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I M ind/B ody/S pirit W e l l n e s s 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 a t americannursetoday.com/category/wellnessl01/. Thank you to the authors at The Ohio State University College o f Nursing fo r their support o f 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 h a t is s p ir itu a lity ? 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

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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 w ell­ ness. This isn't a mistake. We're whole human beings, and these practices support m ultiple dimensions.

Reconnect/reimagine your life's purpose and passion: Set aside some tim e for a "retreat w ith yourself" to carefully consider your purpose and w hether/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 w ith peo­ ple newly diagnosed w ith HIV, Moskowitz and colleagues developed an intervention to improve patie n ts'e m o tio n ­ al outlook even in the midst o f 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 m inor 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 o f grati­ tude" is cited by many spiritual leaders from m ultiple faith traditions as essential to their daily practice.

Consider some kind of m editative practice: Traditional forms o f m editation can include prayer, chanting, or sit­ tin g in stillness w ith a quiet mind. Some people prefer physical action that incorporates meditation, such as yoga, tai chi, gardening, or simply walking. Experiment to find w hat 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 o f Ethics fo r 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.

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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.

J o y in t h e jo u r n e y 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 courage to carry on.

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 the jour­ ney?) If you take a few small steps in the direction you want to go, you’ll be amazed at the results. ★

The authors w ork a t The Ohio State University in Columbus. David Hrabe is associate professor o f clini­ cal nursing and executive director o f academic innova­ tions and partnerships for The Ohio State University College o f Nursing. Bernadette Mazurek Melnyk is the vice president for health prom otion, university chief wellness officer, dean and professor in th e College o f Nursing, professor o f pediatrics and psychiatry in the College o f Medicine, and executive director o f th e He­ lene Fuld Health Trust National Institute for Evidence- based Practice in Nursing and Healthcare. Susan Neale

is senior w riter/ed ito r o f m arketing and communications in the College o f Nursing.

S e le c te d re fe re n c e s American Nurses Association. Code f o r Nurses with Interpretive Statements. 2nd ed. Silver Spring, MD: Nursebooks.org; 2015.

Dossey BM. Integrative health and wellness assessment. In: Dossey BM, Luck S, Schaub BS, eds. Nurse Coaching: Integrative Approaches fo r Health a n d 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.

Loehr J. The Power o f Story: Rewrite Your Destiny in Business a n d in Life. 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.

/yisto ry is replete

with ordinary humans

rising to challenges

of the day in

extraordinary ways.

( c o n t i n u e d f r o m p a g e 2 1 ) waved over the device. Patients also can show their ID card and request alternative screening.

K e e p in g p a c e w it h t e c h n o lo g y 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 is a nursing professional develop­ m e n t specialist a t N ew York-Presbyterian Weill Cor­ nell Hospital in New York.

S e le c te d re fe re n c e s B ernstein AD, D aubert JC, Fletcher RD, et al. T he revised NASPE/BPEG ge n eric c o d e fo r a n tibradycardia, a d aptive-rate, a n d m ul­

tisite pacing. P a c in g Clin Electrophysiol. 2002;25(2):260-4.

Crotti N. Abbott is developing a dual-cham ­ b e r leadless pacem aker. Ju n e 4, 2018. m ed- icaldesignandoutsourcing.com /abbott-is-de- veloping-a-dual-cham ber-leadless-pacer/

Epstein AE, DiMarco JP, E llenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for de­ vice-based therapy of cardiac rhythm a bnor­ malities: A rep o rt o f the American College of Cardiology/Am erican Heart Association Task Force on Practice Guidelines (writing com ­ m ittee to revise the ACC/AHA/NASPE 2002 guideline u p d a te for im plantation of cardiac pacem akers a nd antiarrhythm ia devices): De­ v e lo p e d in collaboration w ith the American Association for Thoracic Surgery a n d Society of T horacic Surgeons. Circulation. 2008;117(21):e350-408.

Leier M. A dvancem ents in pa ce m a k e r tech­ nology: T he leadless device. Crit Care Nurse. 2017;37(2):58-65.

M edtronic. M icra M C I VR01 C linician M a n u ­ al. m an u als.m edtronic.com /w cm /groups/ m dtcom _sg/@ em anuals/@ era/@ crdm /docu- m ents/docum ents/contrib_231758.pdf

M ond HG, Proclem er A. T he 11th w orld 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, O m ar R, et al. A leadless intracardiac transcatheter pacing sys­ tem. N Engl J Med. 20l6;374(6):533-4l.

Roberts PR, Clem enty N, Al Samadi F, et al. A leadless p acem aker in the real-w orld set­ ting: The Micra T ranscatheter Pacing System Post-A pproval Registry. H eart R hythm . 2017; 14(9): 1375-9.

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

U nited States Food and Drug Administration. C irculatory System Devices P a n el Meeting: Leadless Pacemakers. Division o f Cardiovas­ c u la r Devices Office o f D evice Evaluation, Food a n d D rug A d m inistration, February 18, 2016. E xecutive S u m m a ry M e m o ra n d u m General Issues: Leadless P acem aker Devices. 2016. fda.gov/dow nloads/A dvisoryC om m it- tees/Com mitteesM eetingM aterials/M edicalD e- vices/M edicalDevicesAdvisoryCommittee/Cir- culatorySystemDevicesPanel/UCM 486733.pdf

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