Professional Presence and Influence
Lindsay Bylsma
Western Governors University

Abstract
Professional presence is an extremely important aspect of nursing. Professional presence is determined by a persons knowledge, influences, and self-awareness. In nursing, in order to demonstrate professional pressence you must practice being present in the moment with the patient. Nurses that are present in the moment provide a sense of comfort, and safety to their patients. In this paper I am going to analyze my inner and outer worlds to determine what type of professional presence I currently have. I will then create a professional presence plan to address any weaknesses I currently have. I will finish the paper by examing two optimal healing environments.

A. Professional Presence
A1: Compare Two Models of Health and Healing
There are three different Models of Health and Healing also known as Eras I, II, and III. Era I, also known as the mechanical medicine era began in the 1860’s (Dossey, 1999). According to Larry Dossey (1999), in this era, any sort of disease or illness was completely physical in nature. Based on this reasoning, the only way to cure disease and illness was to perform some type of surgical procedure or prescribe a medication. During Era I, the mind did not play a role at all in a persons health (Dossey, 1999). The mind was completely separate from the body and was treated as its own entity. It wasn’t until the 1950s during Era II, that Dossey (1999) realized the mind also had an impact on the body. Thoughts, emotions, beliefs, and attitudes all played a role in a persons health and wellness (Dossey, 1999). During this era, people realized that stress could be a major cause of a lot of their health problems. Research had even shown that our thoughts played a huge role in shaping our minds, in some cases litteraly changing the structure of the brain (Nursing a sacred work). Larry Dossey (1999) also realized that surgeries and medications werent always the best option for all diseases and illnesses. In this era, healing involved different therapies such as such as counseling, biofeedback, and hypnosis, and the patient had more control over their health (Dossey, 1999).

A2: Analyze Difference Between One Model and My Professional Presence
At this point in my career, my professional presence involves concepts from Era III. As a critical care nurse, I have only been able to witness the healing effects of proper medication management and successful surgies. I do however believe, that health and wellness can be achieved in many different ways. Depending on the situation, medication or surgery may seem like the best option but that doesn’t mean that hypnosis or biofeedback may not be just as effective. I think that a patient needs to keep an open mind and be congnicent to different therapy options. As much as I believe that some situations require medication management, I sometimes wonder if we are just masking a fixable problem. For example, I have a lot of patients who come into the hospital and are diagnosed with Afib RVR. The doctor puts the patient on a variety of heart medications and blood thinners and sends them on their way. Could this new onset Afib have been caused by something non physical that can be treated without medication? Nowadays I think that it is important to address physical, emotional and mental aspects of a patients life to determine the most appropriate course of action.

A3: Professional Presence Influence on Nursing Practice
A big aspect of professional presence is mindfulness. Mindfulness can be defined as a state of being attentive to and aware of what is taking place in the present (Rekindling). As much as I would love to say that I use mindfulness every day, that would be a lie. Working on a critical care floor, I find myself being pulled in several different directions at once. I find it hard to spend significant time on one person or one situation. I often feel like I am missing something important with my patients when I am constantly on the go. By learning how to create a mindful presence I can increase patient safety and provide higher quality of care. Mindfulness enhances alertness and the ability to identify certain conditions that may have otherwise gone unnoticed (Cultivating). Another aspect of nursing I find very important but sometimes lost due to everyday tasks is compassion and empathy. When you take the time to stop and listen to your patient without judgement, you are showing your patient that you care about their well being. I would love to be able to incorporate mindfulness based practices to my everyday routine to make myself a better nurse and a better person.
B. Personality Preferences
B1: Jung Personality Test Results:
B2A. Test Result Analysis
After taking the Jung personality test I found out that I am an ISFJ which is an acronym for Introverted-Sensor-Feeler-Judger. ISFJ is one of the sixteen personality types of the Myers-Briggs theory. As an ISFJ, I am considered an introvert who tends to think things through as a quiet observer instead of someone who spends time interacting with people (https://www.16personalities.com). According to the website 16 personalities, I prefer facts and information that is tangible and available now. I also tend to use subjective values versus objective logic when making decisions. My life tends to be very organized, and I prefer having a more structured and well-defined workplace (https://www.16personalities.com). I surprisingly found this test and its results to be extremely accurate. Overall, ISFJ’s really value their relationships even though they may not have many, and they tend to strive for stability and longevity (https://www.16personalities.com). I find this to be true about many of my relationships. I have only been in two long term romantic relationships and my goal for each was marriage. I really worked hard to keep my relationships healthy and happy so that it would last long term. Also, similarly to many ISFJs, I find myself to be happiest with people who I can rely on long term (https://www.16personalities.com). I don’t need to have a bunch of friends, I just prefer having a few good ones who will be around for the long term. Some popular activities for ISFJs include, cooking, gardening, painting, crafts, nature walks, and watching movies (https://www.truity.com). Out of this list, I only enjoy two of the activities, those include, taking nature walks, and watching movies. I have never really been very skilled with crafts or cooking. I have however, always wanted to learn how to cook and how to do crafts, however I tend to get very frustrated and give up after a short period of time. As for careers go, ISFJs tend to enjoy both working with and helping people. Based on this information, the ISFJ is most suited for careers in teaching, as personal assistants, administration, medical, and human resources (https://www.16personalities.com). I was extremely surprised to see that my prior position in administration was listed as a career choice as well as my current position in medical. I have always received enjoyment our of working with people and in typical ISFJ fashion, enjoy seeing what a positive impact I can have.
B2B. Potential Challenges
Two potential challenges or barriers that I should now be able to minimize due to my increased self-awareness are stress and burnout. Nursing is an extremely stressful career and unfortunately, I am a person who becomes stressed very easily. I have tried to deal with the stress myself, however, I have not found a good way of managing it yet. I really think that I can benefit from several strategies that I have learned in this class. I am most interested in trying meditation and yoga, I really think that these practices would be the best option to help me manage my stress. In mindful based meditation, an anxious thought may be able to pass through the mind, but the mind does not judge the thought as positive or negative (Heard, Hartman, and Buschardt, 2013). Mindfulness meditation allows the mind to have these thoughts but doesn’t allow it to dwell on them. I find the more anxious I get the more stressed I get, so mindful meditation will help the stress level by managing the anxious thought that causes the stress. Mindfulness in general also helps nurses deal with the common problem of burnout. Many nurses experience burnout because they become stuck in their ways of doing things and resist change. By being open to new information and new ways of thinking, a nurse becomes less likely to experience burnout. The nurse becomes more flexible and open to change which the medical field experiences daily.
C. Mindfulness Practice
CA. Mindfulness Practice Plan
Physical. My goal with this class is to become a truly mindful person, therefore, I need to develop my own mindful practice plan. In this section, I will create two goals for each aspect of my whole person. The first aspect I will address is physical, which focuses on your body as a tangible structure. My first goal is to decrease my caloric intake to around 1500 calories a day to lose a total of 30 pounds by this time next year. To accomplish this goal, I will have to find healthy meals with lower calorie counts. I will need to make sure that I am still getting proper nutrition despite the decrease in calories. I will need to stay away from junk food and empty calories such as soda as well. My second goal is to start exercising four times a week for at least 20 minutes per day. I will consider all forms of exercising including, but not limited to, walking, running, cardio, and weight lifting. Exercise will help me to feel better about myself not only because of the weight loss, but the extra energy I will have daily.
Vital/Rhythmic. The second aspect of my whole person is vital/rhythmic. To keep your body and brain functioning properly, your body needs to connect to a natural rhythm, therefore, my first goal is to make sure that I am getting a minimum of seven hours of sleep each night. Having an adequate amount of sleep each night allows you to wake up refreshed and ready to take on each day. By limiting my cell phone and tv use, I can make sure that I am getting to bed at a descent time each night. I will also be able to fall asleep quicker without the distraction that the electronics provide. My second goal is to start practicing yoga for at least 10 minutes each day. Yoga will help to relax both my mind and body and allow me to get into a good rhythm. Yoga also helps me with my physical goal of losing weight by getting me off the couch and moving.
Mental/Emotional. The third aspect of my whole body is mental and emotional. In order to accomplish my goal of being whole, I need to be aware of my emotions and feelings at all times. I need to feel good about myself and the life that I am living. To achieve this, my first goal is to find a friend or a loved one who I can go to daily, or as needed to vent and discuss any problems or concerns I am having. This person will help me to keep things in perspective and keep my life on the right track. My second goal is to start a journal that I can use to express my feeling and emotions. This journal will allow me to get in touch with myself and allow me to express any emotions, even the one I don’t feel like discussing with another person. I will have a place to go to after a long hard day to work through any residual feelings or emotions I have that may be keeping me from staying positive about work or life in general.
Spiritual. The last aspect of my whole body is spiritual. I have never really considered myself to be a very spiritual person, therefore, I may have a hard time with this aspect. My first goal with be to meditate at least 10 minutes each day. By taking time out of my busy day to stop and focus on myself, I can get in touch with my spiritual side and keep myself grounded. I am only requiring 10 minutes each day, so I should be able to fit this in even on my busiest days. My second goal is to spend at least 5 minutes per day with prayer. Although I am not extremely religious, I do have my faith and my beliefs, and I still do pray. I have a very busy schedule nowadays, however, I need to remember how important prayer is. If I spend just 5 minutes each day, maybe right before I go to sleep, I can get back in touch with my spiritual side.

D. Healing Environments
D1. Optimal Healing Environments
Johns Hopkins University Hospital
The first optimal healing environment that I am going to look at is Johns Hopkins University Hospital. Johns Hopkins University Hospital website argues it’s healing environment provides the patient and patient family with a sense of control over stressful situations, and, allows for more comfortable rest and recovery. They accomplish this by providing calming elegant interiors with natural surfaces which provide a calming visual for the patient (https://www.hopkinsmedicine.org). According to Johns Hopkins University website, they also use sound absorbing materials in their patient care areas and a quiet nurse call system to eliminate loud overhead paging. Serene landscaped gardens are found throughout the campus which provide a space for meditation and reflection (https://www.hopkinsmedicine.org).
Boston Children’s Hospital
The second optimal healing environment I am going to look at is Boston Children’s Hospital. Boston Children’s Hospital website states that they designed their hospital with the knowledge that many studies show a direct link between patient health, quality of care, and the way the hospital is designed. Armed with this knowledge, Boston Children’s Hospital features a variety of artwork, sculptures, glass pieces, and kinetic and lighted artwork, many of which are originals and custom made for the hospital (www.childrenshospital.org). According to the Boston Children’s Hospital website, the goal of the artwork is to reduce, stress, improve a patient’s ability to cope with pain, and just make people feel better. Each hospital put a lot of time and thought into their hospital environments and really went above and beyond what most hospitals do to create a soothing and healing environment for their patients. My hospital although new, is lacking several key elements of a true healing environment. We are slowly moving in the right direction with plans of a nurse call system in place. Hopefully I will get a chance to work in an optimal healing environment at some point in my career.
D2. Applying Self-Awareness and Insights
Through the completion of this class, I have gained several insights into myself as a person and as a nurse. I have learned that although stress will always be a huge aspect of my job, there are many ways to manage it. I also learned that I must take care of myself before I can fully be of assistance to my patients. They deserve the best I can give them therefore, I need to work on being the best person I can be. I plan on following my mindfulness practice plan to the best of my ability to see if it helps me both in my career and my person life.

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