Running head: SELF-REFLECTION PAPER

Self-Reflection Paper
Genevieve Givens
University of Arizona

Self-Reflection Paper
Overview of Optimal Healing Environments
The optimal healing environment is created and maintained to allow healing of the mind,
body and spirit (Zborowsky & Kreitzer, 2014). This environment is tailored to the needs of the
person to mitigate illness and promote wellness. In the healing environment the state of holistic
wellness is the goal and not simply decreasing symptoms and exacerbations of illness
(Zborowsky & Kreitzer, 2014). In this holistic setting traditional medical practices are integrated
with complementary therapies to not only cure but heal (Zborowsky & Kreitzer, 2014).
In the outpatient setting of Cardiac Rehabilitation patients report for an exercise
prescription and wellness coaching aimed at cardiovascular risk-stratification (Dahhan et al.,

2015). The space is set up similarly to a gymnasium with equipment and machines. There are
multiple pieces of medical equipment and monitors. Patients begin the program as referred by
their cardiologist for having certain cardiac illnesses which serve as eligibility criteria for
enrollment. Eligibility criteria includes: patients that are post myocardial infarction within the
last year, coronary intervention, heart surgery, and congestive heart failure. There patients
typically have many lifestyle changes to make and have fear of trusting the body to handle the
exercise prescription. The healthcare providers work diligently to educate the patients and
support lifestyle changes that slow the progression of heart disease (Baldacchino, 2011).
In Cardiac Rehabilitation an extensive intake interview is conducted to determine the
readiness for change. This includes assessing for mental, physical and emotional wellness and
symptoms of illness. Patients are educated and supported as their needs are determined
objectively from data and subjectively from patient verbal reports. Patients are referred to other
specialties or adjunct professionals to meet their specific needs such as; dietary, psychological, or
physical conditions. All of the information is used to create the plan of care and exercise
prescription.
Stress management is specifically addressed with these patients as chronic stress has
detrimental effects on healing and potentiates heart disease (Dahhan et al., 2015). Patients are
given education and tools for managing stress, practices such as meditation, yoga and massage
are recommended to patients for the reduction of stress and promotion of rest and healing
(Lindquist, Witt, & Crane, 2014). The care delivered is in line with optimal healing however, the
space requires some intervention. The space is lacks natural light, window shades that allow for
natural sunlight would assist with promoting natural wakefulness (Zborowsky & Kreitzer, 2014).
There are large fans that are extremely loud and are distracting when performing education and

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intake interviews, these fans could be removed and replaced with quieter versions and ambient
noise and music could be introduced to promote positivity.
Principles of Integrative Nursing
Humans and healing
Integrative nursing embodies six principles each interconnected and crucial to mitigate
illness and promote wellness (Koithan, 2014). These six include humans and healing, personcentered and evidence-based care and the promotion of health and well-being. In the typical
acute care setting care is given in response to symptoms and illness (Knutson & Lincoln, 2014).
Organization routines and tasks often take priority in the delivery of care. This approach does not
address the humanistic traits within. In healing medical issues and symptoms of illness need to
be addressed in relation to the holistic needs of the patient, this requires the same skill set all
nurses possess for standard care (Knutson & Lincoln, 2014).
These skills include the fundamentals of nursing assessment, caring practice, critical
thinking and judgement. In terms of interventions the integrative nurse would begin with the
least invasive option(Quinn, 2014). In a recent intake interview with a new Cardiac
Rehabilitation patient lifestyle modification and risk stratification were discussed; the patient,
despite his recent heart attack continued to smoke. Instead of simply scolding his behavior
identification of stressors and coping techniques were discussed, the patient stated that his son
had died at the age of twelve from complications of viral cardiomyopathy. In that moment,
support was offered and genuine empathy was demonstrated, in that small exchange a
relationship of trust was earned.
Although important, education and risk-reduction strategies were deferred for the
following session as the patients emotional health required first intervention. This interaction

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illustrates the powerful dynamic of the person within the provider acknowledging the person
within the patient. Humans are drawn to the healing properties of nature; in the acute care setting
access to nature is limited. Research suggests that elements of nature including plants and
animals provide comfort to hospitalized patients (Douglas, Hathaway, & Burks, 2011).
Person-centered and Evidence-based care
Integrative nursing facilitates healing of the mind, body and spirit. According to Patel and
Chatterji, untreated mental health disturbances increase the risk of mortality from comorbid
conditions, modalities that mitigate conditions such as anxiety and depression decrease further
progression of chronic disease (2015). In current research complementary and alternative
therapies have been proven statistically significant in reducing symptoms of illness. In one study,
Reiki demonstrated effectiveness in reducing blood pressure in hypertensive patients (Fortes
Salles, Vanucci, Salles, & Paes de Silva, 2014). Aromatherapy has demonstrated effective in both
reduction of anxiety and nausea, is cost-effective and can be utilized at any time in stick form
(Dyer, Cleary, Ragsdale-Lowe, McNeill, & Osland, 2014).
Focus on health and well-being
The desire for wellness is a fundamental instinct of humans, in this same scenario fear
drove this patient to seek help to return to a state of health versus wellness (Koithan, 2014).
Coaching this patient and developing a relationship that promotes healthy behaviors is an aspect
of the clinicians role in risk-stratification (Aufenthie, 2014). Promotion of wellness begins
within the clinician, as a role model of health clinicians must follow their own advice. In cardiac
rehab while stressing the importance of aerobic exercise, clinicians must also demonstrate the
same wellness practices as doing so has been shown to reduce the risk of burnout (Gerber,

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Lindwall, Lindegard, Borjesson, & Jonsdottir, 2013). Identifying stressors and utilizing effective
coping skills are important for humans, clinicians and patients (Lindquist et al., 2014).
Leadership and Integrative Health
Role of Leaders in Facilitating an Optimal Healing Environment
Leadership within the healthcare setting and in respect to the optimal healing
environment has the unique opportunity to facilitate change and integrate holism into traditional
care delivery (Perlman, Horrigan, Goldblatt, Maizes, & Kliger, 2014). Leaders championing
integrative care must also role model self-care and healing behaviors. Creating a healing work
environment impacts an organization in terms of productivity, cost effectiveness and
longstanding viability (Schwartz, 2014). Optimizing wellness within the industry begins with
providers at every level; an integrative leader would understand the complexity of humans and
implement change to promote a multi-faceted internal and external healing environment (Van
Der Riet, Francis, & Levett-Jones, 2011).
Design of Optimal Healing Environment
The purpose for an outpatient Cardiac Rehabilitation setting are reduced inpatient
readmissions and preventing further progression of chronic disease. Health promotion and
wellness are the intended outcomes for patients in this area, traditionally patients are given an
evaluation and exercise prescription. Patients are given instruction on how to identify stressors
and effective coping. Meditation would be beneficial in the cardiac rehab setting as a tool to
decrease stress and develop a positive outlook (Galla, OReilly, Kitil, Smalley, & Black, 2015).
Meditation techniques could be taught upon a patients initial interview and developed over the
course of their treatment plan. Training would be minimal as staff already has an understanding
of meditation practices extensive training on breathing techniques and stress management. Each

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session would end with a five minute cooldown which is already instituted in which patients are
assisted with a meditation session.
Leadership would support this initiative by allowing staff to tailor the treatment plan and
budgeting for a small increase in office supplies to create instructional and informational packets
for patients. Music therapy has been found useful in reduction of stress and anxiety in patients
and provides distraction(Bae, Lim, Hur, & Lee, 2014). This therapy could be done during a
patients exercise session and a patients could choose their music and use headphones as to not to
disturb others. The cost for this would be minimal; as the only requirement would be to purchase
twelve sets of headphones and mp3 players.
Leadership Strategies for Implementation and Evaluation of the OHE
Leadership would further support this practice by supporting clinicians and patients alike.
The short term goal would be implementing the process and the long term goal would be
improved perception scores on a survey that would be given pre and post treatment.

The data could also be objectively measured as a randomized sample of patients that complete
outpatient Cardiac Rehab in comparison to a randomized sample of patient that have the same
eligibility criteria that do not complete the program. This data would then be used to develop and
integrate other healing modalities that could be tailored to specific patients and patient groups.
This integration would foster a community of wellness and not manage a community of illness,
promoting concepts of nursing which align with the vision of integrative holistic care(Aufenthie,
2014).

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7
References

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