Running head: SELF REFLECTION

Self Reflection
Andrea Hunter
University of Arizona

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Self Reflection

OHEs are areas that support whole-person healing through the environment, including the
people and operating modalities existing inside the environment, fostering the care of patients as
body-mind-spirit beings rather than diagnoses (Zborowsky & Kreitzer, 2014, p 86-87). Optimal
healing environments (OHE) are largely personal, adjusting to patient preference and needs to
obtain wellness through their own individual definitions. It is through these environments that
integrative nurses foster caring, person-centered patient relationships (Koithan, 2014, p 4-5)
My current workplace is an inpatient step down unit caring for post-surgical kidney, liver
and pancreas transplant and surgical oncology patients. We are part of a not-for-profit universitybased teaching hospital and level one trauma center. The unit is circular with 14 private rooms.
Our unit has 43 staff members, two clinical leaders, and a manager. There is a night and day
shift, each working 12-hours per shift.
Aspects of an OHE are present in my unit through pleasing paint colors, windows in
every room, and availability of distractions such as books, movies and TV. In the main hallway is
a thankful tree encouraging patient, staff and family participation in writing gratefulness
affirmations on the trees leaves. There are also cards from past patients and staff photos in a
display case for patients and staff to see and appreciate. These OHE details positively impact
both patients and staff. Patients point out staff that cared for them to their families, and patients
and staff alike fill out leaves for the thankful tree. Although the occasional staff member
performs complementary and alternative medicine (CAM) such as therapeutic touch, use of
music or humor, we do not have a unit-wide practice of CAM modalities. This is an area of
improvement needed, as integrating CAM methods would benefit both staff and patients. Also,

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improvement is needed on our unit in incorporating additional aspects of an OHE, including staff
acceptance of integrative nursing modalities, as it is not a widely accepted practice on the unit.
Application of principles of integrative nursing, although not widely accepted on my unit,
are concepts I have worked to adapt into my own personal nursing practice. Recognizing humans
as systems and energy beings acknowledges the indivisible relationship of body, mind, spirit and
environment to whole person functioning (Koithan, 2014, p 7-9). I honor this concept during
each patient admission. The questions I ask are about medical history, as well as their spiritual
beliefs, personal preferences and relationships and what is important to them during their stay.
The incorporation of these questions fosters a stronger nurse-patient relationship and encourages
integrative care and supporting an OHE from the patients personal views on health.
Identifying personal health views allows for incorporation of integrative nursing
placing the patient in the best possible way for healing to occurthrough the knowledge that
healing and well-being are adaptive and living concepts (Koithan, 2014, p 9-10). Well-being and
balance will occur to those given the proper nursing interventions to support that balance
(Koithan, 2014, p 10). I consistently incorporate self-care, awareness and intention of action into
patient education, preparing them for discharge with tools supporting healing of not only their
incisions but also their mind and spirit as they move towards whole person wellness.
The outdoors has a great impact on wellness (Koithan, 2014, p 10). Nature is from where
we came, and the isolation seen in todays society from both nature as well as people negatively
impact whole-person balance and self-discovery (Koithan, 2014, p 10). I encourage patents to go
outside as often as feasible while hospitalized, taking them as often as I can. Patient demeanor
and especially cognition if they were confused improves after the shortest time breathing fresh
air and seeing sunshine, illustrating clearly our spirits need for the healing power of nature.

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Equally powerful to integrative nursing is establishing a person-centered nurse-patient

relationship founded on a basis of mutual benefit, respect and open collaboration (Koithan, 2014,
p 11-12). Personal application of this concept is done through incorporating the patient into
bedside report and explaining medical jargon in a way they can understand, asking the patient
and family what their goals for the day are and writing all goals, the plan for the day, and any
patient questions on a white board in their room. This allows for mutual understanding, respect
and patient empowerment to guide care through their own views of healing and wellness.
Establishing a patient-centered relationship allows the integrative nurse to identify and
utilize healing modalities best suited for patient needs. Going from least to most invasive based
on evidence-based practice modalities, the nurse implements therapies with the intention of
resorting balance to the patients body, mind, spirit and whole-person care (Koithan, 2014, p 1213). For example, I taught wound care to a young patient with a new ostomy, allowing him to
perform cares independently with my supervision. This fostered patient confidence and
established nurse-patient rapport, trust and sense of caring through time taken to be sure he was
performing cares appropriately as established by appropriate evidence-based practice.
Recognizing the need for self-care and the promotion of self-care in others is another
essential integrative nursing concept. Nurses cannot adequately give care to others if they do not
take care of themselves first (Koithan, 2014, p 13). Through awareness and intentional, loving
care towards self and role modeling healthy behaviors, caregivers can transform their own body,
mind, and spirit and reawaken the ability to heal others through caring and love in return. To
maintain self-care, I think daily of things for which I am grateful. This helps me remember my
blessings, the struggles I have overcome, and the future to which I can look forward. This gives
me hope and strength to live each day with intention and mindfulness to care for and heal others.

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The role of nurse leader is essential in facilitating OHEs. Incorporating holistic healing
into their own self-care, patient care practice and leading paradigm, leaders foster holistic
practice by others thorough good example. Just as nurses practice whole-person healing, nurse
leaders also need to practice whole-systems leadership with ongoing collaboration, education,
awareness, and adaptation to new situations and uncertainty (Kreitzer, Felgen & Roach, 2014, p
49-52). Leading from love, peace, caring and intention and treating staff as whole people fosters
staff relationships, improves morale and energy (Turkel, 2014). Whole-system nurse leaders act
as a catalyst for positive change facilitate integration of CAM and OHEs.
In designing an OHE for an elderly patient, for instance, care needs to be taken to make
the space feel less institutionalized and more like home (Edvardsson, 2008). Music and sound
therapy through listening to, writing, or performing music has shown healing benefits for
incorporation into OHEs for the elderly, as music is closely connected with emotions, mind and
spirit and can offer both stimulation and relaxation and decreased depression in this population
(Keegan, 2001, p 168-169), (Chan, Wong, Onishi & Thayala, 2011). Use of green space through
plants, access to gardens and nature are also shown to promote healing in older adults, and are
equally beneficial to incorporate into the OHE for this population (Detweiler et al., 2012).
Integration of these CAM modalities can easily be implemented with little training or cost.
Promoting music through educating patients about available radio stations on their TVs is easily
implemented, free, and can offer immediate patient benefit. Supporting the use of nature and
outdoors requires time, however with promotion of this modality by invested staff allows other
staff see the benefits outweigh the cost of time. Even the simple act of ensuring window
accessibility for patients, and keeping flowers and plants given to them by family and friends in

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view are quick and easy to perform, free to implement, offers immediate patient impact, and
illustrates the caring intention of the nurse.
Integration of OHE concepts into my current work environment necessitates specific
leadership planning, implementation and evaluation. Compassionate and open leadership
methods foster collaboration, openness and teamwork (Turkel, 2013), empowering staff to
incorporate OHE strategies and continued innovation towards long-term change. Planning
through staff education and buy-in and making small changes first aids in acceptance.
Additionally, placing an emphasis on self-care and intention in action is essential for staff to fully
integrate OHE and CAM modalities into their practice. Promotion of taking their break for lunch,
taking time to breathe, doing things that fill their spirit outside work and incorporating positive
and intentional patient interaction can transform care and make staff open to OHE strategy
implementation. Plan for outcome evaluation of the OHE strategy implementation is the
continued acceptance and integration of adopted strategies by staff. Additionally, evaluating staff
recognition of the need for self care and intentional healing interaction with patients is necessary
to ensure an OHE is being fostered. Patient evaluation of satisfaction of various implemented
strategies can be performed through general surveys and patient rounding.
The principles of integrative nursing and optimal healing environments have re-lit the fire
in my core nursing beliefs towards caring for others through intention and love. It reminded me
why I became a nurse, why I feel this profession is my calling, my must as Nightingale would
say (Dossey, 2010a as cited by Beck, Dossey & Rushton, 2014, p 535). Before learning these
concepts, I felt discouraged and on the path to burnout. However, recognizing the power of
healing for not only the receiver but also the giver has transformed my way of thinking, fostered
my own self-care, and has allowed me to continue down the path of this amazing profession.

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7
References

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transformation: Florence Nightingales legacy for the twenty-first century. In M.J.
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Chan, M. F., Wong, Z. Y., Onishi, H., & Thayala, N. V. (2011). Effects of music on depression
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Detweiler, M. B., Sharma, T., Detweiler, J. G., Murphy, P. F., Lane, S., Carman, J., Kim, K.
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Edvardsson, D. (2008). Therapeutic environments for older adults: Constituents and meanings.
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Kreitzer, M. J., Felgen, J., & Roach, P. A. (2014). Whole-systems healing: A new leadership
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NY: Oxford University Press.
Turkel, M. C. (2014). Leading from the heart: Caring, love, peace and values guiding leadership.
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