Alternative Medicine.

Discuss the safety and effectiveness of alternative and complementary medicine for the treatment of specific

illnesses such as cancer, diabetes, and hypertension. Share your opinions about holistic and allopathic care.

Would have any conflicts or concerns supporting a patient who chooses holistic or allopathic medicine?

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Chapter 13

Stress Management

Goal of Stress Management

To improve quality of life by increasing healthy, effective coping, thereby reducing unhealthy consequences of distress

Dynamic interaction of

Mind
Body
Spirit
Cognitive/emotional states and behavior

Sources of Stress

Stressor: any psychological, environmental, or physiological stimulus that disrupts homeostasis, thereby necessitating change or adaptation
Three categories stressors
Extrinsic factors: stressors over which individuals do not have control (e.g., death of spouse, weather)
Modifiable factors: individual can modify through change environment, interactions, behavior
Intrinsic factors: stressors created or exacerbated by individual response to stress (e.g., negative thinking, procrastination)

Sources of Stress (Cont.)

Stress: the physical, psychological, social, or spiritual effect of life’s pressures and events
Interactive process of appraisal/response
Eustress vs distress

Eustress: challenging and useful stress; not destructive

Distress: chronic or excessive stress; body unable to adapt; threatens homeostasis

Stressors

Textbook Figure 13-1

Homeodynamics

Describes continuously changing nature and interaction among life processes
Extends concept of homeostasis into more inclusive term
Stress threatens homeodynamics which triggers efforts to restore stability
Physiological responses
Behavioral responses
Social responses

Consequences of Stress

Multidimensional effects
Physical
Physiological
Socio-behavioral
Spiritual
General adaptation syndrome (Hans Selye)
Stress can be useful or harmful
Stress increases efficiency and productivity to a point
Point exists where stress has negative impact

Physiological Effects of Stress

Neuroendocrine activation/behavior changes
Fight-or-flight stress response: adaptive, short-term, acute
Hypothalamus signals sympathetic nervous system: epinephrine and norepinephrine
Increased metabolism, pulse, blood pressure, respiration, muscle tension
Maladaptive: cause/exacerbate disease or symptoms of disease

Physiological Stress Response

Textbook Figure 13-2

Psychological Effects of Stress

Contributory role in negative mood states
Anxiety, depression, hostility, anger
Elevated cortisol levels; immune system response
Affects health outcomes in key populations (e.g., elderly, terminally ill, caregivers)
Quality of life
Depressive symptoms
Degree of suffering

Sociobehavioral Effects of Stress (Cont.)

Stress response: individual reliance on less healthy behaviors
Overeating
Excessive use alcohol/drugs
Smoking
Social isolation
Unhealthy behaviors associated with increased morbidity/mortality

Spiritual Effects of Stress

Spirituality: “feelings, thoughts, experiences, and behaviors that arise from a search for meaning…”
Spirituality and religion not synonymous
Stress response: often feel disconnected from life’s meaning/purpose
Spirituality/religiosity: assists coping with stress
Promoting connection with life meaning and purpose: health benefits

Symptoms of Stress

Textbook Figure 13-3 part 1

Symptoms of Stress (Cont.)

Textbook Figure 13-3 part 2

Symptoms of Stress (Cont.)

Textbook Figure 13-3 part 3

Health Benefits of Managing Stress

Stress management is key to disease management and better health outcomes
Caregiver stress/burden is a major concern;
Being a caregiver is taxing
“Sandwich generation”; those caring for their parents while simultaneously raising children
Burnout (stress/burden) is a consequence of caregiver
Social support system protective vs stress-related symptoms and disease

Assessment of Stress

Primary appraisal: descriptions of perceived actual/potential positive and negative outcomes
Negative outcomes: harm (injury, disease, death)
Positive outcomes: challenges which can be managed (graduation, promotion)
Secondary appraisal: individual’s identification of choices to cope with stress
Internal or external resources and responses
Measurement tools:
Improve assessment of stress and coping
Promote accuracy: diagnosis, planning, and evaluating care

Stress-Management Interventions Self-Awareness

Recognize signs (muscle tension resulting in backache, headache)
Attend to cues to reduce negative mood states (anxiety symptoms) or symptoms (stretching for backache)
Nursing role: assist people to identify stress signals, change response (breathe/ relaxation), break stress cycle

Stress-Management Interventions Relaxation

Technique to help develop awareness/ counter-negative effects of stress
Reduces sympathetic arousal
Two components
Repetition of word/thought/activity
Passive disregard of everyday thoughts
Mini-relaxations
Can be used throughout day
Keep initial stress symptoms from intensifying

Stress-Management Interventions Alternative/Complementary Therapies

Developed outside of Western medicine
Acupuncture: ancient Chinese technique
Fine needles placed at specific meridian points on body
Used to reduce pain; prevent/manage disorders
Hypnosis: from Greek word “sleep”
Narrows consciousness; elicits relaxation, inertia, passivity; useful for smoking cessation, anxiety, pain
Reiki: Japanese “universal spirit”
Uses life force energy fields to affect health

Stress-Management Interventions
Additional Modalities

Expressive writing
Telling a story about life events/personal reactions; useful in disclosing/processing emotions; develops insights into problem-solving
Healthy diet
Positive influence on health, physical performance, state of mind; balance in diet improves functioning
Physical activity
Comprehensive health benefits; enhances well-being while decreasing stress

Stress-Management Interventions
Additional Modalities (Cont.)

Sleep hygiene
Altered sleep patterns can result from stress issues; sleep deprivation exacerbates depression/fatigue
Sleep techniques improve quality of life
Cognitive-behavioral restructuring
Modifies negative or exaggerated thinking to reduce stress
Evaluates, challenges thoughts; replaces with more rational responses
STOP, break the cycle, take a breath (relax), reflect, choose a more rational response

Stress-Management Intervention
Additional Modalities (Cont.)

Affirmations
Positive thought (short phrase or saying) that has meaning for person
Repeat affirmation through day—enhances self-esteem and reduces stress
Social support
Network of close family, friends, coworkers, and professionals
Number of supporters and quality of relationships important

Stress-Management Interventions
Additional Modalities (Cont.)

Assertive communication
Need to match statement with intention for effective communication; facilitated by cognitive restructuring
Nonjudgmental, expresses feelings and opinions, reaffirms perceived rights
Format: I feel [emotion] when you [behavior] because [explanation]
Empathy
Consider another person’s perspective and communicate understanding back to person
Active listening (conscious, nonjudgmental)
Reduces emotional arousal, defensive behavior, and conflict

Stress-Management Interventions
Additional Modalities (Cont.)

Engaging in healthy pleasures
Activities that bring feelings of peace, joy, and happiness
Breaking stress cycle more challenging if denied
Spiritual practice
Activities that help people find meaning, purpose, and feeling of connection
Examples: religious or altruistic activities, journal writing

Stress-Management Interventions
Additional Modalities (Cont.)

Clarifying values and beliefs
Identify what is important and meaningful
Implement values and habits to promote stress reduction
Realistic goals
Goal-setting dynamic process
Specific, concrete, measurable, achievable
Attainable goals increase sense of control and mediate negative stress effects
Humor
Laughter: physiological effects similar to exercise
Opens different perspectives and objectivity
Reframes perceptions of an event

Effective Coping

Effective coping: the art of finding a balance between acceptance and action, between letting go and taking control
Stress-management techniques
Differentiate between acceptance and action
Counter harmful effects of stress
Role of nurse—assist individual
To manage extrinsic and intrinsic stressors
To choose the right strategy at the right time

Chapter 13

Stress Management

Goal of Stress Management

To improve quality of life by increasing healthy, effective coping, thereby reducing unhealthy consequences of distress

Dynamic interaction of

Mind
Body
Spirit
Cognitive/emotional states and behavior

Sources of Stress

Stressor: any psychological, environmental, or physiological stimulus that disrupts homeostasis, thereby necessitating change or adaptation
Three categories stressors
Extrinsic factors: stressors over which individuals do not have control (e.g., death of spouse, weather)
Modifiable factors: individual can modify through change environment, interactions, behavior
Intrinsic factors: stressors created or exacerbated by individual response to stress (e.g., negative thinking, procrastination)

Sources of Stress (Cont.)

Stress: the physical, psychological, social, or spiritual effect of life’s pressures and events
Interactive process of appraisal/response
Eustress vs distress

Eustress: challenging and useful stress; not destructive

Distress: chronic or excessive stress; body unable to adapt; threatens homeostasis

Stressors

Textbook Figure 13-1

Homeodynamics

Describes continuously changing nature and interaction among life processes
Extends concept of homeostasis into more inclusive term
Stress threatens homeodynamics which triggers efforts to restore stability
Physiological responses
Behavioral responses
Social responses

Consequences of Stress

Multidimensional effects
Physical
Physiological
Socio-behavioral
Spiritual
General adaptation syndrome (Hans Selye)
Stress can be useful or harmful
Stress increases efficiency and productivity to a point
Point exists where stress has negative impact

Physiological Effects of Stress

Neuroendocrine activation/behavior changes
Fight-or-flight stress response: adaptive, short-term, acute
Hypothalamus signals sympathetic nervous system: epinephrine and norepinephrine
Increased metabolism, pulse, blood pressure, respiration, muscle tension
Maladaptive: cause/exacerbate disease or symptoms of disease

Physiological Stress Response

Textbook Figure 13-2

Psychological Effects of Stress

Contributory role in negative mood states
Anxiety, depression, hostility, anger
Elevated cortisol levels; immune system response
Affects health outcomes in key populations (e.g., elderly, terminally ill, caregivers)
Quality of life
Depressive symptoms
Degree of suffering

Sociobehavioral Effects of Stress (Cont.)

Stress response: individual reliance on less healthy behaviors
Overeating
Excessive use alcohol/drugs
Smoking
Social isolation
Unhealthy behaviors associated with increased morbidity/mortality

Spiritual Effects of Stress

Spirituality: “feelings, thoughts, experiences, and behaviors that arise from a search for meaning…”
Spirituality and religion not synonymous
Stress response: often feel disconnected from life’s meaning/purpose
Spirituality/religiosity: assists coping with stress
Promoting connection with life meaning and purpose: health benefits

Symptoms of Stress

Textbook Figure 13-3 part 1

Symptoms of Stress (Cont.)

Textbook Figure 13-3 part 2

Symptoms of Stress (Cont.)

Textbook Figure 13-3 part 3

Health Benefits of Managing Stress

Stress management is key to disease management and better health outcomes
Caregiver stress/burden is a major concern;
Being a caregiver is taxing
“Sandwich generation”; those caring for their parents while simultaneously raising children
Burnout (stress/burden) is a consequence of caregiver
Social support system protective vs stress-related symptoms and disease

Assessment of Stress

Primary appraisal: descriptions of perceived actual/potential positive and negative outcomes
Negative outcomes: harm (injury, disease, death)
Positive outcomes: challenges which can be managed (graduation, promotion)
Secondary appraisal: individual’s identification of choices to cope with stress
Internal or external resources and responses
Measurement tools:
Improve assessment of stress and coping
Promote accuracy: diagnosis, planning, and evaluating care

Stress-Management Interventions Self-Awareness

Recognize signs (muscle tension resulting in backache, headache)
Attend to cues to reduce negative mood states (anxiety symptoms) or symptoms (stretching for backache)
Nursing role: assist people to identify stress signals, change response (breathe/ relaxation), break stress cycle

Stress-Management Interventions Relaxation

Technique to help develop awareness/ counter-negative effects of stress
Reduces sympathetic arousal
Two components
Repetition of word/thought/activity
Passive disregard of everyday thoughts
Mini-relaxations
Can be used throughout day
Keep initial stress symptoms from intensifying

Stress-Management Interventions Alternative/Complementary Therapies

Developed outside of Western medicine
Acupuncture: ancient Chinese technique
Fine needles placed at specific meridian points on body
Used to reduce pain; prevent/manage disorders
Hypnosis: from Greek word “sleep”
Narrows consciousness; elicits relaxation, inertia, passivity; useful for smoking cessation, anxiety, pain
Reiki: Japanese “universal spirit”
Uses life force energy fields to affect health

Stress-Management Interventions
Additional Modalities

Expressive writing
Telling a story about life events/personal reactions; useful in disclosing/processing emotions; develops insights into problem-solving
Healthy diet
Positive influence on health, physical performance, state of mind; balance in diet improves functioning
Physical activity
Comprehensive health benefits; enhances well-being while decreasing stress

Stress-Management Interventions
Additional Modalities (Cont.)

Sleep hygiene
Altered sleep patterns can result from stress issues; sleep deprivation exacerbates depression/fatigue
Sleep techniques improve quality of life
Cognitive-behavioral restructuring
Modifies negative or exaggerated thinking to reduce stress
Evaluates, challenges thoughts; replaces with more rational responses
STOP, break the cycle, take a breath (relax), reflect, choose a more rational response

Stress-Management Intervention
Additional Modalities (Cont.)

Affirmations
Positive thought (short phrase or saying) that has meaning for person
Repeat affirmation through day—enhances self-esteem and reduces stress
Social support
Network of close family, friends, coworkers, and professionals
Number of supporters and quality of relationships important

Stress-Management Interventions
Additional Modalities (Cont.)

Assertive communication
Need to match statement with intention for effective communication; facilitated by cognitive restructuring
Nonjudgmental, expresses feelings and opinions, reaffirms perceived rights
Format: I feel [emotion] when you [behavior] because [explanation]
Empathy
Consider another person’s perspective and communicate understanding back to person
Active listening (conscious, nonjudgmental)
Reduces emotional arousal, defensive behavior, and conflict

Stress-Management Interventions
Additional Modalities (Cont.)

Engaging in healthy pleasures
Activities that bring feelings of peace, joy, and happiness
Breaking stress cycle more challenging if denied
Spiritual practice
Activities that help people find meaning, purpose, and feeling of connection
Examples: religious or altruistic activities, journal writing

Stress-Management Interventions
Additional Modalities (Cont.)

Clarifying values and beliefs
Identify what is important and meaningful
Implement values and habits to promote stress reduction
Realistic goals
Goal-setting dynamic process
Specific, concrete, measurable, achievable
Attainable goals increase sense of control and mediate negative stress effects
Humor
Laughter: physiological effects similar to exercise
Opens different perspectives and objectivity
Reframes perceptions of an event

Effective Coping

Effective coping: the art of finding a balance between acceptance and action, between letting go and taking control
Stress-management techniques
Differentiate between acceptance and action
Counter harmful effects of stress
Role of nurse—assist individual
To manage extrinsic and intrinsic stressors
To choose the right strategy at the right time

Chapter 14

Complementary and Alternative Strategies

Holistic Practice

Health defined as more than the absence of disease
Health: optimal wellness in all aspects of being
Goals
Support a person’s natural healing systems
Consider the whole person
Consider the environment surrounding person
Often considered complimentary or alternative
Moving into mainstream US practice
Useful adjuncts to nursing practice

Holistic: encompasses emotional, spiritual, and relational well-being
Combine with the physical body
Together they define a whole person
Allopathic medicine: focus is on identifying and treating disease
Care by physician or midlevel provider
Drugs, surgery, procedures to ailments

Holistic Versus Allopathic

Alternative Health Modalities

Source: Nat’l Health Statistics Report # 79 – Nat’l Center for Health (2015)

The American Holistic Nurses Association (AHNA) defines holistic nursing as nursing practice that heals the whole person
Per AHNA: “specialty practice that draws on nursing knowledge, theories, expertise and intuition to guide nurses in becoming therapeutic partners with people in their care.”

Holistic Nursing

Biologically based practices
Mind and body techniques and practice
Manipulative body-based practices
Energy therapies
Ancient medical systems
Whole medical system (includes all domains)

Domains are neither mutually exclusive nor inclusive—considerable overlap

Types of Therapy

Ayurvedic medicine (India)
Evolved over thousands of years
Herbs, massage, diet, drugs
Goal is mind-body harmony
Traditional Chinese Medicine (China)
Evolved over thousands of years
Herbs, CAM treatments, acupuncture
Balance yin and yang life forces
Describes organs via fire, earth, metal,H2O, wood

Whole Medical Systems

Naturopathy:
Combo of traditional and 19th century European modalities based on healing power of nature
No RX, injections, x-rays or surgery
Healthy lifestyle, cleansing regimens, diets, manipulation, exercise
Homeopathy—founded by Hahnemann 1807
Administers small amounts of dilute pathogenic substances to stimulate body’s healing abilities
FDA hearings 2015—unfavorable findings

Whole Medical Systems

Use of natural products—historic roots
Medicinal herbs found in prehistoric man
Botanical herbs inventoried in Middle Ages
Current modalities:
Nutritional counseling: good efficacy data
Herbs, vitamins, minerals (not multivitamins or CA++)
Probiotics (“friendly” bacteria)
Aromatherapy aka essential oil therapy

Uses naturally extracted plant oils to promote health

Hydrotherapy: ice, steam, sauna, compresses

Biologically Based Practices

Spinal or bone manipulation
Application of controlled force on bone or joint
Performed by chiropractors, physical therapists, and osteopathic physicians
Chiropractic focuses as spinal alignment
Cranial and cranio-sacral therapy
Focus on skull and flow of CSF
Gentle pressure cranium, spine, sacrum
Goal to restore free movement of CSF

Manipulative and Body-Based
Modalities

Physical therapy: variety of modalities
Manipulation, massage, heat or cold, movement, electrical impulse
Treat pain and restore function and ROM
Massage—various techniques
Manipulation of muscle and soft tissue
Reduce stress; enhance relaxation
Reflexology—manipulation and energy fields
Pressure to hands and feet
Pressure points correspond to body organs

Manipulative and Body-Based
Modalities (Cont.)

Guided imagery: directs the imagination
Focuses on calming thoughts or experiences
Promotes sense of well-being, relaxation
Randomized controlled study shows improved quality of life and some impact on laboratory values
Meditation—focused attention, mindfulness
Quiets the mind, reduces stress
Part of some religions but not a religious activity
Variable formats: breath, chosen word, walking

Mind Body Medicine

Hypnotherapy
Focused attention of unconscious mind
Recall of suppressed events and behavior change
Commonly used for tobacco cessation
Biofeedback—relaxation technique
Focus on vital functions: HR, BP, breathing rate
Visualizations to bring about change
Neurolinquistic programming (NLP)
Changes behavior via change in thinking/speaking

Mind Body Medicine

Movement Arts

Qigong (Chinese)
Relaxed movement with meditation,
Controlled breathing to move qi energy and increase vital energy
Tai chi (from Chinese martial art)
Combined physical movement, breath control, meditation
Sequence of poses flows in unbroken rhythm to balance energy flow
Brings awareness moment-to-moment state of body
Produces meditative state

Movement Arts

Yoga (Hindu)—many forms
Origins as spiritual practice
Hatha yoga—most familiar in Western culture
Involves positions and breath control
Positions relaxing or may require strength
Documented health benefits

Improves flexibility, promotes relaxation, decreased stress, improves pain management

Dance therapy—mind and body move in response to music

Energy Therapy

Energy flows through the body
Energy nourishes organs/promotes optimal functioning
Goal: energy work releases blockages to energy flow, rebalances life energy
Cultural energy name variations
Chinese: Chi or qi
Japanese: Ki
East Indian: Prana
Western civilization: subtle energy, life energy, or universal energy

Energy Therapy Modalities
Acupuncture

Manipulates chi or qi by stimulating (fine needles) precisely mapped points on the skin points overlie channels (meridians) through which chi travels
Acupuncture points act as valves in meridians
Valve opens/closes, corrects imbalance in chi
Stimulation via needles, electrostimulation, laser, light, burning herbs (moxibustion)
Effective: substance abuse, depression, insomnia, nausea/vomiting, pain

Energy Therapy Modalities
Acupressure and Reflexology

Acupressure
Stimulation of meridian points by hand pressure
No oil needed; can be done with person clothed
Reflexology
Deeply applied pressure to mapped points on feet and/or hands
Pressure applied with thumbs
Pressure points correspond to organs of the body that will be stimulated by pressure

Energy Therapy Modalities
Touch Therapies

Touch therapies fall under umbrella of energy therapies
Practitioners use their hands to direct energy (from environment) to individual
Goal is to restore balance and harmony
Examples: therapeutic touch reiki, attunement, Jin Shin Jyutsu, polarity therapy, healing touch

Energy Therapy Modalities
Therapeutic Touch

Conceptualized by Martha Rogers
Human energy fields interact with environmental energy fields
TT involves three elements
Centering of practitioner (calm, present in moment, connected)
Assessment (sensing disturbances/imbalances by moving hands over body)
Treatment: methods to change patterns of energy field (unruffling), or direct energy to person/redistribute energy (modulation)

Energy Therapy Modalities
Additional Modalities

Healing touch (similar to therapeutic touch)
Adds full-body techniques for moving energy and disorder-specific energy interventions to modulation phase
Qigong (Chinese)
Pranic (East Indian)
Reiki (Japanese): attunement opens energy channel; brings universal energy through body to recipient
Polarity therapy: Clearing energy blockages and rebuilding health
Jin Shin Jyutsu: finger pressure to healing points
)

Prayer and Distant Healing

Prayer
Different meanings to different people
Common belief aids in recovery
Research mixed on therapeutic benefit
Distant healing
Prayer for others
Method: praying circle
Sharing of energy and sending of energy to person in need
Research did not validate this therapy

Music Therapy and Pet Therapy

Music therapy
Use music/sounds to produce desired changes in behaviors, emotions, physiological processes
Influences limbic system (involved with emotions/feelings)
Pet therapy
Two-thirds of three US households have at least one pet
Half of older Americans have a pet
Pets may improve depression, loneliness
Improve physical activity

Nursing Presence

Being available in a situation with the wholeness of one’s individual being
Nurse’s presence can contribute to healing
“Being with” rather than “being there” or “doing to”
Attention “focused” vs attentive
Touch “caring” vs task oriented
“Listen” vs merely hearing patient

Most Complementary and Alternative Medicine (CAM) interventions lack a strong scientific evidence base, as many have not been studied with rigorous, well-designed clinical trials.
Some CAM providers are not credentialed in a standardized national system, credentialing regulations and standards vary nationally
Safety issues for some CAM; caution needed

Safety and Effectiveness

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