Evolution of Medicine: Health and Healing Models

Professional Presence and Influence

Models of Health and Healing

Larry Dossey uses three eras to describe how medicine has progressed since the second half of the 19th century (A Healing Presence). Era I, the physical body era, began in the 1860s when the link between science and medicine became evident. Health and illness were physical in nature. Patients were treated with medical procedures, surgeries, and medications. “A person’s consciousness is considered a byproduct of the chemical, anatomic, and physiologic aspects of the brain and is not considered a major factor in the origins of health or disease” (Dossey & Keegan, 2013)

Era III, the body-mind-spirit era, is the newest and most advanced. This era considers the consciousness as nonlocal

and not bound to one individual body. That one person’s mind can affect another’s body, even when the other is not aware of the effort. A person’s environment, community, and cultural beliefs have a significant impact on health and wellness.

Dossey’s research brings to light the connection of power of prayer, love, and compassion with medicine, and the need to incorporate all of this into the patient's plan of care.

Models and Professional Presence

The physical model of Era I focuses on the physical ailment or problem. Healthcare focused on the physical complaint and the specific treatment for that complaint. There were no link to the patient’s consciousness, emotions, or beliefs.

I am a Southern Baptist with a strong faith in God. I’ve experienced the power of prayer and faith personally. This is part of who I am and is part of my professional presence. I feel it is important to find out what about the patient’s support system, belief’s, how they cope with stress and disappointment, how do they plan to cope with their illness. I believe the patient’s emotions, physical and emotional comfort, religious beliefs, understanding of their problem, environment and overall mental attitude affect

their health and wellness. As a Nurse, it is important to be knowledgeable about the patient’s disease process, to share that knowledge in a way the patient can understand, offer emotional support and understanding without judgment. I believe that we cannot fix the physical problem without taking into consideration the emotional, spiritual and mental wellbeing of the patient and caregiver. A patient who is afraid is never going to have a normal blood pressure. If the nurse does not recognize the fear, explain things in a way the patient can understand, provide the patient with support, compassion, and understanding, they will not get better. While working in MICU, I found that patients who are in distress from pain or trauma often respond best when at least one member of the healthcare team takes the time to explain what is happening, why it’s happening and what to expect next. Offering the patient and family compassion and emotional support helps decrease their fear, anxiety and helps promote better outcomes. A gentle touch, a soft-spoken word, a few extra minutes of answering questions, a cup of coffee for a family member, or something as simple as washing the hair of a patient on the ventilator, go a long way in helping the patient and family begin the healing process. While taking care of the physical problem is the final goal, we must take care of the mental and emotional needs along the way to successfully reach the final goal.
Influence on Nursing Practice
I would describe my Professional presence as one of mindfulness, compassion confidence, and knowledge. I am aware of my patient and tune into their body language, and verbal tone, as well as the spoken word. Over the Years I have learned to separate what happened down the hall from what is happening with my current patient, and to put caring for the patient above all else. I am confident in my ability to care for my patient and empower them to take control and care for themselves. I left bedside nursing 11 years ago and transitioned into home health which has expanded my knowledge of the impact environmental, financial and social factors have on health and healing. My focus changed from caring for the patient to teaching the patient to care for themselves. Instead of knowing what was available to me and having coworkers readily available, I had to learn to be creative and handle situations alone. Home health requires a special kind of nurse who can go into any environment and situation with compassion, understanding and an open mind.
Doctors and nurses in the hospital develop a plan of care for the patient which is often not followed at discharge, resulting in readmissions and patients being labeled as noncompliant. The hospital staff does not know that the patient cannot read, lives in a home with no running water, holes in the floor, only a small kerosene heater, no air conditioning, receives 30 dollars a month in food stamps, and is helping raise three grandchildren. As a home health nurse, I see the patient in their environment, learn about their beliefs, family dynamics, financial concerns and learning limitations. A plan of care that is developed with all of this in mind will be easier for the patient to follow, treats the individual patient, and results in better compliance, outcomes and decreased hospitalizations.
Personality Preferences
Personality Assessment
My Keirsey Temperament report indicates my personality is that of the Guardian Supervisor.
Guardians (SJ's) are the cornerstone of society, for they are the temperament given to serving and preserving our most important social institutions. Guardians have natural talent in managing goods and services--from supervision to maintenance and supply -- and they use all their skills to keep things running smoothly in their families, communities, schools, churches, hospitals, and businesses.
Guardians can have a lot of fun with their friends, but they are quite serious about their duties and responsibilities. Guardians take pride in being dependable and trustworthy; if there's a job to be done, they can be counted on to put their shoulder to the wheel. Guardians also believe in law and order, and sometimes worry that respect for authority, even a fundamental sense of right and wrong, is being lost. Perhaps this is why Guardians honor customs and traditions so strongly -- they are familiar patterns that help bring stability to our modern, fast-paced world.
Practical and down-to-earth, Guardians believe in following the rules and cooperating with others. They are not very comfortable winging it or blazing new trails; working steadily within the system is the Guardian way, for, in the long run, loyalty, discipline, and teamwork get the job done right. Guardians are meticulous about schedules and have a sharp eye for proper procedures. They are cautious about change, even though they know that change can be healthy for an institution. Better to go slowly, they say, and look before you leap.
Guardians make up as much as 40 to 45 percent of the population, and a good thing, because they usually end up doing all the indispensable but thankless jobs everyone else takes for granted.
On the job, you seem to innately understand how to create smooth, working processes in your environment. You can excel at directing others to fulfill their duties. In your ideal workplace, you and your colleagues would know what is expected of you and be predictably rewarded for meeting these expectations.
Overview of the Supervisor (ESTJ) Supervisors is willing to put in hard work to make sure a goal is completed. They excel at scheduling, organizing details, and executing objectives. They enjoy completing tasks and can give a project momentum through difficult times. They are confident in making decisions and will consistently take actions to complete the stages of a project. Supervisors can be very economical and prudent with available resources and can be counted on to protect assets. They are loyal and enjoy being a part of a team. They are objective and can be counted on to find a logical solution to a problem.
How You Communicate as a Supervisor, you often need to have discussions to form your ideas and plans or to digest information, which means that you need to speak your thoughts out loud to process the information. You communicate with others by being serious and sincere, with high energy, but also by being direct and to the point. You will challenge others to give their best, and you enjoy giving a clear framework for others to follow.

Test Result Analysis
The Keirsey temperament test found my personality type to be that of Guardian(SJ). I choose to go a little further to find my Guardian type. I am a Guardian Supervisor (ESTJ). I would agree with the majority this description. I was raised to work hard, do my best at everything, be dependable, honest, and to take pride in what I do. I enjoy having fun but I take my responsibilities very seriously in my personal and professional life. I take pride in being known as someone with integrity, who is honest and dependable. My boss wrote on my evaluation last year that she could depend on me to do the right thing, even if it wasn’t the popular thing to do. I don’t think she could’ve given me a greater compliment.
I do believe in following the rules and cooperating, however, I believe that not all rules are black and white. Life has a lot of gray areas which often requires some creative thinking and bending or stretching of some rules along the way. I am often the one to question rules and can be very uncooperative if I do not agree with the decision or situation at hand. I do feel that today’s society has lost respect for authority and a fundamental sense of right and wrong.
We must be able to accept and adapt to change to be successful in today’s world. I caution about change and prefer slow, well researched and well-instituted change. However, I’ve learned to adapt to poorly instituted change very quickly.
Per Keirsey, Guardians are not comfortable winging it or blazing new trails and are meticulous about schedules, I do not feel this describes me. I am very comfortable winging it and enjoy the challenge of blazing new trails. The thought of me being meticulous about schedules is laughable! I am meticulous about the care of my family, my staff, and our patients, but I am fine with changes in my schedule. In my world, personal and professional, a schedule is always tentative and subject to change without notice.
As Process Improvement Coordinator, understanding how to create smooth, working processes and directing others to fulfill their duties, are essential aspects of my job.

I would agree that my ideal workplace would be one with clear expectations and predictable rewards for meeting those expectations.

I found the description of the Guardian Supervisor very accurate in relation to my confidence in decision making and finding logical solutions to problems. Managers and staff defer to me for decisions in the absence of our Administrator because they know I will make the decision and stand by it. I will also admit and take full responsibility if the decision I make turns out to be the wrong one.

My communication style is very direct and to the point, especially at work and in times of stress. I do not sugar coat or fluff things up just to make people feel good. I state the facts, the need, the expectation and depend on staff to follow through. This communication style is often seen as being rude or demanding which has been a challenge for

me.
In a nutshell, Keirsey’s description of the Guardian Supervisor is an accurate description of my personality. I am the dependable one, the most likely to work hard, follow the rules, take on the job no one else wants to do, make decisions no one else wants to make, and make sure everything runs smoothly in the process.