Transcript Nurses Make a Difference

JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 46:
Holistic Healing
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Differing Perspectives
• Biomedical perspective: allopathy
– Conventional Western medicine/treatment
– Treats pathologies and symptoms
• Holism
– Treats the whole person
– Preventative strategies; lifestyle changes
– Optimal wellness
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Tenets of Holistic Healthcare
• People
– Are unique
– Connect to and interact with the environment
• Health
– Includes spiritual component, self-healing,
balance, integration
• Illness
– Constitutes an imbalance, allows growth
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Terms to Understand
• Modality: method of treating a disorder
– Traditional modalities: antibiotics, surgery
– Holistic modalities
• Complementary: a treatment used together with
traditional medical care
• Alternative: a treatment used instead of traditional medical
care
• Integrative healthcare: encompasses all treatment
modalities
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Holistic Nursing Theorists
• Florence Nightingale
– Optimal health; touch;
environmental influences
• Martha Rogers
– Energy fields affect health
• Margaret Newman
– Disease as disequilibrium
• Jean Watson
– Caring is primary focus of nursing
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Holistic Nursing Concepts
• Know the meaning inherent in disease
• Therapeutic use of self: presence and intention
• Role-modeling balanced health
– Develop a healthy lifestyle
– Obtain support from like-minded colleagues
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Healing Modalities:
Alternative Medical Systems
• Ayurveda
• Naturopathy
• Acupuncture
• Homeopathy
• Chinese medicine
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Healing Modalities: Mind-Body Interventions
• Prayer
• Meditation
• Imagery
• Humor
• Music therapy
• Yoga
• Hypnosis
• Biofeedback
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Healing Modalities: Biology-Based Methods
• Dietary therapies
• Herbs
• Nonherbal dietary supplements
• Aromatherapy
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Healing Modalities:
Manipulative/Body-Based Methods
• Chiropractic
• Massage
• Osteopathy
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Healing Modalities: Energy Therapies
• Therapeutic touch
• T’ai Chi; Qigong
• Reiki
• Magnet therapy
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Therapies
• Complementary — used together with traditional treatment
• Alternative — used in place of traditional treatment
• Complementary and alternative medicine (CAM) — diverse
group of practices and products
• Integrative medicine — combination of traditional Western
medicine and CAM
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Complementary & Alternative Medicine
(CAM)
• Homeopathic medicine — small doses of specifically
prepared plant extracts and minerals to promote
healing
• Naturopathic medicine — employs herbs and
nutrition into health care practice
• Used with or without proven treatment or “gold
standard”, “first line” medicine
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NCCAM Classifications of Alternative
Medicine
• Natural products
• Mind-body therapies
• Manipulative and body-based therapies
• Other (energy, cognitive-behavioral)
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Natural Products
• Probiotics or nutraceuticals (dietary and herbal
supplements)
• Thought to provide health/medical benefits
• Regulated by FDA as food and nutritional
supplements
• Regulation less strict than for drug therapy
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Considerations for Older Adults
• Overuse of dietary/herbal supplements for health
promotion and problems that can be caused by such
overuse
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What Do You Think?
What do you need to know in your role as a nurse
about the use of CAM by patients?
• Think in terms of:
– Patient assessment
– Safety
– Evaluation methods
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17
Patient Teaching
• Caution patients about unreliable sources of health
information/herbal remedies
• Obtain accurate information from:
– www.herbs.org
– www.nccam.nih.gov
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2011 Hospital National Patient Safety Goals
(NPSGs)
• Improve patient safety by focusing on problems in
health care safety and how to solve them:
– Identify patient correctly
– Improve staff communication
– Use medications safely
– Prevent infection
– Check patient medications
– Identify patient safety risks
– Prevent mistakes in surgery
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Probiotics
• Live microorganisms similar to those found in GI tract
• Taken orally; enhance immune response, stabilize GI
mucosal barrier
• Two forms:
– Lactobacillus
– Bifidobacterium
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Probiotics (cont’d)
• Used to treat:
– Antibiotic-associated diarrhea (AAD)
– Irritable bowel syndrome (IBS)
– Bladder and intestinal infections
– Lactose intolerance
http://nccam.nih.gov/health/probiotics
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Aromatherapy
• Essential oils from plants/trees used to enhance
psychological and physical well-being
• Compresses, baths, applied topically
• Stimulates brain to decrease pain
• Improves/enhances cognitive function
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Mind-Body Therapies
• Prayer (most common)
• Imagery
• Meditation
• Music
• Pet therapy
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Imagery
• Formation of mental representation of object, place,
event, situation
• Used to:
– Reduce pain
– Reduce nausea and vomiting
– Decrease anxiety; promote comfort
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Meditation
• Self-directed practice
for relaxing body/mind:
– Mental repetition
– Physical repetition
– Problem contemplation
– Visual concentration
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Music Therapy
• Used in nursing homes
• Calms agitated patients
• Provides reminiscence for older adults
• May decrease pain and anxiety
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Pet Therapy
• Includes animal-assisted therapy (AAT) and pet
visitation
• ATT – animal is part of treatment
• Pet visitation – aimed at increasing socialization, keeps
person in touch with reality
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Yoga
• Improves breathing and
posture through
stretching, positioning
• Decreases BP, increases
heart/respiratory
function, improves
physical fitness, decreases
anxiety
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Acupressure & Acupuncture
• Traditional Chinese medicine therapy
• Acupressure – finger pressure at certain body points
stimulates self-healing
• Acupuncture – needles at specific body locations
(acupoints) address illness or pain
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Manipulative & Body-Based Therapies
• Massage – reduces pain, produces relaxation, improves
sleep
• Tai chi
• Therapeutic Touch
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Massage Therapy
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Tai Chi
• Holistic movement therapy
• Integrates body movements, mind concentration,
muscle relaxation, and breathing to achieve desired
outcome
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Considerations for Older Adults
• Tai chi can be used successfully in various settings
• Evidence-based findings show residents in long-term
care had significant improvement of physical/mental
quality of life
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Therapeutic Touch
• Belief that body has subtle energy that extends
beyond the body
• Practitioner intervenes in patient’s energy field to
stimulate healing potential
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Think Like a Nurse
Holistic healthcare relies on the placebo effect. However,
traditional therapy discourages the use of placebos for pain
control. (Ethicists hold that placebos are deceptive and do not
respect patient autonomy.) Traditional researchers attempt to
factor out the placebo effect when conducting clinical research
trials. React to these two belief systems.
 Which belief is most congruent with your view
of healthcare?
 How do you think these divergent views might affect
research on CAM?
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JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 42:
Promoting Health
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What Is Health? (cont’d)
• WHO (World Health Organization)
– State of complete physical, mental, and social well-being;
not just absence of disease
• Jean Watson
– High overall functioning; a state of mind
• Betty Neuman
– Continuum of energy
• Myers, Sweeney, and Witmer
– Integration of mind, body, spirit; those with disease can
be “healthy”
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Health Protection
• Motivated by the desire to avoid illness
• Health prevention: levels of activities
– Primary: prevent/slow onset of disease
– Secondary: detect and treat illnesses in early stages
– Tertiary: stopping disease progression; return to
pre-illness state
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Health Promotion
• Motivated by the desire to increase well-being
• Related to individual lifestyle choices
• Healthy People 2020 http://www.healthypeople.gov/
– National initiative
– Addresses the effect of lifestyle on health
– Created health improvement goals
– Eliminate health disparities
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Health Promotion Models
• Pender’s Health
Promotion Model
• Wheels of Wellness
• Model of Change
– Four stages:
contemplation,
determination,
action, maintenance
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Health Promotion Programs
• Disseminating information
– Individual level
– Group level
• Changing lifestyle and behavior
• Environmental control
• Wellness assessment/health risk appraisal
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Health Promotion: Program Settings
• Health facilities
• Work sites
• Schools
• Physician offices
• Health clinics
• Hospitals
• Community settings
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Nursing Assessment: Health Promotion
• Health history/physical examination
• Physical fitness
– Cardiorespiratory fitness
– Muscular fitness
– Flexibility
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Nursing Assessment
• Lifestyle and risk appraisal
– Personal habits
– Recreation
– Occupation
– Activities that promote optimal living
– Health risk appraisal (HRA) tools
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Nursing Assessment (cont’d)
• Life-stress review
– Based on work of Selye
– Stress-inducing life changes
– Hardiness versus vulnerability
• Health beliefs
– Cultural beliefs and personal experiences
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Nursing Assessment (cont’d)
• Nutritional assessment
– Dietary patterns
– Body mass
• Health screening
– Blood pressure screening
– Cancer screening tests
– Laboratory studies (e.g., lipid levels, PSA)
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Nursing Interventions for Health Promotion
• Role modeling
• Counseling
– Individual
– Telephone
• Health education
• Supporting lifestyle changes
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Think Like a Nurse
• Undoubtedly you are experiencing stress as a student
in a nursing program. How would you rate your level
of hardiness?
• What statements would demonstrate a hardy
personality in each area (commitment, control,
challenge)?
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