My name is Sarah Jimenez-Valdez, and I am a project manager with the International Association of Forensic Nurses. Today's webinar, as you can see, is titled Collaboration of Forensic Nursing with Holistic Nursing, Extending the Lens of Forensic Nursing with the Framework of Holistic Nursing Practice, which was made possible with the grant funds awarded by the Office of Victims of Crime for the SANE Program TTA Project. I'll ask that you bear with me a few minutes so that I can cover a few things before we get started. I will start with a few disclaimers here. Go ahead and move the slide over. So this presentation was produced by the International Association of Forensic Nurses under the grant number you see listed on the screen. This grant was awarded by the Office for Victims of Crime, Office of Justice Programs, and the U.S. Department of Justice. The opinions, findings, and conclusions, and or recommendations expressed in this presentation are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice. Since there are 1.5 continuing education units being offered for today's presentation, I do need to note that the planners and presenters and content reviewers of this session disclosed no conflicts of interest. I will be sending out an evaluation within a week of this presentation. So it must be completed in order for you to receive the CE. Lastly, for our disclaimers, is that the International Association of Forensic Nurses is an accredited provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. The planners and presenters of this course have no relevant financial relationships with ineligible companies to disclose. All that said, we encourage you to please use the Q&A feature to ask any questions that you might have that come up for you during the presentation. We will also be using the chat to just chat with you all, and also for you all to interact with Rose. I will be available throughout the presentation. So if you have any questions or technical needs, please feel free to reach out through the chat and I can answer any of those that come up for you. With all that said, I would like to welcome our presenter, Rose Hosler. She is a board certified holistic nurse and a health and wellness nurse coach. She has over 30 years of healthcare experience and currently practices in a 500 bed acute care hospital. In her practice, she utilizes acupressure, Reiki, aromatherapy, guided imagery, and I'm sorry, and healing touch. Rose values and is amazed the impact touch, compassionate listening, and presence can have on a person's ability to heal. She's here with us today to share some of this amazing knowledge she holds. Thank you, Rose, for joining us. And thank you for having me. Really happy to be here, to be with all of you and talking about holistic nursing and forensic nursing. And I had the opportunity to be a forensic nurse many years ago when I worked in the emergency room. And so respect the work that you do and honor it and really glad to be here with all of you. And so as we move forward with this, just focusing on, we're gonna talk about what actually is holistic nursing practice and the certification. With that, explain the foundations of holistic nursing practice in relation to your practice as a forensic nurse and review how holistic nursing can support trauma-informed care and explain how forensic nurses can integrate some of the holistic nursing practice philosophies into your practice. And we're gonna explore and I'm gonna demonstrate some holistic modalities that you can use for your self-care and some of these things that maybe you can use at the bedside with your patients. So really encourage you to kind of take what speaks to you and leave what doesn't and have some fun with this. Before I go to the next slide, I want to ask you when you hear the term holistic or holistic nursing, what comes up for you? What are some words or thoughts that come up for you? And if you don't mind just sharing those in the chat. Full person care, okay. Treatment beyond medicine, okay. All right, so I'm gonna go to the next slide. Sometimes, sometimes when I'm working with patients and I introduce myself as a holistic nurse, they'll say, oh, you're into vitamins or you do Reiki. So they're more concerned with the modality or you might hear the term integrative, oh, you practice integrative things. Or you use aromatherapy. So sometimes when we talk about holistic, these are some things that I have heard from patients or even in the community. The big one is herbs and nutrition, or you might, oh, you must do yoga and you don't probably do anything with medicine or anything like that. So we're gonna define really what holistic means, but I appreciate in the chat what was said, collaborative care, treatment beyond medicine, collaborative care. So, and holistic can be all of that. We're gonna delve a little bit into that and how it can be applicable to all of you. Okay. So I thought it would be helpful to talk about, okay, where did the word holism come from or holistic? And holism or holos comes from Greek and it really means all whole or the entire. And it's really the idea that your physical body, biological, social, chemical, environmental, economic, and their properties be viewed as a whole and not as a collection of parts. So the term was actually coined, holism was actually coined in 1926 by Jan Smuts. And he wrote a book on holism and evolution and defined it as the tendency in nature to form holes that are greater than the sum of the parts through creative evolution. And I'm just gonna pick back. So we have also holism, peaceful, relaxing mind, soul, and body in one. And holism really speaks to that. And Jan Smuts also looked at, so a little bit of Darwin theory and a little bit of Einstein's theory of evolution and brought those together and really talking about how the theories are all related. But what he came up with when he coined this term was that everything is intricately connected. And then we have Socrates who wrote, for the part can never be well unless the whole is well. And we get in the medical community, we really get focused in on all the different specialties. You see cardiology, you see nephrology, we see urology. And so over the years, no longer has it been like you go to your primary physician and they kind of took care of everything. Then we evolve from that to all the specialties of medicine. And so I still to this day in practice when I'm at the bedside with patients, they might have three and four specialties that are coming to see them. And sometimes patients will say to me, I don't think any of these doctors are talking to anybody because one's telling me I'm going home, one's telling me I still need this. And so when we're looking at holism, we are viewing the person as an integrated, intricately connected whole, mind, body, and spirit. And we also add in our environment as well. So we're looking at the person from a fully integrated perspective. And that's what holism is. And holistic nursing practice is all about going beyond what we see as the physical and knowing there's many, many, many parts that make up the whole. So we're talking about the whole you. We're talking about the physical you, of course, the body. It's a tangible structure. We have five senses. We feel our bones, our tissues, our organs. Then we move into that mental part of us, our thoughts, our knowledge, our attitudes, our beliefs, our analytical self, maybe that creative part of yourself, the emotional view, your feelings. And goodness knows the range of emotions that we can all fear, that we can all experience. Fear, anger, feeling overwhelmed, happy, joyful, excited. So really tuning into all of that. And then our spiritual side, your relationship with yourself, your creativity, your life purpose, relationship with your higher power if you have one, going beyond your ego, going to your higher level of consciousness, connecting to that. So all of this makes up us. It's not just one or the other. And with holistic nursing, that's what that speaks to is that we're really addressing all of that. And as we know, Florence Nightingale really spoke to this very much. She really taught nurses to focus on the principles of wholism. So yes, she was a trailblazer in the fact that she used science, she used data, but it was all about touch and connection and community and partnering with patients and really bringing that together. She really understood that wellness and the interrelationship of human beings and their environment mattered. And that contributed to their wellbeing, to their healing. So she had a broader scope and it was with a holistic foundation. The American Holistic Nursing Association, or AHNA, defines holistic nursing as all nursing practice that has healing the whole person as its goal. And that makes sense, right? I often think of the infinity symbol that really, that's a good reminder of that, how you can't have one without the other and how everything is intricately connected. So holistic nursing is care which is person and relationship centered. It's healing and prevention focused rather than disease and cure oriented. And some of the foundations of holistic nursing are it is a way of being. So I incorporate practicing self-care, also work on creating a space for healing of others to take place. And so it's a way of being. It's not something added that I do. It is really part of the way I am and the way I practice. It is a way of living. So taking in some of those things that I do for self-care, role modeling that. I can't portray that and be a holistic nurse if I'm not doing some of those things, right? So role modeling, healthy and wholesome living through self-care, exploration, self-reflection, awareness, my own self-development. So taking time for that, as part of growth and development, self-reflection, where am I at? Where do I wanna move to? What is my response with the situation or the work that I'm doing? Where am I in my life personally? So again, it is a way of living and knowing that, you know, this ebbs and flows as well. So it's a way of practice. I'm consciously creating a healing environment through centering and intention. And so as we pay attention to details and the patient's story and what is going on with them, we're setting that intention to be in this space, to create this healing environment. So for me, when I receive a referral and I go to meet with the patient, before I walk in the door, I'm centering myself, taking a few deep breaths so that when I go in, I am fully present with that person in that space. No matter what type of clinical environment I may be in, whether it's the ambulatory center or it's up on the unit or it's in the outpatient area or just a physician's office. So I really try and embody a way of practicing and creating a healing environment for myself and for my own life. So holistic nursing practice does have a set of scope and standards. It is a magnet-recognized certification and the American Holistic Credentialing Corporation, so AHNCC, is the corporation that credentials holistic nurse certification and nurse coach certification. So they're the only accrediting body that has the exam for nurses to get board certified as a holistic nurse. And there's an advanced practice nurse, holistic nurse certification, baccalaureate prepared, and then there's the nurse coach certification. So it helps to, I have found, even though I've been practicing this way for a long time, having the actual certification gives validity. Validity to the practice of holistic nursing and keeping it from being, oh, you do herbs and vitamins or, oh, you just do acupuncture or something like that. So no, it's much more than that. It sets the foundation for practice and really contributes to looking at the person from a holistic perspective. And AHNCC is accredited by the Accreditation Board for Specialty Nursing Certification. So what is a holistic nurse? So a holistic nurse is a legally licensed nurse that incorporates knowledge, expertise, theories, and intuition to recognize and care for the full being of the person. I also like to think that this certification, what is great is that it can apply to all areas of nursing. So whether I, so currently my role is Healing Services Coordinator, a holistic nurse. So I'm practicing within that scope and standard in that framework. But if I were to go back to the emergency room or if I were to go back to work in PACU or do private duty, that certification, the holistic nurse certification supports all those areas of practice. I believe it creates a great foundation for nursing practice in general. So the holistic nurse follows scope and standards of their state and within their holistic nursing specialty. So as a holistic nurse, I'm looking at someone from a mind, body, spirit perspective and environment, and I'm going beyond what's going on physically. And I might incorporate other modalities that I'm certified in and incorporate those into the relationship or the session. Holistic nurses do work in a diverse environment. So you can see them in hospitals, academics and the ambulatory care, hospice, community health, home health, care management. So there's quite many, many areas that you can be a holistic nurse, just as many as you're for our nursing practice as there is pediatrics, everything, a holistic nurse can also be in those areas. The majority of holistic nurses work either in acute hospital, universities, colleges, many have their own private practice and others also work in correctional facilities, community areas. So that also makes up the rest of the area of where holistic nurses can actually practice. The American Holistic Nurse Association is the body of where holistic nurses contribute to or a part of, and that actually came about in 1981 by a nurse named Charlie McGuire. And she brought 33 people together, 33 nurses from eight states. And her focus was really on preserving and carrying the healing connection of nursing and staying true to Florence Nightingale with the science, but making sure the touch was there, the compassion, the holism was really there. And that was her goal. And so AHNA remains today. It is the holistic nursing organization and there's over 5,000 members nationally and internationally. So we have some holistic nurses from Japan, Australia, and Canada. The mission of holistic nursing is to advance holistic nursing through nursing practice, community, advocacy, research, and education. So what are we doing that supports health and wellbeing and adding value to that? So I'd like to bring this model up because I feel like it really speaks to just kind of how we do things when we're looking at medical practice and holistic practice. There's some similarities, but in medical practice, we are looking at, and even in nursing, we're looking at the disorder or the disease and holistic practice and holistic assessment. We're looking at the, yes, the presenting issue and also the disease that is presenting. So we know in the medical side, someone comes in, they get a medical assessment. We do a data collection. We learn about their symptoms and what's going on, offer some treatment. They come in with an infection. This is what's gonna help you. You stay on antibiotics for five days. They take the antibiotics and then they go back to see the doctor or have a follow-up. What's going on? How is the infection? And so there's some ongoing care and reassessment as well. But again, we tend to be still very treatment focused. When you add in holistic practice, in addition to this and integrate it in, presenting issues, okay, so let's say it is an infection. An infection, I have itching, redness, and then core issues. So from my perspective, from my holistic perspective, inflammation infection speaks to, from a body mind perspective, when we have infection, the body is inflamed. And so when you have inflammation, what's going on emotionally? So that's what I'm talking about when I'm speaking to core issues. So yes, you have these signs and symptoms. What's going on with you that your body is so inflamed with infection? So again, we're adding in that emotional and spiritual component. There's more of a mutual agreement with treatment. So this gets into a little bit of coaching. Yes, there still might get antibiotics for sure. But what else? What else might we add? So as the holistic nurse, I might add in aromatherapy, breath work. Maybe I would show some acupressure points to use to help with their support, their healing. So that's part of it. And again, offer that support. Being there, creating that presence, offering that listening, and then reassessing and repeating as needed and staying with that person on a continuum. So you can see how they're a little bit different, how they can be integrated and how really holistic practice can enhance what's going on with our Western way of practicing and being. So one of the things I wanted to bring up was some connections between forensic and holistic nursing. And one of the things that we create as holistic nurses and that all of you do as forensic nurses is creating a safe space, creating that space for someone to receive care, not only the physical care, but the emotional and psychological care that they need to receive. You establish trust pretty quickly when you go into that space to work with that patient. And that's the same part of the holistic nursing process, creating space, establishing trust by being present, by being fully present with them and attending to their needs in the moment and honoring where the person is in their situation. So I'm not judging, I'm open to the process, there to listen, support, facilitate, and allow them and create the healing space for them to be heard, to be acknowledged, to be validated. And whether it's with trauma or if it's with someone that had surgery, we're still creating that space and honoring where that person is in their situation. Many times I work with patients that have addiction and they, or chronic illness, and they continue to come back to the hospital. And as a holistic nurse, I honor where they are. I don't judge it, that is their journey. And I often offer to help support them in any way that I can within my scope of practice as a holistic nurse and as a nurse. So really just allowing that process to unfold and leaving judgment out. Again, you offer support services specific to trauma, counseling, rape crisis, law enforcement, and the same is true for holistic nursing. I will refer patients for support groups, counseling, other modes of therapy, not physical therapy, but more of like perennial sacral therapy or some other holistic integrative modalities that might help them as well. So there's a lot of connections that we actually have in supporting our patient populations. And we have a responsibility to educate others, to educate the community, educate ourselves and continue that self-development, but educating the community, law enforcement, for us, the healthcare landscape and all the disciplines that make up the healthcare landscape So really there's a lot of similarities with creating space and coming into this session or into this relationship with someone that you're caring for that are really founded in holistic nursing. So I wanted to touch on trauma-informed care and holistic nursing. And one of the theories I just wanted to bring up, and maybe some of you are aware of this, this was developed, the Polyvagal Theory was developed in 1994 by Stephen Korges. And it looks and examines at what happens in the body and mind when trauma is experienced. It also discusses the evolution of the social engagement system of mammals and their need for the survival of the species. So in phylogenic evolution, where mammals split from reptiles, they developed a more complex nervous system. So the vagus nerve, which developed a new branch that was myelinated and had influence over superdiaphragmatic organs. So basically, hence mammals can be close to others in the time of safety. And also this theory recognizes older dorsal, unmyelinated vagal response is access for fight and flight. And we know trauma and other life experiences alter brain development, function, and structure. And when we talk about this nerve, how it really represents the interconnectedness of the system, the vagus nerves do so much. It really facilitates communication internally for the mind and the body, but also externally as it speaks to neuroception. And we know neuroception is the unconscious knowing how we perceive from others about their emotional state, whether it's through presence, their movements, their eyes, what we are noticing, that's our neuroception. So polyvagal theory has changed the way we understand the response to threat and stress. So it really helps us to foster ideas of how nurses can foster physical and psychological emotional safety in supporting not only others, but themselves. And there are holistic nurses that work in trauma and that are trauma-informed. And as I said, you can take this specialty to any part of nursing practice. So this really speaks to that. So in holistic practice, when we talk about supporting that individual from a mind-body-spirit perspective, the four R's of trauma-informed care, I think really speak to this. So we realize trauma impacts are everywhere and there is also opportunity for healing. And being open to the signs and symptoms of trauma and those you encounter, and recognizing this in yourself. Again, that self-reflection, where are you at, knowing yourself and your limitations and knowing your boundaries. So again, tuning into yourself and your wellbeing. We respond by role modeling and championing trauma-informed care. So personally and professionally. So through the lens of holistic nursing and the Polyvagal theory, you can recognize that the burden of trauma goes well beyond just what's going on in the mind. The body is affected, our emotions are affected, everything is affected during trauma. And how do we go forward with that? It's also, again, sharing education, speaking to colleagues, speaking to the community, really creating more awareness about trauma and how we can help support those that have experienced it. And also resisting re-traumatization of others and within yourself. So again, knowing how, unfortunately, the clinical environment can inadvertently trigger someone. I know from, I work with quite a few women up on our antepartum unit. Some have had past trauma and they're here for preeclampsia or they have something else going on and they have had trauma in the past. And we know that labor and delivery can re-traumatize someone. So having that trauma-informed care of how we support someone during the birthing process to limit, prevent any re-traumatization is very valuable to helping them move through that process in the best way that they can. So a couple of things I wanted to bring up here. Trauma-informed self-care, universal precautions. I listed both of these and a checklist for wellbeing. Both are a little bit different approaches, but really they're speaking quite the same language. So when we talk about universal precautions for your own self-care and for those of others, when we talk about safety, we're talking about physical safety, which you all establish when you meet with them and are doing the exam. And psychological, the need for healthy growth and restoration, but also really that physical and psychological safety. Support, so for yourself, what are your resources for wellbeing and resilience? What are your resources for wellbeing and resilience? Where do you like to go? What people lift you up? Is it colleagues? Is it family? Is it friends? Who encourages you? So really recognizing that support system. Maybe it's, you know, you worked with a patient. It was a very, a lot of moving parts a lot of dynamics in the situation and you needed to debrief. Who do you go to debrief with? So again, recognizing the support that speaks to you. Self-soothing, so this goes back to kind of centering and breath work, really promoting your own self-regulation and what you can do to do that. So is it taking a few breaths? Is it doing some tapping? Is it, you know, whatever allows you to regulate and tune into your emotions? What are some of your strengths? Know your strengths. What are you good at? What are, maybe you reach out to someone else because they do something really well. Know your limits again. So, and acknowledge that that's okay. Self-care and self-care. Know when to say no. And is your cup half empty? Are you trying to fill up from an empty cup? You know, self-care is a term that we have, you know we hear about all the time and it continues to be highly put out there. And I think sometimes we say, oh, you know I gotta do self-care, I gotta do self-care. But really it is so, so valuable. And it doesn't have to be something that takes an hour or even 15 minutes. Recognizing what speaks to you to help you, to help your cup stay full. What do you draw on? And the things listed before really help us to draw on those, our strength, things that self-soothe, our support. So just being aware of that. And nursing is still one of the professions that puts everybody before themselves. And so that self-care can really go out the window pretty quickly. So when we put intention and attention to it, very valuable for our wellbeing and our own healing. So this checklist for wellbeing comes from the wellbeing initiative. And a little bit, I just wanted to bring up both of these. So when we talk about self-care, this part talks about review. So what we mean by review is maybe before you leave work you acknowledge a challenge that you faced. You take a breath and you let it go. And you leave it, you choose to leave it at work. When we speak to reflection, this is maybe a point of gratitude. Consider three positives in your day. And we know gratitude fosters and supports healing and wellbeing. And so what are three things that went well for you in the day? What are you grateful that went well? And again, it can be whatever it speaks to you. I know sometimes at night when I have been at home and I'm doing a little bit of this reflect and review before I go to bed, I've actually said, I'm grateful I'm putting my head on the soft pillow. Just acknowledging that. Regroup. Regroup. So this speaks to offering support to your colleagues and asking for their help. So we have a program caring for caregivers. There's some employee assistance programs that employees can reach out to. I know one of our hospitals in the Cleveland area recently changed up and let go of their employee assistance program. And all the information is online. So you get a packet of paper. This doesn't really help regrouping when maybe you need to seek out some additional support. So again, reaching out to colleagues and it's okay to ask for help. You don't have to go it alone. Re-energize. So this is about really turning your attention to home and as you leave work, leaving it at work. I teach a lot of workplace violence classes. And one of the things we talk about is tap out or Q-tip. Q-tip is like quit taking it personally. Like don't take it on. It is not mine to carry. That is that person's issue. And the other thing is tap out. And this speaks to regroup as well. Tap out. If you see a colleague struggling, tap them out. Maybe something's going on for a lot longer or they're really struggling or maybe it's sitting too close to home for them. So maybe tapping them out, letting them take a break, have a moment to process. So again, so those are two things I like to bring up that I utilize. So we talk about re-energizing, allowing yourself to be present. When you leave work, work is at work. And again, that's bringing your attention and your intention to that. So that is how you begin to really focus in on self-care. And that needs to be with some self-reflection and honoring who you are and acknowledging maybe what you need and giving yourself the space and the grace to do that for yourself, whether it's to do something for yourself or to receive. So some of the things I wanted to share with you are some techniques. And techniques, these are techniques that I actually use at the hospital. So I thought we would go, we'll be able to get through most of these and I'll explain each one as we go along and as we practice. So we won't be doing the emotional freedom technique, but I will talk about it. So I'll start with that one first. So emotional freedom technique is also known maybe as tapping. And I like to describe it as when you have a set of dominoes and you press that first domino and they all fall down. Well, tapping is like pressing that first domino and then taking one out. You just change the neural pathway. So in emotional freedom technique, you're using two things. You're using a little bit of talk therapy and a little bit of acupressure. So the physical part of emotional freedom technique is the tapping part. You physically tap on the body, acknowledging your emotion and how you're feeling. While you're tapping and after you've acknowledged and said everything you need to say about the emotion, so it can be, yes, I'm really angry right now. Once you've said everything you need to say about that, you begin to reframe. And so it is in the reframing that you create that new neural pathway. So emotional freedom technique is used quite a bit with veterans with PTSD, can be used with trauma. I use it in all different types of incidences. I've used it with kids as young as six years old that have terrible anxiety to a physician that I worked with that was 99 years old. So you might also hear EMDR, which is the eye movement desensitization and reprocessing. So EFT is a little bit different in that it uses that touch and the tapping. So I just wanted to bring that to your awareness. I do a lot of tapping for myself, for my own wellbeing. So as we move forward together for the rest of this presentation, we're going to be doing some of these things. And again, I like to talk about them and then we'll demonstrate and do them together because it's helpful to experience. I feel it's helpful to experience. And at the end, you can always, again, take what speaks to you and leave what does not. So when I work with patients, many times we really take breath for granted. Thankfully, our respiratory has its rate and we don't have to worry about it. And it is the first thing we do when we enter this world. And it is the last thing we do when we leave. And so we know that changes in the body are first seen in the breath and the quality of the breath, your deep, how the frequency can help support balance. And many times we don't even realize how we are holding our breath, how we are breathing very, very shallow. And breath allows us to center. It allows us to be present with ourselves. And after a few minutes of focused breathing, using some deep breathing, we're stimulating the parasympathetic nervous system, which is the rest and digest, excuse me. And it all starts with the breath. We really just need to focus in. And with breathing, it gives us a chance to really pause. And so what I would like us to do now, we know that people that practice focused deep breathing and if they have high blood pressure, excuse me, they actually help to regulate their blood pressure, their heart rate, even to come off of some blood pressure medications. And the thing I like about this, it's free. I don't need anything. I just need me. So we just so underutilize it in medical and healthcare. So I am going to invite you to sit back, be comfortable, and simply just rest your hands. I'm going to invite you, if you'd like to put one hand to the abdomen, excuse me, and one hand to the heart. So you can keep your hands like this. And we know alternating your hands helps that neural regulation. There's that vagus nerve again, connecting you to your body. So be comfortable. You can put your gaze downward. You can close your eyes. Again, whatever feels good to you. But I'm going to invite us to be quiet and to focus in on your breath. So simply breathe in through the nose and out through the mouth. Breathe at your own pace and begin to notice the rhythm of your breath, the power of your breath as you breathe. As you breathe in. Now, if your mind wanders a little bit, that's okay. Focus in and count to four as you breathe in, and as you exhale out, try and count to six so that you're making an intention to letting your exhalation be longer than your inhalation. I encourage you to breathe in, exhale out, and if your hand is to your heart and belly, just reverse your hands and continue to breathe, noticing maybe your shoulders are more relaxed, letting your breath be a little bit deeper and the exhalation be a little bit longer, knowing you're engaging your whole nervous system. And I'll ask you to take another deep breath in. And as you exhale out, coming back to center and opening your eyes. I can't stress enough how impactful focused breathing is. If you do yoga, you know, always movement with the breath. And so it really can help shift someone. It can help them calm. It can help them feel centered. It can help them gain control. Now, oftentimes, if I'm working with someone and they're in distress, I will make sure that I am connecting with them visually with my eye contact and telling them to breathe with me. Because once you begin to breathe with someone, they will pick up on your breath and follow through. So I often do this with patients. I don't just explain it. I actually physically do because then I get the benefit too. So I'm working with the patient and we're both getting the benefit. So some of the mind-body connections for calm, which can help to just engage our senses and allows the nervous system to register the present environment. Again, when we're talking about that psychological safety. And this can be helpful when the nervous system is triggered into that vagus response. So it will help mediate that survival, that fight or flight response when we do the gaze. And so with the gaze, this is really just about orienting. So as you're looking, you're probably all looking at the computer, but if you want to look at something in the room, what you wanna do is keep your head forward and straight and just keep your chin level. You don't have to hyperextend or lower, just a nice levelness with your chin. Continue to look at the screen or an object and you're kind of looking far. So look beyond the computer screen, looking beyond that horizon. And just take a breath as you're doing that, breathing in and breathing out. And keeping your head straight, shift your gaze to your eyes to the right. So you're looking to the right of the screen or what you've been looking at. Take a breath. And now expand that gaze, keeping your head straight so that you're looking to that right shoulder. Even if you don't see it, that's fine. You're just looking to expand that gaze. I'm trying to do that 180 or even that 180 look. But take a breath here. And exhale out. And now bring your eyes back to center, keeping your head straight, looking forward at the horizon. Take your gaze, your eyes to the left. And now expand that look so that you're going far to the left as if you're trying to see that left shoulder. And take a breath. And bring your gaze back to the center. So again, this is all about orientation and mediating that fight and flight response. The other technique, maybe you know of this or you have done it yourself when you're with a patient or you've done it for yourself, is to engage, to focus on the five senses. And again, this is orienting us to present moment. Maybe I'm feeling very hurried or just not settled or my morning didn't start right. And before I go in to see a patient, I pause and engage five senses. So what we're gonna do is you're gonna name five things out loud. And I want you to put that into a form of a sentence. So, oh, I have a cup. I see the computer. The clock is on my desk. I have a calendar. This keyboard is long. So just name five things out loud. And now we're gonna move to feel four sensations and name them out loud. So we might be, my belly is grumbling. My cheek is soft. My pants are smooth. This desk is firm. So four sensations you feel. Then moving down, name sounds out loud. So three sounds that you name out loud. So I'm just gonna do clap, ohm, and snapping of my fingers. Again, bringing us right here into the now. I love the ohm. Good to do that to really just bring some centering as well. And then to sense and name them out loud. Oh, I smell my chai lotion. And my berry tea. Just smell. And then the last one is taste and name. I'm tasting my berry tea. Or I'm sipping my coffee. So stating the flavor. Again, just all about engaging. So you might use this for yourself. You might use it with a patient that you're working with. Again, utilizing what you have in your environment. Next thing I wanna talk about is guided imagery or visualization. How many of you have heard the term or use it? I'm just curious if you wanna put any of that in the chat. If not, you might have heard of the term. So when I use visualization or imagery, how I like to describe it when I'm working with patients is it's using all of your senses. And it's really the practice of getting a mental image in your mind's eye of something that brings you peace or calm. And when you use imagery, I like to describe it as when you go to the movie and maybe it's a scary movie and you're sitting in the theater, you know you're in the movie theater, but the movie's very scary and your heart races, your breath increases, you close your eyes, you open your eyes. That's because whatever you take in, whatever you see, your body takes in and it has to have that response. So visualization imagery is using a peaceful setting, creating that imagery in your mind so that your body responds. So when used with other techniques, the aim is to associate the sensations of relaxation with a peaceful visual image. So this is when people talk about visualization or imagery and they say, oh, what's your happy place? This is what they're speaking to, something that you can, you know, where you go physically that is very meaningful for you or calming, it might be sitting on your back porch, it might be walking in the woods, it might be at the mall shopping, whatever really speaks to you that you like to do, you can use as imagery because when you do that, so for me, hiking in the woods is very calming for me. I like to just, it's very quieting, very centering for me. I like to be at the beach. So those are probably my two go-to places for imagery. And when I am using imagery or when I'm walking in the forest and I'm imagining that, I can smell the trees. I can feel the strength of my legs as I walk forward. I can hear the crunch of the leaves. I notice the birds, I notice the deer, I notice the turtle that's by the bank of the river. So when you're using imagery, you're using all of your senses smells, sounds, everything. So when I'm, you know, if you're visualizing the beach, you would feel the warmth of the air or the coolness of the water or the grittiness of the sand and you're putting yourself there. I worked with a patient one time that was on a neuro floor. He had a virus and it paralyzed him from the waist down. And one of the things that we used was imagery and his imagery was him being on his pontoon boat on the lake. And his hands were, he was able to move his hands. And so one of the things that he would, when I would bring him through the imagery, he would envision himself driving the pontoon boat, feeling his body, feeling in control of the boat, feeling the breeze off the lake. And he would actually take his hand off the bed and kind of tap it motioning like he was dipping his hand into the water. So again, imagery can be very powerful because you're using what you already know and using your imagination. We know people that use imagery pre-surgery. They use 50% less narcotics post-surgery. It helps with anxiety. It also lowers the perception of pain. And it is part of our capacity, our mind's capacity to use imagery. And so when you hear people say, let's go into our mind, in your mind's eye, see it in your mind's eye, that's what they're talking about using imagery for this. So again, there's many different guided meditations that use imagery that you can Google, YouTube, things like that that are really accessible and not expensive and are free to utilize. And so I thought I would bring you just through a very brief use of imagery. So I'm gonna invite you to rest back and be comfortable. Closing your eyes and choosing your place or something you like to do that's peaceful to you, that's calming to you. And when you get to that place, just bringing your thumb and index fingers together and now tuning into what do you see? What colors do you notice? What sensations do you notice? Moving into the body, what do you feel like when you're in this place? You notice your centeredness, your calmness. What does it feel like? Notice how you move. And take in all that's available for you, all the surroundings. Notice how your body moves very easily. Notice your feet connected to the earth, to the floor, wherever you are. Just allowing yourself to be in this space. Nothing to do, but just be. And when you're ready, just take a nice deep breath. You come back to center, releasing your fingers, knowing that anytime you need to come back to this space or this place, bringing your thumb and index finger together provides that anchor. It's you grounded to visualize. So that was a very, very, very short process of guided imagery. But again, I want to demonstrate to you the power of the mind and how we have the capacity to use imagery, even if you use it passively. So what I mean by that is maybe you find something on YouTube or you look up a meditation or have a meditation app. Even if you're kind of passively listening to it, your subconscious is still taking it in. You're still getting some benefit of it. So even if you're not fully into it and you feel like you're kind of, oh, I got to do this, I've got to do that, but I want to listen to it. Having it on still benefits you. The mind is still taking it in and so is the body. So it's something you can play even with the patient and just to help a calm, soothing voice come over. So I just want to talk a little bit about affirmations or algorithms. So affirmations I have listed here are just, affirmations are positive statements. They're present tense. And we know when we write things, it's an expression. So when we meditate or write, we strengthen that prefrontal cortex. So it's the part of the response that helps to minimize that fight or flight response. So that when we do this, when we're writing, not only is it an expression of creativity or getting some of our thoughts out there, it can really help us to pause and feel more calm and help that prefrontal cortex out. So affirmations are statements. They're I statements, they're in present tense. So it's not, maybe it will be, or I'm hoping it's going to be. It is, I allow myself calmness. I choose strength. I allow hopeful, positive thoughts. I am fully capable. I am fully present with myself and acknowledge all that I've been through. So however, whatever speaks to you, even if you quite don't believe the statements as you're saying them, that's okay. The body is still taking them in. It is taking everything in, the good, the bad, the ugly. The body has no choice. That's the body's inner wisdom. So what we say and how we say it really affects our health and wellbeing. So when I ask patients, well, you think positive. What does that mean for you? How do you do that? Affirmations is a way to help guide you into that. So if you're saying, well, I try to think positive, but sometimes we know the stress of every day, the stress of our work. Sometimes writing out the affirmation can allow us to focus. And when you say that out loud, you hear it. And like I say, even if you don't fully believe it, continue to say it, very valuable. And then some algorithms, picking a word and then writing, adding some words into it. So this word I picked was self and then care. So just some words that I came up with that have meaning to me, that helped me to focus. So spirit, empower, listen, compassion. So you can use those, but whatever feels good to you. But affirmations can be a wonderful tool for a little bit of self-expression and honoring how we're feeling. So I wanna talk about acupressure and get into some points before we round out the rest of our session. So acupressure predates acupuncture. It's based in Chinese traditional medicine. It applies the same principles as acupuncture. There's no use of needles with acupressure. And acupressure and acupuncture, it's all about bringing the body into balance. The body is always trying to get back into balance. And when we experience trauma or illness, or we live with a chronic illness, acupressure is one way to really help the body do this. Chinese medicine focuses on the yin and the yang, the positive and the negative energy and bringing things into balance. So you don't have too much yin and you don't have too much yang. And we work with meridians or pathways. So these are energetic pathways. They're not physical pathways in the body. And acupressure is very forgiving in that if you don't quite get the spot, you have about a two inch radius that you're still going to have some effect on. Whereas acupuncture gets very, very specific with using the needles. So I wanted to give you some acupressure points that I use for myself and that I use with patients and that I encourage them to use for themselves. So one of the pressure points, the acupressure points, this is for calming. And basically you gently just take your fingers right to the center of your sternum and let them rest there. And you want to hold the acupressure point for about a minute. Now someone could rest their whole palm into the center of their chest. You can just kind of fold over like your knuckles, like you're making a fist and let your fist kind of just rest. You don't have to press in to the center of the chest. So I'm inviting you to hold this point and we're going to hold it for a little bit and I'll be mindful of the time. And bring into your awareness some breathing. So just continue to breathe easy, in and out at a comfortable pace. And I'm going to share, so sometimes I'll put my hands like this and I'll go right to the center of my chest. So you can do that as well. And next, we're going to go to the nine gamut point. So this one is very helpful for stress. So I'm so everyone take your left hand. And we're going to work with the right hand. So simply feel the well between your ring and pinky finger. And you're just going to press right in that kind of your, your hand has a natural well between the bones, or the V. So to do this, you can tap that area gently, or you can create some circles. So tap or circle that area staying right in that that well. Sometimes I'll put my hand to heart center and do this and tap. You can also do that. And now we're going to switch. So take your right hand to the left hand, find the well or the V between ring and pinky finger, press in, make some circles or tap the area and take a breath. A lot of kids like this point. It's easy. They can keep their hands in their lap. Nobody knows what they're doing. So if you're feeling a little bit overwhelmed or stressed, this is very helpful. The next point that we're gonna do is called frontal occipital holding. And this is very calming. I use this a lot when people are confused or overwhelmed. You can do it for yourself. You can do it for others. And simply place your palm of your hand right over your forehead. And your other hand just goes to the back of the head. So you're kind of just holding. This is also good if someone has a headache. It is very calming. You wanna hold this point for at least a minute. Now, sometimes I'll do this when I'm resting at night in bed and I just let my back of my hand just rest into the pillow. You can also do this by just kind of leaning forward and putting your elbows on the desk so you're not holding up your arms and just resting your forehead and your hand and your other hand is still at the base of the occiput there. So you can apply a little bit of gentle pressure. Take a deep breath. Next we're going to move. There's three more points that I have listed on here. So this first one says large intestine, but it's also known as headache relief, but it's for general pain as well. And so what you want to do is take your left hand, take your left thumb and press in to the right hand between the thumb and the index finger. Now it looks like they're pressing it really deeply. You do not need to press, use about the weight of a nickel. So as you kind of press in curve towards the index finger, and I just want you to experience holding this point. Now if you had a headache or just had some general pain, you'd want to hold this point for at least a minute or two and then switch and hold the other hand until the headache lessened. So again, sometimes when we're doing acupressure, people get impatient, like after 15 seconds, they're like, Oh, nothing's happening. So be patient with the process. Remember the body is always trying to come back into balance. And now we're going to switch and we're going to hold, take our right thumb and press in gently to the left hand between thumb and index finger. So you're not down way at the bony part and not in the little fleshy spot, just kind of in the soft indentation, press in kind of curve in towards the index finger towards and then use about the weight of a nickel. and release, take a deep breath. The next point is just under the collarbones. And this is a very good calming point. And it helps stop the parasympathetic response. And it's below the collarbone. I'm gonna turn my camera so you can see maybe a little bit more. So feel your clavicles and come over towards the throat and just come down. You feel that little dip, that indentation. That's where this point is. So this is a very grounding point. So tapping this point, let me stand up. So tapping this point or holding the point is very calming and it will ground the person, it will ground you. So again, holding for a minute or longer. The other way to hold this point, which is very calming, which if some of the nurses have had a really stressful day, they've been really anxious. I encourage them to take their hand like this and place your thumb there and your fingers here. So you're kind of just actually cradling that point with one hand. So you can do it either way. One hand under the clavicles. And again, you can still tap if you want, or you can just kind of press in. And again, it's just gentle pressure. You don't need to dig in for the acupressure point to work. And so just hold this point. This is really good to do if you're in a difficult meeting maybe, just nonchalantly put your hand here, rub. You're really helping that fight or flight response to calm down. And the last one I want to show you is really giving yourself a hug. And I really like this one. This is also stress relief, but where this point, where this intersects is an acupressure point at the base of the diaphragm. So take your right arm and you're just going to come across the lower part of your, or the upper part of your abdomen across the diaphragm. Let your fingers just rest on your right side so you can kind of feel your ribs. Take your left arm and come underneath that arm so that your left hand is holding your right elbow. So, and then just let your arms rest right into your belly and breathe. So where the diaphragm is, that is called the point of the acupressure point gate of hope. And this is a very supportive acupressure point. So also it's giving you, you are telling yourself in your body's inner wisdom, I'm supported, I'm okay. Okay, so that's what this is doing. Then you hold, after you hold this, we're just going to repeat it so you experience it. Now you're going to take your left arm and wrap it around so that your hand is touching your right side of the ribs, bring your right hand underneath. And so your right hand and palm are now cradling your left elbow. Rest the shoulders, allow your arms to rest right into your abdomen. Just letting the natural weight of your arms rest into this. So I would encourage doing this for a couple of minutes using breath, but very helpful. And again, you don't have to do all of these. You can pick one or two or one that works for you. So I want to touch on aromatherapy. Aromatherapy really speaks to mind, body and spirit. So aromatherapy has been all the rage the last few years, and it's really the use of essential oils that really impact our senses and emotions. And that's because with aromas, you can immediately recreate a memory or a feeling even before you have that conscious awareness. So our olfactory receptors in our nose, once we breathe in that aroma, that amygdala, the limbic system, the learned memory of our memories and emotions, we immediately recognize that, oh, this is nice. There's many synapses from your frontal cortex. So when we're talking about the amygdala and the limbic system and the learned memory, I might've had a teacher, let's say, that wore lavender and she was very nice to me. And when I smell lavender, it reminds me of the teacher or my grandmother. And it makes me feel comforted. It makes me feel safe. I feel calm. So this is one way that aromas can really intercede powerfully in cases of chronic pain, emotional trauma and anxiety, not only for your patients, but for yourself. So I use aromatherapy professionally and personally. In the hospital I'm at, we have now developed a policy and aromatherapy is stocked on all the units. It's a nursing intervention. So it's really working with essential oils and they are plant-based, so they are not fragrances or cologne. Now, I think of like a Glade plug-in or a Bath and Body type of plug-in. Let's say there's vanilla. So the vanilla might still elicit that calming response, but from a physical standpoint, it's not really healthy for you to be breathing that in just because of the chemical base of that. So just being aware about that. What I like about the aromatherapy is that it is plant-based. So how do essential oils work? Actually, the chemistry of an essential oil, basically the chemistry of a plant determines its therapeutic properties. So we know that peppermint has a lot of alcohols in it. So it is more astringent. Peppermint is a go-to for also for nausea. Lavender, we know, has a lot of sesquiterpenes. That's what makes lavender so calming. So even if you quite don't believe in essential oils or anything, there's science behind that supports what they do because of the chemical makeup of the plant. So when we inhale something, your limbic system recognizes the smell and triggers a response, and that's connected to the involuntary action. So it really tells us about our perception of our environment. So when I walk into my mother's home and she has a pot of pasta sauce cooking on the stove, right away, I feel good. I know I'm home, I'm gonna get a good meal, and I automatically relax. So that's how essential oils work. Now, depending on your area of practice, where you are in your hospital environment, you can have, it won't be the same if you don't have the essential oil, but you can use, maybe you have tea, maybe you, you know, even an alcohol swab. We know those have been used for nausea and help wake people up. If you have peppermint lifesavers, something like that. So, but there is opportunities to use essential oils safely and effectively at the bedside with patients and for yourself. We use them here at the hospital in a inhaler form, which kind of looks like a Vicks inhaler or an aroma stick, you could say. And we also use them in lotion form for those patients that maybe can't hold the aroma stick or just find it easier to use the lotion. So essential oils, aromatherapy, essential oils have been around for a long time and almost every culture has used essential oils, whether it's for rituals, it's for beauty or healing. So aromatherapy can be very, very helpful and it's pretty inexpensive. And there's a lot of great companies out there that make essential oils, but they all, if they're a pure essential oil, not a fragrance oil, they have their own makeup that gives them a therapeutic property. So the last, one of the last things I wanna share with you is Donna Eden's energy practice. And two real quick things just to do, the crisscross technique. This is about bringing your body into balance and helping your energy. Your energy is meant to be an RNA, DNA helix. So it's meant to kind of ebb and flow. And as you go about the day, what happens is your energy kind of goes up and down. So very simply take your right hand to your left shoulder, press in your left shoulder and drag your arm across your body to your right hip. And then repeat that. Take your right hand to your left shoulder, press in, keeping your hand connected to you, pull and drag to your right hip. And we're gonna do that one more time. Right hand to left shoulder, press in and pull. It's like you're almost gonna make a half X. Next, take the left hand to the right shoulder, press in and drag and go now to the opposite left hip. Take your left hand back to the right shoulder, press in, drag the hand across the body. So you're completing that X. And one more time. Left hand to right top of the shoulder, press in and pull across the body. And then you can do single. So you're just making an X down the front of your body, keeping your hand and palm fully connected to you. So when you feel run down and you feel tired or you need to go in to do an exam, you can do this just to help kind of reinvigorate your energy. The next is called the hookup. And this is really connecting the breath and the chakras and just bringing some balance in. Take your right hand, middle finger to the belly button and take your left hand, middle finger right between your eyebrows, breathe in and up. Like you have a string pulling you up, just really helping you to connect. And you can stay like this for a minute or two. Just breathe in and out. We won't do that today, but just until you feel kind of connected, breathing in and up. So I have to talk about music as well because I use my phone at the bedside with patients. We have music therapy, which we know music therapy can help neurologically. It can help with pain, anxiety, any type of distress. Sometimes I bring things along. I will do instrumental music, nature sounds. Sometimes you might have access to any music channel on your TV in the hospital or relaxation channel. So really just being open to using music for calm. Many people find, I will ask, what music do you like? What works for you? I have the luxury of having music therapy to help support our patient population, but it's something that could be totally available for you depending on how you want to incorporate it. Some people use like sound machines and you can have rain or you can have birds or something, even something like that. So again, really just allowing yourself to tune in and to use music. I don't know if many of you, I use a drum. I use Tingsha bells personally, but I know there's many people that are getting certified in singing bowls, using Tibetan bowls and sound therapy. So that gets into working with the energy of the body, but those are also beautiful things to listen to or tune into. Sometimes I pull those up on my phone. So I try and access those things to create, again, that healing environment for someone. And for myself, I know listening on the way home from work is very helpful when I'm listening to music. And recognizing our spirituality that expressed in experience through our living connectedness, our human, our essence of our being and that human spirit, our spirituality also, what gives us meaning and purpose when we experience pain and suffering? What does that do for us from a spiritual aspect? So understanding the human spirit and our human interconnectedness, our humanity going beyond ourselves and being open to experiencing that. So some of the healing comes through, involving a chaplain or creating that spiritual space. Maybe it's offering a prayer or reading a poem or something. Sometimes people find their spirituality in nature. Sometimes they find it through music. So sometimes they find it through their religious practice and ritual. So acknowledging that and utilizing that with interaction or utilizing it for yourself. So I just wanna share, I know we're almost out of time and I wanna be mindful of everyone's time. So I wanna just share one of these working with a teenager who had an eating disorder and past sexual trauma. I used in working with her and establishing trust in that caring safe space when she was here at the hospital with us, I used Reiki with her. And the one place she said that I could not touch was her head. So I did shoulder and hand, knees and feet and hovered above her heart center. After we continued to establish a trusting relationship because she was here for quite a while, the last couple of sessions, she invited me to place my hands on her head. And what I wanna share about that is sometimes through that touch and through that process and using some holistic integrative modalities, we create a process where people can experience and be open to their healing. So sometimes it's coming in through those modalities that can help us. And so I just want to thank you all for being here with me and allowing me to share holistic nursing and forensic nursing. Thank you so much. Rose, thank you so much for your time today and being here with us. You truly shared some valuable information with us and it's great timing for the nurses that are on today's call in this appreciation week, not only to learn something for the patients, but also to take a well-deserved moment for yourself. I hope you all are able to incorporate the strategies that Rose shared with us to enhance your practice, but also make those significant mind-body connections for yourself. And on behalf of the International Association of Forensic Nurses, we thank you for joining us today and we look forward to seeing you on a future webinar.

forensic nursing

holistic nursing

safe environment

healing environment

addressing trauma

holistic nurses

trauma-informed self-care

holistic nursing principles

deep breathing

mindfulness

guided imagery

acupressure

aromatherapy