NURSING AT McLEAN

Creating a Holistic Healing Environment on SB2

By Jill Standish RN, BSN, HNB-BC

Holistic nursing, which is a specialty recognized by the American Nursing Association, has five core values drawn from nursing philosophy and theory, the caring process, therapeutic environment and communication, education and research, and nursing self-care. As a team, Marisa Schuman, RN, and I provide holistic nursing care, focusing our attention on healing the whole person (mind, body, spirit). We recently examined the dynamics of the SB2 unit, with the goal of strengthening the healing environment for patients, one of the major goals of holistic nursing.

A calm, secure atmosphere is particularly important on SB2, the Geriatric unit, which cares for patients ranging in age from late forties to late nineties. Our patients are in various stages of cognitive impairment, from mild to end stage. It is often challenging for staff to care for patients with such a wide range of memory deficits. Our unit can be over-stimulating at times. Patients start to wander. They frequently become confused, difficult to redirect or console, and frightened by ADL care. In a significant number of cases, patients strike out at staff and other patients.

Staff members on the unit know that anxiety, aggression, and noise levels increase at certain times of day, particularly during morning care and after lunch, when sundowning may occur. Sundown syndrome usually develops in late afternoon and extends into evening as the outside light changes. It refers to behavior changes that tend to escalate when patients sense that work is done for the day. They may think that it is time for them to go home. Women often become worried about their children. Not surprisingly, these behaviors frequently occur when the day shift is leaving for home.

We realized that the quality of environment and caring is key. Florence Nightingale’s philosophy of placing the patient in the best environment for healing took on a new relevance. We looked at Jean Watson’s theory of caring to modify our approach with patients. We developed a plan that centers on relaxing music, therapeutic or caring touch, and aromatherapy to foster a caring, calm environment that helps patients, as well as families and staff, feel more relaxed and less stressed.

To make these proposed changes easy to understand and their implementation more readily accepted, we provided an experiential in-service for MHS staff to discuss ideas for helping our patients cope with their anxiety, and to explore ways to minimize sundown syndrome and afternoon aggression.

A few weeks ago, at shift change, Marisa and I set the scene by placing comfortable chairs around the conference room table. We put a blanket on the back of each chair for anyone who felt chilled by the air conditioning. We brewed herbal tea, played relaxing Reiki music, and released the scent of lavender into the room. After a brief introduction, Marisa spoke about the importance of caring touch. We then asked everyone to team up and offer his or her partner a gentle hand massage, using lotion scented with lavender. After explaining how this technique could be easily implemented during an afternoon group, we ended with a ten-minute guided imagery.

The ten participants, who felt calmer, more relaxed, and more present after the session, were enthusiastic about providing this type of experience to their patients. We have since incorporated music, which is played during stressful times of the day, and have had many positive comments from people coming onto the unit. Caring touch is encouraged, and hand massages are currently offered on an individual basis. We have not yet instituted a regular group. The aromatherapy portion of our program is in process, as I continue to work on my aromatherapy certificate course. We plan to continue enhancing the healing environment, as we expand our knowledge and techniques over time.

We would love to share our excitement about this concept with any of you who are interested in trying these techniques on your unit.

09.2011