Running head: SELF-REFLECTION PAPER INTEGRATIVE NURSING

Self-Reflection Paper Integrative Nursing

Anne Gonzalez
University of Arizona

Self-Reflection Paper Integrative Nursing

Overview of Optimal Healing Environments
Many healthcare providers believe they are providing the population they care for with an
optimal healing environment (OHE). At one point I thought I was providing an optimal healing
environment when in actuality I was not treating the patient entirely of mind body and soul. This
course has enlightened me to the true definition of an OHE that I should be fostering for my
target population. Readings by Zborowsky and Kreitzer (2014), has improved my knowledge and
nursing practice to care for patients as a whole and create an environment that will allow healing
in a nurturing setting. Many elements are considered when managing an OHE such as lighting,
artwork, incorporation of nature, the color of the room, background noise and scents (Zborowsky

& Kreitzer, 2014). The integration of elements needed to create an OHE should be carefully
evaluated based on the subgroup that is going to be treated in that particular setting.
Creating an effective OHE will need to be composed of the balance of three main
principles: people, place and process (Zborowsky & Kreitzer, 2014). Working in acute care
setting in Arizona many areas of the organization can benefit from integrative nursing. My
workplace in the cardiac cath lab is loud, fast paced, cold, and bright. The cath lab is composed
of prep consist of ten bays, the recovery has 19 bays and five procedural suites. Patients are
moved in an assembly line manner with the emphasis to get them in and move on. The process
is influenced by nurses but is mainly physician driven with the mentality to hurry up. There are
ten nurses to manage the prep and recovery area, and each caregiver has different beliefs and
methods for their ideal way to provide an OHE. There needs to be a unification of people, place
and process in the cath lab to support an OHE.
There is a limited amount of integrative nursing or complementary alternative medicine
practiced in the cath lab. There is currently one nurse that will apply integrative nursing to his
practice daily but is often frowned upon by some providers. The OHE that is available to the
population is a TV with spiritual music, warm blankets, dim lighting (when agreed upon by all
nurses), the services of a chaplain and skills that have been developed by nurses from
experience. The nurse that practices integrative nursing daily is a great leader to influence and
teach the positive aspects of alternative therapy (Archer, 2015). Putting effort into the integration
of alternative therapies sends the message to the community that we care, and we will try
different modalities to provide excellent patient care. To improve the OHE of the cath lab, the
nursing staff will need to redirect their focus on self-care and self-awareness (Quinn, 2014).
Nurses fail to give optimal healing care when struggling with insufficient self-care of

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physiological, psychological and spiritually (Quinn, 2014). As a leader, I would like to help
nurses increase self-care by improving our nursing stations. Nursing stations are considered to be
a sanctuary to many bedside nurses. Improving the nursing stations can be simple with
inspirational posters, something to make you laugh or even the thought of the day (Wooten,
2013). Every nurse can be involved, providing a daily quote to be a part of the team and improve
the overall morale in the work setting. I would like to incorporate guided imagery as a new
alternative therapy available for the patients and staff of the cath lab. Adding guided imagery to
the cath lab would help decrease anxiety and sadness experience and distract the patient from a
prolonged bed rest in recovery (Foli, AlReza Tadayonfar, Mohsenpour, & Hasan Rakhshani,
2015).
Principles of Integrative Nursing
Humans and Healing
Healthcare is now trending towards treating patients as a whole system. Organizations
such as a hospital can be view as a complex adaptive system, our focus as healthcare providers
should mirror this concept when treating patients. The care delivered to patients should
encompass everything about the patient and not just the disease process. Each aspect of the
patient should be addressed including physical, mental and spiritual (Koithan, 2014). The
environment is another part of the system that should be considered when caring for patients. A
healthy setting will support and nurture the ill back to health without compromising wellbeing
(Koithan, 2014). As humans, we need to surround our self with a positive energy environment
and deflect negative emotions, people and settings to maintain a healthy existence. Admitting a
patient to the cath lab we ask many questions about the home environment if the patient feels
safe to return home, is there anyone available to help them, and if they have money to buy

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prescribed medications. This information provides the details needed to know how to treat the
patients whole wellbeing. Caring for the whole patient wellbeing goes beyond placing a stent in
a narrowed coronary. It is the care that will follow after the stent is placed, the teaching,
maintenance, and changes that will need to happen to maintain a healthy being (Wolff & Boyd,
2015).
Humans are born with the innate capacity to want to be healthy and well. Properties of
integrative nursing will foster the patients ability to improve and maximize the possibility to be
healthy (Koithan, 2014). Talking to the patient and family about the importance of selfawareness and self-care is teaching that should be completed during hospital admission. Hearing
the same information about self-care will help rekindle the flame of wanting to be a healthier
being. Patients can struggle with self-care when they are suffering psychologically and will need
the assistance from the integrative nurse. The nurse will guide the path for the patient to become
self-aware, which will develop into self-care. An example of this principle can be viewed as a
patient who has multiple stents in peripheral vessels of the legs and fail to follow the rules and
take the appropriate medications. The patient returns to the cath lab and the leg is revascularized. At this point, the patient is very scared and ready to make the lifestyle changes
needed to be healthy because of the recent event. The patient has now become self-aware
because of the in-stent stenosis and is ready to practice self-care.
Nature has a majestic healing property that humans gravitate toward in a time of spiritual
need or distressed (Koithan, 2014). Many different cultures use nature as an anchor for self-care
and to connect with nature. The ancient Chinese culture uses nature in the meditative movement
of Tai Chi. While the participant of Tai Chi is performing this art, it is important that they are
barefoot and touching the Earth (Sun et al., 2015). This connection with nature allows the

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member to channel the energy from the Earth and heal spiritually. In the clinical setting
connecting with nature can be a challenge working long hours. Upon discharging a patient, each
nurse will take a turn escorting the patient outside to the car. This break allows a moment for
fresh air and a mental disconnection from the stress of the cath lab.
Person-Centered and Evidence-Based Care
The bonded relationship that the nurse can develop with the patient promotes healing and
overall wellbeing. Person-centered care will support the patient physically, mentally, and
spiritually and identify the patient as a human being. Providing care in this manner will help the
nurse identify with the patient that they are treating a person and not a monitor (Koithan, 2014).
Providing caring in this way it is important that all nurses and organizations develop
relationship-based care. Improving how care is delivered will change how the community heals
and maintains a healthy lifestyle while in the recovery phase of care (Koithan, 2014). To form a
connection with the patient in the prep or recovery phase of care I take the time to talk to the
patient and family. It can difficult to appear engaged and have all the time in the world to answer
questions, in an extremely fast paced environment. This mannerism of care supplies the patient
and family with ease and trust with the healthcare team.
Many nursing interventions are integrative modalities that treat the patients whole
wellness (Koithan, 2014). Therapeutic modalities can be viewed as noninvasive treatments that
can be easily done at the bedside. Providing the patients with alternative options will increase the
amount of self-care and self-managed care the patient will contribute participation (Koithan,
2014). Using guided imagery during a painful intravenous (IV) start or the art of distraction
will allow the patient to relax (Foli et al., 2015). The patient will listen to the nurse talking to
them controlling the breathing allowing the vessels to relax and dilate. Modalities of breathing

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relaxing and imagery will prevent the use of medications as lidocaine and avoid multiple IV
sticks.
Focus on Health and Wellbeing
Healthcare providers endure a significant amount of stress from the work environment.
Stress can be related to lack of support from leadership or a demanding patient assignment. This
disruptive balance can damage the nurse's ability to care for self in the appropriate manner of
mind, body and spirit (Koithan, 2014). The care that will be delivered will reflect the stress and
lack of self-care, creating a hostile work and healing environment. In each healthcare setting,
there is an individual that is mean, rude and unprofessional. It is evident that this harmful
behavior can disturb the Chi (the natural flow of energy) in a healing environment. Identifying
the underline cause and correcting the delinquent behavior will allow the nurse to heal and create
a healthy balance of self and healing environment.

Leadership in Integrative Health

Role of Leaders in Facilitating an OHE
Leaders have a significant role in facilitating an OHE for all the members of the unit.
Leadership will learn to view the system as a whole, with distinct skill set to enhance the healing
environment (Kreitzer, Felgen, & Roach, 2014). Acquiring vast knowledge of integrative nursing
will support the leader in developing awareness to the system and self. Leadership will reflect the
organization's mission, vision and values when full committed and understanding how to lead the
whole-system (Kreitzer, 2009).
Design of Optimal Healing Environment
The setting of the cath lab is primarily outpatient with the occasional add-on of an

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inpatient. The population treated in the Heart Center is 65 and older. However, in recent years the
population's age has trended in a downward motion as young as 23 years old. Our OHE consists
of warm blankets, flat lighting, natural color paint, soothing music on the TV and one nurse
fluent in integrative nursing. Creating an OHE for this population will foster care and promote
wellness needed for the patients and families (Halm & Katseres, 2015). Our OHE show positive
results in satisfaction surveys and will increase the amount of money reimburse from Medicare
(Kreitzer & Somerville, 2014).
Our environment could be improved with the addition of complementary and alternative
modalities (CAM) of guided imagery and meditative breathing techniques from yoga. Guided
Imagery (GI) has been researched in other cath lab recoveries and determines the effectiveness of
decreasing anxiety (Foli et al., 2015). The second CAM that should be added to the OHE is
meditative breathing from yoga that has been researched in many different setting including pain,
anxiety and depression (Li & Goldsmith, 2012). Patients are bombarded with multiple emotion
pre, intra and post procedure the use of controlled breathing and meditation will assist in
decreasing heightened emotions. The modality will be strategically integrated with little to no
cost to the heart center. The assistance of the nurse educator will research and collect data that
can be present to the staff on how to use GI and meditative breathing. An in-service will be
mandated at various times to complete the teaching and train all healthcare team members.
Leadership Strategies for Implementation and Evaluation of OHE
A leader's role in creating an optimal healing environment will be complex but worth the
effort for all the participants, healthcare providers, and the community. Identifying areas that can
be improved simply will be the best first step in moving forward. Communicating with all staff
members and presenting a question of how they would improve the healing environment would

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be a tactic to assess the current setting (Halm & Katseres, 2015). Providing information verbally
and written about how to improve or maintain an OHE will help support change. Cultural change
can be met with resistance but with the proper education and presentation acceptance will follow.
Creating goals and an integrative nursing committee for the unit will support change and involve
all members of the healthcare team (Halm & Katseres, 2015). Short-term goal will be in the next
two weeks to meet with the cath lab educator and director to develop a plan of action to
implement and disseminate information. The long-term goal will be six months all healthcare
providers will be trained and implementing the new modalities into nursing practice.
The success of the implementation can be measured by various methods. Patient
satisfaction score will reflect how patients feel about the care they received from the cath lab.
Follow up phone calls can be tailored to ask questions about the new approach to care. It is also
very positive when patients and family members verbalize satisfaction to the nursing staff at the
end of the day how pleased they are with the care they received today.

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References
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Foli, S., AlReza Tadayonfar, M., Mohsenpour, M., & Hasan Rakhshani, M. (2015). The study of
the effect of guided imagery on pain, anxiety and other hemodynamic factors in patients
undergoing coronary angiography. Complementary Therapies in Clinical Practice, 21,
119-123. http://dx.doi.org/10.1016/j.ctcp.2015.02.001
Halm, M. A., & Katseres, J. (2015). Integrative care: The evolving landscape in American
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