bedpans, bandages, and bollocks.

Turning up day after day to the stressful environs of the ED, constantly having to deal with an endless exposure to OPP (other peoples problems) can quickly sap your resilience, stifle your spirit and leave you open to that nastiest of medical infections; necrotizing cynicism.

Your perception of the nursing profession quickly narrows to an endless cascade of repetitious, menial activities. Passing out bedpans, inserting cannulas, dressing wounds, hanging fluids. The patients before you resolve into a set of medical caricature’s. The bowel obstruction in bed 4. The Gerri in bed 8.

Work is shallow and stagnant. In order to get the fluids flowing again it may be necessary to push off into deeper waters. Lets have a look at some deeper nursing at the confluence of three streams of nursing practice:

• Engaged practice.
• Reflective practice.
• Contemplative practice.

Or you could think of them as doing, thinking and being.

Attention to these three areas will allow you to cultivate a significantly enriched and rewarding nursing experience for you and a higher quality of care for your patients .

engaged practice.

I was watching a TV show the other day about an expedition to climb Mt Everest. During the ascent to base camp one of the climbers stuck his crampon into his leg, sustaining a laceration to his shin.
The expedition doctor attended to the distressed climber and I was mesmerized by the way he ministered his craft.

You would have thought this was the most important procedure he had ever performed. He was totally absorbed as he interacted with the patient, engaging with the climber in hushed reassuring tones whilst gently probing as to whether the lapse in concentration that led to this injury might not in fact be the pro-drome of a more serious altitude related problem.
His actions whilst performing the apparently simple task of cleaning and dressing the cut had an observably calming effect on his patient. There was a lot more going on here than the disinfecting of a wound.

The psychologist Mihaly Csikszentmihalyi coined the term Flow to describe this state of engaged activity. Total immersion in the present moment produces an energized focus in which the doer of the action and the action itself merge.
Time may condense or expand, tasks are accompanied by feelings of calm or joy, complex activities seem effortless.
The cannula simply inserts itself.
The entire shift is over in a happy flash (ahem…advanced practitioners only).

reflective practice.

Reflective practice is the process of applying a structured inquiry to the actions and experiences of your work.
To step back and explore the *how’s* and *why’s* of the interactions and relationships that are occurring. To drop the pre-conceived and the pre-known and replace them with an open curiosity. And then to make course corrections or practice changes based on lessons learned from these explorations.
Utilizing reflective practice to foster an atmosphere of continuous learning has been called a defining characteristic of professional practice (Donald Schön (1983)).

Reflective practice can occur as reflection in action (whilst doing) or reflection on action (after doing).
You place a Hudson Mask delivering oxygen at 6 liters a minute on a lady experiencing chest pain. Why do we do this?
Once the oxygen is commenced the lady becomes anxious and restless. What is this all about?

Tools to assist this process include:

• Mentorship: Perhaps the most useful tool is finding a mentor to both guide and listen during the reflective process.
• Journaling: Some find it useful to keep a journal or written narrative of their experiences. The very act of structuring and arranging your thoughts, and funnelling them through your left hemispheres onto paper may be very illuminating.
• Blogging: opens a great potential for reflective practice that has been underestimated and largely ignored by our profession. It provides ample opportunity for interaction, extrospection and cross-referenced reflection.

contemplative practice.

Developing a contemplative practice is perhaps the most difficult discipline. It requires a deep and often uncomfortable examination of *you* as well as the places where you and your profession touch. The reward for looking into these nooks and crannies is the possibility of making profound changes in your relationship with your work (and your life) and greatly enhancing both your engaged and reflective practices.

Contemplation comes from the Latin root templum (from Greek temnein: to cut or divide), and means to separate something from its environment.
Which is pretty accurate ’cause contemplative practice isn’t all quiet incense, pan pipes and swimming with the dolphins. It is about cutting and peeling open. It is fleshy and raw and will get no doubt get yourself covered in bitter-sweet juices.

And what is it that you must attempt to tease out from this warp and woof of your life? Well that is for you to unveil. This is a path of self-discovery. If it were easy I would simply send you here.
Developing a contemplative practice will add verticality to your work. You will learn to trust your intuition and develop a solid foundation on which to build your knowledge, skills and values.

Tools for developing contemplative practice might include:

• Find a teacher. Most of the contemplative traditions say something along the lines of; when the pupil is ready, the teacher will appear. If you take some time to listen, you will probably hear the pull towards the necessary path. That may mean reuniting with your religious roots, perhaps exploring for some affinity with other religions or contemplative traditions.
  Perhaps a more comfortable fit for you will involve perusing scientific enquiry as to where your place is in the universe, by simply asking, why is it so?
  Whichever path you choose finding someone who has explored the territory a little further ahead will be invaluable.
  But remember life is short, so get up off your arse.
• Bodywork: such as yoga, or just improving your level of fitness.
• Meditation or prayer: taking some time for undisturbed stillness.

So here I have offered as a quick overview some methods you might wish to explore further to deepen your doing, thinking and being. Take pause from splashing about in the shallows and consider the mystery of deeper waters.