Sunday, January 1, 2023

Hurricane Katrina: A Response Worse than the Disaster?

In August 2005, Hurricane Katrina hit the southeast coast of the United States, causing loss of life and damage to property in excess of $100 billion (Gibbens, 2019). This Category 3 storm took the lives of at least 1200 people, and countless others suffered years of destitution as a direct result of the damage, which increased with the failed response efforts by the government (Gibbens, 2019). The common theme emerging from each of the sources reviewed - and many that are not referenced in this work – is that although the Katrina storm was a natural disaster that did a great deal of damage on its own, the true devastation and resulting catastrophe was caused by the disastrous response by government authorities, specifically the Federal Emergency Management Agency (FEMA).  

The National Response Framework contains 29 different federal agencies that have a role in disaster relief (Edwards, 2015). There is also a National Incident Command System, so there may be too many “nationally” focused systems, and these may not be as effective in a local or state-level response need. Is it possible that the delay in federal response and subsequent dysfunctional coordination of relief, was driven by the race or socioeconomic status of the residents? Is it conceivable that local and state response systems would provide more successful outcomes than the national or federal red-tape-laden agencies? Let us further explore the inequities of this disaster response.  

Minimizing or Preventing the Disaster in Advance 

The first failure lies within the warnings about the strength and design of the levees, that we now know were dismissed repeatedly for several years prior to Katrina. The southern border of Louisiana was supposed to be safe from flooding because of a network of levees that made up the federal flood protection system. This system, though, was redesigned and a rebuilding process began in 1965. After years of budget cuts and diversion of funding to other projects, the rebuild was only 60-90% complete when Katrina hit (Pruitt, 2020). When levees broke in more than 50 locations, almost 80% of the city of New Orleans was under water (Pruitt, 2020). The city sits uniquely below sea level already, according to McMahan (2022). This was not the first time for severe flooding though, as hurricanes had previously flooded New Orleans five times since 1915, according to History.com Editors (2022).  

A population of roughly 100,000 remained in the city during the storm despite evacuation orders, but one must consider how many residents were physically unable to evacuate, could not afford to evacuate, did not know to evacuate, or did not have the transportation necessary to evacuate (McMahon, 2022). According to the History.com Editors (2022), over 110,000 of the New Orleans residents (approximately 500,000) did not have access to a car.  

Weaknesses in the Response 

In a catastrophe of this magnitude, there are so many working parts that need to be addressed and yes, it starts with prevention, but beyond that there should be a process in place as soon as possible to mitigate loss of life and property. These are just a few considerations that come to mind: 

  • Is there a warning/alert/announcement system in place? Is it accessible to all members of the public? Is it audible/visible without power supply? Who would potentially not receive the alerts? 
  • What is the evacuation need? Is there a plan for evacuation? What is the timeline? How quickly can residents be evacuated? Where will they be directed to go? 
  • What search and rescue resources are available for those who did not, could not, or would not evacuate? Where can those affected go after the fact, to gather? Where can the remaining residents commune for food, shelter, water, clothing, supplies, and medical aid?  

Suggested disaster risk management steps include components of prevention, mitigation, transfer, and preparedness (United Nations Office for Disaster Risk Reduction [UNDRR], n.d.). During Katrina, there were extreme limitations in assistance available to the victims, and tragically, the response by the federal government was also delayed. The government response turned out to be too little, too late. The worst of the disaster came not from the storm itself, but from the response (or lack thereof) by the government. It should be noted that much of the damage from the storm was unavoidable, but the ripple-effect disasters that followed could have been prevented.  

There was plenty of time to begin evacuation efforts prior to the storm and subsequent flooding. Because of the confusion and lack of proactive engagement by officials, faulty information was provided to the public (Edwards, 2015). Edwards goes on to report that “there was general confusion over mission assignments, deployments, and command structure” (2015, para. 3). Despite simulation exercises performed the prior year, officials failed at learning and implementing the key lessons from that drill (Edwards, 2015). During Katrina, there were breakdowns in communication, supply chains, and decision making (Edwards, 2015). Those put in key leadership positions for FEMA were inexperienced in disaster management (Edwards, 2015).  

In the aftermath, there were instances of excessive fraud and abuse regarding distribution of relief funds (Edwards, 2015). Millions were left homeless and more than 400,000 ended up leaving New Orleans for good (Pruitt, 2020). Probably the most appalling aspect of this entire disaster response system is reported by Edwards in his 2015 article. He notes that FEMA blocked relief from the people of New Orleans and he provided examples of actions taken by FEMA. The following bullet points are directly quoted or minimally altered from the Edwards (2015) article, depicting actions taken by FEMA (para. 9):  

  • repeatedly blocked delivery of emergency supplies ordered by Methodist Hospital in New Orleans 
  • turned away volunteer doctors because they were not listed in the government records as emergency volunteers 
  • actively blocked flights intended to emergently evacuate residents and offered no assistance in coordinating evacuation services 
  • refused Amtrak offers for evacuation assistance and would not return calls from the American Bus Association or even the Motorcoach association, who were offering evacuation assistance 
  • denied necessary access for the Red Cross to deliver emergency supplies to the Superdome 
  • turned away trucks from Walmart loaded with water for New Orleans and prevented the Coast Guard from delivering diesel fuel  

This list is not exhaustive but depicts the abhorrent inequities of this disaster response. So again, is it possible that these actions occurred because 69% of the New Orleans population is black (Sastry, 2009)? Was it race or socioeconomic status of the New Orleans residents that caused those in power to dismiss the emergent nature of the disaster? It must be considered based on the extreme negligence and inequity that anathematized the city of New Orleans. 

What Went Right 

Despite all the atrocities listed in the previous section, many things went right with some of the response to Katrina. The local Coast Guard response was integral to the rescue of more than 30,000 people, after they deployed 4,000 service members (Edwards, 2015). The state-commanded National Guard was there to establish and reinforce law and order, when the police force was incapacitated by the storm (Edwards, 2015). The strength of the private sector was revealed with the Red Cross, The Salvation Army, Walmart and its employees, and the Home Depot, all coming through with provisions and supplies for food, shelter, water, clothing, and support (Edwards, 2015). 

Preventing Future Occurrences 

In looking at the potential for preventing or minimizing a disaster like this from happening again, certainly community risk assessments could be performed. For this Katrina disaster, the well-studied failures offer more insight than anything else on how to prevent or respond in similar situations. For New Orleans, a rebuild was required for hurricane defenses and “...cost $14.6 billion...” to complete by 2018 (Gibbens, 2019, para. 19). Federal, state, and local governments spent more than $20 billion to construct new levees along more than 350 miles of coastline (Pruitt, 2020). Prior to Katrina, funding for the United States Army Corps of Engineers (USACE) which would have allowed for the addition of safety measures in their design and upkeep of the levee system was not provisioned (McMahon, 2022). This funding decision was made based on a risk analysis that was conducted, which weighed the costs of installing new levees against the cost of coping with the after-effects of a major disaster (McMahon, 2022). The risk analysis performed in this instance did nothing to benefit the community when it came to the Katrina disaster. 

Conclusion 

All-in-all, Hurricane Katrina was a terrible natural disaster that garnered a slow, dismissive, and poorly constructed federal response effort that failed to help the people who needed help the most. As if there were not enough lessons from other past failures, this disaster set the bar at an all-time-low for government response in the United States.   

References  

Edwards, C. (2015, August 27). Hurricane Katrina: Remembering the federal failures. Cato.org. Retrieved December 30, 2022, from https://www.cato.org/blog/hurricane-katrina-remembering-federal-failures Links to an external site. 

Gibbens, S. (2019, January 16). Hurricane Katrina facts and information. Environment. Retrieved December 30, 2022, from https://www.nationalgeographic.com/environment/article/hurricane-katrina Links to an external site. 

History.com Editors, H. E. (2019, August 9). Hurricane Katrina. History.com. Retrieved December 30, 2022, from https://www.history.com/topics/natural-disasters-and-environment/hurricane-katrina Links to an external site. 

McMahon Last Modified Date: December 21, M. (2022, December 21). What caused the levees to break in New Orleans during hurricane Katrina? UnitedStatesNow.org. Retrieved December 30, 2022, from https://www.unitedstatesnow.org/what-caused-the-levees-to-break-in-new-orleans-during-hurricane-katrina.htm Links to an external site. 

Pruitt, S. (2020, August 27). How levee failures made hurricane Katrina a bigger disaster. History.com. Retrieved December 30, 2022, from https://www.history.com/news/hurricane-katrina-levee-failures Links to an external site. 

Sastry, N. (2010, August 1). Tracing the effects of hurricane Katrina on the population of New Orleans: The Displaced New Orleans Residents Pilot Study. Sociological methods & research. Retrieved December 30, 2022, from https://pubmed.ncbi.nlm.nih.gov/20161061/ Links to an external site. 

United Nations Office for Disaster Risk Reduction (UNDRR). (n.d.). Disaster risk reduction & disaster risk management. PreventionWEB. Retrieved December 30, 2022, from https://www.preventionweb.net/understanding-disaster-risk/key-concepts/disaster-risk-reduction-disaster-risk-management Links to an external site. 

Saturday, October 5, 2019

Thoughts on a College Education

Found this quip in my iPhone notes, it was dated October 5, 2014... exactly 5 years ago today. Just think it is interesting to review prior thoughts and writings every once in a while to see how you may have grown or how you may have departed, from past thoughts. Or in this case, how the past 5 years in my growth and experience has validated my thoughts from 5 years ago. I hope to expand on these thoughts in the future, developing a practical metaphor to convey the true spirit of learning in a college setting.

I believe that college is a place, a lifestyle, an action, and a mode of transportation. 

Place
attend
participate
learn
grow

Lifestyle
way of life
absorb
expose
enrich

Action
be
do
see
think
feel
experience

Mode of transportation
past
present
future

Kristie Hartig
10/5/14


Thursday, June 20, 2019

What kind of nurse are you?

I believe the world needs nurses, nurse educators, and nurse leaders who are idealistic motivators, leading the way for the future of nursing, through education, support, collaboration, and service.


I think I am one of them. My passion for authenticity, integrity, transparency, ethics, advocacy, and tolerance, drives my desire to motivate and encourage new nurses along a similar path.

If we reach nursing students early in their nursing program and hold onto them in a mentor-to-mentee capacity throughout the curriculum, we may be able to introduce them to a world of professional nursing where they still have a solid grasp on compassion and equity in practice and peer relationships. (Image credit: Forbes.com)

There has to be some way to circumvent the cynicism of well, so many nurses. For those who are cynical new grads, maybe you have been mistreated and have experienced what it feels like when "nurses eat their young." Maybe you aren't to blame for your negative, judgmental attitude.


Maybe you are among the misguided who somehow believe that RNs, you know, real nurses, only work in hospitals. Ha! Good grief, give me a break. Real nurses take care of people. All people. No matter the facility, no matter the person. How are you missing that? All I can say is walk a mile, sweetheart, walk a mile!


Cynical nurses are like a vortex...the Coriolis force leading to an infinite abyss of broken spirits. These cynics purloin energy from nurses who believe and practice as I do. They drain the life force of others and even push some to burnout. Since many can't beat you and your nasty attitude, they join you, only to find that there is nothing sweet about the energy created at a negative nancy convention.


Redirect your energy. It's never to late to change your attitude. Life already sucks most of the time, don't make it worse by feeding into the negativity. #EmbraceTheSuck

Where your thoughts are,
your energy is.
Where your energy is,
you will be.
What you think about,
you bring about,
automatically!

Wednesday, June 19, 2019

Free CEUs for Nurses

Here are a few websites offering a bit of free training and CEUs for nurses! Some are more than just 1 education credit!! FREE! From this list alone, there are more than 25 free CE units waiting for you to grab!

For your first free CE unit, check out my publication, on the use of nutrition supplements and how they enhanced patient outcomes. (CE Hours: 1.00)
https://anhi.org/education/course-catalog/83223D52C57B4343BFF3CEE508A56ABF

Next...here is a website with tons of free CE courses available all the time. They change out pretty often so get them while you can and keep checking back on the site. Just search "free" and you will see a list of free CE available at that time. https://www.nurse.com/ce/free-courses?p=2

For access to additional free CEU courses, check out NurseCEU.com, QuantumUnitsEd.com, and Nurse.com.

Here are a few examples from Nurse.com that were free as of June 19, 2019 (copy and paste the links into your browser):

1) Keep It Clean: Hand Hygiene and Skin Antisepsis (CE Hours: 1.00)
http://ce.nurse.com/RVignette.aspx?TopicId=5133

2) Using Emotional Intelligence to Create the Work Environment You Desire (CE Hours: 1.00)
https://www.nurse.com/ce/using-emotional-intelligence-to-create-the-work-environment-you-desire

3) Do You Reflect a Positive Image of Nursing? (CE Hours: 1.00)
https://www.nurse.com/ce/do-you-reflect-a-positive-image-of-nursing

4) Unlock Your Creativity: Be an Innovator! (CE Hours: 1.00)
https://www.nurse.com/ce/unlock-your-creativity

5) Work Life Balance: Learning to Say \\"No\\" Strategically! (CE Hours: 1.00)
https://www.nurse.com/ce/work-life-balance-learning-to-say-no-strategically

6) Promoting a Culture of Safety to Prevent Medical Errors (CE Hours: 1.00)
https://www.nurse.com/ce/promoting-a-culture-of-safety-to-prevent-medical-errors

7) Family Caregivers: Doing Double Duty (CE Hours: 1.00)
https://www.nurse.com/ce/family-caregivers-doing-double-duty

8) Transitions of Care (CE Hours: 1.00)
https://www.nurse.com/ce/transitions-of-care

9) The Healing Power of Humor (CE Hours: 1.00)
https://www.nurse.com/ce/the-healing-power-of-humor

10) Compassion Fatigue (CE Hours: 1.00)
https://www.nurse.com/ce/compassion-fatigue

11) What's on the Inside: An Overview of Blunt Chest Trauma (CE Hours: 1.00)
https://www.nurse.com/ce/whats-on-the-inside-an-overview-of-blunt-chest-trauma

12) Motivational Interviewing (CE Hours: 1.00)
https://www.nurse.com/ce/motivational-interviewing

13) Recognizing Drug-Seeking Behavior (CE Hours: 1.00)
https://www.nurse.com/ce/recognizing-drugseeking-behavior

14) Evidence-Based Approaches to Pain Control (CE Hours: 2.50)
https://www.nurse.com/ce/evidence-based-approaches-to-pain-control

15) Opioid Use Disorder and Pregnancy: What Does Evidence-Based Care Look Like? (CE Hours: 1.00)
https://www.nurse.com/ce/opioid-use-disorder-and-pregnancy-what-does-evidence-based-care-look-like

16) Health Literacy and Discharge Education: I Didn’t Understand (CE Hours: 1.00)
https://www.nurse.com/ce/health-literacy-and-discharge-education-i-didn-t-understand

17) Patient Counseling: Preventing and Combating Opioid Misuse (CE Hours: 1.00)
https://www.nurse.com/ce/patient-counseling-preventing-and-combating-opioid-misuse

18) Responsible Opioid Prescribing, Chronic Pain, and Addiction (CE Hours: 1.50)
https://www.nurse.com/ce/responsible-opioid-prescribing-chronic-pain-and-addiction

19) Chemotherapy-Induced Nausea and Vomiting as a Barrier to Good Patient Outcomes (CE Hours: 1.00)
https://www.nurse.com/ce/chemotherapy-induced-nausea-and-vomiting-as-a-barrier-to-good-patient-outcomes

20) Effective Pain Management is More Than Just a Number (CE Hours: 1.00)
https://www.nurse.com/ce/effective-pain-management-is-more-than-just-a-number

21) Meeting the Challenge of Pediatric Pain Management (CE Hours: 2.90)
https://www.nurse.com/ce/meeting-the-challenge-of-pediatric-pain-management

Just keep learning!

My journey to become "educated" has been long and winding, and the path continues far ahead of where I am now. I either can't see the end, or I just don't want to. (Photo retrieved from The Wilderness Road, a blog on wordpress)

I initially went to college at age 17, only three days after my actual high school graduation day. I made it somehow through five semesters of college (Summer, Fall, Spring, Summer, Fall) without having any direction or goals, without a plan or purpose. I married, left college, went to beauty school, moved to another state, had kids, worked here and there, then divorced...

Rough time...through the divorce. I can't imagine it is ever easy when kids are involved. But I had to do something to earn a decent living and provide for the kids, so I decided to go back to school. After all, I was now an experienced adult who could finally appreciate the process of learning.

So, I "restarted" college 15 years ago as a single parent of two. Whoa, that was so hard. Balancing bills, parenting, school, being broke, and being the oldest in class... I don't think I could do that again, as I don't even know how I did it to begin with! I was 32 years old, so that probably helped as far as energy and motivation...but it was still pretty tough!

After completing a certificate program at a vo-tech training center to become a licensed vocational nurse (LVN) in 2005, I decided to continue with school. I worked as much as possible, hungry for stabilized income, but decided to enroll in prerequisite courses for an RN program. I think half of the reason I kept going to school was that I was able to borrow enough money to help with living expenses while I did my pre-req courses, and the other half was that my previous loans were deferred while I was enrolled in school!

And okay, I admit it. I did the same thing when I went to a university where I was enrolled in a nontraditional nursing program. Yep, that's how I survived financially, scraping money together from full time work, financial aid loans, and scrooge-like spending practices. I finally graduated with a BSN degree in 2013. I remember being so excited to finally be accepted and starting in an RN program.

But boy, oh boy! Every single quiz, paper, exam, and clinical simulation, turned into such a high-stakes event--the threat of being booted "out of the program" was such a giant, dark, heavy storm cloud, always looming, even on the sunny days.

I am currently enrolled full time in an MSN program with Education as my designated specialty. I was so gung-ho to start but ooophf -- it is so hard to
stay motivated and see this thing through.

The end is so close but I am so over it! I am in my last semester and I only have two classes left to go. I can DO this, right?


Dare I say that I will probably continue with schooling until I receive a terminal degree in nursing (PhD or DNP)...
Yep, I think I have to. Heck, it sure beats
having to start payments on the student loans I racked up while trying to survive school as an adult (who already had bills, kids, car troubles, and lots of other responsibilities).

Wednesday, April 3, 2019

The Affordable Care Act

Oh wow. This is great! It is the best summary of the Affordable Care Act (ACA) purpose and intent that I have seen to date. It is from the article The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice by Sarah Rosenbaum, in the Public Health Reports journal Vol. 126 No. 1, published in 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/


“Consisting of 10 separate legislative Titles, the Act has several major aims.

The first—and central—aim is to achieve near-universal coverage and to do so through shared responsibility among government, individuals, and employers.

A second aim is to improve the fairness, quality, and affordability of health insurance coverage.

A third aim is to improve health-care value, quality, and efficiency while reducing wasteful spending and making the health-care system more accountable to a diverse patient population.

A fourth aim is to strengthen primary health-care access while bringing about longer-term changes in the availability of primary and preventive health care.

A fifth and final aim is to make strategic investments in the public's health, through both an expansion of clinical preventive care and community investments.”



This is not what people understand, and there is just no way to educate those that don’t want to know more. I will leave you with something I read in a book I am reading for school (reference is Nickitas, below). It is a quote that completely strikes my funny bone, as probably the most ignorant comment about the Affordable Care Act…


Early in President Obama’s first term, when healthcare reform was being proposed, he reported receiving a letter from a woman who did not know the difference between a government and a private health insurance plan. She said, “I don’t want government-run health care. I don’t want socialized medicine. And don’t touch my Medicare” (Cesca, 2009)


Ok, she takes the cake for sure...







...and then for her official winner's certificate...












References:

Nickitas, D. M. Policy and Politics for Nurses and Other Health Professionals, 2nd Ed. Chapter 2, page 15. Retrieved from an e-book online through Western Governors University.


Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Reports, 126 (1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/

Wednesday, January 30, 2019

Nursing: Professional Presence and a Healing Environment

Achievement of success is reliant upon a winning merger of professional and personal life, and maintaining the healthy balance between them. One way you can attain this balance is to develop a professional presence plan that can be used to bridge the two worlds. Professional success in nursing depends upon the nurse’s self-knowledge and awareness, as well as the technical training and experiential practices. Various personality tools can be used to identify your your personality type, which can provide insight about how you think, plan, react, and self-manage.

This post will help you to explore self-awareness practices to increase the presence of mindfulness in your life and health care practice, by encouraging you to understand your strengths and weaknesses. It will also focus on professional presence, mindfulness practice, and healing environments. Utilizing the awareness gained from analyzing your thoughts, beliefs, and values, as well as your activities, relationships, and experiences, you can transform... and create a healing environment through the use of self-knowledge, active listening, authentic leadership, and mentoring.


Models of Health and Healing

According to Larry Dossey there are three eras of medicine between the 1860’s and current times (Koerner, 2011). Initially, illness was thought to exist as a physical response to brain functions. In the 1950’s we began to understand that illness presented with the culmination of physical, emotional, spiritual and mental aspects, internal to the patient.

It wasn’t until the 1990’s that the care models began to integrate external, social and spiritual components and how this metaphysical energy, both intangible and invisible, has a direct impact on patient health and healing. The core differences can be identified in the approach to care.

In Era I, providers sought only to reverse or correct the physical properties of the illness and used scientific facts and objective data to provide care. In Era II, providers began to understand that the subjective data the patient provided also had an impact on care—how and what the patient thought, felt, and understood resulted in variant outcomes. In the modern era of practice, there is a deeper understanding of the impact that the environment of care has in patient healing, and the patient’s own power in healing.

To be human is not just to have power over the mechanical or chemical components of the brain. It is the culmination of the physical, mental, spiritual, social, emotional, cultural, theoretical, and mechanical components that pertain to that patient.

Era III ushers a practice where there is greater consideration for the environment of care, and in order to promote a “healing environment” we must consider the human, and all that this means, to positively impact on patient’s health. The core difference in the eras then is based on consideration of internal versus external powers and the persuasion they have over the outcome of healing.

Models and Professional Presence

The environment of care has such an impact on patient outcome, as does the patient’s current human state. “[Mind-mediated phenomena] should inspire doctors to find more ways of treating the ills of the body by taking advantage of the powers of the mind and convince patients that those powers are always available to help restore lost health” (Weil, 2004, p. 234).

The Era I practices are comparable to the practices you have as a novice nurse, where you use a mechanical, textbook approach to care. You are not yet experienced enough to incorporate anything other than completing tasks, recording and reporting data, and advocating for patients in small ways. You may have since progressed through the levels of nursing experience to become a proficient clinician, and may have emerged to practice with intention, incorporating the needs of the patient and family in a meaningful way to promote an environment of healing.

Does your practice recognize the multitude of factors affecting patient outcome, including your beliefs, thoughts, and attitudes, and those of the patient? You must not allow your own beliefs or attitudes to obstruct the progress of patient healing, because your sole purpose as a nurse is to advocate for the patient in any way necessary.

Influence on Nursing Practice

Certainly your professional presence influences your nursing practice. If you are perceived to be competent, calm, self-assured and poised, it will promote an environment of trust and collaboration, which will in turn result in an increase of self-assurance, poise, competency, and composure. When this is perceived by the patient or fellow staff, it promotes a healing environment.

Many principles are used to promote healing presence in nursing practices. With self-knowledge, you begin to understand how you perceive your surroundings, and how you tend to react to situations. Knowing your personality type can be of great benefit as you learn to facilitate a healing environment. Knowing your personality traits as determined by the Meyers & Briggs typology test, enables you to be mindful in your practices. Use the principle of authentic leadership to influence the practices of others, and to unite in the common purpose of providing a healing presence to your patients.

Koerner defines healing presence as “the difference between safety and quality,” (p4 Koerner, 2011). I disagree with this definition and believe that healing presence is the bridge between safety and quality, not the difference. When I ask myself ‘what is the difference between the two,’ I think about how I define the two terms in this context. Safety, simply stated, is determined by the technical or mechanical aspects of providing patient care. Quality can then be determined by how that care was provided, focusing more on an emotional or mental application. Therefore the nurse’s healing presence does not differentiate between safety and quality, but rather bridges the obvious gap between the two.

Whole Person Goals

Mindfulness in essence, is self-reflection-in-action (Sherwood & Horton-Deutsch, 2012, p.80). In developing your own practice of mindfulness, you can create a plan to strengthen your health and balance in the physical, vital, mental, and spiritual bodies/aspects.

To be more mindful physically, it is important that you nourish your body and provide it with adequate exercise. You could prepare a menu on a weekly basis, to increase the opportunity to make smart and healthy food choices rather than fast food or processed foods.

To be more mindful in the vital/rhythmic aspect, you can institute a specific curfew for yourself by setting an alarm on your phone/watch. At that time, you would stop what you are doing and begin your bedtime routine. This cut-off time for you nightly, will enable you to achieve the recommended 6-8 hours of sleep each night.

You can also begin the practice of meditation using a phone app like Headspace. You can use the app daily as it suggests, and evaluate the effectiveness after seven days. Meditation will help to ease anxiety and focus your thoughts, and can help to prevent burnout as a nurse (Lichtenberg, et al., 2013).

To account for the mental and emotional balance, you can incorporate breathing exercises as an adjunct to the meditation. You can integrate the use of the 4-7-8 (Relaxing Breath) breathing exercise several times throughout the day and thoughtfully begin to practice it when you recognize that your stress level is high (Gonzalez, 2016). The act of intentional breathing is a “bridge between the conscious and unconscious minds” (p62, Weil, 2004). You can also read books for pleasure, to gain mental and emotional balance.

To achieve and maintain spiritual balance, you can look into attending church weekly, or complete daily scripture readings, or daily religious/gratitude journaling. This will help to restore a positive attitude and bring the realization that you are loved, cared for, and watched over.

Achievement of Goals

The wholeness of being human, involves attention to all of the aspects of mind, body, and spirit health. In order to achieve the goals you set for myself, you must continue to grow in the understanding that only balance among those aspects will bring ultimate health and allow you to help others in their pursuit of health and wellness. You can make a chart for yourself, to help sort the practices you plan to implement and to help meet the goal of mindfulness. Here is an example of a goal chart:


To adjust to the changing of your “whole person,” you will have to keep in mind why you chose to observe mindfulness. In order to become an agent of change you need to carry out changes in your own life.

Healing Environments: Best Practices

There are two facilities I have found in particular, that stand out in their patient care optimal healing environments. Their goal is to promote healing environments that reduce stress, anxiety, to speed healing, to shorten hospital stays, and to reduce the need for additional medications. Grinnell Regional Medical Center (GRMC) offers many different benefits in internal (spiritual care, meditation room), interpersonal (massage therapy, essential oils, café and dining options), behavioral (guided imagery, art therapy), and external environments (healing garden, bird aviary) (Grinnell Regional Medical Center, 2017).

The Johns Hopkins Hospital works to reduce the stress of hospitalization for the patient and family, incorporating artistic and aesthetic elements into the environment of care. They have rooms designed to be filled with sun, public spaces that are peaceful and elegant, ceiling tiles that absorb sound over patient care areas, gardens that are lush with landscaping designed for reflection and meditation, an art collection on display throughout their buildings, and animal sculptures in the children’s center. They have even included art images on the window shades in private patient rooms (Hopkins, n.d.).

Professional Presence Promotion

You can apply self-awareness and insights from review of the healing environments that were discussed, to promote professional presence in your current health care setting. As discussed in Management Learning by Becker, Jordan, and Messner in 2009, reflection plays a key role in organizational learning and has been based more on reflection-on-action than reflection-in-action. To engage staff in learning, it is important that they be enabled to learn and reflect as they go, so allowing time for review and reflection is a necessary element. Staff should be offered education on mindfulness practices, and encouraged to develop their own sense of mindfulness.

In the optimal healing environments discussed above, noise reduction was a key component to promotion of the healing process, both for the patient and for the family. Partnering with the patient, and allowing them time and space to “sort through the issues of the day, offering understanding and interpretation along the way” (p138, Koerner, 2011) is imperative to patient healing. You can begin to offer a quieter, safer, more supportive environment to your patients as a result of this research. There are areas where we can reduce stress for our patients through noise reduction on the unit, during changes of shift and nurse-to-nurse reporting practices. We can create an enhanced healing environment simply by ensuring that the patient room and bedside table are clean and free of debris and clutter.

We can begin to guide patients through their own mindfulness practices, and teach them non-medicinal techniques to manage their stress and pain – such as breathing exercises, meditation, darkening the room, decreasing environmental stimuli, or repositioning. There are many ways to initiate the use of mindfulness, self-awareness, and healing environments in your organization.

In Conclusion


Achievement of success is reliant upon a winning merger of professional and personal life, and maintaining the healthy balance between them. Adhering to a professional presence plan can bridge the two worlds. There is power in knowing that professional success in nursing can be secured through your own self-knowledge and awareness, as well as the technical training and experiential practices you have and those you will encounter.

In using personality tools to identify your personality type, you can explore self-awareness practices to increase the presence of mindfulness in your life and your health care practice, by understanding your strengths and weaknesses. You can more clearly focus on your professional presence, mindfulness practice, and the healing environment. You can transform and create a healing environment through the use of self-knowledge, active listening, authentic leadership, and mentoring.

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