10/19/2017 ILLUMINATING PRACTICE POTENTIAL THROUGH CREATING A CARING ENVIRONMENT NURSE SAVED MY LIFE CENTERING GREETINGS & OBJECTIVES

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1 CENTERING ILLUMINATING PRACTICE POTENTIAL THROUGH CREATING A CARING ENVIRONMENT GREETINGS & OBJECTIVES 1. Personal holistic journey 2. Organizational holistic journey 3. AHNA journey Reflections, Examples and Videos Who am I: Staff Nurse Geriatric Nurse Practitioner Nurse Manager Nursing Quality Director Holistic Nurse NURSE SAVED MY LIFE NEW YORK CITY NEW YORK PRESBYTERIAN HOSPITAL Bedside Night Shift Nursing Chronic Illness; Vascular disease; & Geriatrics Personal Values Presence Active Listening Touch Relationship Connectedness Spirituality Why do so many patients write letters about you? 1

2 CIRCLE OF INFLUENCE CIRCLE OF INFLUENCE Desire to make bigger impact Caring for those who cannot care for themselves Geriatric NP- caring for patients and families Influence improving systems Patient Care Director-Nurse Manager Master s Public Administration- life long learner Doctorate BirchTree Center AHNA Director of Nursing Quality Systems & Populations BACKGROUND NURSES ATTITUDES AND BARRIERS TO PROVIDING SPIRITUAL CARE Gallison BS, Xu Y, Boyle S & Jurgens C. (2013). Acute Care Nurses Spiritual Care Practices. Journal of Holistic Nursing 31(2) Patients biological, social, emotional and spiritual beings Spirituality essence of person seeking meaning and purpose in life Spirituality broad dimensions of relationships with self and others, with ties to past, present and future events BACKGROUND Nursing care suggest spiritual care is warranted but not given adequate attention Need to examine nurses perspective of spirituality and spiritual care for hospitalized patients Identify barriers Assist patient being highly resilient Improve outcomes Increase satisfaction NURSES OMIT IDENTIFYING / ADDRESSING SPIRITUAL NEEDS Believe patient s spirituality is private Outside role of nursing Anxiety, fear viewed as proselytizing Discomfort Lack of knowledge, time, training & institutional support 2

3 PURPOSE METHOD Describe awareness & preparedness to meet spiritual needs of patients Define nurses perception -own spirituality & spiritual care provided Exploratory, descriptive online questionnaire Setting 800 bed academic medical center in NYC Division of Medical Nursing oncology, critical care, step-down, geriatrics, research & general medical units MEASUREMENT Convenience sample (N=271) Spiritual Care Practice (SCP) Questionnaire SCP Part I: determines percentage of acute care nurses who provide spiritual support to their patients SCP Part II: assesses the perceived barriers in providing spiritual care by nurses Two open-ended questions List any other barriers to providing spiritual care Describe a meaningful spiritual intervention Vance, D. L. (2001). Nurses Attitudes towards Spirituality and Patient Care. MedSurg Nursing. PROCEDURE & ANALYSIS SCP Part I: measured on a five-point Likert-type scale ranging from 1 to 5 1 = Very Seldom, 5 = Very Often. Ideal mean 32 spiritual care activities between Occasionally to Often SCP Part II: determines perceived barriers inhibit providing spiritual care Two choices agree or disagree Percentages perceived barriers measured SPIRITUAL CARE PRACTICES I Questions Include: I provide or make arrangements for my patients to be able to participate in their spiritual and/or religious practices and adaptive techniques I assess for signs of spiritual distress I personally participate in spiritual and/or religious practices that enhance my patients spirituality I inquire about spiritual and/or religious practices that might have an impact on my patients' medical care Very Seldom Seldom Occasionally Often Very Often SPIRITUAL CARE PRACTICES I Sample % participation rate 7 incomplete Subsample 113 Mean 29.94, SD (39%) score (61%) < 32 Median score Mode score Range Statistical significance in mean scores Currently screen 3

4 Spiritual Care Practices II % Agree % Disagree Addressing spiritual needs is within the role of the nurse 95 5 OTHER BARRIERS TO PROVIDING SPIRITUAL CARE 31/120 My co-workers criticize and/or ridicule my efforts 6 94 I do not give much thought or attention to my own spiritual self Confident in managing problems resulting addressing spiritual needs Difficulty meeting the spiritual needs when beliefs/practices differ from my own Difficulty distinguishing proselytizing and spiritual care Sufficient time to address spiritual needs Patient's 19 spirituality is private Barriers Time-40% System-30% Patient Resistence-15% Lack of Knowledge-15% DESCRIBE A MEANINGFUL SPIRITUAL INTERVENTION 70/120 Interventions Referrals-45% Prayer-35% Presence-17% Resources-13% IMPLICATIONS Holistic Caring Process Connect needs specific actions Strengthen nurse-patient relationship Holistic Education and Research Implement evidence-based guidelines Holistic Communication, Therapeutic Environment & Cultural Diversity Address physical barriers Expand cultural awareness FLORIDA BH Caring Nurses 4

5 June 2012 Shared Governance Reboot Numerous Nursing Theories reviewed Sept 2012 Dec 2012 Staff elected-jean Watson Human Caring Theory Adoption of Theory June 2013 Quarterly Clinical Retreat- Caring Theory Model of Care - Developed, Adopted & Implemented Dec 2013 DAISY Award Adoption Caring Occasion/Caring Moment July 2014 Quarterly Clinical Retreat Introduction Holistic Nursing April 2014 May 2014 Quarterly Clinical Retreat Transformational Leadership; & Mentoring & Coaching Nurses Week Auxiliary Appreciation Gift Massage Chairs Oct 2014 Quarterly Clinical Retreat Leadership In Action & Self Care for Management Holistic Care Council Formed Charter Policy HOLISTIC CARING COUNCIL Develop & implement Holistic Care Council Share Holistic Care information Discuss, solve problems, make decisions & recommendations regarding Holistic Care in patient care environments Identify opportunities to increase & celebrate Holistic Care 5

6 RELEVANCE/SIGNIFICANCE Promote the values of kindness, respect, care & compassion for ourselves, our patients & our peers Caring for our patients & each other as colleagues and caregivers Promote & implement self-care plan Address the spiritual, emotional & physical concerns of ourselves, our patients & our peers STRATEGY & IMPLEMENTATION Meets monthly & primarily focuses on: Transformational leadership Foster an environment of healing Adopting & implementing Human Caring Theory Promoting therapeutic partnerships & Caring Moments Helping improve the health of the workplace Providing education in holistic care Nov 2014 Dec 2014 Jan 2015 Culture of Safety Journey Florida Hospital Association Safety Summit Collaborate Broward Healing Light Chapter of AHNA Quarterly Clinical Retreat Leading from the Heart & Holistic Self-Care Holistic Care Council Monthly Caritas writing-handout Feb 2015 Apr 2015 May 2015 Healing Gardens Quarterly Clinical Retreat Reawakening the Heart BirchTree Center -Veda Andrus Nurses Week Auxiliary Appreciation Gift- Foot Massage Units Grand Rounds Mindfulness Based Stress Reduction Program Clinical Grand Rounds-Aromatherapy June 2015 Partner Humane Society Cuddles Project Partner with HR on Work life Balance- Salsa, Yoga, & Zen in Ten July 2015 Quarterly Nursing Retreat Lateral Violence Compassion Fatigue Holistic Caring 6

7 Oct st International Caritas Consortium: Weaving a Tapestry of Caring through Collaboration & Connection Onalaska, WI CENTILE International Conference Promote Resilience Empathy & Well-being in Health Care Professionals Washington DC HealthCare Leadership Resiliency through Caring: A Model for Practice & Education Nov 2015 Fort Lauderdale Chamber of Commerce Excellence in Healthcare Award for Wellness/Lifestyle Program Holistic Care Council Florida Association for HealthCare Quality Annual Conference Illuminating Practice Potential through creating a caring environment A Collaborative Balancing Act: Using the World Health Organization Surgical Safety Checklist to Improve Surgical Team Communication Jan 2016 Holistic Competency Fair Feb 2016 Article published Creating a Caring Environment Illuminates Practice Potential. AHNA Beginnings 36(1) Apr 2016 NICHE Conference Aromatherapy: Creating a Caring Moment May 2016 Sept 2016 Auxiliary Appreciation Gift Nurses week Clinical Unit Aromatherapy Pod & essential oils Physician Gift for Nurses Week Personal diffusers & bottle of essential oil Article published- Use of a Surgical Safety Checklist to Improve Team Communication. AORN Journal, 104 (3) BHIP Clinical Research Managing Stress with Meditation: Got a Minute? A practical application of Jean Watson s Theory of Human Caring (Caritas) in a hospital setting. 7

8 CULTURE OF SAFETY JOURNEY Pursuit of clinical excellence, promoting a just culture & becoming a highly reliable organization Protecting patients, visitors and staff, from infections, medical & medication errors, accidents & injuries Recognizing Performance Improvement opportunities enhance, develop & support interventions reducing risks to hardwire a. Culture of Safety aiming for zero failures Safe Care Campaign PATIENT SAFETY PERFORMANCE IMPROVEMENT PLAN Structure Goals to improve Quality & Safety Process Implement processes to improve patient Quality & Safety Comply with regulatory agency standards Outcomes Evaluate processes to determine effectiveness of internal controls & outcomes CULTURE OF SAFETY SETS STAGE Senior Leadership Support Quality - Everyone s Responsibility Individual Ownership & Accountability for Role Dissemination Plan Communication & Feedback Loops ACCOUNTABILITY FOSTERS QUALITY Accountability Empowerment Quality Clinical leaders: held accountable & hold others accountable Patient Quality & Safety are most important outcomes- Patient Centered Quality & Safety Barometer Internal & external 8

9 IMPROVE COMMUNICATION TRANSFORMATIONAL LEADERSHIP Authentic Leadership Presence Active Listening Open & Safe Environment for Communication Inclusiveness Ability to Deal with Conflict in Communication Attitude for Gratitude EVOLUTION OF HOLISTIC NURSING Late 1970 s Charlotte McGuire (AHNA Founder) distressed by: Lack of caring, respect, support, compassion among nurses & other healthcare providers Sick healthcare system & practitioners Nurse burn out little focus on own health & self-care HOLISTIC NURSING IS A CALLING Honor our place in the Sacred Circle of Life Live from awareness All things are Connected Appreciate how we care for ourselves affects all others in our Circle of Life 9

10 FOUNDING VISION Empower nurses to recognize and develop selves as healers and leaders in a more caring and healing system The mission is to advance holistic nursing through community building, advocacy, research, and education. Our vision is a world in which nursing nurtures wholeness and inspires peace and healing. AHNA SCOPE & STANDARDS Holistic Philosophy, Theory & Ethics Holistic Caring Process Holistic Communication, Healing Environment & Cultural Diversity Holistic Education & Research Holistic Nurse Self-Reflection & Self-Care BENEFITS OF HOLISTIC NURSING PRACTICE Holistic model promotes wellness and empowerment for giver & receiver Helping people in a holistic way also feeds & nourishes the nurse s spirit SELF-CARE PRACTICE OF REFLECTION & CENTERING Holistic nurses integrate self-reflection & self-care into their own lives in order to tend to the sacred flow of life 10

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