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Professional Presence
Professional Presence
Tracy Williams
Western Governors University
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Introduction
Nursing as a profession is defined and governed by Nursing Theories. These Theories are the
framework which forms the backbone of the profession and are used to define and guide the
practical application of care. To understand the models of health and healing as a Nurse I need to
relate it to the original nursing theorist, Florence Nightingale, and apply her Environment Theory
in choosing my two models of health and healing. Florence Nightingale defined being human in
her 4 metaparadigms. To her being a human “… is one of the elements in the four metaparadigms in the individual receiving care” (Selanders LC, 1998, p247-263). The person’s
environment was also a factor. Nightingale states, “An environment that promotes health allows
the patient to retain their energy, or vital powers for use towards selfhealing” (Nightingale F,
1992). The 3rd meta-paradigm is Nursing and Nightingale states, “I use the word nursing for
want of a better. It has been limited to signify little more than the administration of medicines
and the application of poultices” (Nightingale F, 1992). The last one is Health in which
Nightingale defines "Health is not only to be well but to be able to use well every power we
have" (Selanders LC, 1998, p247-263). Building on these 4 concepts we have the Three Models
of Health: Medical, Behavioral, socio-environmental, and many models of health and healing. I
am attracted to Madeleine Leininger’s Transcultural Theory of Nursing which states that the
cultural background of the patient is key to providing appropriate treatment. Based on this I have
chosen for my comparison, The Body-Mind-Spirit or the Biopsychosocial-Spiritual Model and
the Western Model of Health and Healing.
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Models of Health and Healing
Jean Watson developed the Theory of Human Caring which focuses on the holistic approach to
healing. This focus states that it’s imperative in treating a patient to heal not only the body but
the mind and the soul. Health and Healing as they relate to being human comprise the treatment
of a patient’s mind, body, and soul. As stated in ‘Concepts of Healing & Models of Care (2004)
“Health beliefs are powerful predictors of future health status and mortality.” As a practicing
nurse considering that statement when providing care to a patient I not only have to treat the
disease but I have to keep in mind the patient’s overall health which includes mental as well as
physical. The Biopsychosocial-Spiritual Model states that a person’s psychological, social, and
spiritual are all dimensions of a person. The body-mind-spirit is part of one entity that is the
person. In treating my patients I have to be aware of and treat simultaneously all those
dimensions. As mentioned by Sulmasy (2002, p.27) “No one aspect can be disaggregated from
the whole.” This model is a modern humanistic and holistic view of being human. In treating a
patient I have to be aware of the person’s deep-held spiritual belief, psychological and social
issues as well as the actual physical illness. This model puts forward that all these aspects of a
human being affect his/her wellness. The cultural background of a person shapes their spiritual
belief, psychology, and social interactions. Following this model, I will view illness/disease in
relationships with the other aspects of the patient being treated. Spending time assessing all of
these aspects of a person will provide better care and ensure healing success. In my opinion, this
is an altruistic approach to nursing.
In contrast, the Western Model is purely science-focused. It takes a reductionist view of health in
its diagnostic approach and its treatment methodology. The body is seen as a machine made up
of functional parts. When the parts in this machine breakdown or stop functioning, the process of
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diagnosis is in identifying which part is deficient and using drugs or surgery to fix it. The mind is
seen as separate from the body. What this model fails to realize is that when a physical part is
broken the entire person along with the mind is affected. It deals with the physical aspects of the
body and how this biological environment functions. Disease and illness are seen as only
something in the system that is no longer functioning properly and the methods to fix this are
purely scientific. There are no connections between the social and psychological aspects of the
biological. Each is seen as isolated parts of a whole not affecting the other. The Western Model
of Health and Healing is based on the evidence of disease using diagnostic tools to identify this
disease. This method is purely based on the scientific method of analysis and proof. The patient’s
cultural and social background has no impact on the disease itself. A Disease is the same no
matter the patient and the outcome will be the same if treated similarly.
As stated above those are 2 fundamentally different approaches to treatment and viewing illness.
One centers on the entirety of a human being and encompasses all the aspects in a human body,
the other focuses on only one, the biological/mechanical aspect. In the Western Model, the body
is a mechanical entity, and when a part is broken/not working then all you need to do is
fix/replace the broken part. As the medical profession evolved, health care professionals have
realized that human beings are not just the sum of their parts but a whole organism that functions
symbiotically. The treatment methods for these 2 models are essentially different. In the
Biopsychosocial-Spiritual Model, the approach is holistic. It uses a variety of
methods/techniques, i.e. relaxation techniques, hypnosis, cognitive behavioral therapy, etc.… to
engage the mind in the physical treatment of the body. The body is still treated using both the
scientific approach, i.e. medicines and homeopathic approach using natural remedies depending
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on the severity of the illness. The Western Model emphasizes scientifically proven treatments i.e.
medical drugs that have been tested along with other tested methods.
Models and Professional Presence
Currently, I work in a hospital setting that caters to people from varied cultural, social
backgrounds, and psychological makeup. In treating my patients I have to keep these
dimensions in mind. I use a Transcultural Body-Mind-Spirit approach in treating my patients.
For example, someone from the Caribbean and someone of American background has different
cultural experiences and different religious beliefs when applied to illness. Some Caribbean
islanders view illness as a social ill originating from a lack of balance in the patient’s life or
some form of magic that was done to them: Biopsychosocial-Spiritual. American culture views
illness as purely biological/mechanical: Western Approach. A person’s views of illness which
are based on cultural experiences affect that person’s views on treatment. If as a patient, you
view illness as ‘magic’ or outside of yourself then the treatment has to include a
psychological/spiritual aspect. In treating my patients I pay attention to their body and mind and
anything that influences their mindset. This is not an easy task since I work in the ICU. Patients
in the ICU have conditions that are critical and demand immediate attention. Sometimes I do get
lost in the details because I have to act quickly to save someone’s life. When a patient is crashing
you don’t have time to think about the holistic approach because you are focused on the Western
approach. But once the emergency is passed I revert to the holistic approach to ensure that the
care that I have previously administered will carry on in the patient’s future wellness.
Influence on Nursing Practice
As a nurse, I am a person just like my patients. I have to be “authentically present” (Falk-Rafael,
2005). I use my professional presence to convey an air of knowledge and reassurance to my
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patients. I dress and professionally comport myself, actively listening to my patients, and being
keenly aware of unspoken body language. I want my patients to feel at ease and confident in my
ability to address their illness. I also want them to feel that as a human being that I empathize
with their condition and will do my best to ensure a solution. In actively listening to my patients'
concerns I am not dismissive. Part of the body-mind-soul approach is to validate and
acknowledge the person as a human being. I feel that my approach to my professional presence
influences my nursing practice and makes me a more efficient and caring nurse.
Personality Assessment Submission
Test Results Analysis
I am an ISFJ (Introverted Sensing Feeling Judging). My character trait is focused on service to
others which fully explains my career choice. The Jung Personality Test fully captures all ranges
of my personality and as such is very accurate. In my workspace as a teaching nurse, I’m very
methodical. I am studying for my Master’s to apply what I learn in the classroom to my work
environment. I’m not interested in studying just for learning's sake. The subject matter has to
engage my feeling and emotions and my learning style is systematic. I am not interested in
concepts and theories that I cannot put to practice in my day to day environment. I am motivated
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to care for others and I frequently put others first. I am not good at delegating because I feel that
I can do the work myself much quicker and better.
Preferences Alignment
The Jung Personality Test is fully aligned with my relationships, favorite activities, and career
choice. I was shocked when I read the results of the test. In my relationships, I am very caring
and compassionate. I cherish my family and close friends dearly and I am always ready and
willing to help. This test aligns with my activity because I enjoy being alone or watching TV.
My friends never understand why I prefer to stay at home instead of hanging out. I am a
registered nurse which was one of the choices picked for my personality type. I am very much
attuned to my patient’s needs and wants. I am also never late for work.
Potential Challenges or Barriers
The primary challenge that I see is my inability to delegate. For example, my education
department had to do an in-service on blood transfusion. We had to get 100% compliance in 2
weeks, which was a very big task. Because of my lack of delegation, I ended up working
overtime including weekends to accomplish this task. Had I delegated and shared the
responsibility with my team, I would have had more free time to dedicate to my family and not
have felt overwhelmed. This lack of delegation affected not only my family but also took away
from my downtime that I use to recharge and refresh. The inability to delegate limits my range of
effectiveness in freeing my time for other tasks. Since I insist on doing things myself and my
time is limited I can’t do everything. I need to work on this so I can progress in my career to
manage a team and trust that my team will perform as expected. I am currently working on my
theoretical aversion to studying by enrolling in this Master’s program. Though most of what I
learn is theoretical they do have a practical application. The theories are the big picture views of
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my working environment. This is very helpful since I tend to focus on the details and short term
views.
As an ISFJ working with other personality types is an adjustment. As an ISFJ and being an
introvert it’s not easy to open up to others. For example, when working with an ENFJ, an
extrovert who likes to be the center of attention, I find that I always want to be in the
background. I cringe when I feel attention directed towards me while associated with an
extrovert. I also like some alone time which extrovert’s always intruded on. Also, ENFJ’s see the
big picture but I as an ISFJ see the details. Though we complement each other, at first it’s rough
going.
Whole Person Goals and Achievements of Goals
Below are my goals for the mindfulness practice for a month to see if I can adopt it for longer as
a life change.
Physical
1. I will endeavor to go for an early morning walk for 30 minutes or less before my shift.
This will open my mind to a new day and new challenges and contribute to my overall
mental and physical fitness. I find that upon waking up I’m anticipating the day, so I
automatically get a bit stressed.
2. I will aspire to take a 30 mins Yoga class when I return home to promote mental
relaxation before studying for my classes. Overall this will free my mind of the day’s
work and prepare it for the next challenge, studying. I find that when I return home from
work my mind is still at the hospital instead of at home with my family.
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Vital/Rhythmic
1. A good meditation regimen for 30 mins, at the end of the day before sleep, would help to
stabilize my sleeping pattern. With both school and work my mind is a bit overwhelmed;
this would help me in keeping a balance.
2. I will aspire to maintain a healthy work-life balance. In this current climate of Covid19
and isolation, this is essential. On top of that with the addition of the school, I have even
less free time. Designing an effective schedule would ensure that I can fit in all my
activities.
Mental/Emotional
1. My classes will provide mental stimulation to challenge myself intellectually. Normally
with work and home life, I seldom have a chance to self-improve. The classes that I am
currently taking will make me concentrate on myself and my improvement.
2. Both Yoga and meditation will provide the mental and emotional outlet for my stressful
life.
Biographical/Social
1. Meditation and Yoga would assist in making me more self-aware of my presence in this
universe connecting me to the universal life force. I can also combine prayer into my
meditation practices every evening.
2. Attending weekly church services on Sundays would re-connect me socially and provide
a soothing environment.
I will achieve each of my goals by keeping an effective diary and schedule for a month.
Physical: Creating a schedule mapping out the hours that I’m available for the above physical
goals and creating alarms to ensure that I accomplish them.
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Vital/Rhythmic: I will reach out to my support system to keep me honest about achieving the
goals I have set for myself. I will also research potential meditation techniques that are appealing
to me.
Mental/Emotional: I will reach out to my support system of friends and family for mental
strength and if needed childcare.
Biographical/Social: I will continue my self-growth journey of discovery by setting specific
times for my above tasks.
Healing Environments Best Practices
Most hospitals and healthcare centers these days do try to model themselves to create an optimal
healing environment for their patients. An Optimal Healing Environment (OHE) was first coined
by the Samueli Institute to describe an environment “that is designed to stimulate and support the
inherent healing capacity of patients, families, and their care providers. An OHE consists of
people in relationships, their health-creating behaviors, and the surrounding physical
environment.” (Jonas WB, et.al.., 2014 May; 3(3):82-91.).
The criteria for an OHE are internal, interpersonal, behavioral, and external environments. The
Internal environment is the patient’s thoughts, hopes, and expectations, emotions, and beliefs.
The interpersonal environment is the relationship between the patient, and the healing
organization, which includes all caregivers i.e. Physicians, nurses, other support staff. The
behavioral environment is made up of the actions taken to promote health and healing. The
external environment is the work, home, and socialization places. These form the framework of
the OHE.
I have chosen 2 hospitals that in my opinion are best practices for put the OHE to practice: Cape
Coral Hospital, FL, and John Hopkins Hospital, MD.
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Cape Coral Hospital, part of the Lee Memorial Health System, in 2013 implemented the OHE
framework by using it to design their overall strategic plans. The hospital uses the OHE
framework to guide their entire decision making. Their vision, values, and purpose are driven by
the OHE framework and communicated to their staff at all levels. This change has led to an
increase in staff engagement and loyalty, an increase in community engagement, and cultural
change.
The strategies put in place uses the OHE framework to guide their operational plans which are
then put into practice. Internal examples are operational plans that incorporate leadership
commitment, OHE integrated into policies and procedures, staff, and family respite. These are all
designed to be measured through staff engagement, satisfaction, and retention. Interpersonal
examples are their Connectivity Program for all staff, Patient Care Ambassador Volunteer
Program, ICU Care Cart, and Medication Room, all measurable through Patient and Care Giver
relationship satisfaction surveys, Team Cohesion, and Hours of Service for volunteer program.
Behavioral examples are the creation of a malnutrition program, stairwellness, identification of 7
behaviors of wellness, Spirit Award, and Stroke program, and the integration of complimentary
medicine to care protocols measurable through their readmission rates, length of stay rates, staff
wellness rates and patient satisfaction. Their External examples are a series of gardens to
encourage an eastern approach to Wellness: Pathway to Discovery, Teaching Garden, Staff
Serenity Garden, Healing Garden, and Green Team which can be measure via the assess and use
of these spaces and community monetary and action-based support. (Jonas, WB et.al, 2015)
Similarly, Johns Hopkins Hospital has similar programs based on the OHE framework with
measurable outcomes. Serene landscaped gardens, sound-absorbing materials in patient care
areas, a quiet nurse-call system, art images, sculptures, and elegantly designed interior.
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Professional Presence Promotion
I can apply self-awareness and insights gained from these two best practices by advancing those
same practices at my hospital, Brookdale University Hospital Medical Center. My hospital is a
full-service teaching hospital in a challenging neighborhood in Brooklyn. We do provide an
integrated healthcare system to the community but we face some financial challenges. In 2015
Brookdale Hospital earned an F in the spring 2015 Hospital Safety Scores. We’ve made
improvements but we have far to go to being an OHE. As a teaching nurse, I can propose
changes gained from the insight of the above best practice hospitals to improve our
environments. I can do a quick survey of our facilities based on the OHE framework and identify
areas of improvement and hopefully come up with something that management can work with.
For example at Brookdale, we can introduce sound-absorbing materials in patient care areas to
reduce the noise level, we can also integrate a quiet nurse-call system to reduce call bell fatigue
and also reduce the noise level at night when the patient is trying to rest.
Conclusion
The theories and best practices developed based on these provide a blueprint to improve nursing
practices and develop patient care that will provide a body-mind-spirit approach to Healthcare.
In learning about these models as nurses we gain a toolbox that we can utilize to solve issues in
our current work environment keeping sight of the patient and their overall healthcare. Wellness
is not confined to the hospital setting but continues long after the patient has left and as nurses, it
behooves us to come up with a solution that will address obstacles in their environment. After
all, we as nurses are continuing Florence Nightingale’s legacy of the 4 metaparadigms of
nursing.
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References
Curtis, Peter, Gaylord, Susan, Norton, Sally K. Concepts of Healing & Models of Care. The
Program on integrative Medicine, Department of Physical Medicine & Rehabilitation of the
School of Medicine of the University of North Carolina at Chapel Hill, 2004
https://www.med.unc.edu/phyrehab/pim/files/2018/03/Concepts-of-Healing.pdf
Falk-Rafale, A. (2005). Advancing nursing theory through theory-guided practice: the
emergence of a critical caring perspective. Advances in Nursing Science 28(1), 38-49.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424933/
Nightingale F (1992) Notes on nursing: What it is, and what it is not. Lippincott Williams &
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ons/Meaningful_Staff_Engagement.pdf
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_environment.html
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