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AHA Reflection Assignment Discussion Paper

AHA Reflection Assignment Discussion Paper

AHA! Reflection Paper (worth 10%) 3 page limit

Identify one AHA! An AHA! is when things came together to give you new insight or understanding about something. For this course (Being Happier: Enhancing Professional Quality of Life) the focus has been on your happiness and professional quality of life-what insights have you gained? More than one AHA is ok-just don’t go over the page limit.
This too is a reflective paper. a title page is necessary, and if you cite, you must provide full references.
Again, APA Format/Grammar- up to 2 points can be detracted from grade. Please proofread all work! AHA Reflection Assignment Discussion Paper

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The medical world is changing, thus requiring all healthcare professionals to ensure that they are up-to-date with the most effective patient care strategies. That means that as much as healthcare professionals want to fulfill their work obligations, they must be enthusiastic about their work and strive to be better nurses. In most cases, most healthcare professionals think that being better nurses revolves around having more knowledge of medical terms and being able to identify various diagnoses to better the lives of the patients. However, most forget that being present and expressing different values like listening, compassion, and reading the patient situation can also enhance one’s ability to be a better care provider. The reflection will identify an AHA moment and the lesson gained AHA Reflection Assignment Discussion Paper.

The AHA Moment

My AHA moment is based on understanding the importance of mindful awareness in the nurse profession. According to Schwartz (2012), mindful awareness involves connecting with the world through a conscious effort. While exploring the place of mindful awareness in my life, I can recall an instance that led me to realize its importance. In 2020, the world was held at ransom by the threat of Covid-19, where everyone would try all protective ways to prevent developing related symptoms due to the virus’s lethal effects. During this time, I happened to develop a severe fever which was similar to that of Covid-19. At that moment, my mind was so distracted that I started thinking beyond limits, including the probability of dying. That is because my family members had been asked to quarantine me within our home until the physician in charge would assure them that I had no risk to them. Initially, I did not know what a quarantined patient felt. That is because all I would see are patients refusing to quarantine. The experience was humbling, but I also learned about myself, including how strong I became after realizing that I had no option but to quarantine. Also, my experience was informative despite the scary bit since it enhanced how I would care for my patients.

Lesson Learned

As Schwartz (2012) postulates, mindful awareness has been a project that American Nurses Association has been working on since it helps nurses prevent mechanical thinking and start acting. Mindful awareness is an essential aspect of nursing care since it is not only beneficial to the nurse, since patients are also part of the enhanced picture. One important factor to note is that being a patient is scary and can lead to various mental health implications like anxiety and depression since what the healthcare providers feel and think is normal is new to the patients. Therefore, just like the physician who would visit to examine my condition regularly, I realized that regular visits to a patient are essential even if they are not part of the treatment schedule. That is because so many things can happen within the official visit time. In addition, I have learned that for appropriate mindful awareness practice as a nurse, there will always be a  need to acknowledge my feelings about the issue I am going through and that there is always a chance to choose what reaffirms one’s life purpose. That way, it will be easier to extend people-centric and patient-centered practices to others within and beyond the healthcare environment AHA Reflection Assignment Discussion Paper.

Conclusion

Mindful awareness is an essential aspect of the life of a nurse since it helps nurses reconnect with themselves and ensure that it positively affects patients. However, for a nurse to engage in mindful awareness, they need to recognize their feelings. In my case, my mindful awareness was enhanced by the situation that led me to be quarantined despite not having full Covid-19 symptoms. Aspects like the nurses checking on patients regularly without generally waiting for the indicated was also a great lesson since it helped me cope with the situation, a state that I would like to extend to my patients.

The medical field is constantly changing, thus requiring all healthcare professionals to ensure that they are up to date with the most effective patient care strategies. That means that as much as healthcare professionals want to fulfill their work obligations, they must be enthusiastic about their work and strive to be better nurses. In most cases, most healthcare professionals think that being better nurses revolves around having more knowledge of medical terms and being able to identify various diagnoses to better the lives of the patients. However, most forget that being present and expressing different values like listening, compassion, and reading the patient situation can also enhance one’s ability to be a better care provider. This reflection will identify an AHA moment and the lesson gained AHA Reflection Assignment Discussion Paper.

My AHA moment is based on understanding the importance of mindful awareness in the nursing profession. Mindful awareness involves connecting with the world through a conscious effort. According to Todaro-Franceschi, V. (2019), it denotes a way of being connected with the rest of the world by making a conscious effort to do so. While exploring the place of mindful awareness in my life, I can recall an instance that led me to realize its importance. In 2020, the world was held at ransom by the threat of Covid-19, where everyone would try all protective ways to prevent developing related symptoms due to the virus’s lethal effects. During this time while on the frontlines, I happened to develop a severe fever which was one of many symptoms to that of Covid-19. At that moment, my mind was so distracted that I started thinking beyond limits, including the probability of dying. That is because my family members had been asked to quarantine me within our home until they were sure that I had no risk to them. Initially, I did not know what a quarantined patient felt. Therefore, the experience was humbling, but I also learned about myself, including how strong I became after realizing that I had no option but to quarantine for my own safety, family, and patients. Also, my experience was informative despite the scary bit since it enhanced how I would care for my patients.

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As Todaro-Franceschi, V. (2019) mentions, mindful awareness stops the mechanical activity of the mind, because once you are aware of what you are doing, you are “thinking” about the moment you are in, rather than unthinkingly acting. Mindful awareness is an essential aspect of nursing care since it is not only beneficial to the nurse, but patients as well. One important factor to note is that being a patient can feel scary and can sometimes lead to various mental health implications like anxiety or depression. Therefore, just like a nurse would visit to examine a patient’s condition regularly throughout a shift, I realized that regular visits to a patient are essential even if they are not part of a nurse’s specific case load. My time alone during quarantine allowed me to reflect and realize it’s significance. In addition, I have learned that for appropriate mindful awareness practice as a nurse, there will always be a need to acknowledge my feelings about any issues I am going through and that there is always a chance to choose what reaffirms one’s life purpose. There needs to be time for nurses to talk about and reflect upon the meaning and purpose of our work, so that we do not lose sight of the fact that it stems from and is maintained by our connection with others. With this awareness in mind, it will be easier to extend patient-centered practices to others within and beyond the healthcare environment AHA Reflection Assignment Discussion Paper.

Mindful awareness is an essential aspect of the life of a nurse since it helps us to reconnect with ourselves and ensure that it positively affects the population we serve. However, for a nurse to engage in mindful awareness, they need to recognize their feelings. In my case, my mindful awareness was enhanced by the situation that led me to be quarantined despite not having full Covid-19 symptoms. Aspects like the nurses checking on patients regularly without generally waiting for the indicated was also a great lesson since it helped me cope with the situation, a state that I would like to extend to my patients.

The ART of Reaffirming Purpose: A Healing Model for Carers

So many people walk around with a meaningless life. They seem half asleep, even when they are busy doing things they think are important. This is because they’re chasing the wrong things. The way you get meaning into your life is to devote yourself to creating something that gives you purpose and meaning.

—Morrie Schwartz

 

KEY TOPICS

  • ART©: A Model to Enhance Professional Quality of Life

INTRODUCTION

 

When caring work becomes just work, and one is dreading going to work each day, it is time to Acknowledge that there is a problem. It is time to Recognize and explore one’s options, reexamine intentions, and reaffirm purpose. And, it is time to Turn toward self and other.

What nurses need is to have a practice that emulates connection with ourselves and with others. Most of us start out that way. Like children are more aware of their connection to things, the majority of us, as nursing students, are very aware of the human-to-human connection. Later on in school, students are taught to distance themselves, to apply a “therapeutic use of self,” and they are essentially told to be empathetic while always remaining objective. This kind of classic teaching may inadvertently set the stage for the development of burnout later on; disturbingly, some nurse researchers have reported findings that suggest that the nursing educational process may lead to a reduction in caring behaviors (Murphy, Jones, Edwards, James, & Mayer, 2009)AHA Reflection Assignment Discussion Paper.

The reduction of caring behaviors, by whatever means, brings us further away from compassion contentment because it encourages disconnection and distancing rather than connection and presencing. Still, I remain convinced that nurses know more than most that “everyone needs to feel a sense of belonging, in living, and in dying” (Todaro-Franceschi, 1999, p. 130). Watson (2008) emphasizes that we need to consider an ethic of “belonging before being” (p. 304). This ethic, I believe, has been the light that propels most of us to choose a nursing vocation; however, somewhere along the way, many nurses seem to forget our reason for being what we are. We deny that sense of connection to other. The nature of the healthcare system contributes to this sense of disconnect, and it often prevents us from remembering the reason for our being during our day-to-day living–working.

Years ago, when I recognized that many RNs who were coming back to school were not content with their work, I began to incorporate this knowledge into many of my classes. In an elective offering I wrote and regularly taught for over 15 years, I did a lot of work trying to bring compassion contentment back into the nursing practice of my RN to BSN pathway students. The course was about changing death experiences in healthcare. However, teaching this content for so many years taught me the profound applicability of Virginia Woolf’s words when she wrote, “I meant to write about death, only life came breaking in as usual” (Woolf, 1922)AHA Reflection Assignment Discussion Paper. No discourse on dying and death is very meaningful without equal attention to life and living.

I always began the course by telling the students that they were there for a reason and that no matter what brought them to enroll in the course, their lives would be forever changed by the end of the term. At the end of the course I asked them to identify one AHA!, a moment where things seemed to come together to make more sense for them. The majority of the students shared more than one, and sometimes many, AHA! moments like the following one written by an RN to BSN pathway student:

My second AHA! moment happened when one more time I got inside myself and I was able to reflect on the real me. That was when we spoke in class about finding some time in our busy work schedule to pull up a chair and talk with our patients. After this class, I realized how much I have changed since I became a nurse—to tell the truth, for the worse . . . . I still remember how passionate I was about my work, how very eager I was to stay one or two hours after work to finish documentation for which I never had time during my normal work hours because I had chosen to spend all this time with my patients. Many times I was ridiculed by other nurses and was told that I had a problem with time management . . . . I also recall my conversation with one of my coworkers who asked me why I like to work on Medical–Surgical units and not in the Emergency Department. I told him that I really enjoy talking with my patients and I don’t have time when working in such a busy place as the ER, where you work like a robot that only follows orders AHA Reflection Assignment Discussion Paper.

After taking this class, I realized that working for 2½ years as a floater on many different units has changed me a lot. Now I am no longer willing to stay after my regular work hours, no longer am I getting into long conversations with my patients, and the place that I like the most is . . . . Emergency Department, the place where I became one of those robots . . . . Am I happy with who I have become? I am not sure about it. But I am certain about one thing—I am glad that I have taken this class because it has opened my eyes to myself; I am more aware of myself, my unresolved conflicts, my hidden angriness, my current preferences and who I am right now . . ..

Nurses need to reawaken what most of us intuited when we first entered into nursing—that it is all essentially one. We need to reaffirm a sense of both unity and purpose. What is deemed negative or bad—compassion fatigue—is a pattern of the whole, a pattern which indicates that transformation is needed. When we get to the ugly—burnout—we have become automated, apathetic, and are working mindlessly rather than mindfully.

WHAT PURPOSE?

Some of you may be asking yourselves: Is there a purpose in the things I do as a nurse these days? You may be wondering exactly what it is that I am referring to when I write of reaffirming purpose. You might think, “I am running around for 12 hours, with barely a moment to myself; it seems all I do is administer medications and check prescriptions for accuracy. In between, I document, and document, and document. Occasionally I empty a bed pan, or turn a patient, but most of the time the only interaction I have with my patients is when I am giving meds. I might speak collegially with a physician or therapist, but more often than not I feel like I am being spoken to and not with. Increasingly, of late, I find myself avoiding having to speak with patients and their family members; who has time for them and what can I say to them that will make any difference, anyway?” AHA Reflection Assignment Discussion Paper

Does any of this sound familiar to you? If so, then you are right to question what I mean by our purpose in nursing, and most assuredly, you need help to recognize and reaffirm your sense of purpose. It is not easy, and I will not claim that anything will be fixed; I only claim that it can be fixed and that each of us always has a choice in how we go about being in the world, both personally and professionally.

What I mean by reaffirming purpose is that nurses who have forgotten or lost enthusiasm for nursing can recover zeal for who we are and what we do. Individually and collectively, we can heal from and/or possibly avert compassion fatigue or burnout, and at the same time, reaffirm purpose in nursing, by following certain steps depicted by the acronym ART.

ART: A MODEL FOR ENHANCING PROFESSIONAL QUALITY OF LIFE

ART is an acronym for Acknowledging, Recognizing, and Turning. Over the years, as I have taught and presented on this topic, I have come to think of the ART of reaffirming purpose as a healing model for our wounded workforce (Todaro-Franceschi, 2008, 2013, 2015)AHA Reflection Assignment Discussion Paper. Following these steps can help you enhance your professional quality of life.

You first need to acknowledge your feelings and that you may have wounds, wounds that you have not been aware of and that are festering. With this newfound knowledge, recognize the choices that you have and reexamine your intentions. Then, through your purposeful actions based on the choices you make, you can re-enchant yourself with the nature of your work. Last, you must turn outward toward yourself and other. It is through reconnection rather than disconnection that we can prevent and/or overcome feelings of compassion fatigue and burnout. In Auden’s classic 1940 poem, he notes we must “love each other or die.” We must love ourselves as we love others, too. In healthcare, it is through our connection to self as well as other that we can maintain and enhance our individual and collective professional quality of life; I call this my reconnect contention. Understanding and practicing mindful awareness (also referred to as mindfulness practice or meditation) can broaden your ability and make it easier to use ART. AHA Reflection Assignment Discussion Paper

Mindful Awareness

Mindful awareness is an ancient Buddhist practice that can be acquired through study. It denotes a way of being connected with the rest of the world by making a conscious effort to do so. Mindful awareness really entails being aware of being and doing it while you are in the moment. Some people might get turned off when they hear it is a form of meditation, but it is not the kind of meditation that requires one to drop everything. It is actually more like embracing everything, by being attentive and aware of it; accepting it, just as it is.

I became enamored with mindful awareness in 2003 when I was diagnosed with uterine cancer and one of my daughters bought me an audiotape of the book, Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life (Kabat-Zinn, 1994). Although I had a vague idea of what it was, I had never practiced mindful awareness. It was fitting at the time that I learn the lesson that mindfulness meditation expert Jon Kabat-Zinn was teaching. When I was diagnosed with cancer, I became worried about the future, about having surgery, surviving surgery, developing complications from surgery, learning I might have advanced cancer, and ultimately, I was worried about dying and what would happen to my family. I was so fixated on what might happen that I could not appreciate what was happening, right there in each moment. Consequently, I was losing all of my moments.

Mindful awareness helps one appreciate the present, and as Kabat-Zinn (1994) noted, the present is really all we have; what is past already happened, but what is happening right now will transform our future. In light of that he asks, should we not pay more attention to our now? AHA Reflection Assignment Discussion Paper

In every moment, we find ourselves at the crossroad of here and now. But when the cloud of forgetfulness over where we are now sets in, in that very moment we get lost . . . . By lost, I mean that we momentarily lose touch with ourselves and with the full extent of our possibilities. Instead, we fall into a robotlike way of seeing and thinking and doing . . . . If we are not careful, those clouded moments can stretch out and become most of our lives. (Kabat-Zinn, 1994, p. xiii)

Who has not, at one time or another, gotten caught up in a robotic way of being? It is, as Kabat-Zinn (1994) noted, our nature to be habitually unaware as we go about our lives.

In just the past few years, there has been an increasing emphasis on the use of mindfulness in nursing and other health-related professions. Since 2015, the American Nurses Association (ANA) has been working to promote awareness of the ways that nurses can incorporate mindfulness into daily life. Not only is it a way to improve the well-being of the nursing workforce, but there is also a butterfly effect; improving our lives in turn transforms the lives of our patients, coworkers, and loved ones outside the workplace.

Mindful awareness stops the mechanical activity of the mind, because once you are aware of what you are doing, you are “thinking” about the moment you are in, rather than unthinkingly acting. When applying ART, being mindfully aware will help you to complete each step of the process. In the following chapters, I often encourage you to be mindfully aware of your feelings and thoughts; you will be prompted to “capture your moments” (Kabat-Zinn, 1994, p. 17)AHA Reflection Assignment Discussion Paper.

Step 1: Acknowledgment

 

Acknowledgment of our feelings is accomplished by self-reflection and mindful awareness. How do you feel, right now, in this moment? If you are reading this book, chances are that you are already unhappy with your work and are searching for ways to improve your professional quality of life. Or perhaps you are a nurse leader and are searching for ways to increase staff retention or help them improve productivity. Acknowledging that there is a problem and identifying what is contributing to it involves looking back and trying to discover turning points, accompanied by in-the-moment reflection on one’s current experiences and behavior.

Narrative storytelling is a useful way to identify turning points. In some instances, it may also entail exploring the behavior and experiences of others who are sharing or have shared your moments. As you go about your work, try to look toward yourself, your actions and reactions to others, coworkers, patients, and the environment. Jot down your thoughts and feelings. Identify patterns of behavior and any negativity. Has the way you go about your practice changed for the better or worse since you began nursing? If so, can you identify when it started to change?AHA Reflection Assignment Discussion Paper

The Dalai Lama emphasizes that “If you directly confront your suffering, you will be in a better position to appreciate the depth and nature of the problem” (Dalai Lama & Cutler, 1998, p. 136). The problem with us in nursing is we often do not realize we are suffering. We have to learn how to be mindfully aware, as Madeline Ko-I Bastis (2000) shared with us how she learned to “sit in the midst of my suffering, feeling my feelings” (p. xiv).

There is this great little book written by Kent Keith (2003), Do It Anyway: The Handbook for Finding Personal Meaning and Deep Happiness in a Crazy World. He writes about overcoming adversity and making our lives have meaning through personal efforts to do good and to be kind, no matter what happens. He notes that in order to move forward, we need to acknowledge the past, and if we are stuck, we need to get unstuck (p. 18). No matter what is in our way, his message is that we can get beyond it. What’s more, we need to do it, for our own sake.

On the flip side, it is also helpful to acknowledge things that are good for you: things that contribute to a sense of well-being and wholeness. When we acknowledge the gifts inherent in our lives, it fills us with joy. There are many aspects of our work as nurses that can make us feel heartful.

The environment in academia, as many will attest, is fraught with issues that can make the workplace unhealthy at times. Sometimes I really miss being with patients, but the students sustain me and my sense of purpose. Teaching end-of-life care, there are times when I am notably feeling compassion fatigued. You simply cannot help cosuffering when teaching about dying, death, and bereavement. But I love what I do. I love teaching this topic and could not imagine doing anything else. It is the emails, notes, cards, and occasional visits from students who tell me what a difference my teachings have made for them that remind me when I seem to get overwhelmed and forget: The work I am doing is meaningful AHA Reflection Assignment Discussion Paper.

Think about the lives you have touched. You have no idea how far your reach has gone with your purposeful actions. One of my daughters told me she bought an extra cup of coffee while in Dunkin’ Donuts and “put it on the ledge.” Just picturing that cup of coffee makes me smile. This act of kindness is thanks to students in a leadership class who, when I assigned an unguided teaching–learning creating change project, took it upon themselves to go around town to coffee shops to get store managers to institute the practice of “hanging coffee.” Essentially, a customer goes into a coffee shop, and buys an extra cup of coffee. The store management then makes it known to the community (usually by posting signs) that extra cups of coffee are “hanging around” for those who cannot afford to buy one. This great idea came from a coffee shop in Prague called The Hanging Coffee Café and Pub. A student had gone to this café while visiting Prague and she shared the idea with her group members. They in turn shared the idea with their families, friends, and classmates, who shared the idea with others . . . it is about 15 years later and in local cafes, thanks to student efforts, they are still “hanging” cups of coffee. Random acts of kindness, paying it forward; these things are purposeful acts of caring that can make a huge difference.

If you think about it, nursing is a continual process of sometimes random, sometimes intentional, but always purposeful, acts of kindness. Our compassionate caring actions in nursing practice come at some of the most significant times of our patients’ lives. What we do is so meaningful. Being mindfully aware and acknowledging the contributions we make in our day-to-day work nourishes and enhances our compassion contentment, leading us to feel ever more heartful.

Step 2: Recognition

The second step of ART is the Recognition that we always have choices, and then, with intention, we are able to choose those actions that will reaffirm our purpose. In this way, one may achieve a re-enchantment with one’s life (and our life’s purpose). Our lives are full of choices; they not only shape the path of each person’s present and future, but also inform and transform the lives of others. And it is important to note that “from a conventional viewpoint, we make ‘bad choices.’ But from a transcendental perspective, there are no wrong decisions, only different lessons” (Millman, 2000, p. 138)AHA Reflection Assignment Discussion Paper.

Things are happening in our day-to-day living that are very meaningful and could help us along our life journey, but many times we miss them entirely because we are not paying attention to our moments. I am referring to magical moments such as when a child smiles at you or when you walk out into a gloriously beautiful day and are met with melodious birdsong or a butterfly nectaring on a flower nearby (or perhaps flapping its wings!). However, I am also referring to what we may deem to be insignificant moments, events that we tend to shrug off as chance happenings, but which in actuality may be very important, if only we would recognize them as such. As Henry David Thoreau (1854/1995) noted, “We should be blessed if we lived in the present always, and took advantage of every accident that befell us” (p. 203).

Meaningful Coincidences

“Chance” happenings can be very meaningful, especially when we stop to reflect upon them. When something that is unlikely to happen does happen, and it is appreciably connected to some other thing, this is referred to as synchronicity or meaningful coincidence (Jung, 1973; Peat, 1987). I am a firm believer in synchronicity and have studied the phenomenon as it relates to grief healing (Todaro-Franceschi, 2006). Meaningful coincidences are purposeful changes—energy transformation—that emerge out of our wholeness; our oneness (Todaro-Franceschi, 1998, 1999). People who pay attention (to the changes occurring) can be directed in momentous ways to actualize their potential; in other words, the synchronicity is transformative!

For years I had a Celestine Prophecy poster in my office to remind me to pay attention to my moments (Redfield, 1993). I no longer need the reminder to pay attention to the synchronicity occurring in my life, although I do not always follow up as I should. A case in point was when my husband and I traveled to Maui for our 25th wedding anniversary. While there, we hiked to one of only a few red beaches in the world, Kaihalulu (Roaring Sea) or Red Sand Beach. It was a difficult hike, very hilly and slippery, and parts of the trail had drastically eroded.

The trail wound through a very old cemetery, and many headstones had fallen below into the surf. It was very scenic and sad. As we rounded the last bend of this rugged trail, there was the most magnificent place—a bright red volcanic sand beach—contrasted against the turquoise blue ocean, with frothy white waves rolling into the shore. I immediately noted that there were only six other people there; one was a man who had carried his child there on his back in an infant carrier. He had passed us along the trail, obviously much more comfortable with the rough terrain than we were. As we waded in the ocean, awestruck by this glorious place, a newlywed couple approached us and asked us to take a picture of them. We spoke with them briefly. Imagine our surprise to find that we lived less than a mile from each other, in Brooklyn, New York! I would have pursued the meaning of this synchronicity; however, it was their honeymoon, after all, and it seemed intrusive to prolong our goodbyes. Still, I often wonder why we met when we did, for how unlikely was it that we had? It really is a small world; when synchronicity occurs like this, we realize that it is all one AHA Reflection Assignment Discussion Paper.

Have you ever had a day where everything went smoothly and things you did not expect happened to make it all come together in a profoundly good way? Belitz and Lundstrom (1997) referred to these synchronicity events as “being in the flow”:

In those times, we know we’re in the right place at the right time doing the right thing. We feel both exhilarated and at peace, somehow connected to something larger and greater than ourselves. Life is rich with meaning, magic, and purpose. (p. xi)

When things seem to go wrong, I think perhaps it is synchronicity, too. There are messages in everything, if only we take the time to recognize and reflect upon them. Realizing that things are connected can lead us to make choices we would never have thought of making.

We Always Have a Choice in the Matter!

Even when we think we do not have any choice in the matter, we always do. Doing nothing is a choice, too! It is all one, and as such we are always participating, whether knowingly or unknowingly (Todaro-Franceschi, 1998, 1999). As nurse scholar and friend John Phillips always says, you cannot not participate! Recognition of choices can be enhanced by paying particular attention to what is going on in your moments and trying to keep track of them through such things as journaling or recording events and memories. Once you recognize the possible choices you have, then you can choose to take purposeful action to actualize some potentials rather than others. Always know that making a decision does not necessarily mean you cannot change your mind later. In fact, in most cases, you can easily change your mind and then make another choice. Of course, if you have carefully thought through your options and make a radical decision, it is unlikely you will want to go back and renege after the fact. What do I mean by radical decision? I mean a decision that results in a big change in your way of being in the world, and make no mistake, one that will transform other people’s ways of being in the world, too AHA Reflection Assignment Discussion Paper.

A Radical Decision

I worked for a time in a small community hospital first as per diem nursing staff and then as a full-time clinical supervisor of the ICU and a medical–surgical unit with some dedicated telemetry beds. Dedicated telemetry beds in this hospital meant that we had portable units, which were hooked up to patients, and strips were obtained on a regular basis. It did not mean that they were actually being monitored; in fact, most of the nursing staff who worked there had not been taught how to read rhythm strips and were only required to print out strips and place them in the patient’s chart.

It was a rough place to work because the nurses were not well respected by many of the physicians. It was one of those places that had what we call an “old boys’ club,” a group of physicians who considered nurses to be handmaidens and little else. Even the top hospital administrator was one of those old boys. Naturally, staffing was a big problem. The hospital administration not only had a problem with bedside nurse retention, they also had difficulty keeping their nurse leaders. While I was working there, the director of nursing (DON) retired and the administration hired a new director. It immediately became apparent who buttered her bread. When she was not kissing up to her boss, she was “enforcing” rules and regulations.

One day, we had a code in the ICU, and there was only one regular staff member along with two per diem nurses on duty. It was already a terrible day in that unit. There were seven patients and every one of them should have been one-to-one assignments. Having a code made it all the more horrific, putting both the patients and the staff at risk. Of course, I went up to the unit to assist the other nurses; there was no way I was staying out of there. Shortly after I arrived and was up to my neck multitasking, I was called to the phone because the DON wanted to speak with me. As I listened agape, she proceeded to tell me that I was to—right now!—go around the hospital and count the number of wheelchairs that did not have safety belts. I simply informed her that “now” was not a good time for me to leave the unit, that there was a code going on and they were short-staffed, and then I quickly hung up the phone. That woman actually called back to yell at me! I was pretty disturbed by her behavior; I waited until things calmed down in the unit and then did what she asked AHA Reflection Assignment Discussion Paper.

Not too long after, I had another experience, which left me reeling yet again. I was the weekend administrator on duty, meaning that all emergencies over the course of the weekend had to come to me. I received a call from one of our ED nurses who was concerned about a new admission; he told me he wanted to give me “a heads up” that there might be a problem. The nurse proceeded to tell me that the patient came in with chest pain. He believed that the patient was experiencing a myocardial infarction (MI) and, although he had told the physician this, the physician on duty had insisted the patient be admitted to the telemetry unit. To this I responded, “We cannot do that”—but in fact, it had already been done. I immediately went to the telemetry unit and found this patient alone in a private room, with a portable telemetry monitor at his side. What good was that, I thought? One look at the patient told me that the ED nurse was correct and that we needed to quickly get this patient up to the ICU where he could be properly monitored and cared for.

I was upset with the physician who knew it was our hospital policy that all patients being ruled out for MI were to be directly admitted to the ICU. I notified him via phone that the patient would have to be moved. His response was to scream into the phone that I was “just a nurse” and that I had no right whatsoever to question him or to make any decisions regarding patient admissions. I had no choice but to call the chief of cardiology, who lived nearby. Before I could blink my eyes, it seemed, the chief had arrived to assess the patient. Of course, the patient had to be sent to the ICU and that meant the physician on call, who was already so irate, had to transfer one of the patients out of the ICU to make room for this new patient.

Later on in the day, when I was making rounds, I was confronted by the physician who asked me to step into the lounge area to speak privately. He proceeded to literally scream at me and swung his hands in my face. I was perceptibly shaken but determined to hold my ground. So I told him he had no right to speak to me like that and I walked away. I wrote up the incident and submitted it to our DON the following Monday.

Never hearing anything further about it from the DON, I assumed that it was being taken care of and that the physician would at least be reprimanded for his inappropriate behavior. Imagine my dismay and anger when I heard from one of the other clinical supervisors that the director was investigating the way I related to physicians, by asking the MDs whether my responses to them “were appropriate!” I went to a few of the nurses and physicians to confirm that this was indeed occurring and left work at the end of the day fuming. I sat down that evening, acknowledged that there was a problem, and made a list of my possible choices:

  • I could go to work and act like nothing had happened (yeah, right).
  • I could go to work and ask the director why she would choose to investigate one of her staff rather than support and advocate for her (and nothing would happen).
  • I could take it over her head to the hospital administrator, who was an MD and had been in the position for years (and nothing would happen)AHA Reflection Assignment Discussion Paper.
  • I could quit the position.

So, what did I do? You guessed it; I quit. I am proud to say that I did it with real flare. I wrote my resignation, to be effective at 3 p.m. the next day. In it, I shared my concerns for a hospital administration that did not put the best interests of the patients first and foremost. Of course, I also shared my concerns for a workplace that did not sufficiently support its nursing staff and leaders.

The next morning I went in at 8 a.m., left the resignation letter for the director, who was not yet in her office, cleaned and packed up my office, and then made my rounds. While I did so, I informed everyone I would be out of there for good at the end of the day. I then spent the remainder of the day saying “hell no!” to physicians and staff alike who stopped by my office begging me to reconsider.

To leave that place the way I did was a radical decision and one I have never regretted, although I did lose my sick time and a few weeks of vacation pay because I did not give the mandatory 2-week notice. Some folks thought I cut my nose off to spite my face; I thought it was well worth it. I am a firm believer in the “take this job and shove it” mentality, when the job is putting you at risk. That job was putting me at risk for a lot of ugliness. Had I stayed, the ugly head of burnout would surely have surfaced eventually—and when I think about it, of all the possible ugly issues that could have surfaced, that might have been the prettiest of the bunch. Composing another list of the possible changes, depending upon making different choices, is helpful too. In this case, here are a few possibilities, had I chosen to stay there: AHA Reflection Assignment Discussion Paper

  • Having units with inadequate staff could result in serious errors or omissions, causing more harm than good to the patients and as the covering supervisor I could be jeopardizing my RN license (e.g., if something were to happen to a patient as a result of being admitted to the wrong unit, I could be charged with negligence).
  • Emotional, physical, and spiritual exhaustion (compassion fatigue and/or burnout) can lead to altered health status and serious, perhaps even life-threatening, illness.

At the end of the day, the job was not worth it!

If you are having difficulty recognizing the choices you have and you have no one to be a sounding board, you can try pulling up a chair and having a chat with yourself. In fact, even if you have others to talk with, occasionally it is helpful to just talk to yourself. Indeed, I do it often and consider it a sign of normalcy. Eric Maisel (2005), famed creativity coach, suggests pulling up two chairs and alternating your position, first being yourself and then being your coach. When you sit in the first chair you can be you, and when you sit in the second chair you become your own coach. In this way, you can coach yourself to make choices that will lead you toward a plan of action to reaffirm your purpose in nursing.

Step 3: Turning Outward Toward Self and Other

The third step, like the others, is meant to be ongoing and entails a Turning outward toward self and other. It is when one becomes aware that through reconnection, not only with self but also with other(s) (our loved ones, coworkers, and patients), we can remain content in our work and feel heartful. If we are compassion fatigued, reconnecting with ourselves and other(s) can help us to heal (the reconnect contention!).

Nurses are human beings taking care of human beings. We need to frequently remind ourselves of this as we go about our day-to-day work. Reiterating my earlier words, we are not robots. When discussing how to keep compassion fatigue at bay through the reconnect contention, I accentuate making time to see things you normally would not notice. We can use this practice in both our personal and professional lives. At the end of a work day, how often do we go home at night and barely notice our loved ones? The dog’s tail is wagging as you walk through the door and you tell him to get out of your way. Your husband, wife, or children are trying to tell you things and you are completely zoning them out. Does this sound familiar? AHA Reflection Assignment Discussion Paper

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In our work environment, oftentimes we lose sight of the person in the bed, so intent are we to do all the multitasking that needs to be done. Nurse Doris Hines (1992) noted that we should “enfold the skills and technologies within the relationship rather than performing the task according to safety requirements and as the main function of the time spent together” (p. 303). I regularly ask my fellow nurses, “What if, when we are with a patient, taking care of IVs, Foleys, and wounds, we make the focus the patient, rather than the things associated with the person? What if we encourage our patients to talk to us as we take care of the mundane day-to-day activities of nursing, the things we barely think about as we are doing them because they have become second nature to us?”

It is important to take time to see our patients, really see them. How often do we notice the color of a patient’s hair or eyes? These are small things, perhaps, but nevertheless a beginning step in reconnecting with others. Our purpose as professional carers is to provide care, to heal, and we cannot do that effectively without forming some connection with those we care for every day. To remain disconnected only feeds the illusion that all things are separate. It is unrewarding to feel this way and over time can only generate a growing discontent with work and life in general AHA Reflection Assignment Discussion Paper.

It may be a human defense mechanism to distance oneself from painful experiences; however, to keep loving what we do in nursing, we need to remind ourselves time and again that we are allowed to feel; essentially, we need to get closer to others rather than put more distance between us. We need to Turn outward, toward ourselves and other(s), even when doing so means that we feel more, not less.

Nussbaum (1996) pointed out that:

Equipped with her general conception of human flourishing, the spectator looks at a world in which people suffer hunger, disability, disease, slavery, through no fault of their own or beyond their fault. In her pity she acknowledges that goods such as food, health, citizenship, freedom, do all matter. Yet she acknowledges, as well, that it is uncertain whether she herself will remain among the safe and privileged ones to whom such goods are stably guaranteed. She acknowledges that the lot of the poor might be (or become) hers. This leads her to turn her thoughts outward [italics mine], from her own current comfortable situation to the structure of society’s allocation of goods and resources. For, given the uncertainty of life, she will be inclined to want a society in which the lot of the worst off—of the poor, of people defeated in war, of women, of servants—is as good as it can be. (p. 36)AHA Reflection Assignment Discussion Paper

Through our empathetic concern, we recognize that “I” is “we”—it is all one. Mindfully remaining aware of our “we-ness” can keep us loving what we do.

Healing our workforce must entail a reawakening of what Capra, Steindl-Rast, and Matus (1991) referred to as a sense of belonging to the universe. Studies on how spiritual experiences and practices can lead to a transformation of consciousness suggest that “altruism and compassion may arise as natural consequences of experiences of interconnectedness and oneness” and that these transformational experiences “appear to lead to shifts in perspective and changes in one’s sense of self and self in relationship to others” (Vieten, Amorok, & Schlitz, 2006, p. 915)AHA Reflection Assignment Discussion Paper.

By encouraging experiences of connectedness and oneness, we may enhance our altruistic compassionate nature, which is integral to the nurse’s authentic self. We do not have to accept compassion fatigue and/or burnout as the costs of caring; with intention, we can make choices that help us to reaffirm our purpose and actively sidestep feeling dissatisfied and disenchanted with our work.

Eckhart Tolle (2005) wrote that all of us have both an inner purpose and an outer purpose. Our inner purpose is for each of us to awaken; it is a collective purpose for all human beings: “Your inner purpose is an essential part of the purpose of the whole, the universe and its emerging intelligence” (p. 258). To awaken means to become aware of the connectedness–oneness. It means to be able to rid oneself of the ego or what he refers to as the “illusory self” (p. 27), along with the corresponding idea that we are separate from everything else. With true awakening, we can perceive the patterns of the whole and the words “I,” “me,” “my,” and so forth, disappear, and in their stead it is “we” and “us.” On the other hand, each of us has an outer purpose that is unique—it varies from one person to another and it is fluid—it changes over time.

When both our inner purpose and outer purpose are in alignment, we are in a state of “awakened doing,” which essentially means our acts are more closely in tune with the purposeful actions of the universe (Tolle, p. 294). Tolle (2005) suggests that we can purposefully do “awakened doing” through the use of three modalities: (a) acceptance, (b) joy, and (c) enthusiasm (p. 295). Each of these modalities is appropriate at different times and all of them can help us tap into what he calls “the creative power of the universe” (p. 295)AHA Reflection Assignment Discussion Paper.

APPLYING ART FOR COMPASSION CONTENTMENT

 

Having considered the positive aspect of professional quality of life—compassion contentment—in previous chapters, we can take the ART model (Todaro-Franceschi, 2008, 2013, 2015) and apply it to hold and augment a sense of heartfulness. When you use ART to enhance compassion contentment, you are, in essence, doing an appreciative inquiry or self-interview. Appreciative inquiry is a means to mindfully identify the positive aspects of our lives so that as we move through life we can repeatedly experience and appreciate what brings us joy and happiness (also see Chapter 13).

Try the following:

  • Acknowledge a good feeling from an experience you had at work, something that made you feel glad to be a nurse. What did you choose to do that day that made it all seem worthwhile and that had you leaving at the end of the day feeling content about your day’s work? Did you look forward to going to work the following day? Acknowledge how good you felt while you were in a specific moment. What were you doing and how did you feel while doing it? Jot down the things that contributed to your good feeling.
  • Recognize that one always has choices and then choose appropriate actions to reaffirm purpose. Going back to that good day at work, can you identify the choices you made that contributed to the day turning out the way it did? Is having a good moment or day an anomaly in your work life? If so, why? What are the obstacles? What can you do to make it a regular happening? What did you choose to do that day that made it all seem worthwhile? Can you make the same or similar choices today? If not, why not? If so, what is preventing you right now, this moment, from doing it?AHA Reflection Assignment Discussion Paper
  • Turn outward toward yourself and other. Can you take the positive experience you had and reproduce it? Were you able to connect with your patients, loved ones, and coworkers? Grasp your sense of well-being from that time. Reconnect with those feelings.

Hopefully, as you read and work on each of these steps, they will encourage you to be present with yourself and to be aware of your connection to others Combined ART can be thought of as awakening AHA Reflection Assignment Discussion Paper