I arrive at work to find out I have three patients to admit in one hour. Does that sound familiar? One may wonder how that can be done. I work in Same Day Surgery (the pre-operative area) at busy northeast academic major medical center and that is the norm, as we generally have 20 plus patients to get ready with 7-8 RNs between 6:00 and 7:30 am. Our day can average 35-45 plus patients.
Nursing practice in a busy pre-op environment can be quite challenging, as there is a lot to accomplish in a short time. The goal is for the patient to get into the operating room for an on-time start safely by making sure all pre-op testing and documentation is complete, consents are verified, patients received safe-site marking, have seen their surgeon and anesthesiologist, have real time charting complete, and, oh yes, reduce their anxiety. Peri-op can become a stressful environment if you let it. I don't accept the stress. How? Grounding and centering myself is empirical. I have already centered myself on my way to work by listening to some relaxing music, letting go of whatever is going on at home, and setting intention for a great day. I do the same on my way home so I can be fully present there as well.1
The Patient's Needs
As a Holistic RN, I am concerned as to how my patient and their family members are coping with their upcoming surgery; their fears, their anxiety. They most likely did not sleep well last night. Are they in pain? Do they have a support system? How can I help them? I am contemplating what is the best plan of care that I am able to implement in a way that I can engage, build a relationship with the patient, and connect.
I review the chart, ensuring completeness, and go see my patient. Before I enter my patients' room, I pause for a moment, setting aside concerns regarding the past or the future, I breathe. I inhale deeply and exhale slowly bringing awareness to my heart and mind. I envision something or someone that evokes my love and compassion. I breathe again, maybe twice more. When I feel connected with a state of consciousness full of love and compassion, I say to myself, I am present to the moment. This process of grounding and centering takes about 10 seconds. This process is repeated each time I go in to engage with my patient. 2
We call our patients the day before to give them pre-op instructions, information and go through the pre-op checklist, as not much changes within a 24-hour period. Since the checklist is out of the way, I am able to focus on the individual and their family. I can become a caring presence. I am not as concerned with what modality I should use, as there is not always time to perform guided imagery or give a Reiki treatment. As I enter my patients' room, I set an intention of healing. The modality I use is therapeutic presence.1 I engage my patient, I connect by being authentically present. I am present-in-the-moment with the patient, to communicate and obtain the information needed to understand the patient and family members' knowledge, thoughts, feelings and problems, which contributes to improving a therapeutic environment. 3 I achieve this using touch, maybe holding their hand or placing my hand on their arm, as I sit with them and engage eye contact. I am able to listen carefully to their story, explain the process of the peri-op period, and individualize care based on their needs.3 While actively listening to this individual, I am focused on what is being said, being empathetic, understanding, and comforting. 4 Active listening decreases anxiety and gives importance to their story. 3 A smile, a caring touch, a warm blanket, dimming the lights enhances a healing environment. As I leave, I thank my patient and family for sharing with me. This is not time-consuming, as it only took 20-30 minutes. I pause, take a breath, and address the patient in a kind manner. I breathe!
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I go to my next admission; I take a deep breath to give a moment to ground and center before engaging with my next patient. I am then able to offer compassionate care while being a therapeutic presence. This is holistic nursing.
"Therapeutic presence defined: Presence is defined as existing or occurring now, being in the moment, in immediate proximity. Therapeutic is defined as "treating or curing disease." By combining the two words, the definition of therapeutic presence is: "Being in the moment and in immediate proximity to treat disease."5 The concept of nursing presence has been viewed, as a way to build meaningful and trusting relationships, which can increases Hospital Consumer Assessment of Healthcare Providers and Systems. 6
"Holistic nursing is not necessarily something that you do: it is an attitude, a philosophy, and a way of being"7, which includes therapeutic presence, centering/grounding prior to patient engagement, compassionate care and personal self-care practices.1,5,6,7 Self-care is a core value for holistic nursing and is essential for the nurse to be a caring presence, not only in nurse patient engagement but also combat compassion fatigue 8:
Take your breaks, eat healthy meals, avoid negative conversations, know your limitations, and set boundaries at the workplace.
Get enough sleep, adequate exercise, and self-reflection/meditation.
Make time to do you a priority: practice yoga, Reiki, tai chi, receive regular massage, connect with nature. 8
The possibilities are limitless; get creative. Self-care activities will provide the necessary renewal to be therapeutically present throughout the day. Yes, it does take practice to care for one's self, without guilt.
Holistic nurses may integrate complementary/alternative modalities (CAM) into clinical practice to treat people's physiological, psychological, and spiritual needs. Doing so does not negate the validity of conventional medical therapies, but serves to complement, broaden, and enrich the scope of nursing practice. 7 Holistic nurses may integrate aromatherapy, Reiki, guided imagery, and breath-work into their skill-set to assist healing the whole person and help individuals access their greatest healing potential.
Music Therapy: Patients may be allowed to listen to their favorite music or I am able to offer the C.A.R.E. Channel. Music can reduce stress and unfamiliar noise, while contributing to a more pleasant environment. 3
Reiki/Healing Touch are gentle, noninvasive energy-based therapies that soothe and balance the flow of energy from the practitioner to the patient, which helps restore the patient's mind, body, and spirit connection. 3
Aromatherapy (when used in our periop setting) is the inhalation of essential oils of which the purpose is to achieve a therapeutic benefit. Essential oils can affect the mood, alleviate fatigue, reduce anxiety and promote relaxation.
Holistic nurses may also incorporate into their practice: guided imagery, acupuncture, herbology, acupressure, polarity, therapeutic touch, reflexology, Qigong, yoga, massage, biofeedback, nutritional counseling, art and color therapy, and the list goes on. Most all modalities require specialized training and separate certifications must be maintained to practice in individualized states. 7
"Loving care does not require twice the time, but it does require more than twice the presence," said Erie Chapman, JD, MTS, president/CEO of the Baptist Healing Hospital Trust, Nashville, Tenn. 1, 9
Holistic nursing is defined as "all nursing practice that has healing the whole person as its goal".7 Holistic nursing is a specialty practice that draws on nursing knowledge, theories, expertise, and intuition to guide nurses in becoming therapeutic partners with people in their care. This practice recognizes the totality of the human being - the interconnectedness of body, mind, emotion, spirit, social/cultural, relationship, context, and environment.7
Further information on holistic nursing may be accessed at the American Holistic Nurses Association and The Birchtree Center for Healthcare Transformation.
1. Andrus, V. Therapeutic Presence: By truly being present with patients, nurses bring comfort and care. http://www.advanceweb.com/. Advance for Nurses. April 14, 2010.
2. Mayo Clinic. Centering and Intention Setting Techniques. http://www.mayo.edu/pmts/mc5500-mc5599/mc5574-109.pdf
3. Selimen, D. & Andsoy, I. The Importance of a Holistic Approach During the Perioperative Period. http://www.aornjournal.org/. 93 (April 2011) 482-490. © AORN, Inc, 2011. doi: 10.1016/j.aorn.2010.09.029
4. Boeck, PR. Presence: A Concept Analysis. sgo.sagepub.com/content/4/1/2158244014527990. DOI: 10.1177/2158244014527990. 21 March 2014.
5. Andrus, V. Therapeutic Presence: The essence of nurse-patient engagement. http://www.advanceweb.com/. March 17, 2014.
6. Andrus, V. Caring Presence: The key to improving the patient experience. http://www.advanceweb.com/. Advance for Nurses. October 9, 2013.
7. What is Holistic Nursing. http://www.ahna.org/About-Us/What-is-Holistic-Nursing.
8. Hines, M. Holistic Presence at the Bedside: Challenges and Rewards. Beginnings. AHNA. 2010.9. Chapman E. Radical loving Care: Building the healing hospital in America. Nashville, Tenn.: Erie Chapman Foundation; 2010: 80.
Joyce ZaffarUllah is a staff nurse at New York Presbyterian Hospital, a faculty advisor for The BirchTree Center for Healthcare Transformation and a licensed acupuncturist in private practice in New York City and Malverne, N.Y.