1. Donnelly, Gloria F. PhD, RN, FAAN, Editor-in-Chief

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Ellie was 2 years old when her mother noticed a distinct curving of her right foot that became much more pronounced after a day of active play. The pediatrician recommended an orthopedic consultation and the news was dire. Ellie's foot would need to be broken and reset to straighten the bones and then casted several times to accommodate growth. The intervention seemed counterintuitive to Ellie's parents. Why break a perfectly good bone, although it was a bit crooked, to set it straight? Ellie would then have to endure double healing of the fracture and then of the direction of the bone. But the orthopedic surgeon asserted, everything would be "fixed" in 8 weeks-surgery healed, cast gone, foot straightened.


Ellie's parents asked the orthopedic surgeon if he could recommend another, less-invasive approach. Although he cautioned that the process would be long-term and involved, he recommended a pediatric rehabilitation specialist who used dance and focused exercise with children experiencing similar foot curvatures. So to heal, Ellie learned to dance. As she moved her foot in specific ways many times per session, Ellie associated healing with fun and beauty. She danced and practiced in her pastel tutus-a different one for every day of the week. And slowly but surely Ellie's foot joined the straight-and-narrow path perhaps in gratitude for the healing method selected. By the time she entered kindergarten, Ellie's feet were perfectly normal and she had turned into quite an accomplished dancer.


The distinct difference between fixing and healing also offers a dynamic relationship between the 2 approaches. Health care is enamored with fixing, and we now have the technological interventions to do plenty of it. Whether the intervention is body or mind, fixing implies removing, rearranging, reconstituting, and replacing usually from an external to an internal direction. We can fix seriously blocked arteries with medication and stents, though we might have remained healthy through diet and exercise. We can adjust seriously depressed moods pharmacologically, though we might have remained emotionally healthy through meditation, T'ai Chi, or through engaging our creative and spiritual processes with art, music, or dance.


It seems that the more fixing the health care system has to offer, the more the general public seeks and finds holistic modalities that promote healing. Healing interventions imply repairing, restructuring, re-energizing, and restoring usually from an internal to an external direction. The human organism is designed to maintain and heal itself given that pathology has not reached the point of no return. The relationship between healing and fixing is akin to the yin yang symbol with its undulating bisecting line, with fixing and healing each assuming the dominant position according to the situation.


Fixing/healing combinations can be powerful. The person with chronic malignant hypertension often combines medication and nutritional and exercise approaches to gain the maximum therapeutic advantage. A severely depressed individual may take medication until enough energy has returned to engage in other healing modalities. The trick lies in knowing when to fix, when to heal, and when to strategically combine the two approaches. It was Nightingale who reminded nurses that their role was to put the patient in the best condition for nature to act. In this modern health care era of fixing, nurses need to keep healing prominently in the care equation