The purpose of this assignment is to allow the learner to demonstrate good organization, appropriate resources, and correct APA formatting for preparing a scholarly paper.

I Mind/Body/SpiritW ellness 101

Spiritual wellness: A journey toward wholeness

By David Hrabe, PhD, RN, NC-BC; Bernadette Mazurek Melnyk, PhD, RN, APRN-CNP, FAANP, FNAP, FAAN; Susan Neale, MFA

Through spirituality, we connect with the world around us.

Editor’s note: This is the last installment in a 10-article series on wellness. You can read all o f articles in the se­ ries at Thank you to the authors at The Ohio State University College ofNursingfor their support of nurse wellness.

Have you ever felt like a “human doing” instead of a “human being”? As we fling ourselves from one activity to another, we sometimes find that getting beyond our list of “to do’s” and staying in touch with those aspects of our lives that mean the most to us is difficult. Re­ member that well-rounded self-care also involves spiri­ tual wellness.

W hat is spirituality?

Barbara Dossey, a pioneer in the holistic nursing move­

ment, writes that our spirituality involves a sense of connection outside ourselves and includes our values, meaning, and purpose. Your spiritual well-being isn’t what you own, your job, or even your physical health. It’s about what inspires you, what gives you hope, and what you feel strongly about. Your spirit is the seat of your deepest values and character. Whether or not you practice a religion, you can recognize that a part of you exists beyond the analytical thinking of your intel­ lect; it’s the part of you that feels, makes value judg­ ments, and ponders your connection to others, to your moral values, and to the world. For this reason, spiritu­ ality frequently is discussed in terms of a search. Spiri­ tual wellness is a continuing journey of seeking out an­ swers and connections and seeing things in new ways. It also means finding your purpose in life and staying aligned with it.

Although religion and spirituality can be connected, they’re different. A faith community or organized reli­ gion can give you an outlet for your spirituality, but religion isn’t spirituality’s only expression. Hope, love, joy, meaning, purpose, connection, appreciation of

24 AmericanNurseToday Volume 13,Number 10

Continue the journey

Here are some ideas to consider as you continue your nurs­ ing journey. You’ll notice that many are connected to rec­ ommendations we’ve made for other dimensions of well­ ness. This isn’t a mistake. We’re whole human beings, and these practices support multiple dimensions.

Reconnect/reimagine your life’s purpose and passion:

Set aside some time for a “retreat with yourself” to carefully consider your purpose and whether/how you’re living it out. Where do you need to make adjustments? What do you need to stop doing? What do you need to start doing? What would you do in the next 5 to 10 years if you knew that you couldn’t fail? Periodically “taking stock” is critical to staying on track.

Ramp up your positive outlook: In their work with peo­ ple newly diagnosed with HIV, Moskowitz and colleagues developed an intervention to improve patients’emotion­ al outlook even in the midst of a very challenging circum­ stance. The intervention involves cultivating positive emo­ tions through these daily practices:

  • Recognize a positive event each day.
  • Savor that event and log it in a journal or tell someone about it.
  • Start a daily gratitude journal.
  • List a personal strength and note how you used it.
  • Set an attainable goal and note your progress.
  • Report a relatively minor stress and list ways to reap­ praise the event positively.
  • Recognize and practice small acts of kindness daily.
  • Practice mindfulness, focusing on the here and now rather than the past or future.
  • Results were promising and showed that, over time, the positive effects increased. Cultivating an “attitude of grati­ tude” is cited by many spiritual leaders from multiple faith traditions as essential to their daily practice.
  • Consider some kind of meditative practice: Traditional forms of meditation can include prayer, chanting, or sit­ ting in stillness with a quiet mind. Some people prefer physical action that incorporates meditation, such as yoga, tai chi, gardening, or simply walking. Experiment to find what works for you.
  • beauty, and caring and compassion for others are asso­ ciated with spiritual well-being.
  • Spirituality as part of nurses’ DNA
  • As nurses we’re fortunate that the very basis of our practice is grounded in spiritual ideals. From the be­ ginning of our education, we learn about the impor­ tance of spirituality in relation to a person’s overall health. Even our ethics emphasize the value of a spiri­

tual connection. Provision 1 of the Code ofEthicsfor Nurses with Interpretive Statements states, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” But many nurses are surprised to find that Provision 5 extends this compassion and respect to nurses them­ selves: “The nurse owes the same duties to the self as to others, including the responsibility to promote health and safety, preserve wholeness of character and in­ tegrity, maintain competence, and continue personal and professional growth.” We have a responsibility to both our patients and to ourselves to honor our spiri­ tual heritage.

Think about your job and what you do every day. When do you feel most energized? Great satisfaction can come from learning a new skill and mastering it, and of course it’s vital that you complete your many tasks efficiently and competently, but there’s more. When asked about the times they felt most energized, many nurses cite moments when they really connected with another person—family, friends, colleagues, pa­ tients. This is the “more”—when we go beyond just our needs and wants to connect beyond ourselves. Hu­ mans are wired to be in relationship with others. Spiri­ tuality is fundamental to nursing practice.

Disconnected much?

Although most nurses would likely agree that spirituali­ ty is an important component in the care they provide and in their personal lives, too often the pressures of modern life interfere with what’s most important to us. Crushing workloads, family responsibilities, financial pressures, and fast-paced living create the perfect storm that makes acting on our values difficult. Many nurses suffer chronic illnesses, including depression, at a rate greater than the general population and other health professionals. In a study, Letvak and colleagues dem­ onstrated that nurses are twice as depressed as the pa­ tients they serve. A study by Melnyk and colleagues of more than 2,000 nurses across the country found more than half of the nurses reported poor mental or physi­ cal health and depression. Additionally, nurses with “…worse health were associated with 26% to 71% high­ er likelihood of having medical errors.”

Living life on purpose

In his groundbreaking work with professional ath­ letes, performance psychologist Jim Loehr, EdD, ar­ gues that being out of touch with our life’s purpose creates an extraordinary energy drain. People may run in marathons, eat the healthiest foods, and be at the top of their game professionally, but these really good things can become an end to themselves when they’re disconnected from life’s purpose. Without that connection, anything can become meaningless.

October 2018 American Nurse Today 25

Loehr writes: “When you find—or, more aptly, choose-—your pur­ pose, then you are the agent of your own happiness. You have the opportunity to harvest joy in both the pursuit and the achieve­ ment, the journey and the desti­ nation.” Our purpose, our reason for living on this planet, is at the foundation of our spiritual nature.

Joy in the journey

All of us experience tragedy, sadness, and grief; they’re part of the human condition. If you’re wondering if finding joy and peace is possible under what appear to be impossible conditions, remember this: History is re­ plete with ordinary humans rising to challenges of the day in extraordinary ways. They were able to unlock that part of themselves that gave them the strength and couragetocarryon.

Nurses are extraordinary—don’t lose sight of the amaz­ ing work you do to improve the lives and comfort of the people you touch. It’s never too late to make a positive change in your life. (See Continue thejour­ ney?) If you take a few small steps in the direction you want to go, you’ll be amazed at the results. ★

The authors work at The Ohio State University in Columbus. David Hrabe isassociate professor of clini­ calnursingandexecutivedirectorofacademicinnova­ tionsand partnershipsforTheOhioState University CollegeofNursing. BernadetteMazurekMelnykisthe vice president for health promotion, university chief wellness officer, dean and professor in the College of Nursing, professor of pediatrics and psychiatry in the College of Medicine, and executive director of the He­ lene FuldHealthTrust National InstituteforEvidence- based Practice in Nursing and Healthcare. Susan Neale

(continuedfrom page 21)

waved over the device. Patients also can show their ID card and request alternative screening.

Keeping pace with technology

The LP represents a profound change in pacemaker technology. More literature is needed to pro­ vide nurses with the education they need to keep up with these innovations. Currently, LPs are lim­ ited to right ventricular pacing; however, other implanted cardiac devices are being investigated that will work in combination with the LP for use in other areas of the heart. ★

Joyce Bulger-Noto isa nursing professional develop­ ment specialist at NewYork-Presbyterian Weill Cor­ nell Hospital in NewYork.

Selected references

Bernstein AD, Daubert JC, Fletcher RD, et al. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and mul­

tisite pacing. Pacing Clin Electrophysiol.2002;25(2):260-4.

Crotti N. Abbott is developing a dual-cham­ ber leadless pacemaker. June 4, 2018. med- veloping-a-dual-chamber-leadless-pacer/

Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for de­ vice-based therapy of cardiac rhythm abnor­ malities: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing com­ mittee to revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices): De­ veloped in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation.2008;117(21):e350-408.

Leier M. Advancements in pacemaker tech­ nology: The leadless device. Crit Care Nurse.2017;37(2):58-65.

Medtronic. Micra MCI VR01 Clinician Manu­ al. mdtcom_sg/@emanuals/@era/@crdm/docu- ments/documents/contrib_231758.pdf

Mond HG, Proclemer A. The 11th world sur­ vey of cardiac pacing and implantable car­

dioverter-defibrillators: Calendar year 2009—A World Society of Arrhythmia’s project. Pacing Clin Electrophysiol. 2011;34(8):1013-27.

Reddy VY, Knops RE, SperzelJ, et al. Pennanent leadless cardiac pacing: Results of the LEADLESS trial. Circulation. 2014;129(14):1466-71.

Reynolds D, Duray GZ, Omar R, et al. A leadless intracardiac transcatheter pacing sys­ tem. N EnglJ Med. 20l6;374(6):533-4l.

Roberts PR, Clementy N, Al Samadi F, et al. A leadless pacemaker in the real-world set­ ting: The Micra Transcatheter Pacing System Post-Approval Registry. Heart Rhythm.2017;14(9):1375-9.

Udo EO, Zuithoff NP, van Hemel NM, et al. Inci­ dence and predictors of short- and long-term complications in pacemaker therapy: The FOL- LOWPACE study. Heart Rhythm. 2012;9(5):728-35.

United States Food and Drug Administration.

Circulatory System Devices Panel Meeting: Leadless Pacemakers. Division o f Cardiovas­ cular Devices Office ofDevice Evaluation, Food and Drug Administration, February 18, 2016. Executive Summary Memorandum General Issues: Leadless Pacemaker Devices.2016. tees/CommitteesMeetingMaterials/MedicalDe- vices/MedicalDevicesAdvisoryCommittee/Cir- culatorySystemDevicesPanel/UCM486733.pdf

26 American Nurse Today Volume 13, Number 10

/yistory is replete with ordinary humans

rising to challenges of the day in extraordinary ways.

issenior writer/editor of marketing and communications in the College of Nursing.

Selected references

American Nurses Association. Codefor Nurses with Interpretive Statements.2nd ed. Silver Spring, MD:; 2015.

Dossey BM. Integrative health and wellness assessment. In: Dossey BM, Luck S, Schaub BS, eds. Nurse Coaching: IntegrativeApproachesfor Health and Well­ being. North Miami, FL: International Nurse Coach Association; 2015; 109-21.

Letvak S, Ruhm CJ, McCoy T. Depression in hospital-employed nurses.Clin Nurse Spec. 2012;23(3):177-82.

LoehrJ. ThePowerofStory:RewriteYourDestinyinBusinessandinLife.New York: Free Press; 2007.

Melnyk BM, Orsolini L, Tan A, et al. A national study links nurses’ physi­ cal and mental health to medical errors and perceived worksite wellness.

J Occup Environ Med. 2018;60(2):126-31.

Moskowitz JT, Carrico AW, Duncan LG, et al. Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. J Consult Clin Psychol. 2017;85(5):409-23.

Copyright of American Nurse Today is the property of HealthCom Media and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use.

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