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By U. Farmon. Southampton College.
Its practitioners treat underly- as the gallbladder of bears purchase nasonex nasal spray 18gm free shipping allergy forecast japan, tiger teeth and bones, ing causes of illness by facilitating the body’s and rhinoceros horn, increasing the hazards facing response to disease through its “life force. Naturopaths are licensed in 11 states, but with a directive to begin a program of research on most third-party payors, including Medicare, do alternative therapies. Disease is initiated grant projects and creating a clearing- thought to arise from imbalance or stress in an house for information on alternative medical individual’s consciousness, and is exacerbated by practices. Three doshas determine one’s tary and alternative medicine have been funded unique “body type,” and combined with diagnos- with grants of about $1 million each, to study spe- tic readings of the radial pulse, guides the healer cific health conditions, including cancer and 198 The Encyclopedia of Complementary and Alternative Medicine women’s health issues. As its eval- about half of all the out-of-pocket expenses to uation director Carole Hudgings, PhD, states in the physician services ($23. Initially, no rules tive therapies can decrease costs by decreasing uti- were set up to guard against conflicts of interest lization of conventional services. However, the by panel members, or to prevent them from using Eisenberg study showed that the cost of alternative their panel membership in self-promotion. Qual- vates magical notions to matters of serious ity-control committees will gauge appropriateness scientific debate. It is important to distinguish of care and whether the modality used lies within these experiences [such as kindness or sunsets] the scope of practice of the alternative therapist. This new venture may have the effect these areas to the satisfaction of its critics. Patients may not have had the diagnosis for often give people more time and attention than tra- which they were “cured” or the data may have ditional providers; people want to feel in control of been falsified or misinterpreted by the healer. After therapy, common complaints presented to unconventional patients may not have been followed long enough practitioners were back complaints (36%), anxiety to accurately assess cure or observe relapses. Con- (28%), headache (27%), chronic pain (26%), and current conventional therapy is often being taken cancer or tumors (24%). About one-third of by patients who undergo alternative treatments, patients in the same survey reported using alterna- with inappropriate credit given to the unconven- tive healers for health promotion and disease pre- tional method. Finally, misinterpretation of infor- vention advice, or for nonserious conditions not mation by patients who believe themselves related to their chief complaint. However, he points out that some of the a pediatric outpatient clinic in Quebec had been clinical trials examining different areas of alterna- taken to chiropractic, homeopathic, naturopathic, tive therapy have raised enough questions to make and acupuncture practitioners, mostly for respira- further investigation of these methods desirable, in tory and ear-nose-throat problems. Parents assumed order to help answer the essential question in this these treatments to be more “natural,” and to have debate: do these methods merely make one feel bet- fewer side effects, but did not seek alternative ther- ter, or do they really help one get better? Recent surveys show their physicians in seeking such care, but their that from 3%25 to 9%27 of patients with cancer physicians reported these encounters differently. Patients reported that their physicians recom- Older surveys with smaller data bases found higher mended or approved their use of unconventional usage rates, showing that 13%28 to about 50% of therapy 50% of the time, and 31% cited the physi- patients with cancer sought alternative treat- cian as the source of information about alternative ments. Forty percent of patients in this group sought or seriously considered unconventional reportedly abandoned traditional therapy after find- cancer therapy has been reported widely in the lay ing alternative care. In the same study, 52% of press as well, and adds to the perception that such physicians who treated this group of patients practices are quite common and might be useful. Patients did not tell physicians about toe or mushroom extract with the expectation that their alternative cancer care 35% of the time. The whole gamut of Other surveys report that for all uses of alterna- unconventional therapists is utilized by cancer tive medicine, up to 70% of patients may not patients, ranging from acupuncturists to Gestalt reveal their use of unconventional treatment to therapists. The “cures” may have come from misdi- lenge to the medical community, because not being agnosis, and when the anecdotes of healing are able to understand what many [patients] are using 200 The Encyclopedia of Complementary and Alternative Medicine outside of the medical mainstream presents a real the same survey, 22% of respondents reported per- barrier to good clinical care. It is likely that most physicians are physicians view complementary medicine to have unaware of the scope, breadth, and extent of use of an “effectiveness rating” of 46± 18 on a scale of unconventional therapies in the United States. There was no trend among these data to The level of interest among physicians in learning suggest increasing endorsement of alternative more about alternative therapy, however, seems to medicine by conventional practitioners, but the be high. A regional survey of family physicians in authors conclude that European physicians give the Chesapeake Bay area showed that more than these therapies a “considerable degree of accep- 70% were interested in training in such practices as tance. While informal training courses in these fractures, or antibiotic therapy for specific infec- areas may be available, the scientific basis for such tious diseases.
When something causes distress we can try and change either the stressor or ourselves cheap 18gm nasonex nasal spray mastercard allergy treatment europe. These coping mechanisms may be positive or negative/palliative, so that attempts to escape reality (changing ourselves) with drugs (e. However, taking antidepressants (again, changing ourselves) can be a positive coping mechanism, the problem (depression) being internal. Palliative coping mechanisms include: ■ denial Stress management 435 ■ smoking ■ excessive drinking ■ excessive overeating. Positive coping mechanisms attempt to change stressors, which may require finding out further information about them, just as preoperative information can reduce postoperative pain (Hayward 1975). Permitting and enabling people to express and release their stress may be more beneficial than trying to offer advice (cf. Recognising stress Recognising distress in others is often relatively easy, but recognising signs of stress in ourselves can be harder. The stressors may be common to all, but their responses (types of stress) differ from person to person; in order to recognise stress, therefore, we must recognise how each stressor affects each person by trying to understand experiences from their viewpoint (i. Unrecognised distress can progress, causing multiple problems, such as staff conflict, absenteeism, low morale, inefficient/poor work and (eventually) burn-out (Stechmiller & Yarandi 1993). Problems usually prove increasingly difficult to resolve, possibly causing potentially valuable staff to leave the unit and even, perhaps, nursing. Tyler and Ellison’s (1994) recommendation that nurses should attend stress management study days could be extended to other self-awareness courses, such as time management. Enabling staff to recognise their own (and others’) stress can help to limit crises. Burn-out, ultimate failure of coping mechanisms, causes: ■ decreased energy ■ decreased self-esteem ■ output exceeding input ■ a sense of hopelessness and helplessness ■ the inability to perceive alternative ways of functioning ■ cynicism ■ negativism ■ feelings of self-depletion (Farrington 1997) Intensive care nursing 436 When burn-out is reached, work becomes hard, unrewarding and of poor quality. Burn- out is a form of mental ill-health, potentially ending in suicide (see the opening of this chapter). Being stressed is not a personal failure; recognising and acknowledging our own stress helps us to resolve it. Stress and response to stress are complex effects, which are often not helped by over- simplistic behavioural explanations. Humanistic stress management seeks to identify the motivation underlying apparent behaviour. This necessitates discussion, but to be effective neither person should feel threatened by the other. Anyone seeking to help distressed colleagues should adopt Rogers’ (1967) ‘unconditional positive regard’, respecting the person for whom they are and what they are. Recognising the rights of both yourself and others is fundamental to assertiveness: everyone has the (moral) right to disagree with others and openly state disagreement, but not to deny others the right to their own opinion. By respecting others it becomes easier both to respect oneself (self-esteem) and be respected by others; self- esteem and the esteem of others form the penultimate level of Maslow’s hierarchy of needs (Maslow 1987 [1954]). Positive thinking about ourselves helps us to believe that we can (and should) change harmful stressors rather than change (harm) ourselves. Type A and type B personalities Much of the early literature on stress identifies two types of personalities: type A and type B. Type A describes active, competitive, potentially aggressive people, highly stressed but also seeking out stress (Rentoul et al. Traditional links between the type A personality and coronary disease have been questioned by more recent studies, and Case et al. However, these over-simplistic stereotypes, more appropriate to behaviourist approaches than humanist, are still being used. Time management Lack of time is often a major stressor: managing our time effectively reduces stress, especially when under pressure. Work, pleasure (recreation) and rest (restoration/sleep) should be balanced; watching television is a positive pastime if enjoyed (recreation), but a negative one if the viewer simply cannot be bothered to do something else. Effective time management enables nurses to work well while enjoying a full social life.
The degree of anxiety that an individual experiences in response to stress is related to cer- tain predisposing factors 18 gm nasonex nasal spray free shipping allergy medicine for 18 month old, such as characteristics of temperament with which he or she was born, past experiences resulting in learned patterns of responding, and existing conditions, such as health status, coping strategies, and adequate support systems. Deep relaxation can counteract the physiological and be- havioral manifestations of stress. Various methods of relaxation include the following: Deep-Breathing Exercises: Tension is released when the lungs are allowed to breathe in as much oxygen as pos- sible. Deep-breathing exercises involve inhaling slowly and deeply through the nose, holding the breath for a few seconds, then exhaling slowly through the mouth, pursing the lips as if trying to whistle. Progressive Relaxation: This method of deep-muscle re- laxation is based on the premise that the body responds to anxiety-provoking thoughts and events with muscle tension. Each muscle group is tensed for 5 to 7 seconds and then relaxed for 20 to 30 seconds, during which time the individual concentrates on the difference in sensa- tions between the two conditions. A modified version of this technique (called passive progressive relaxation) involves re- laxation of the muscles by concentrating on the feeling of relaxation within the muscle, rather than the actual tens- ing and relaxing of the muscle. It brings on a special state of consciousness as attention is concentrated solely on one thought or object. During meditation, as the individual becomes totally pre- occupied with the selected focus, the respiration rate, heart rate, and blood pressure decrease. The frame of reference is very personal, based on what each individual considers to be a relaxing environment. The relaxing sce- nario is most useful when taped and played back at a time when the individual wishes to achieve relaxation. Biofeedback: Biofeedback is the use of instrumentation to become aware of processes in the body that usually go un- noticed and to help bring them under voluntary control. Biological conditions, such as muscle tension, skin surface temperature, blood pressure, and heart rate, are monitored by the biofeedback equipment. With special training, the individual learns to use relaxation and voluntary control to modify the biological condition, in turn indicating a modification of the autonomic function it represents. Bio- feedback is often used together with other relaxation tech- niques such as deep breathing, progressive relaxation, and mental imagery. Assertive behavior increases self-esteem and the ability to develop satisfying interpersonal relationships. This is ac- complished through honesty, directness, appropriateness, and respecting one’s own rights, as well as the rights of others. Individuals develop patterns of responding in various ways, such as role modeling, by receiving positive or negative rein- forcement, or by conscious choice. These patterns can take the form of nonassertiveness, assertiveness, aggressiveness, or passive-aggressiveness. Nonassertive individuals seek to please others at the expense of denying their own basic human rights. Assertive individuals stand up for their own rights while protecting the rights of oth- ers. Those who respond aggressively defend their own rights by violating the basic rights of others. Individuals who respond in a passive-aggressive manner defend their own rights by expressing resistance to social and occupational demands. Some important behavioral considerations of assertive be- havior include eye contact, body posture, personal distance, physical contact, gestures, facial expression, voice, fluency, tim- ing, listening, thoughts, and content. Example: “I don’t want to go out with you tonight,” instead of “I can’t go out with you tonight. Example: Telephone salesperson: “I want to help you save money by changing long-distance services. Example: Male board member: “You made a real fool of yourself at the board meeting last night. Changing the focus of the communication from discussing the topic at hand to ana- lyzing what is actually going on in the interaction. Concurring with the critic’s argu- ment without becoming defensive and without agreeing to change. Putting off further discussion with an angry in- dividual until he or she is calmer. In cognitive therapy, the in- dividual is taught to control thought distortions that are consid- ered to be a factor in the development and maintenance of mood disorders. In the cognitive model, depression is characterized by a triad of negative distortions related to expectations of the environment, self, and future.
The relationship between self-reports of life events and causal models of illness is an interesting area of research 18 gm nasonex nasal spray allergy immunology salary. Research projects could select to use this problem of selective recall as a focus for analysis. However, this influence of an individual’s present state of health on their retrospective ratings undermines attempts at causally relating life events to illness onset. For example, a divorce, a change of jobs and a marriage would be regarded as an accumulation of life events that together would contribute to a stressful period of time. However, one event may counter the effects of another and cancel out any negative stressful consequences. Evaluating the potential effects of life experiences should include an assessment of any interactions between events. Accordingly, it was assumed that if the life experiences were indeed stressful then the appropriate outcome measure was one of health status. The most straightforward measure of health status would be a diagnosis of illness such as cancer, heart attack or hypertension. Within this framework, a simple correlational analysis could be carried out to evaluate whether a greater number of life experiences correlated with a medical diagnosis. However, such an outcome measure is restrictive, as it ignores lesser ‘illnesses’ and relies on an intervention by the medical profession to provide the diagnosis. Therefore, the individual could be asked to rate not only their life experiences but also their health-related symp- toms (e. Within this framework, correlational analysis could examine the relationship between life events and symptoms. However, this outcome measure has its own problems: Is ‘a change in eating habits’ a life event or a symptom of a life event? Choosing the appropriate outcome measure for assessing the effects of life events on health is therefore problematic. Stressors may be short-term or ongoing Traditionally, assessments of life experiences have conceptualized such life events as short-term experiences. Moos and Swindle (1990) identified domains of ongoing stressors, which they suggested reflect chronic forms of life experiences: s physical health stressors (e. Moos and Swindle (1990) argued that life events should not be evaluated in isolation but should be integrated into two facets of an individual’s life: their ongoing social resources (e. This perspective is also reflected in versions of life events theory, which suggests that individuals respond to life experiences with a stress response that is therefore related to their health status. However, the above criticisms of the life events theory suggest a different approach to stress, an approach that includes an individual who no longer simply passively responds to stressors but actively interacts with them. This approach to stress provides a role for an individual’s psychological state and is epitomized by Lazarus’s transactional model of stress and his theory of appraisal. The transactional model of stress The role of appraisal In the 1970s, Lazarus’s work on stress introduced psychology to understanding the stress response (Lazarus and Cohen 1973, 1977; Lazarus 1975; Lazarus and Folkman 1987). Lazarus argued that stress involved a transaction between the individual and their external world, and that a stress response was elicited if the individual appraised a potentially stressful event as actually being stressful. Lazarus’s model of appraisal therefore described individuals as psychological beings who appraised the outside world, not simply passively responding to it. According to Lazarus, the individual initially appraises the event itself – defined as primary appraisal. There are four possible ways that the event can be appraised: (1) irrelevant; (2) benign and positive; (3) harmful and a threat; (4) harmful and a challenge. Lazarus then described secondary appraisal, which involves the individual evaluating the pros and cons of their different coping strategies. Therefore, primary appraisal involves an appraisal of the outside world and secondary appraisal involves an appraisal of the individual themselves. The form of the primary and secondary appraisals determines whether the individual shows a stress response or not. According to Lazarus’s model this stress response can take different forms: (1) direct action; (2) seeking information; (3) doing nothing; or (4) developing a means of coping with the stress in terms of relaxation or defence mechanisms.
