place

McCormack (2016)

McCormack (2016)

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Each gesture has a


relationship to one of
the signs of the zodiac
Mood of nursing
Inner preparation
Attitude in doing
activities and tasks
The middle between
inner preparation and
outward activity

Awakening
Challenging Affirming

Stimulating Supporting uprightness

Balancing out Cleansing

Enveloping Nurturing

Making room Relieving


Protecting
Enveloping Heine (2005, 2015)

Christoph von Dach

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Awakening
Challenging Affirming

Stimulating Supporting uprightness

Balancing out Cleansing

Enveloping Nurturing

Making room Relieving


Protecting
Heine (2005, 2015)

Virgo - Virgin
Power to heal objectively
In soul life
Not unrestricted sympathy, but measured

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Pisces - Fishes
Interest in something and able to let go again
Conscious touching of another
Return to ourselves in order to be able to take
up the next patient
Prevent burnout

Libra – Scales
Finding a new middle
Balancing between extremes
Conscious positioning
Balancing out burdens during extreme times in
a biography

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Aries – Ram
Allowing the new to emerge –
Not simply scrubbing the old away
Pushing up – springing forth with something
new
A new insight –
A change in action

Scorpio - Scorpion
Slightly provocative
Only justified when the individual has the
forces to meet it.
Mustard compress or footbath
Mildly stinging

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Taurus – Bull
Vision of cow – taking in physical substance to
transform
Metabolic process
Turning substance into action

Sagittarius – Centaur
Strength and aim
Reason and clarity
To give direction

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Gemini – twins
Taking into account one’s own strength in
order to help the other
Groundedness

Capricorn – goat
Consciousness
Presence of mind
Patience
From the darkness to the light
Lifting heaviness to the light airy element
Thinking, feeling, willing

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Cancer – crab
Summer –
Awareness outside of one’s self
Warmth

Aquarius – Water bearer


Affirming the present
Acknowledging the past
Hoping for the future
Cosmic light pouring on the earth

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Leo – Lion
Reaching out into the periphery
Coming back to center
Centrifugal and centripetal forces
Creating space for healing to occur

38 year old female admitted for heart failure


2 children living with grandmother
States does not do drugs
Drug screen comes back positive for methamphetamines
No idea how she got to hospital
Thin, nervous
Heart echo shows enlarged left ventricle
Medications include beta blockers, calcium channel
blockers,
What 2 or three moods/gestures might you
consider?

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5/18/2017

57 year old woman, currently separated in


divorce process after long unhappy
marriage. Had debilitating depression last
year, now stable with medications and
therapy, has open weeping wound on
elbow and eyebrow.
Wants to feel more comfortable in her own
skin.

An 84 year old female with a femur fracture/ left total hip arthroplasty.
History of CVA, Parkinson’s and dementia. She received Norco for pain,
perioperative IV abx and Sinemet for Parkinson’s symptoms. The family
was constantly at the bedside and extremely concerned about her
receiving the Sinemet.
The RNs on the floor were administering the hospital and her home doses
around the clock, one twenty minutes before the other, every 3 hours.
This patient was at risk for aspiration because of her history of
CVA/swallowing issues. The family insisted on feeding her.
They had initially wanted to feed her when she was too sleepy, this raised
concerns.
With this in mind, teaching and demonstration became the priority.
It is such a blessing to have family wanting to care for their loved one, but
at the same time this creates a huge educational burden for the RN and
staff sending the patient home.

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This 70 y/o male patient was being difficult with staff, disrespectful and yelling at a
CNA to get out because he couldn't understand her. He was having loose stool due to
antibiotic therapy. Pain in his left foot. Diminished lung sounds at the bases. Due to
chronic kidney disease the patient may need dialysis in the future requiring a port to
be placed, this is causing concern for the PICC line placement.
Patient was educated on respectful behavior towards all staff and set boundaries on
inappropriate behavior.
Patient was receptive and cooperative with boundary setting .
Patient responded to one on one attention.
Patients pain was managed throughout the shift.
Patient had a hard time remembering to use the Incentive Spirometer.
Patient seemed to be indifferent to the PICC and Port decision, although did
understand why it was being discussed.
The nurse who gave report in the morning mentioned the patient was difficult and
that it was a good idea to set boundaries while establishing the relationship.
“I appreciated the suggestion as I was ready to be kind and firm and the day ended
up going well. He was receptive to my education, respectful and had good humor. “

Chinn, P. L. & Kramer, M. K. (2014). Knowledge Development in Nursing Theory and Process, 9th Ed. Mobsy,
St. Louis

Fawcett, J. (2012). Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories.
F. A. Davis, Philadelphia, PA.

Heine, R. (2015). Anthroposophische Pflegepraxis: Grundlage und Anregungen für alltägliches Handeln. Salumed
Verlag, Berlin, Germany.

Heine, R. (2009). The Twelve Nursing Gestures and the Zodiac. Anthroposophic Nursing Association, Kent,
Great Britain.

Helming, M., Barrere, C., Avino, K., Shields, D. (2014). Core Curriculum for Holistic Nursing, 2nd Ed. Jones
& Bartlett, Burlington MA.

McCormack, B., Karlsson, B., Dewing, J., Lerdal, A. (2010). Exploring person centeredness: a qualitative
metasynthesis of four studies. Scandinavian Journal of Nursing Sciences, 24,3, p 620-634.

McCormack, B., and McCance, T. (2016). Person-Centred Practice in Nursing and Health Care: Theory and
Practice, 2nd Ed. Wiley and Blackwell, Oxford, England.

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