BSN215 NOTES

Complementary and Alternative Approaches; Mind-Body Interventions -aromatherapy -art therapy -biofeedback -breath work -dance therapy -hypnotherapy -imagery -labyrinth meditation -meditation -music therapy -prayer -psychotherapy -yoga Complementary and Alternative Approaches; Energy Medicine -qigong -reiki therapy -therapeutic touch CAM Approaches and Holistic Nursing -relaxation therapy -imagery -music therapy -simple touch -massage -prayer Nursing-Accessible Approaches -practice a variety of approaches such as imagery, meditation, support groups, and therapeutic touch -easily learned and provided for patients within independent nursing practice -designed to teach how they can alter their physical responses to stress Relaxation -stress response triggers physiological reactions -lower heart rate and blood pressure; decrease muscle tension, improve perceived well- being

The Nursing Act, 1991 Nursing defined as: “the promotion of health and the assessment of, the provision of care for, and the treatment of health conditions by supportive, preventative, therapeutic, palliative and rehabilitative means to attain or maintain optimal function” Nursing Role for Collaboration -Knowledge and skill to provide safe an ethical care -legislation regarding complementary approaches -patient education -determination of patient’s use of therapies -CAM viewed as adjunct to care that may be offered in conjunction with, and not to the exclusion of, other approaches -supplement to conventional healthcare practices Cultural Assessment -examination of the cultural care values, beliefs, and practices of individuals, families, and communities -enables the nurse to provide culturally competent care Ethnohistory Social organization Socioeconomic status, biocultural ecology, and health risks Language and communication Religion and spirituality Caring beliefs and practices Experience Culturally congruent care -does not conflict -use of sensitive, creative, and meaningful care practices to generally fit clients’ wishes Culturally competent care -bridges the gap -explicit use of culturally based care and health knowledge in sensitive, creative, and meaningful ways to meet the needs of clients Cultural awareness -towards understanding of differences

Health Equity -health disparities -health inequities -Social determinants of health -social justice

Week 8: Sexuality -central aspect of being human that is present throughout life and changes with each stage of development -Sexuality -sex -gender -identities and roles -sexual orientation -eroticism, pleasure, intimacy -reproduction Sexual Health -physical, emotional, mental, and social well-being related to sexuality -characterized by a positive and respectful approach to sexuality and sexual relationships Sexual Identity -objective labelling of a person as male or female -variations possible in genitalia, gonads, chromosomes, or hormones Gender Identity -a person identifies as male, female, or some combination -usually consistent with physical sex at birth; transsexuality physical body is at odds with gender identity Sexual Orientation -predominant gender preference of a person’s sexual attraction over time: heterosexual, homosexual, LGBTQ2S+ Sexual Development -changes in sexual functioning and the role of sexuality in relationships 1. Infancy and childhood 2. Puberty and adolescence; visible changes 3. Adulthood 4. Older personhood; intimacy/affection Sexual Response Cycle 1. Excitement 2. Plateau 3. Orgasm 4. Resolution

Week 9: Sleep -Sleep is a basic necessity of life and is as important as air, food, and water -on avg, people are sleeping less -chronic sleep loss has adverse outcomes for health and well-being -insufficient sleep alters mood, decreases the ability to concentrate, make decisions, and participate in daily activities Physiology of Sleep -cyclical physiological and behavioural process that alternates with longer periods of wakefulness -controlled by three distinct processes -Ultradian process: non-rapid eye movement (NREM) and rapid eye movement (REM) -Homeostatic process (process S): sleep-wake cycle -Circadian process (process C): maintaining wakefulness -Circadian rhythms -24-hour circadian rhythm -light, temperature, social activities, work routines -biological clock; synchronizes sleep-wake cycles, affects individual’s optimal time of day -hospital routines may interrupt sleep -Sleep regulation -regulated by a sequence of physiological states integrated by central nervous system activity (hypothalamus and anterior pituitary) -reticular activation system (RAS) affects wakefulness and sleep-wake transactions -bulbar synchronizing region causes sleep Stages of Sleep 1. Stage 1: Non-rapid eye movement a. Lightest level of sleep 2-5% of adult sleep time 2. Stage 2; Non-rapid eye movement a. Sound sleep 45-55% of adult sleep time 3. Stage 3: Non-rapid eye movement a. Deepest sleep 10% of adult sleep time 4. Rapid eye movement (REM) sleep a. Dreams 25% of adult sleep time Sleep Cycle -pre-sleep period 10-30 min -4-5 complete cycle stages lasting 90-120 min/cycle -newborns and children spend more time in stage 3 NREM sleep

Factors Affecting Sleep -Drugs and substances -hypnotics, diuretics, antidepressants, alcohol. Caffeine, narcotics, beta-blockers -lifestyle -work schedule, social activities, routines -usual sleep pattern -may be disrupted by social activity or work schedule, travel -environmental stress -noise, temperature -emotional stress -worries, physical health, death, losses -exercise and fatigue -restful sleep enabled by moderate exercise and fatigue -food and caloric intake -time of day, caffeine, nicotine, alcohol Sleep and the Nursing Process -Assessment: usual sleep patterns, assess patient/bed partner/parents -sleep history: • Description of sleeping problems • Usual sleep pattern • Physical and psychological illness • Current life events • Bedtime routines • Bedtime environment • Behaviors associated with sleep deprivation -Examples of nursing diagnoses • Anxiety • Ineffective breathing pattern • Compromised family coping • Ineffective coping • Ineffective health maintenance • Fatigue • Insomnia • Sleep deprivation -Planning -goals and outcomes; identify factors in home environment that disrupt sleep -setting priorities -collaborative care

Nutrition During Growth and Development o Infants  Breastfeeding  Formula  Intro to solid food  Childhood obesity o Adolescents  Nutritional deficiencies  Eating disorders  Physical activity o Young and middle-aged adults  Obesity  Pregnancy  Lactation o Older persons  Nutritional deficiencies  Health status  Dehydration Alternative food patterns - Based on religion, culture, ethnicity, health beliefs, preferences o Meaning of food o Lactose intolerance o Hot and cold foods o Vegetarian diet Nutrition and the nursing process - Assessment o Nutritional screening o Nutritional assessment  Anthropometry: the scientific study of the measurements and proportions of the human body.  Lab and biochem tests  Dietary and health history  Clinical observations and physical examination  Patient expectations o Nursing diagnoses  Excess fluid volume

 Health maintenance; ineffective  Imbalanced nutrition: more than body requirements  Fatigue  Hopelessness  Activity intolerance  Risk for impaired cardiovascular function  Social isolation - Planning o Diet planning  Cardiac  Renal  Lactose-free  Gluten-free - Implementation: health promotion o Food insecurity o Fortification of food staples o Food safety  Food-borne illness i.e. salmonella, e. coli o Diet progression and therapeutic diets o Promoting appetite o Assisting patients with feeding - Evaluation o Measure the effectiveness of nutritional interventions

Week 11: Stress and Adaptation Stress - Is the appraisal or perception of a stressor o Stressors are disruptive forces operating within or on any system (Neuman, 1995) o Appraisal is how people interpret what is happening (primary or secondary) o Crisis is when stress overwhelms a person’s coping mechanisms. - Physiological Conceptualizations o Fight-or-flight response o General adaptation syndrome  Alarm reaction  Resistance stage  Exhaustion stage o Homeostasis o Primary appraisal  Identification o Secondary appraisal  Coping Crisis - Developmental crises o Can be related to mastering developmental tasks as an individual or family - Situational crises o Natural disaster, end of relationship, loss of work Stress Response Systems - Sympathetic-adrenal-medullary system o Reticular formations o Limbic system o Midbrain and pons o Medulla oblongata - Hypothalamic-pituitary-adrenal axis o CRH-ACTH-cortisol release o Hypothalamus o Pituitary gland o Adrenal gland

Stress and the Immune System - Immune response to antigen - Increased risk of stress-related illness, cardiovascular disease, insulin resistance, metabolic syndrome, and autoimmune disease Types of Stress - Distress: damaging stress - Eustress: stress that protects health - Chronic stress - Acute stress - Trauma - Post-traumatic stress Stress-Related Disorders - Acute stress disorder o Caused by exposure to one or more traumatic events and lasts up to 1 month after a traumatic event; the reaction is one of intense fear, helplessness, or horror o Flashbacks o Avoidance of memory of trauma o Hyperarousal o Sleep disturbance, irritability, anger - PTSD o Symptoms and trigger are similar to those of an acute stress disorder, but symptoms are more persistent (longer than 1 month) Nursing theory and the role of Stress - Neuman’s systems model (1995) o Prevent or reduce stressors o Based on an individual’s/family’s/community’s relationship to stress and the reaction to stress. o “Normal line of defence” o Prevention strategies:  Primary  Secondary  Tertiary

- Health promotion model (Pender et al., 2002) o Proposes that health promotion is directed toward increasing the level of well- being of an individual or group o Avoidance of negative events o Stress-reduction strategies Situational, Maturational, and Sociocultural Factors - Situational factors o Arise from job changes, illness, caregiver stress - Maturational factors o Vary with life stages - Sociocultural factors o Environmental and social stressors perceived by children, adolescents, and adults Nursing Process - Assessment o Subjective findings  Nonthreatening physical environment for interview o Objective findings  Observing body language, speech quality, eye contact, vital signs o Patient’s expectations - Nursing Diagnoses o Ineffective coping o Anxiety o Caregiver role strain o Chronic pain o Post-traumatic stress disorder o Powerlessness - Planning o Goals and outcomes  Effective coping o Setting priorities  Prioritizing needs of patient experiencing stress o Continuity of care  Recognize the need for collaborative practice

- Implementation o Health promotion  Regular exercise  Support systems  Time management  Guided imagery and visualization  Progressive muscle relaxation  Assertiveness training  Journal writing  Stress management in the workplace  Burnout o Acute care  Crisis intervention  Restorative and continuing care - Evaluation o Patient care o Patient expectations General Adaptation Syndrome - Physiological response of the whole body to stress - Involves several body systems, primarily the autonomic nervous system and the endocrine system - 3 stages o Alarm reaction- same as fight-or-flight o Resistance stage- trying to attain balance o Exhaustion- variety of health consequences

Week 12: Grief, Loss, and Death Nurses’ Role - Nurse is responsible for carrying out orders - Nurse meets with family to discuss changes, treatment options, and family concerns o These meetings are to discuss sensitive health issues such as discontinuing life support or transfer of people o Can be intimidating - Nurses can help people and their families by continuing conversations after the healthcare team leaves - Answering questions and providing support Kubler-Ross’s Five Stages of Grief - Denial - Anger - Bargaining - Depression - Acceptance Bowlby’s Four Phases of Mourning - Numbing - Yearning and searching - Disorganization and despair - Reorganization Worden’s Four Tasks of Mourning - Accepting the reality of loss - Working through the pain and/or grief - Adjusting to the environment without the deceased - Emotionally relocating the deceased and moving on with life 5 Categories of Loss - Loss of external objects o Misplacement, deterioration, theft, destruction by natural causes o Situational loss - Loss of known environment o Moving from neighborhood, hospitalization, leaving or losing a job, moving out of ccu o Situational loss

- Loss of a significant other o Through being promoted, moving, running away