Models of Health and Healing

Professional Presence and Influence

Introduction

This paper explores transition to professional practice by examining self in the context of healthcare. Assessing my current professional practice, personality, and mindfulness is compared with models of health and healing, and healing environments. Using the reflective practices explored in this paper allows for a thoughtful, mindful practice that will translate to an improved and deliberate professional presence and influence in my current role as a hospital educator.

Models of Health and Healing

The definitions of being healthy and being human are remarkably similar. Health, as defined by the World Health Organization (n.d.) “is a complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Being human is defined in our course work as “being whole physically, mentally, emotionally, and spiritually” (Professional Presence and Influence, n.d.). Health and humanity, then, are intertwined concepts that require focus on holistic well-being.

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The definition of health as including both the body and mind was adopted by the World Health Organization in 1958 and has remained unchanged since (World Health Organization, n.d.). This concept of health has evolved over time, as argued by Dr. Larry Dossey (“Biography,” n.d.). Dr. Dossey is a leader in both the practice and advocacy of the role the mind plays in health and healing (“Biography,” n.d.). He purports that beginning in the 1850’s, Western medicine focused primarily on the physical body (“Biography,” n.d.). Around the time of the World Health Organizations health definition, in the 1950’s, Western medicine moved into a new Era that he calls Era II, or the “Body-Mind Model” (“Biography,” n.d.). 

The Body-Mind Model of medicine is reflected in the understanding of psychosomatic illness. In 1974, Dr. E.D. Wittkower wrote a review of psychosomatic treatment of disease. He sought to identify the most appropriate treatments for patients suffering from psychosomatic disorders (Wittkower, 1974). His review argued that a choice had to be made with each patient between alleviating their symptoms and alleviating the underlying psychological etiology (Wittkower, 1974). This highlights a particular feature Dr. Dossey notes of this Era – health was viewed as a “local phenomenon” (“Biography,” n.d.). In other words, healing practices were focused on the individual in vitro, disparate from their environment. This Model of health and healing improved upon our understanding from health being restricted to the physical body but ignored the bigger picture of our interconnectedness as humans through our spirit.

In contrast, Dr. Dossey purports we are currently living in the “Body-Mind-Spirit” Era, or “Biopsychosocial-Spiritual Model” (“Biography,” n.d.). This Era of medicine began in the 1990’s and dovetailed with the understanding of quantum physics and the interconnectedness of the world (“Biography,” n.d.). Just as the world is interconnected, so are humans through our spirit and soul. Using this Model of health and healing, it becomes obvious that healing requires health care practitioners to holistically support the individual as they exist in vivo. In the Body-Mind Model, medicine developed an understanding of psychosomatic illness. In the current Biopsychosocial-Spiritual Model, medicine understands that spiritual concerns may also manifest themselves as physical or mental illness (National Center for Cultural Competence, n.d.). Just as the practitioner must understand a person’s baseline blood pressure in order to detect important changes, it is essential to understand what spirituality means to each patient, how it has been affected by their illness, and strategies to return them to an acceptable baseline.

Models and Professional Presence

My appreciation of the context of health and healing is well aligned with the current Biopsychosocial-Spiritual Model of health and healing. Georgetown’s National Center for Cultural Competence (n.d.) notes that each individual has a particular mix of body, mind, and spirit components. Body and mind happen to be very important to me, with little personal significance placed on spirit. This personal matrix cannot affect the care patients receive. It is preposterous to think of not treating a patient’s hypertension because I am normotensive. Understanding that spirituality plays the same role in health and healing as other indicators we can measure requires us as practitioners to evaluate and work towards becoming equally as comfortable with discussing and treating the spirit.

I continue to work on my comfort with discussing spirituality, particularly in the setting of an organized religion. My background is primarily in the Neonatal Intensive Care Unit. When precepting a newly graduate nurse, we were assigned to a family who had decided to withdraw care on their critically ill baby. During this               time, they leaned heavily on their religion in understanding their infant’s health and in making decisions about his care. They requested the Lord’s Prayer be said if their baby passed when they were not at the bedside. Their religious beliefs aligned with my orientee’s, but not my own. This gave us an opportunity to reflect on the importance of meeting the parent’s needs, even though they did not align with my own. We did end up saying the Lord’s Prayer, with the parents, when he did pass away. Later in her orientation, we participated in a religious ceremony at the request of a family who did not share either of our personal beliefs. This is the major understanding of health and healing I appreciate from the Biopsychosocial – Spiritual Model of health and healing. Healing must include spiritual health and be individualized to the patient and their family.

Influence on Nursing Practice

Mindfulness is an important part of my professional presence. This was not always the case. As a new graduate nurse, I found myself frequently running back and forth from my patient’s bedside to the stock room to grab supplies I had not thought to grab before beginning care. This eventually became frustrating enough that I inadvertently began working on mindfulness. I made a conscientious effort to take 3 deep breaths after report, before walking to each patient’s bedside to see what supplies were there and what I might need. This began my mindfulness journey. Now, I take the opportunity to stop, take a deep breath, notice, and name my emotions before moving on with my work when it feels overwhelming. As a hospital educator, I teach all classes for a new graduate nurse residency in Labor, Delivery, and Postpartum. We meditate at the beginning of class and often again in the afternoon if learners are feeling overwhelmed. We also discuss mindfulness practices learners can incorporate into their practice on the floor. Mindfulness allows for clear and thoughtful practice, regardless of role.

Personality Assessment Submission

(Humanmetrics, 2019).

Test Results Analysis and Preferences Alignment

The Jung Personality test thoroughly expressed all aspects of my personality, including what I identify as personal strengths and weaknesses. My lifelong goal has been to be an educator. After being dissuaded from K12 education by my mother, a 38-year veteran of the education system, I decided to go into nursing. Nursing combined my love for exploring the intricacies of biological systems with teaching. Recently I was given the opportunity to become a hospital educator. I have always assumed that my path to teaching was paved primarily from my experience with my mother. The Jung personality test was eye opening. Per Typology Central (2018), ENFP personalities often are successful as teachers thanks to inherent creativity, open-mindedness, and ability to successfully translate obtuse concepts into understandable information. In nursing and education, I have constantly looked to explore new ways of doing routine things and looked for innovative solutions to roadblocks and red tape. This has been a beneficial aspect to my personality, but also has a downside. Consistently practicing this way makes it nearly impossible to settle in a routine and often causes me to overextend myself. Knowing that this is a typical part of my personality will allow me to be more conscientious and purposeful in my work.

My needs and expectations of others are also well aligned with the results of this personality test. While I have developed a “thick skin” over time, I spent many years fretting over what others thought of me, characteristic of my personality type (Typology Central, 2018). I certainly assess the value of my ideas based off the responses they get from people I respect. This has led to conflict in all sorts of relationships when I do not receive the feedback I want. Defining this aspect of my personality and developing a shared language with intimate friends and family has allowed for improved conflict resolution and better understanding intimacy in these relationships.  

Wiki Typology (2018) says this of ENFP personalities: “Few types struggle more with the battle against boredom than ENFPs.” This has certainly been the case throughout my adult life. After losing the ability to professionally dance due to injury, I spent many years enthusiastic to become expert in some sport or activity, only to abandon it shortly after starting. I may have finally found a solution to this frustrating part of my personality by training for a triathlon. The varied exercises have continued to be interesting and ever changing. This aspect of my personality also explains my love for travel and interest in living around the country.

Potential Challenges or Barriers

 One aspect of my personality that can be challenging with other personality types is my tendency to think big (Typology Central, 2018). Rather than looking to solve the issue at hand, my instinct is to take the bird’s eye view in an effort to determine different ways to fix the entire system that led to the current problem. This situation occurred recently, and thankfully after I took the Jung Personality Test. Our hospital was undergoing a major practice change. As is typical in these projects, issues with the operating system continued to present themselves throughout the trial period. The morning before going live with the new process, the system lead asked me to approve a flyer going out system wide. I reviewed the flyer and began asking clarifying questions on the audience for the flyer and scope of change. This was frustrating to the lead, as evidenced by her continuous feedback that we needed to send the flyer out “an hour ago.” It quickly became clear the scope of the change was far beyond that identified in the original flyer. This created tension with the system lead who remained concerned about delays in communication. By reflecting on the importance of relaying accurate information, and updates on the scope of the change, I was able to develop a flyer that was useful to those who needed the information. In this situation, my tendency to look at the big picture ended up being helpful in disseminating useful information. It initially created conflict with someone who did not share the same personality. Reflecting on these differences allowed me to identify our shared goal of disseminating correct information, communicate that effectively, and have the time to do the work well.

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 Being cognizant that working through the nitty gritty of a project is much less fulfilling or interesting to me than starting one is also helpful to identify (Typology Central, 2018). There are other personalities that thrive on details. When working on group projects, my tendency is to procrastinate on the projects that do not interest me as much. This can lead to dissatisfaction with others in the group. Currently, I am working with a multidisciplinary group on a unit-based process change. I continue to struggle to find balance with this aspect of my personality in relation to my role as an educator. This unit is generally apathetic right now due to a variety of factors. I understand that getting nurses involved in decision-making that directly effects their practice will help improve attitudes at work, but do not want to shrug the detail work off on nurses because it is not something I am personally interested in. Understanding this part of my personality allows me to continually reflect on the choices I make to be respectful of others’ time and needs. 

Whole Person Goals and Achievement of Goals

The physical body is our body and senses (Thorp, n.d.; Utopia Wellness, n.d.). In service of my Physical Body, I will perform a minimum of thirty minutes of exercise daily. I have previously set a goal to complete a Sprint Triathlon on July 21^st, 2019. I have been exercising one to two hours daily five days a week. The other two days of the week I have done little to no exercise. I can achieve these thirty minutes of exercising by gardening on the weekend or in the evenings, jogging for just thirty minutes, hiking, or performing a home strengthening workout for thirty minutes. I am beginning to improve my physical body by working out, however, my nutritional status leaves quite a bit to be desired. Ice cream is my favorite dessert and I have no self-control with it. I will begin to improve my nutritional status by no longer purchasing ice cream to have in my home. These changes will improve my physical body. These physical body goals require focus and determination, which will aid in success in other aspects of being whole.

The Vital/Rhythmic Body represents our connectedness to natural rhythms (Green, n.d.). As discussed in the Jung Personality Test section, I naturally tend towards a chaotic day. I will use the Bedtime portion of the Clock application on my phone to set bedtime and wake up reminders to establish a routine. This will serve to help structure a routine and rhythm in my day. An additional vital rhythm in life is our heart beat. Currently, I rarely take the opportunity to check in with my heart. In service to my Biographical/Spiritual Body, I intend to meditate daily. There are unlimited ways to place your physical body when meditating. I will place a hand over my heart to connect with my heart beat while meditating daily. Completing these goals will help me be more in tuned with my daily rhythms.

The Emotional/Mental Body is the third aspect of wholeness. This body represents my analytical self, or my thoughts, beliefs, goals and emotions (Thorp, n.d.; Utopia Wellness, n.d.). I am currently practicing my Mental Body by working on my master’s degree in Education. My first goal is to make On-Time Progress in my master’s degree by completing the four courses I am enrolled in before October 15^th, 2019. I will accomplish this by dedicating two hours daily during the work week and four hours daily on the weekend to course work. In service of my Emotional Body, I will self-reflect by performing a daily recapitulation before going to bed nightly. These goals will help me think critically about my career and personal self to allow my thoughts and beliefs about myself and the world around me to grow and evolve.

The fourth aspect of wholeness is the Biographical/Spiritual Body. This body represents connectedness with energy, to yourself and your life purpose (Thorp, n.d.; Utopia Wellness, n.d.). Inner calmness and openness are required to develop this relationship. I will attend yoga once weekly, setting my practice intention as connecting to my personal energy by focusing on sensation in my body during each pose. Yoga is available three times weekly at work. I will attend the Monday class as it does not interrupt recurring meetings in the afternoon later in the week. Friday is a reasonable back up plan if Monday becomes unavailable for some reason.  Additionally, I will practice meditation daily. I downloaded the Headspace meditation app that has options for meditations between three to thirty minutes. A minimum of one five-minute meditation is reasonable to do daily before eating lunch. Both a weekly moving meditation and a daily mindfulness meditation will give me resources to find inner calmness to connect effectively with my Spiritual Body.

Performing the tasks to achieve the goals set above for each aspect of my whole person will allow me to be more introspective of myself. They will give me insight into who I am and who I want to be. This insight will allow me to interact with others more effectively. I look forward to developing these insights and being flexible in understanding myself more fully.

Healing Environments Best Practices

Providence St. Peter Hospital (PSPH) is a community hospital in Olympia, Washington. The population in this area has boomed over the past decade and the hospital, like all those in the area, are often facing more patients coming in to the hospital than beds available. Even facing these challenges, PSPH retains the elements of an Optimal Healing Environment (OHE). OHEs create an environment and culture that values patient-centric healing equally to curing
(Sakallaris, MacAllister, Voss, Smith, & Jonas, 2015). The environmental elements of an OHE are internal, interpersonal, behavioral and external (Sakallaris et al., 2015). The internal environment includes a healing intention and personal wholeness (Sakallaris et al., 2015). Twice daily, once for the day and once for night shift, a prayer is said overhead. It is generally under two minutes long and focuses on the themes of health, healing, and connectedness. The prayer is said overhead, which allows patients and staff alike to hear and internalize the intention.

The interpersonal environment focuses on healing relationships and organizations (Sakallaris et al., 2015).  The prayer said overhead helps to establish the intention for health and healing to occur. Organizationally, the Vision of PSPH is “Health for a Better World.” They work to achieve this vision using the Core Values of compassion, dignity justice, excellence, and integrity (Providence Health and Services Washington, n.d.). In practice, this is seen through interdisciplinary rounds, specific social-work rounds that focus on placing patients in the most appropriate healing environment outside the hospital, and care conferences with patients and the interdisciplinary team. Additionally, the spiritual care team rounds daily on patients.
 The behavioral environment establishes the importance of healthy lifestyles and integrative care (Sakallaris et al., 2015). At PSPH, the Nutrition Department intermittently has booths set up in the cafeteria with healthy snack options and their recipes. They also have a board in the cafeteria that changes out monthly with healthy snack or meals ideas and recipes. Lights in the hospital are cycled day-to-night to promote normal sleep-wake cycles, and “quiet time” is promoted on certain floors with posters up that explain the importance of a time of day with low stimulation for the patient. Care is multidisciplinary and includes generalists, specialists, physical and occupational therapies, and spiritual services to serve the whole person. In the Family Birth Center, staff are encouraged to use and teach family to provide massage and counter pressure for patient care. For staff wellness, fifteen-minute massages are available once weekly, and a healthy snack cart is brought to the units monthly.

The external environment includes healing spaces and ecological sustainability (Sakallaris et al., 2015). PSPH is set within a forest with several trails available to walk around the hospital. Two formal healing gardens are also on the grounds. The grounds are cared for by a crew that manually cares for it without using any pesticides.

Children’s Hospital of Colorado (CHOC) also meets the elements of an Optimal Healing Environment. The internal environment of the hospital is evidenced in how nursing report is standardly given. Patient and family goals are part of the standard shift report. This encourages and allows nurses to reflect with the patient and family on their goals for care moving forward and be better advocates. The interpersonal environment is exemplified by the mission of the hospital. It is “To improve the health of children through the provision of high-quality, coordinated programs of patient care, education, research and advocacy” (Children’s Hospital Colorado, n.d.). CHOC’s internal environment works towards this Mission in the hospital by devoting resources to clinical research and innovation, and outside the hospital by establishing community partners to improve pre-hospital health of the community. The behavioral environment focuses on the healthy lifestyle of both staff and patients. For the staff, each unit has a quiet room with an ergonomic lounge chair, low-light lamp and blankets available for relaxation. Free massages are intermittently available to staff. For both patients and staff, the cafeteria lists the nutritional information for everything it served and color-codes all food choices to red, yellow or green to aide in decision-making. Care at the hospital is integrative, and complementary therapies including massage, acupuncture, spiritual services, and play are used to promote healing and relieve suffering. The external environment includes several healing gardens, patient rooms that encourage and allow families to room in with the sick loved-one, and calming colors on the walls.

Professional Presence Promotion

Without the context of an Optimal Healing Environment, I have begun the work to improve my external environment to promote mindfulness in my work environment. I recently moved offices into an area that was once a patient exam room. The walls and floor are the off-white color typical of hospital rooms. I purchased two canvases for the walls, one of a large oak tree and the other a field of poppies to bring the outdoors into the stark environment. This allows me to feel calmer in my environment. As an educator, I have my office door open when I am in and have had several nurses tell me they enjoy coming to my office because it feels relaxing. Healthy lifestyles are an important piece of developing an OHE. I have a sit-to-stand desk and have purchased a sit atop stationary bike that I can ride upon rather than sitting in a chair when working at my desk. The internal environment is an area I will continue to work on. My professional presence tends to mindfulness. As part of this practice, I will set a healing intention towards my work each day when I come in to the building. Depending on the work I am currently engaged in, intentions may include helping new graduate nurses establish goals for their wellbeing, improving patient safety as the ultimate goal in any practice change, or helping staff nurses identify and achieve self-care goals.

Conclusion

Mindfulness is the thread that runs throughout this reflective paper. In the first section, models of health and healing were evaluated against each other, with further reflection on the interaction of those models with my self-identified mindful professional presence. The second section allowed me to delve into my personality by using the Jung Personality Test to self-identify strengths and potential pitfalls I encounter is personal and professional life. Next, mindfulness was tackled directly by creating a realistic plan for improving mindfulness and thoughtful reflection. Finally, two hospitals were compared in their achievement of an Optimal Healing Environment and I was able to reflect on influencing and creating one in my current workspace. Developing a mindful practice that extends through all aspects of my personal and professional life, as exemplified in this paper, allows for thoughtful interactions with my environment moving forward.

References

• Biography (n.d.). Retrieved from http://www.dosseydossey.com/larry/default.html
• Children’s Hospital Colorado (n.d.). What makes Children’s Hospital Colorado so special? Retrieved from https://www.childrenscolorado.org/about/mission/

         Green, S. (n.d.) By connecting to our natural rhythms we improve our well-being. Retrieved from http://www.unimedliving.com/mental-health/personal-development/by-connecting-to-our-natural-rhythms-we-improve-our-well-being.html

• Humanmetrics. (2019). Jung typology test. Retrieved from: http://www.humanmetrics.com/cgi-win/jtypes2.asp
• National Center for Cultural Competence (n.d.). Body/Mind/Spirit. Retrieved from https://nccc.georgetown.edu/body-mind-spirit/framing-holistic.php
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• Providence Health and Services Washington (n.d.). Our mission, values, vision, promise. Retrieved from https://washington.providence.org/about/mission
• 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. 10.7453/gahmj.2015.043
• Thorp, T. (n.d.). Daily practices for spiritual, mental, emotional, and physical well-being. Retrieved from https://chopra.com/articles/daily-practices-for-spiritual-mental-emotional-and-physical-well-being
• Typology Central. (2018). ENFP. Retrieved from: http://jung.test.typologycentral.com/

• Utopia Wellness (n.d.). The four aspects of you. Retrieved from https://utopiawellness.com/the-four-aspects-of-you/
• Wittkower, E. D. (1974). Historical Perspective of Contemporary Psychosomatic Medicine. The International Journal of Psychiatry in Medicine, 5(4), 309–319. 10.2190/3E22-QE77-PMDY-CWDD
• World Health Organization (n.d.). Constitution. Retrieved from https://www.who.int/about/who-we-are/constitution