Influences on Nursing Professional Practice

The Illness-Wellness Continuum, developed in the 1970s, illustrates that health is a dynamic state; there are several degrees of health. “Good health”, or High-Level Wellness, is achieved through awareness, education and growth, and is found on the right of the horizontal Illness-Wellness Continuum diagram. Signs, symptoms, and disability, which are evidence of worsening health (and eventually Pre-Mature Death), are found on the left side of the Illness-Wellness Continuum illustration as “Poor health”. In the center of the continuum is a “Neutral Point”, at which there is “no discernible illness or wellness”. (Travis, 2004).

Congruent with the Illness-Wellness Continuum, the Constitution of the World Health Organization defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. (World Health Organization, 1946). It is interesting to note that this definition has not been revised in more than six decades. This definition describes the integration of physical, mental and social well-being as health, and differentiates the state of health from the lack of disease.

Wellness can be considered as “the integration of mind, body and spirit. Optimal wellness allows us to achieve our goals and find meaning and purpose in our lives. Wellness combines seven dimensions of well-being into a quality way of living. Overall, wellness is the ability to live life to the fullest and to maximize personal potential in a variety of ways. Wellness involves continually learning and making changes to enhance your state of wellness. When we balance the physical, intellectual, emotional, social, occupational, spiritual, and environmental aspects of life, we achieve true wellness.” (Nordqvist, 2014).

Harvard-trained Andrew Weil, MD wrote that humans become familiar with health when they are ill or have a disease (page 41). (2004). It is important to realize that the traditional valuations of health as good and desirable, and illness as bad, are not necessarily clear-cut; “health is the expansion of consciousness that transcends the illness-wellness dichotomy”. (Koerner, 2011). “Health is wholeness – wholeness in its most profound sense, with nothing left out and everything in just the right order to manifest the mystery of balance. Far from being simply the absence of disease, health is a dynamic and harmonious equilibrium of all the elements and forces making up and surrounding a human being.” (page 41) (Weil, 2004). Health, then, encompasses both wellness and illness and/or disease. Health and healing may be examined in a number of ways, including through the models of the physical body and the body-mind-spirit.

Models of Health and Healing

Larry Dossey, MD pointed out how the perceptions and beliefs about health and illness have changed over time (Koerner, 2011). In Era I, which began in the 1860s, science was assimilated into the practice of western medicine. Health and illness were considered in the context of the physical body; the consciousness of individuals was a result of biochemical, structural, and physiological facets of the brain. Illness was considered to be “physical in nature”; therefore, treatment had to be physical in nature. Surgery and medications treated physical illness. The term “physical” refers to the body of a person, rather than their mind, and existed in a tangible form which could be touched or seen. It was reasonable to conclude that the physical body was a basic component of each individual’s identity. The consciousness, or mind, of a patient was connected to the role of the brain.

In the 1950s, Era II arose as practitioners expanded their considerations of health and noticed that thoughts, feelings, personal principles, attitudes and values impact physical health. Hypertension, myocardial infarctions, and ulcerations of the gastrointestinal system were attributed to emotional stress. During this time period, treatment modalities began to address the mind consciousness. (Dossey, n.d.). It has been said that many people still hold this perspective. (Koener, )

Based on the quantum physics pattern, the current perspective, Era III, identifies the consciousness which is not limited to a person’s body, but is described as “infinite, immortal, omnipresent”. (Riley, 2011). A nonlocal mind is one without limits; consequently, an individual’s consciousness can influence and be influenced by others’ emotions, including love and compassion. This meshing of consciousness creates unity, or “oneness” among all humans; we have the ability to influence each other through connections which can be made in the nursing profession by nurturing transpersonal activities.

Discussion. A significant distinction is found by comparing the mind in the physical body of Era I to the consciousness of Era III. In the 19^th century, the mind was considered to be entirely separate from the neurologic function of the brain. In the modern Era, the limitless mind has been expanded to

Body-Mind-Spirit and My Professional Presence

Nurses are human beings, just like their patients. To truly partner in relationships that advance wholeness in patients (p. 18.) (Korner, 2011), nurses must be “authentically present” (Falk-Rafael, 2005). Rather than focusing on past or present events to explain physical and emotional states, nurses can assist patients to “stay with their feelings and learn to observe…without reaction, description, or interpretation.” (p. 18) (Koerner, 2011). This nursing presence creates the opportunity “for real transformation and growth.” (p. 18) (Koerner, 2011).

Nursing theorist Jean Watson’s caritas illuminate that “at its core, transpersonal recognizes that the power of love, faith, compassion, caring, community and intention, consciousness and access to a deeper/higher energy source, i.e., one’s God, is as important to healing as are our conventional treatment approaches, and is possibly even more powerful in the long run” (Falk-Rafael quoting Watson. See reference #30) http://eds.b.ebscohost.com.wgu.idm.oclc.org/ehost/pdfviewer/pdfviewer?sid=2020dce1-204d-47df-b6fd-1fa7c4e3cb68@sessionmgr111&vid=1&hid=104 The framework of Caring Science “is grounded in the ethic of ‘Belonging’ to that which is greater than our ‘Being’; it goes beyond medical science, acknowledging the relational, life force; they philosophical, unitary field dimensions underlying all of humanity.” (Watson & Browning, 2012).

http://watsoncaringscience.org/about-us/caring-science-definitions-processes-theory/ ???

My Professional Presence Influences My Professional Practice

Self-confidence, comfort with uncertainty, integrity, optimism, passion for work, and empathy are 6 features of professional nursing presence (Lachman, V, 2001). A nurse’s professional presence can facilitate an “aura of competence and authority”. (Chater, 2011) Classic dark suits with white blouses, a tidy hair style, quality shoes, and traditional jewelry project an appearance of confidence and create a favorable first impressions. Making eye contact, smiling, active listening and open body language can promote confidence from others.

A professional presence allows nurses to distinguish themselves from other nurses. My knowledge, skills and abilities…. My ability to complete assignments and demonstrate accountability… Self-promotion through networking, volunteering, appropriate social media can increase my professional presence. Promoting my own professional presence and showing respect to those with whom I come in contact can stimulate the profession of nursing.

Crittenden, J. (2013). The discreet guide for executive women. San Diego, CA: Whistling Rabbit Press. ???

http://www.discreetguide.com/articles/your-personal-brand-and-professional-presence/

I most closely relate to the concept of the body-mind-spirit in relation to my professional presence. Most disease or illness is manifested in our physical bodies. The physical pain we feel is a symptom of something in our body needing attention. We need diagnostic studies to identify abnormalities, and can

Additionally, if we find ourselves catching bacterial and viral illnesses, it is beneficial to evaluate if there is compromise to the immune system, and address any deficiencies. The thoughts and emotions of individuals influence health, too. Anxiety, anger and frustration can cause blood pressure to elevate, resulting in poor perfusion. The spirit is “the force within a person that is believed to give the body life, energy and power” http://www.merriam-webster.com/dictionary/spirit Because of my Christian beliefs, I consider each individual’s spirit to be their connection to divinity.

If someone is experiencing pain, I think it is valuable to consider if there is pathological disease (i.e., a broken bone or diseased organ) which would benefit from medical attention through pharmaceuticals; some type of physical therapy; or rest. It is beneficial to examine

Professional presence

Increased awareness of my professional presence as a nurse can help me better integrate my insights, goals, and beliefs as I serve in roles of leader and follower. I was excited to read about Carla Woody’s five-stage transformational remembering process of sparking, separation, searching, initiation, and re-entry. (p. 208). (Koerner, 2011).

There is an opportunity for me to practice mindfulness in my personal life and professional life. I also am willing to take the time to learn and practice mindfulness. At greater frequency over the past year, I have found myself wondering the extent of “nursing burnout” that I feel. I turned 50 last year, and that milestone began me asking questions about what I want to do with the rest of my life. I am satisfied as a nurse; however, I am restless and relatively bored in my current position at work. I have recently completed my BSN, a second bachelor degree, and obtained board certification. One of my reasons for pursuing an MSN in Nursing Education is to keep a spark of learning, new knowledge, and inquisitiveness about me, because that is who I am. I embrace the possibility that “a mindful person is relaxed. He or she’s fully immersed in the here and now and has no regrets about the past or worries about the future.” (Heard, Hartman, & Bushardt, 2013).

One thing that I have realized is that my focus is not going to be on tasks (which I referred to as what I want to do with the rest of my life), but on being—what I was to be for the rest of my life. The current assignment to examine what it means to me to be human has been a satisfying journey. I have identified that I want authenticity in my relationships, and that I want simplicity in my material belongings. By authenticity, I mean that I want to be myself, be natural, and find myself surrounded by a small core group of friends and family members who are the same way. When I say simplicity, I mean that I do not clutter in my surroundings. I want order and minimalism. I do not want fluff or dust collectors. I want my surrounding to be peaceful while reflecting who I am and buoying me, too.

Jean Watson’s Theory of Human Caring/Caring Science incorporated the principle of an “authentic presence” in which nurses honor, or respect, and connect as a human to other humans. http://watsoncaringscience.org/files/Cohort%206/watsons-theory-of-human-caring-core-concepts-and-evolution-to-caritas-processes-handout.pdf

http://greatergood.berkeley.edu/topic/mindfulness/definition

References

A conversation about the future of medicine. http://www.dosseydossey.com/larry/QnA.html

Barnett, J. & Shale, A. (2013). The integration of complementary and alternative medicine (CAM) into thepractice of psychology: A vision for the future. Professional Psychology: Research and Practice. 43(6). 576-585. A review of this article that I will source: http://www.apa.org/monitor/2013/04/ce-corner.aspx

Chater, S. (2011). Professionalism. In M. Greenberg, G. Alexander, & H. Feldman (Eds.), Nursing leadership: A concise encyclopedia> New York: Springer Pub. Co.

Dossey, L. (n.d.). A conversation about the future of medicine. Retrieved from http://www.dosseydossey.com/larry/QnA.html

Falk-Rafale, A. (2005). Advancing nursing theory through theory-guided practice: the emergence of a critical caring perspective. Advances in Nursing Science 28(1), 38-49.

Heard, P, Hartman, S, & Bushardt, S. (2013). Rekindling the flame: Using mindfulness to end nursing burnout. Nursing Management(44)11. DOI-10.1097/01.NUMA.0000436366.99397.10

Koerner, J. (2011).Healing Presence: The Essence of Nursing (2nd ed). New York City: Springer Publishing Company.

Koerner, J. (n.d.). “Complete Health and Healing” by JoEllen Koerner (Retrieved from:https://wgu.hosted.panopto.com/Panopto/Podcast/Embed/079cf429-e2d6-4692-842c-0fc5b3833cf2.mp4)

Lachman, V. (2001). Professional presence: How do you get it? Nursing Management 32(10). 41-42. Retrieved from http://eds.b.ebscohost.com.wgu.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=1&sid=b59f700b-1efa-48a8-9269-56c3290db60b%40sessionmgr115&hid=108

Nordqvist, C. (2014). What is health? What does good health mean? Retrieved from http://www.medicalnewstoday.com/articles/150999.php

Physical. (n.d.). In Merriam-Webster.com. Retrieved May 9, 2015 from http://www.merriam-webster.com/dictionary/physical

Riley, S. (2011). Review of Reinventing Medicine: Beyond mind-body to a new era of healing.

Travis, J. (2004). Illness-Wellness Continuum. Retrieved from http://www.thewellspring.com/wellspring/introduction-to-wellness/357/key-concept-1-the-illnesswellness-continuum.cfm

Watson, J. & Browning, R. (2012). Viewpoint: Caring Science meets Heart Science: A guide to authentic caring practice. American Nurse Today 7(8). Retrieved from http://www.americannursetoday.com/viewpoint-caring-science-meets-heart-science-a-guide-to-authentic-caring-practice/

Weil, A. (2004). Health and healing: The philosophy of integrative medicine and optimum health. Boston, Massachusetts: Houghton Mifflin Harcourt.

World Health Organization. (1948). Preamble to the Constitution of the World Health Organization. Retrieved from http://www.who.int/about/definition/en/print.html

A. Professional Presence

1. Discuss the differences betweentwomodels of health and healing (e.g., physical body, body-mind, body-mind-spirit/bio-psycho-social,) as they relate to what it means to be human.
2. Analyze differences betweenoneof the models discussed in part A1 and your professional presence (i.e., current beliefs, attitudes, and actions regarding health and healing).
3. Discuss how your professional presence (mindful or distracted) influences your nursing practice.