Optimal Healing Environments

Optimal Healing Environment Overview  

An Optimal Healing Environment (OHE) is a shared space where healing occurs by addressing all aspects of a person’s individuality.  Individuality includes; the physical, psychological, social, cognitive, economic, environmental, spiritual and behavioral components of humans (Zborowsky & Kreitzer, 2014).  When considering an OHE, it must focus on external factors like, light, fresh air, architecture, color of walls, furniture, art, activities, and music.  It also reflects internal aspects like, relaxation, meditation, prayer, and energy exchange.  An OHE accounts for interpersonal items like, relationships, communication, leadership and teamwork, as well as behavior like, collaborative healthcare, exercise and integrative practice (Dossey & Keegan, 2013). 

Our Roots and True Purpose of Caring

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Integrative nursing brings us back to our roots and the true purpose of caring.  It recognizes a human’s need for deep connection with others and self.  It combines the art and science of nursing, relating to beings as whole people who are more than physical bodies with disease.  An integrative Nurse relates to patients as complex beings with differing needs, desires and culture, and they strive to partner with patients, hearing their story by listening with full presence and using intuition and sensitivity to allow for healing.  Integrative nurses combine many methods of healthcare from traditional medicine to complimentary and holistic practices.  Integrative nursing does not assume, instead, it is curious, creative and in constant flow, seeking opportunities to better connect to the patient, self, colleagues and the environment (Hess et al., 2013).

Whole systems’ Healing

Whole systems’ healing aligns with the concepts of integrative nursing, understanding that adjustments to any systems’ pieces will affect change through the entire system.  In our complicated healthcare environment, emerging leaders are being shaped to guide the way (Kreitzer, Felgan, & Roach, 2014).  The conventional top-down approach does not allow for change in culture, instead, a whole systems’ leader incorporates employee participation to determine actions that affect many, are innovative, evolving and adaptive, yet they still honor the past. 

Well being is balancing the body, mind and spirit

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Well being is a balancing of the body with the mind and the spirit, including elements of social, economic, career, relationships, community, environment and more.  Any imbalance of these areas can cause a decrease in well being and overall health (Kreitzer, Delagran, & Uptmor, 2014).  Individuals are affected by genetics and culture and one also makes behavioral decisions based on personal choice, or sometimes social pressure.

Kreitzer et al. state that health lies in choosing lifestyle behaviors that create health, resiliency and control.  Behavior choices help one feel whole and satisfied with one’s health and well being. Perhaps choosing to exercise daily with weight training, running or yoga, or choosing to o eat whole foods and limit processed food daily. Choices like meditation and journal, and choosing to continue educating the mind.  Volunteer in my community. Healthy behaviors lead to well being.

Feeling connected to nature, the earth and the universe, generates awareness that humans are linked to more than just each other.  Feeling close to nature, like trees, flowing water or sunshine help provides spiritual strength, inspiration and comfort (Dossey & Keegan, 2013, p. 725).  Noticing nature and feeling its presence decreases stress, heart rate and blood pressure and increases inspiration from being with it.  Acknowledging nature’s benefits enlivens the spirit by keeping it healthy and supporting self-care.

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Focus on People and Their Communities

Integrative nursing focuses on people and their communities to enhance health and wellness.  It co-creates relationships specific to the patient or community, enhancing strengths and wisdom, and exploring challenges and risks as both parties contribute to growth (Koithan, 2014).  Nurse Coaches, strive to partner with clients by listening with presence, asking specific questions and then combining all information to help clients find clarity. Nurse Coaches enhance clients strengths, explore opportunities and use intuition to accept them where they are, but also know it is important to ask them to dive deeply into their possibility. 

Complementary therapies like essential oils, guided imagery, meditation, therapeutic touch, massage, coaching, exercise, whole foods and others have scientific merit in healing and pair well with Western medicine to support patient needs (Hamilton, Fawson, May, Andrade, & Kavanagh, 2103; Koithan, 2014).  Integrative nursing offers patients methods to support their whole being, and are aware of options to benefit them.  Offering clients choices allows them to explore their entire being and encourages opportunities for healing. 

Take Care of Self Before Others

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We must take care of self before effectively caring for others.  In 1984, Quinn proposed that a “…caregiver’s use of self is the most powerful instrument for healing” (Koithan, 2014, p. 13), and developing self-awareness aids with self-healing.  Practicing as an ICU RN, I focused solely on my physical health, not realizing how important healing my mind and spirit were. I was strong physically, but my spirit and mind were suffering, it was here when I suffered from compassion fatigue and left nursing.  When I learned what compassion fatigue was I was filled with an indescribable relief. Finally, I had answers and I took action by beginning to heal my whole self.  Understanding the importance of caring for self fully through balancing my wellbeing, practicing mindfulness, self-reflection, breathing and awareness has made me a better person and caregiver.  I am thankful to have returned to nursing.

Facilitating an Optimal Healing Environment

Leading change and facilitating an Optimal Healing Environment (OHE) requires complete dedication to visualizing the environment, processes and its people as interconnected.  It requires the skill of honoring the past, embracing the unknown future and engaging the entire team for collaboration of ideas, concepts and learning and it requires developing and reassessing self, since self-awareness guides decisions and relationships (Kreitzer et al., 2014). An OHE has many moving parts that are connected and leading innovation is challenging, in fact, “Innovation does not occur in isolation but it is an art and science sustained through an organizational climate and culture” (Joseph, 2015, p. 117), and understanding the culture can have boundless impact on creating a shared vision.

Design of Optimal Healing Environment

Design of an optimal healing environment is essential for success. Employees are exposed to stress, high workload, confrontation, long hours and more, because of this their risk for developing burn out and illness is high (Bush, 2009), prevention of burnout and illness is imperative for employee health, satisfaction and retention.  An OHE for this group will begin with an assessment of the environment, its people, the culture and relationships and their specific needs, desires and values (Horner & Shellinger, 2014). 

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Integration of complementary and alternative medicine (CAM) into each OHE will be important to its success.  Methods like, meditation, guided imagery, relaxation, will reduce stress and create improved self-awareness. Guided imagery through the use of narratives, visualizations, energy creation and symbolism decreases anxiety (Greene & Greene, 2012).  Another CAM to incorporate could be meditative movement like Tai Chi or yoga to decrease stress, improve overall health and improve physical resiliency, potentially reducing injury and decreasing the stressors which lead to burnout (Chen, Ueng, Lee, Sun, & Lee, 2010).  Other complimentary modalities include Integrative Nurse Coaching, where Nurses partner with employees to uncover what is important to them in regards to their health and healing, and then co-create action plans to move clients towards their goals. Of course food and mindful eating contribute to greater awareness of how food choices contribute to health and wellness, energy levels, and obesity.

Leadership Strategies in Developing an OHE

In developing an OHE for employees at risk for burn out, a leader would begin by learning about the present culture, work flow, attitudes, challenges, opportunities and strengths, desires, needs and wants of the organization.  They would assess the physical environment, the people, the feel and culture of the space to truly understand the depth of need.  They can do this by observation, discussion, surveys, focus groups, process review and more. Then taking all this information into account, a data driven proposal would be created to share with leadership to obtain support, this will include opportunities for adding CAM like, increased employee morale and retention, increased employee confidence, improved customer satisfaction, and overall health improvement, and a reduction in employee health insurance costs. 

Once leadership support is obtained, along with a designated leadership champion, the CAM therapies would be added slowly.  Of course, employee buy-in is imperative, so all information shared with leadership will also be shared with employees and how CAM will benefit their health and the work they do, as well as at home.  Baseline data like employee stress/anxiety levels, job purpose and attitude about work, employee and customer satisfaction scores will be collected before CAM is implemented.  All data will be shared with leadership and employees.          

Evaluating the OHE

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Evaluating the effectiveness of CAM and the OHE can be determined through data collection of post anxiety/stress levels, workplace satisfaction and purpose, and employee satisfaction score comparisons pre and post CAM.  Subjective evaluation through focus groups and actual usage of CAM will be additional important information to determine its success.  Opportunities to share this information throughout the work place by working with the onsite wellness team and marketing department will be important when extending CAM practices. 

Integrative nursing and the development of an Optimal Healing Environment includes many areas of focus and complete collaboration with people, communities and systems.  This focus places the employee at the center and allows all attention to be upon them as they guide all processes.  Nurses are leaders in this concept and honoring our past, yet looking to systemic, innovative and evolving solutions to healthcare challenges will position nursing as effective and whole leaders for healthcare. 

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Nicole Vienneau MSN, RN, NC-BC has been a registered nurse for 20+ years, is a board-certified integrative nurse coach, personal trainer, group fitness and yoga instructor, faculty with the International Nurse Coach Association and founder of Blue Monarch Health, PLLC. She specializes in the prevention of brain and heart disease by partnering with clients to uncover their wisdom and enhance their health. Nicole is a passionate Nurse advocate who strives to transform healthcare through nurse coaching. She loves exploring nature, finding solace with her cats and traveling with her awesome husband.

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References

Bush, N. J. (2009). Compassion fatigue: Are you at risk? Oncology Nursing Forum, 36(1), 24-28.

Chen, S., Ueng, K., Lee, S., Sun, K., & Lee, M. (2010, November). Effect of T’ai Chi exercise on biochemical profiles and oxidative stress indicators in obese patients with type 2 diabetes. Journal of Alternative and Complementary Medicine, 16(11), 1153-9. http://dx.doi.org/10.1089/acm.2009.0560

Dossey, B., & Keegan, L. (2013). Holistic nursing:  A handbook for practice (6th ed.). Burlington, MA: Jones and Bartlett Learning.

Greene, C., & Greene, B. (2012, May-June). Efficacy of guided imagery to reduce stress via the internet:  A piolet study. Holistic Nursing Practice, 26(3), 150-63. http://dx.doi.org/10.1097/HNP.0b013e31824ef55a

Hamilton, J., Fawson, S., May, J., Andrade, J., & Kavanagh, D. (2103, December). Brief guided imagery and body scanning interventions reduce food cravings. Appetite, 71, 158-162. http://dx.doi.org/10.1016/j.appet.2013.08.005

Horner, A., & Shellinger, E. (2014). Transforming the healthcare environment through a hospital-based integrative health initiative:  Sanford Medical Center. In M. Kreitzer, & M. Koithan (Eds.), Integrative nursing (pp. 68-83). New York, NY: Oxford University Press.

Joseph, M. (2015, March). Organizational culture and climate for promoting innovativeness. The Journal of Nursing Administration, 45(3), 172-178. http://dx.doi.org/10.1097/NNA.0000000000000178

Koithan, M. (2014). Concepts and principles of integrative nursing. In M. Kreitzer, & M. Koithan (Eds.), Integrative nursing (pp. 3-16). New York, NY: Oxford University Press.

Kreitzer, M., Delagran, L., & Uptmor, A. (2014). Advancing wellbeing in people, organizations and communities. In M. Kreitzer, & M. Koithan (Eds.), Integrative nursing (pp. 125-136). New York, NY: Oxford University Press.

Kreitzer, M., Felgan, J., & Roach, P. (2014). Whole systems healing:  A new leadership path. In M. Kreitzer, & M. Koithan (Eds.), Integrative nursing (pp. 47-55). New York, NY: Oxford University.

Zborowsky, T., & Hellmich, L. (2011). Impact of place on people and process: the integration of research on the built environment in the planning and design of critical care areas. Critical Care Nursing Quarterly, 34(4), 268-281. http://dx.doi.org/10.1097/CNQ.0b013e31822c3831

Zborowsky, T., & Kreitzer, M. (2014). Creating optimal healing environments. In (Ed.), Integrative nursing (pp. 84-100). Oxford, NY: Oxford University Press.