Optimal Healing Environments Integral to Workplace Health Presented by: Dr. Cynthia Hamilton & Dr. Amandah Hoogbruin

Introduction In nursing, A healthy work[place]is…a practice setting that maximizes the health and well-being of nurses, quality patient/client outcomes, organizational performance and societal outcomes. (RNA0, 2010, p.2)

Why is a healthy workplace important? To protect worker’s health, safety, and well-being. Ethical- do no harm to others Practical- benefits of prevention surpass the work-related costs of illness, injury, & disability Legal- occupational health & safety violations

Elements of a Healthy Workplace Healthy Workplace practices Workplace balance Health & Safety Employee Recognition Employee Well-being Stress Management Job Satisfaction Staff Morale Organizational Improvements Absenteeism Accident/Injury Rates Staff/Patient Satisfaction A Business Model Key Influencing Factors Communication Leadership- “walk the talk” Listen and act on employee identified needs & recommendations Be coherent, consistent, & timely (Grawitch, Gottschalk, & Munz, 2006)

The Nurses’ Workplace An exceptionally, stressful environment Increased acuity levels of patients, shorter lengths of stay, & less than optimal staffing ratios Crawford & Thornton, 2010) RNs continue to have the highest rates of absenteeism due to illness or injury in Canada (Canadian Federation of Nurses Union, 2009) 1 in 5 nurses leave their job in Canadian hospitals each year. (O’Brien-Pallas, L., Tomblin-Murphy, & Shamian, 2008).

Hospitalization: A Source of Stress

A Paradigm Shift from Cure to Healing in the Health Care Environment Health trends Aging population Negative Impact of multiple life stressors More people living with chronic disease Need for a sustainable health care system Research evidence Environmental psychology An interdisciplinary science that focuses on the interplay between human beings and their surrounding environment Psychoimmuneurology Interaction between psychological processes and the human neurological & immune systems. Health trends Aging population Negative Impact of multiple life stressors More people living with chronic disease Need for a sustainable health care system Research evidence Environmental psychology An interdisciplinary science that focuses on the interplay between human beings and their surrounding environment Psychoimmuneurology Interaction between psychological processes and the human neurological & immune systems.

Towards an Optimal Healing Environment An environment in which all aspects focus on supporting and stimulating healing & wholeness Physical Emotional Spiritual Behavioral Environmental ©2009 Mary Grande Pre, Inner Embrace Pastel

©2011 Jonas, W. Cultivating OHEs in nursing & health care

Here is a more detailed description of the key components of the optimal environment originally proposed by the Samueli Institute in 2004. There are inner and outer environments that interface through the internal, interpersonal, behavioral and external relationships among patients, their families, caregivers, and the whole health care system. All of these factors are based on evidence related to for example in our inner environment, when we develop inner healing intention we enhance awareness that enables experiencing personal wholeness and enhanced integration; at the interpresonal level by cultivating healing relationships, caring is enhanced; and healing organizations can be created to enhance a culture of caring. ©2011 Jonas, W. Cultivating OHEs in nursing & health care

Design For Optimal Healing ©2011 Jonas, W. Cultivating OHEs in nursing & health care

©2011 Jonas, W. Cultivating OHEs in nursing & health care

©2011 Jonas, W. Cultivating OHEs in nursing & health care

Healing Places, Healing Spaces The Hospital Environment Healing paths/ gardens/ pleasant view Windows with natural light in the room Community, staff, personal & sacred space Private rooms for family & friends to be together Architectual design to increase time for staff to interact with their patients

©2011 Jonas, W. Cultivating OHEs in nursing & health care

Next Steps: Optimizing the healing environment in a public hospital Part 1 Making healing as important as cure A self-assessment survey about healing programs A wide variety of staff at Lions Gate Hospital will be invited to complete this survey To gain a comprehensive understanding of the status of the organization, on its journey to becoming an Optimal Healing Environment

Attending to Inner Environments Part 2 A research demonstration of a mindfulness-based stress reduction (MBSR) intervention developed by Dr. Jon Kabat-Zinn at the University of Massachusetts Medical Center; now offered in over 200 medical centers, hospitals, and clinics Practicing mindfulness-based stress reduction is associated with significant improvement: chronic pain sleep deprivation depression, mood disorders, and heart disease

MBSR Intervention 8 weekly classes & 1 full day session Guided instruction in mindfulness meditation practices such as walking meditation and the "body scan." Gentle stretching and mindful yoga Group discussions aimed at enhancing awareness in everyday life Individually tailored instructions and daily home assignments “A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.” – Hippocrates ©2011 Laura Schenck

Specific research questions to be addressed What is the feasibility of delivering MBSR as a 2 hour weekly group session for 8 weeks in two different work environments (acute psychiatric and acute oncology and palliative nursing units)? What is the impact of MBSR on subjective wellbeing (i.e., stress, burnout, depression levels, and anxiety trait); and health and safety in the workplace (i.e., frequency of adverse events, overtime, and absenteeism related to illness or injury) What is the experience of the nurses who participated in the MSBR? What are the potential barriers and facilitators of implementing MBSR in each context? What is the experience of the respective action teams who engage in the participatory action part of this research demonstration project?

Acknowledgement Funding for this pilot study has been generously provided by the

References Crawford, J. & Thornton, L. (2010). Why has holistic nursing taken off in the last five years? What has changed? Alternative therapies, 16(5), 22-24 Canadian Federation of Nurses Union (2009). Quick facts on the Canadian nursing Landscape. Retrieved 20 June 2011, from http://www.nursesunions.ca/sites/default/files/Nursing_Stats_Factsheet.final2__0.pdf Grawitch, M.J., Gottschalk, M., & Munz, D.C. (2006). The path to a healthy workplace: A critical review linking healthy workplace practices, employee well-being, and organizational improvements. Consulting Psychology Journal: Practice & Research, 58(3), 129-147 O’Brien, P., Tomblin-Murphy, G., & Shamian, J. (2008).Understanding the costs and outcomes of nurses’ turnover in Canadian hospitals: Final report. Toronto: University of Toronto, Nursing Health Services Research Unit.