FEATURE ARTICLE
Continuing Education
Holistic Self Care
Strategies for Initiating a Personal Assessment
by Julia Balzer Riley, RN, MN, HNC
Section Editor: Joy E. Wachs, PhD, APRN, BC, FAAOHN
T
here is so much for occupational health nurses to
do, and so much they would like and want to do,
but it is difficult for them to make time for themselves. How can occupational health nurses authentically
support clients on a journey of self care if they do not
understand the struggles along the way?
To give to others, nurses need to nourish all aspects of
self. The self extends far beyond the needs of the
physical body. Therefore, giving of the self requires
self nurturance of the physical, mental, emotional,
and spiritual aspects (Burkhardt, 200 I).
Self care is a matter of giving oneself permission to take
the time, to make the commitment,-itnd to negotiate the
roadblocks.
How can occupational health nurses be fully present
in the work setting and alert to the many faceted needs of
employees if they are distracted by their own unmet
needs? Holistic self care attends to the needs of the whole
person, and although the effects of body, mind, and spirit cannot be separated from the whole, bringing attention
to each component can help nurses set the intention to
care for their whole selves. According to Dossey (2000b),
"When nurses live and practice from a holistic perspecABOUT THE AUTHOR
Ms. Riley is President, Constant Source Seminars, Ellenton, FL; CoFounder, Holistic Nursing Institute, Tucker, GA; and Adjunct Faculty,
University of Tampa, Tampa, FL.
ABOUT THE SECTION EDITOR
Dr. Wachs is Professor, East Tennessee State University, Johnson City, TN.
OCTOBER 2003, VOL. 51, NO. 10
tive, they recognize that there is not separation between
their personal and professional selves," This article
examines attitudes and strategies to help occupational
health nurses initiate holistic self care plans.
ASSESS CURRENT SELF CARE PRACTICES
As I care for myself, so I care for my clients. As I
care for myself, so I care for my family and the people
who are important to me (Riley, 2003).
Occupational health nurses who create life balance
can be fully present for clients. Hans Selye (1978), the
father of stress management, suggested there are two
keys to stress management: Know thyself, consider what
messages the body gives that are signs of personal stress,
and variety in life. People who are sedentary at work
should explore physical activity for leisure. To begin this
process, the occupational health nurse can complete the
personal assessment of current self care practices (see
Tables 1 and 2). The nurse can then reflect on this personal assessment and add modalities or other useful
strategies to meet identified needs. Articles by Bascom
(2002a, 2002b) in the AAOHN Journal provide a description of complementary and alternative therapies.
ATTITUDES THAT PROMOTE SELF CARE
Life is not measured by the number of breaths we
take, but by the moments that take our breath away
(Heidi Willis, 2003).
Values
How high a value do nurses place on taking care of
themselves? Do they give themselves permission to take
time to do things to promote their health? Are they com-
439
Table 1
Personal Assessment Of Current Self Care Practices
For Iha body
Do I have an annual physical and diagnostic tests for my age? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
I can tell I am at a high energy state when
The warning signs and symptoms my body gives me when I need renewal are - - - - - - - - - - - - For Iha mind
To leave work at the office, I - - - - - - - - - - - - - - - - - - - - - - - - - - - To relax, I - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - To get through a tough day, I say to myself
To "lighten up" at work, I - - - - - - - - - - - - - - - - - - - - - - - - - - - - To "lighten up" at home,
For the spirit
To renew my spirit, I - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Ways I deal with events that seem to have no meaning or beliefs that help me are - - - - - - - - - - - To disconnect from daily pressures, I - - - - - - - - - - - - - - - - - - - - - - - - - Benefits I receive from prayer, meditation, or time alone in nature are - - - - - - - - - - - - - - - -
I------------------- --------
fortable with the notion of having fun and of taking time
to just "be" and not do? A nurse friend once recommended more "staring at the wall time." Is it okay to rest
or sit quietly in contemplation even when there are
things left to do at home? Do nurses Jove themselves
enough to believe they deserve to be treated well by
themselves and others? Behaviorists suggest people can
reverse the order: Begin with caring for the self and then
feeling more lovable. It is important to first change the
behavior-the attitude change will follow.
Prior/I/BS
Are nurses able to put themselves first, to say no to
even reasonable requests, if they have plans for self care
activities? How good are their assertive skills? How well
can they say no? How willing are they to say yes to themselves? At a time management seminar in the 1980s
(Jacksonville, FL) at which Franklin Planners (FranklinCovey, Salt Luke City, Utah) were sold, the trainer talked
about their system based on principles elucidated by
Benjamin Franklin. They called it "value-centered event
control" and conducted an exercise in which participants
listed their life values such as lifelong learner, loving
spouse, or loving parent. They were then asked to review
their calendars. Would they see their values reflected in
their calendars?
The trainer shared a story of a man who wrote after
a seminar to tell of his experience applying value centered event control. He had written loving spouse as a
value, but had no time with his wife allotted on his calendar. He went home and they negotiated time to walk 3
days a week. Later, when the wife happened to glance at
his calendar, she noted her name was written in three
times for each week in the year. He credited their commitment to this written goal as having revitalized their
marriage of 20 years. Think what nurses can do when
440
they become clear about their values and priorities and
make a commitment to them. Are they willing to write
exercise time into their calendars, in ink?
Responsibility
One can consider studies that shed doubt on the
belief that hormone replacement therapy prevents heart
disease in menopausal women and a study that reported
surgical treatment of osteoarthritis of the knee that produced similar results as the placebo effect on clients
who believed they actually had the surgery (Gordon,
2002). Gordon, former chair of the White House Commission on Complementary and Alternative Medicine
Policy and current director of the Center for
Mind-Body Medicine in Washington, calls for a study
of the integration of self care with exercise, acupuncture, yoga, massage, and glucosamine sulfate for the
treatment of osteoarthritis (Gordon, 2002).
Is it possible that an aging nurse population, facing
the health challenges of midlife and older adulthood, is
becoming clearer about the need to commit themselves to
holistic self care? A study of a pilot mind-body-spirit
educational program at Saint Mary's Mercy Medical
Center in Michigan indicated promising outcomes with
self care, including the empowerment of internal health
locus of control and the integration of body, mind, and
spirit approaches (Lawson, 2002).
STRATEGIES TO IMPLEMENT HOLISTIC SELF CARE
Nobody made a greater mistake than he who did
nothing because he could only do a little (Edmund
Burke, British Statesman, 1783).
Writing Goals
Are occupational health nurses willing to take the
time to commit their goals to paper? Writing a goal
AAOHN JOURNAL
Table 2
Holistic Modalities
Review the following list and mark the appropriate response:
Acupressure
Acupuncture
Aromatherapy
Art therapy
Cognitive therapy
Counseling or psychotherapy
Dance therapy or movement
Exercise
Goal setting
Guided imagery
Humor or laughter
Hypnosis
Journal writing
Massage or body work
Meditation
Music or sound therapy
Nutritional counseling
Play
Prayer
Reflection
Relaxation techniques
Smoking cessation
Therapeutic touch
Walking meditation
Weight management
Aregular part of
my self care
Have tried at
least one time
Am w/11/ng
to try
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
0
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
0
D
D
0
0
0
D
D
D
D
D
D
0
0
0
0
D
0
0
D
0
0
The following are definitions of selected modalities: Acupuncture is a treatment from the tradition of Chinese medicine and can be traced back
2500 years. Thin, solid metallic needles are inserted into the skin at specific anatomical points to correct the balance of energy flow (Qi) believed
to be essential for health. It is used for a variety of purposes, such as to alleviate back pain, headache, pain from osteoarthritis, neck pain, and
in the treatment of chemotherapy induced nausea (Freeman, 2001). Acupressure Is a healing art based on Chinese and Japanese medicine Irr
which pressure is applied by fingers or thumb to specific points to relieve pain or tension (Dossey. 2000b). Cognitive therapy "addresses the
relationship among thoughts, feelings, behaviors, and physiology" (Dossey. 2000b). It may be used to treat depression, anxiety, and burnout by
changing negative thoughts and perceptions that trigger and perpetuate distress (Balevre, 2001; Dossey, 2000b).
makes it more real. Placing it in a highly visible place
serves as a reminder. Displaying a picture of the final
result of a desired goal or a representation of it can
strengthen resolve. Keeping a written or a visual journal or creating a collage from clipped magazine pictures or drawings can make the process more fun. Creating a mental image of success taps the power of
imagery and adds another dimension to writing goals.
OCTOBER 2003, VOL. 51, NO. 10
Setting The Intention For Holistic Sell Care
Do nurses consciously set the intention to have balance and harmony in their lives? The ancient Latin root
of the word "intention" means to reach out or stretch
toward (Locsin, 2002). Intentionality, however, is more
that just setting a goal. Intentionality is being open to the
process necessary for success. It is remaining open to
other ways of achieving a state of wholeness where a
441
Creative Ways to Relieve Stress
• Belly dancing classes offer exploration Into different
cultures, an opportunity to meet new people, and a fun
way to move the body.
• Tai Chi Chuan Improves balance and builds leg
strength (Krapu, 2003). For 20 years, classes have
been held every morning at the national meeting of the
American Holistic Nurses Association. A study of
women ages 72 to 96 showed statistically significant
Improvement in self assessed health among those
participating in tal chi (Taggart, 2001 ).
• Yoga students use eye masks filled with lavender in the
resting posture at the end of classes (Pettinati, 2001 ).
• One nurse administrator, a friend of the author's, takes
Zydeco dance lessons, based on the music of the
Creoles and Cajuns In Louisiana, with her husband for
stress relief.
• One nurse supervisor, a friend of the author's,
recommended classes in stained glass because the
sound of the breaking glass helped her get rid of her
anger and sadness when her husband died.
deeper order of possibilities for success exists (Watson,
2002). For example, an occupational health nurse concluded that the current work setting was not conducive to
personal balance and harmony, yet was unable to resign
for financial reasons. When the nurse was asked to leave
shortly thereafter, another position was available that
offered more opportunities for professional development
and better hours. The nurse had set the intention for a life
of bulance and harmony, meditated about it, Jet go of the
final way to reach the illusive state of peace, and in the
end, found a better resolution.
Being Open To Exp/oration
Do nurses consider the benefits of combining one or
more self care modulities to make the process more fun?
Could they try a walking meditation, walking ulone, and
paying attention to ull the senses? Could they listen to the
sounds; smell the smells; see the beauty in nature; and
experience the heat of the sun, the cold crisp winter air, or
a clean fresh spring rain'? They may find they are able to
access intuition for better problem solving when they stop
worrying about a problem and relax in nature (Cameron,
1997). They may find themselves more creative when
they combine more than one form of artistic expression
such as a walking meditation before writing a report or
listening to music before teaching a class (Rogers, 1997).
Are nurses open to trying new ways to relieve stress?
Consider the examples listed in the Sidebar.
A11um/ng A Beginner's Mind
Can occupational health nurses simply look at
something in nature, such as a cloud or flower, and soft-
442
en the gaze, seeing with fresh eyes (Travis, 2001)?
"Wellness is not a matter of accumulating something,
like more data or more special programs. Rather, wellness is realized by being present and unburdening yourself of all that prevents a natural state of basic healthfulness," according to Travis (2001). Can nurses look at
art for wellness in a new way by creating a mandala, a
circular design seen in many cultures and for many centuries? Tracing a compact disc and drawing and coloring a design in the circle encourages one to reflect on
the message of the mandala. Some nurses keep a mandala journal and later look back for life patterns in the
drawing (Fincher, 1999). Coloring for stress reduction
can be useful as an adult activity (Riley, 2002a).
Starting With Small Changes
Small changes can make a big difference (Travis,
2001). A good place to begin could be with drinking 8 to
IO glasses of water each day. Going outside at least one
time during the workday or hanging a landscape painting
in a room with no window can also be starting places.
Taking a few moments to imagine a beautiful place for a
mental mini vacation can be helpful. Principles of
imagery suggest this relaxed state is similar to being in a
beautiful place (Assagioli, 1965).
Recognizing, Acknowledging, And Accepting Feellngs
Feelings are neither good nor bad. They just are. It is
no worse to be sad or angry than it is to be happy, yet
some may be embarrassed by a demonstration of feeling.
Studies have shown that writing about emotional experiences improves physical and emotional health (Pennebaker, 1997). Writing about feelings in a journal or
talking about feelings with a friend or professional can be
therapeutic. It can help individuals discover patterns in
their behavior and the relationship between their feelings
and the body's response.
Selye's ( 1978) admonition to "know thyself' means
to learn to recognize how one's body gives clues to perceived stress. Occupational health nurses can learn to
monitor their bodies by asking such questions as: "When
I am angry, how does it affect my body?" and "In what
situations do I respond with anger?" This focusing is a
way to become aware of body sensations that carry
meaning about issues or concerns (Klagsbrun, 200 l ).
Journal writing can facilitate life reflections that can
lead to making decisions about which situations are
beyond one's control and which involve a matter of
choice. For example, nurses in jobs they perceive as
stressful have three choices:
• To work within the organization to promote change.
• To remove themselves from the situation by a lateral
move in the organization, to change jobs, or return to
school to prepare themselves for a different position.
• To accept the situation, avoid voicing their dissatisfaction which can be demoralizing to others, and nurture other
parts of their life which bring them joy and meaning.
It is important to notice the word "perceived." The
same event does not evoke the same response in all nurses. Personalities vary and the perceived opportunity from
AAOHN JOURNAL
organizational change invigorates some nurses and overwhelms others who prefer performing in ways already
proven to be successful.
When fear, anger, or sadness threaten to overwhelm,
a gratitude list may be helpful. Practicing forgiveness is
constructive. Holding a grudge against someone does
them little harm, but can drain the nurse's energy.
Occupational health nurses need to feel free to
experience sadness and grief at the loss of a client, family member, or friend. They are often called on in workplace disasters to be strong, and it is sometimes difficult
for them to give themselves permission to take time to
grieve. Hospice staff whose work involves multiple
losses may seek each other out to talk, support each
other in taking time to cry, or spend time alone in a
place of natural beauty.
Recognizing that gender differences exist in grief
responses and that American men have been marginalized in their experience of grief and loss is important.
Men may reject the help of others and seek to actively
control their feelings. They may use humor, seek companionship through activities rather than direct emotional support, use private times for reflection, and use
private therapy techniques such as bibliotherapy and
journal writing (Zinner, 2000). Women may be willing
to experience the emotional pain of loss and be open to
and expect direct comfort, support, and counseling.
These are considered more conventional styles of grieving, but men and women can display either style (Zinner, 2000). Knowing that unresolved grief can be cumulative, occupational health nurses can improve self care
by being open to allowing themselves time for grief as
sadness arises.
Paying Attention To Breathing
Paying attention to breathing includes taking a
moment to breath slowly. One way to focus on breath~bdom~nal
ing is by taking abdominal breaths. Dur~ng
breathing, the abdomen expands the durmg mhalation,
and contracts the during exhalation. It is helpful to
imagine breathing in "peace and calm" and blowing out
"tension and negativity."
Paying Attsnllon To Ss/f Talk
Monitoring mental self talk can be very helpful. It is
important to note all the negative messages and replace
these with affirmations. An affirmation is a positive statement of what is desirable with no negative words. For
example, "I am in the right place, at the right time, doing
the right thing, in the right way." "There is always enough
time." Or a more spiritual statement such as, "Centered
and poised in the presence of God, I move through the
activities of today, easily and gracefully." Or, "I have a
forgiving spirit, I look for the good in all people and situations, and I find it." Phrases such as these can be
repeated when fear or anxiety threaten peace of mind.
Simplifying Life
Nurses, like others, may benefit from clearing out,
cleaning up, organizing, and reducing the clutter in their
OCTOBER 2003, VOL. 51, NO. 10
The joy of spending time with people one
cares about is a solid foundation for self
care. Scheduling time with those who
encourage laughter and feeling good about
one's self Is a proactive use of supportive
individuals in one's life.
lives. By simplifying, there is less to clean, tend, and
maintain and more time for other activities.
Eating simpler foods with less processing and time
consuming preparation is also a positive response.
Choosing raw fruits and vegetables, drinking milk or
water, eating fruit for dessert, and eating smaller portions
more frequently are all healthy alternatives.
Adding movement in simple ways such as climbing stairs; parking the car farther away; or turning on
music and dancing to relieve boredom, anger, sadness,
or just to express joy are simple activities that bring
positive results.
Being discerning about the number of electronic
devices, methods of communication, and the amount of
time spent can simplify life and free time.
Developlng Comic Vision
Do nurses laugh enough? When was the last time the
staff had a good laugh together? To have the energy to see
the humorous side of life, occupational health nurses
need to nurture their sense of humor with play. It can be
effective to take time as a group to make a list of things
each person in the group likes to do for fun. Each person
in a group can choose one fun activity to pursue just for
fun and then write a contract, "I (name) promise to (list
one fun thing to commit to do), by (2 weeks from current
date), Signed (signature)."
Building Support Systsms
How can occupational health nurses nurture personal and professional relationships, take time to make new
friends, and remain connected to old ones? The joy of
spending time with people one cares about is a solid
foundation for self care. Scheduling time with those who
encourage laughter and feeling good about one's self is a
proactive use of supportive individuals in one's life.
It is important for occupational health nurses to pay
attention to special moments of connection and be open
to a change in plans to make room for others. They can
elicit the support of friends in making positive behavior
change. They can problem solve about challenges. They
can voice their frustration and receive the mercy of a
friend or intimate partner who assures them they are
loved just the way they are. When they assess their sup-
443
Sample Holistic Self Care Plan
For Your Body
Love your body just as it Is and take care of it.
Move your body. Turn on music, twirl, sway, swing your arms, touch your toes. Go to a driving range and hit some golf
balls. Feel the joy of full range of motion. Take a walk.
Pamper your body. Use peppermint foot cream to soothe tired feet. Try aromatherapy. Schedule a massage or ask for
massage gift certificates for special occasions.
Feed your body. Choose healthy foods and eat more slowly. When you indulge, slow down and savor the food.
Rest your body. Create a bedtime ritual and cue your body and mind that it is time to rest. Adopt a favorite afghan, quilt,
or robe. Children respond to comfort rituals and these can be soothing for adults as well.
For Your Mind
Stimulate your mind. Listen to an audio book on the way to work. Take a field trip to the library and browse. When you
are curious about a topic search the Internet for information. Commit to the goal of being a lifelong learner to keep
your brain alert and your life Interesting.
Quiet your mind. Try silence. Sit In a comfortable position. If stray thoughts come into your mind, just acknowledge
them and let them go without judgment.
Humor your mind. Play on purpose. Put something fun to do on your calendar. See a movie. Dig in the garden. Make a
picnic and Invite a friend. Take a trip to a store that sells funny greeting cards and laugh out loud. Visit a pet store and
hold a kitten or puppy. Visit a toy store and buy a toy for yourself. Play cards or a board game and listen to music.
For Your Spirit
Soothe your spirit. Take time for quiet reflection, meditation, or prayer. When you awaken early In the morning with
anxiety, think of the acronym F.E.A.R. for Forgetting Everything is All Right. Start a gratitude list.
Feed your spirit. Read Inspirational or spiritual material to start your day. Even 5 to 10 minutes can make a difference.
Try reading something inspirational. Consider how you can set the intention for a peaceful day. Take time to enjoy a
cup of herbal tea in a beautiful cup or special mug and drink it sitting down.
Nurture your spirit. Find peace in nature. See the sunrise or sunset at least once a week. If you cannot get to a beautiful
place in nature, go to one In your imagination. Purchase a CD or audiocassette of music from a special vacation
location and play it at home or In the car to evoke vacation memories. Find peace in a place of beauty in your own
home. Choose colors that soothe. Choose plants and objects that remind you of a joyful event and create harmony
at the end of the work day.
Give words to your spirit. Create an affirmation for how you want to live. Imagine breathing In peace and calm and
blowing out negativity and tension (Riiey, 2002b).
port systems and find them lacking, they can actively
seek to build new friendships.
Applying SB/I Cars At Work
Recognizing small moments that allow for opportunities for self care throughout the work day is essential.
Examples include taking a moment to pay attention to
breathing, walking outside when emotions threaten to
overwhelm, and bringing beauty and nature into the
office (e.g., soothing sound of a small table fountain).
Music can help to calm and center. A healthy lunch
brought from home can trim unneeded fat grams. A quiet
moment of reflection, meditation, or prayer can refresh.
A daily and weekly review of the calendar in light of personal values and goals can help prevent overscheduling.
A psychiatric clinical nurse specialist working as a
psychiatric nurse consultant in an emergency department
444
offers useful holistic self care strategies. When overwhelmed by a sense of chaos with clients, she takes a few
moments for imagery of the beach with the waves washing away exhaustion. When. feeling frustration with a
client who was admitted multiple times for relapse in
substance abuse treatment, she took time for hand washing before seeing the client and imagined washing away
any bias toward the client (Falsafi, 2001).
NIGHTINGALE ON SELF CARE OF THE BODY, MINO,
AND SPIRIT
And remember every nurse... must have a respect for
her own calling, because God's precious gift of life is
often literally placed in her hands (O'Brien, 2003).
Where can occupational health nurses find the roots of
the admonition to care for themselves? In a Jetter to Ellen
Pirrie, a nurse in Belfast, Florence Nightingale wrote:
AAOHN JOURNAL
Pray, for all our sakes, observe some regularity in
exercise and meals .. .lf one can get in flowers, and
plants, a canary or living bird in a cage, a tame cat
which will not hurt the canary, it is a civilizer is it
not...I hope you have these cheerful things in your
rooms (Dossey, 2000a).
According to Dossey (2000a), in Nightingale's
annual addresses to her nurses and probationers,
"Woven throughout was her loving message of self
healing with quiet time, prayers, self discipline, and
becoming aware moment by moment of how to deepen
one's inner knowledge of the interconnectedness with
self, others, nature, and God." In Notes on Nursing,
Nightingale (1859) writes about nurses' need for respect
and humility at the awesome privilege and responsibility of nursing as a healing ministry or healing practice.
GETIING STARTED
Truth has no special time of its own. Its hour is
now... always (Albert Schweitzer, Humanitarian, 1990).
To begin, occupational health nurses can reflect on
the attitudes and strategies supporting holistic self care
and take a few minutes to write an individualized plan
for holistic self care (see Sidebar). Nurses who actively
pursue self care understand it is not easy, that they do not
always feel like flossing their teeth or getting up early to
take a walk. They know that smoking cessation or
changing eating habits are difficult. They understand
being discouraged and can empathize with the person
with Type II diabetes who faces daily feedback with one
more finger stick. They have learned to forgive themselves for detours on the self care journey. They have
learned to laugh and start again and they can help clients
to do the same-one day at a time.
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OCTOBER 2003, VOL 51, NO. 10
IN
SUMMARY
~~~~~~~~~~~~~~~~~~~~~~
Holistic Self Care
Strategies for Initiating a Personal Assessment
Riley, J.B.
AAOHN Journal 2003; 51(10), 439-445.
be fully present for clients, occupational health
nurses must assume responsibility for meeting their
1 Toown
self care needs.
promote holistic health care, occupational health
2 Tonurses
must assess personal values, priorities, and
responsibilities. This can be accomplished by
completing a personal assessment focusing on current
use of holistic modalities.
implement a plan for holistic self care, nurses can
3 Towrite
goals, set intentions, be open to holistic
modalities, begin with small changes, recognize
feelings, pay attention to breathing and self talk,
simplify their llves, build support systems, and apply
self care at work.
Krapu, T.M. (2003). Summary of research on T'ai Chi Ch'uan. In
Researr:h on T'ai Chi Ch'uan. Retrieved January 22, 2003, from
http://www.krapu4.com/taichilresearch/tairesum.htm
K.J. (2002). Roots and wings: A pilot of
Lawson.' K.L., & H?~neffer,
a mmd-body-spmt program. Journal of Holistic Nursing, 20(3),
250-263.
Locsin, R.C. (2002). Culture of nursing, preoccupation with prediction,
and nursing intention. Holistic Nursing Practice, 16(4), 1-3.
Nightingale, F. (1859). Notes on nursing: What it is and what it Is not.
London: Harrison & Sons.
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