SBM Final

gratitude

state of thankfulness

state of being grateful

effect of gratutide on brain is short or long-term?

long-term

train yourself to constantly be thankful for little things in life

Acknowledging and appreciating the little things in life, can rewire the brain to deal w/ present circumstances w/ more awareness and broader perception

healthiest of all human emotions

gratitude

physiologic effects of practicing gratitude

• Decreased BP

• Decreased HR

• Decreased adrenaline

• Decreased cortisol

• Decreased C reactive protein

• Decreased BG

• Decreased anxiety, stressors

• Feeling grateful triggers "good" hormones and regulates effective functioning of the immune system

• Hormonal release (+) w/ consistent practice of gratitude - Endorphins, Dopamine

  • Oxytocin (love hormone)

mental health effects of practicing gratitude

• Best kept secret for reducing stress and anxiety

• Reduces aggression

• Builds professional commitment

• Improves health

• Practicing gratitude correlates w/ confidence, kindness, happiness, empathy

limbic system

• Consists of Thalamus, Hypothalamus, Amygdala, Hippocampus, CingulAllows us to make emotional attachments and bond w/ people

• Monitors all sensory information received and interprets it for emotional content

• Essential connection b/w mind, body, and spiritate gyrus

gratitudes effect on pain

16% of pts who kept a gratitude journal reported reduced pain sxs and were more willing to work out and cooperate w/ txt procedure

regulating level of dopamine, gratitude fills us w/ more vitality, thereby reducing subjective feelings of pain

gratitudes effect on sleep quality

• Activates hypothalamus

  • Regulates bodily mechanisms (Deeper and healthier sleep naturally everyday)

• Brain filled w/ gratitude and kindness more likely to sleep better and wake up feeling refreshed and energetic every morning

gratitudes effect on stress regulation

• McCraty - Participants felt grateful showed a marked reduction in level of cortisol

• Better cardiac functioning and more resilient to emotional setbacks and (-) experiences

• Practicing gratitude can enable individuals to handle stress better than others

gratitudes effect on anxiety and depression

• Reducing stress hormones and managing the ANS functions - Reduces sxs of depression and anxiety

• Feelings of gratitude = increase in neural modulation responsible for managing (-) emotions

• People who keep gratitude journal more empathetic and (+) minded by nature

how to cultivate gratitude

• Sig dimension of (+) Psychology - Increases optimism and improves sleep and health

• Habitual focusing on and appreciating the (+) aspects of life

• Practicing gratitude - Keep journal, Look for times to be thankful

pursuit of happiness

• Happiness encompasses living a meaningful life, utilizing your gifts and time, and living w/ thought and purpose

  • Engagement w/ family, work, or a passionate pursuit

  • Finding meaning from some higher purpose

6 dimensions of health

physical

emotional

social

intellectual

occupational

spiritual

spiritual health

• connected to religious beliefs and practices

  • Personal relationship w/ God or supernatural power force

  • Connection w/ something greater than ourselves

• Includes integrity, principle and ethics, the purpose of life

• Feeling of connection to the universe, focuses on our beliefs and values we each hold that lend meaning to life

• Awareness and appreciation that lifts oneself beyond the physical

spirituality features

• Spirit = energy and power

• Spirituality describes

  • Awareness of relationship w/ all creation

  • Appreciation of presence and purpose that includes a sense of meaning

• Discovering/using one's own unique "specialness" to become a (+) and creative person

• Discovering what brings life's significance, purpose, and direction to people's lives

• Very personal, intimate, and unique

spiritually healthy individuals

• Identify their own basic purpose in life

• Learn how to experience love, joy, peace, and fulfillment

• Help others, and themselves, achieve their full potential

• Have a sense of greater meaning in their lives

spiritual health can be key factor in

• How people cope w/ illness

• Experience healing

• Achieve sense of coherence, balance, hope, and interconnectedness

spiritual readings and practices can increase

calmness

inner strength

meaning

improve self-awareness

spiritual screening

• Assess for spiritual emergencies

  • Which needs attention of a trained chaplain right away

• Identify pts that may benefit from spiritual counseling and/or care

• FICA spiritual hx tool

FICA spiritual hx tool

• Faith and belief

  • Do you consider yourself spiritual?

  • Do you have spiritual beliefs that help you cope w/ stress or w/ what you have been going through?

• Importance

  • What importance does spirituality have in your life?

  • What role does spirituality play in health care decision making?

• Community

  • Are you a part of a spiritual or religious community?

  • Is there a group or community of people that support you?

• Address

  • How would you like me to address these issues in your healthcare?

religion

• System of beliefs and practices observed by a community

• System of symbols which act to empower motivation to followers and formulate conceptions of general order of existence

• Relies on a set of scriptures or teachings that describe the meaning and purpose of the world

• Typically offers a moral code of conduct that is agreed upon by members of the community, who also adhere

religious activity may be

• Organizational religiosity - Public, Social, Institutional

• Non-Organizational religiosity - Private, Personal, Individual

religion in USA

• 49% of adults religious

  • Previously 66% in 2015

• 69% Christian

• 21.4% non-religious

• More people "spiritual but not religious"

characteristics of religion

• Focusing on defining structures, rituals, and doctrines

• Practices carried out by those who profess a faith

• Typically organized around a prophet, teacher, or set of human generalities/rules/concepts

• Associated w/ ethical teachings of specific religious bodies and traditions

• Outward practices are in the beliefs, values, codes of conduct and rituals

• Religiosity

religiosity

• Degree of religious commitment of an individual, reflected in their beliefs, attitudes, and values

spirituality vs religion

• Spirituality

  • Fundamental element of human experience

  • Encompasses individual's search for meaning and purpose in life

  • Encompasses connections one makes w/ others, his/herself, nature, sacred realms

• Religion

  • Formal structure through which a person expresses spirituality within a community

  • Religious community then organized around common beliefs, attitudes, practices, traditions, and relationships

interfaith prayer

• Powerful to unite cultures and religions

• Binding force for people to discover common ground and feel connected

• Prayer seems to play an important role in uniting people from across cultural and religious backgrounds

faith-based medicine and practices

• Faith & religious txt methods are integral parts of health care for many cultures

• Use of charms and external articles to promote faith & healing have deep roots in many cultures

• Examples

  • Native Americans - sweat lodges

  • Hoodoo - enslaved AAs practice of root medicine

  • Voodoo - spirit medicine

how spiritualiy and religion improved med outcomes

• Active practice of prayer

• Deep spiritual belief

• Regular attendance at religious services

• (+) attitude

• Healthy lifestyle

• Physical and emotional support of a community

spirituality’s impact on health

• Prayer and meditation

  • Change the brain

  • May slow aging and decrease psych sxs

  • May increase feelings of compassion, security, and love

• Going to church - May account for an additional 2-3 yrs of life

high spirit/relig associated w/

• Improved pt QOL

• Better psych well-being

• Increased longevity

• Church attendance accounts for 2-3 yrs of additional life

• Directly related to an overall improved medical experience

health benefits among those practicing spiritual beliefs

• Sig reduced BP

• Reduced cardiac dz

• Stronger immune systems

• Fewer health problems & hospitalizations

• Shorter lengths of stay

• Stronger social support systems

• Stronger family ties

• Stronger and healthier marriages

• Stronger rates of wellbeing and acceptance

• Lower rates of depression

• Less drug & alcohol abuse

• Increases life satisfactions

• Health-promoting behaviors

health promoting behaviors

• Exercise

• Proper nutrition

• More seatbelt usage

• Smoking cessation

• Greater use of preventive services

• Greater functioning among disabled individual

• Fewer hospitalizations

• Shorter hospital stays

relationship to death

• Mortality

  • People w/ involvement live longer

    • Living and active involvement within a religious community and self-reported religiosity

• CVD

  • Decreased incidence of CVD

    • Lower BP/HTN

    • Higher med compliance

    • Less cigarette smoking

      • Decreased CLD, stroke, lung cancer, and all cancers

spirituality in med care

• Until 1990s, spiritualty was component of med care

• Return to more spiritually sensitive care could enhance experience

• Most pts engaged in some spiritual type of practice/lifestyle

• Important in all aspects of pts care

  • Palliative

  • Oncology

  • EOL

  • Chronic dz

  • Disability

• Pts of children receiving EOL care had better experience when spiritual needs met

pt’s perspective on spirituality and religion within health

• Sig coping mechanism during illness or hospitalization

• Primary way of finding meaning from illness OR find hope, forgiveness, or guilt in situation

• Pts wish to discuss spiritual or religious needs

• Attention must be give to providing holistic, pt-centered, comprehensive care

Integrating spirituality into pt care for provieders enhances

• Person-centered care

• Foster connection w/ pts

• Improve healthcare provider job satisfaction

• Reduce burnout amount inpt team members

• Facilitated awareness of the need for recognition of and response to pt spiritual needs in a timely manner

various approaches to ascertaining spirit/relig

• Many families find faith or spiritual beliefs a source of strength or comfort during a hospital stay. I’m wondering if your spirituality or religion is important to you?

• “Do you follow a particular religious tradition or spiritual path?”

• “Would you like a visit from your clergy or hospital chaplain during your stay?”

• “Would you like to include that person in the conversation when it comes time to make an important treatment decision?”

• “How does your faith influence the way that you think about this illness?”

• Are there ways that we can help you maintain your spiritual strength or routine during this stay?”

spirituality’s relationship to illness

• Illness grasps persons by the soul and the body and disturbs them both

• Illness raises Qs

• Being present to pt's suffering can change the healthcare provider - His/her own values, Priorities, Beliefs

• Healthcare is dynamic spiritual practice that impacts the development of the pt and the healthcare provider

• Medically ill pts rely on religion to cope often adapt more quickly

• Med pts more spiritual/religious less likely to develop depression - Even if develop, more likely to recover

• Lower rates of Suicide, Alcohol abuse, Drug abuse, Delinquency and criminal behavior

Dr. Harold Koenig of Duke University

• Prayer = good medicine

• Like to see all physicians assess their pt's spiritual needs and, if need be, refer to someone who can address those needs

what does/can spiritual care do?

• Enlivens or sparks

• Changes expressions

• Interacts w/ and connects

• Affects emotions

• Creates function

• Creates meaning

• Gives hope

• Reconnects w/ belief or faith

• Creates feelings of being loved and valued

what does spiritual care look like?

• Picking up a clue

• Taking a risk

• Engaging w/ person

• Creating dialogue or permission

• Acting or facilitating a religious need

• Aiding religious ritual

• "Being with..not just doing"

useful skills in delivery of spiritual care

• Adopting a caring attitude and disposition

• Recognizing and responding appropriately

• Using observation to identify cues

• Listen and attend to individual needs

• Being aware of when it is appropriate to refer to another source of support

• Looking for the best in the worst

• Being personally hope-filled

  • Believing that what 1 does and what one is, always of some value

  • Knowing that it is never too late to do good

spiritual care summary

• Not just about religious beliefs and practices

• Not about imposing our own beliefs and values on another

• About meeting people at their point of deepest need

chaplaincy care

• Spiritual, religions, pastoral, ethical, existential, emotional care that involves

  • Active and empathic depth listening

  • Respect for and nurturing of the strengths of person's own spirituality

    • Not proselytizing

  • Meeting people where they are in their lives and negotiating what they want to talk about or work on

  • Ongoing spiritual exploration/assessment and intervention

    • What person's spirituality looks like, how it works for them, what issues concern them

  • Connecting w/ local communities for faith specific needs

when to consult chaplains

• Pt or family request

• Sacramental or devotional ritual

• Pt is dying

• Sxs of spiritual distress

• Pt wants to consider med txt from a spiritual/faith perspective

• Religious or spiritual beliefs appear pathological or problematic

• Provider requests more info about religious tradition or relevance

Intimacy w/ formality (how discuss spiritual needs w/ pts)

• Follow lead of pts in discussing spiritual concerns

• Unethical to ignore spiritual concerns

• Unethical to try to address those that extend beyond one's professional expertise or comfort

• Open and honest communication

• Honor and respect individual beliefs and values

• Pts must never feel that care they deserve is dependent on meeting unstated or implied expectations of provider

• Honor professional code of ethics

• Role of clinician is facilitator

mindfulness creator

• Dr. Epstein "Mindful Practice"

  • Mindful practitioners attend in a non-judgmental way to their own physical and mental processes during ordinary, everyday tasks

• Mindfulness should be considered a characteristic of good clinical care

critical self-reflection enables physicians to

• Listen attentively to pts' distress

• Recognize their own errors

• Refine their technical skills

• Make evidence-based decisions

• Clarify their values so that they can act w/ compassion

  • Technical competence

  • Presence

  • Insight

mindfulness

• Type of meditation in which you focus on being intensely aware of what you're sensing and feeling in the moment, w/o interpretation or judgment

• Cognitive skill of sustaining meta-awareness of the contents of one's own mind in the present moment

• Derives from sati

  • Element of Buddhist and Hindu traditions

practicing mindfulness

• Breathing methods

• Guided imagery

• Practices to relax the body and mind and help reduce stress

4 skills in practicing mindfulness

• Being in the present

• Distress tolerance

  • Reacting less often or less intensely to distress

• Interpersonal effectiveness

  • Having more satisfying personal interactions

• Emotional regulation

  • Recognizing and controlling your emotions

  • More aware and awake to each moment

  • Being fully engaged to what is happening

    • w/ acceptance and w/o judgment

mindfulness in healing

• Survivors can create a safe space within themselves

  • Fostering resilience and promoting emotional wellbeing

• Self-compassion

  • Reinforcing the importance of nurturing oneself

    • Fundamental aspect of healing

classical conditioning

Pavlov’s experiment

stimulus that invokes response

unconditional stimulus

eventually will evoke predictable response

conditional response

operant conditioning

BF Skinner

animal/individual free to act in ways that produce reward

reward determined by environment, not only the experiment

conditioned to repeat action

relate to trial-and-error learning

Health Belief Model

social psychologists - 1950

tried to explain why people do not participate in - preventive health, disease detection programs

combination of stimulus response and cognitive theory

model expanded to explain response to sxs, to dx and compliance w/ meds

components of health belief model

• individuals will act to ward off, to screen for, or control ill health condition if they

  • regard themselves as being susceptabble

  • percieve risks/serious complications of dz

  • perceive benefits if course of action reduces susceptibility

  • perceive anticipated barriers (costs) outweighed by benefits

shaping behavior

involves changing behavior in deliberate and predetermined way

reinforce those behaviors that are in a desired direction

closer the reinforcement to the operant behavior, the better the learning

transtheoretical model

uses stages of change to integrate processes and principles of change from across major theories of intervention

core components - stages of change, decisional balance, self efficacy, and processes of change

decisional balance pros/cons

pros - benefits of changing, modifying behaviors

cons - cost of changing, to modify or not

self efficacy

confidence that one can engage in the healthy behavior amid different & challenging situations

temptation to engage in unhealthy behavior amid different & challenging situations

behavioral modification goals

pt adherence/compliance

cruicial link b/w clinician’s txt recommendations AND pt’s health outcome

5 stages of change

precontemplation

contemplation

preparation

action

maintenance - relapse

pre-contemplation

pt not considering change

not interested or considering any kind of help

may be defensive when confronted about changing behavior

provider role in precontemplation

validate thier lack of readiness

clarify that the decision is theirs

encourage re-eval of current behavior

explain and personalize the risk

contemplation

spending time thinking about some change

ambivalrnt about change

more open to receiving info

not considering change of behavior within the next month

provider role in contemplation

validate their lack of readiness

clarify that decision is theirs

encourage eval of pros/cons of behavior change

identify and promote new, (+) outcome expectations

preparation

getting ready to change

some experience w/ change and are trying to change

realizing something must change

planning to change within the next month

provider role in preparation

identify and assist in problem solving

help pt identify social support network

verify that pt has underlying skills for the behavioral change

encourages small initial stages

action

belief in their ability to change

actively engaged in taking steps to change their bad behavior

shortest of all stages

practicing the new behavior for 3-6 mos

provider role in action

focus on restructuring cues and social support

encourage self-efficacy for dealing w/ obstacles

establish short term rewards to sustain motivation

combat feelings of loss and reiterate long-term benefits

maintenance

continued commitment to sustaining new behavior

successfully avoiding any temptations and/or return to bad behavior

goal = sustain status quo

post 6 mos - 5 yrs

provider role in maintenance

plan for f/u support

reinforce internal rewards

discuss coping w/ relapse

relapse

resumption of “old” behaviors

normal and natural to “regress” part of the process

normal process of changing a habit

provider role in relapse

eval triggers for relapse

reasses motivation and behaviors

plan stronger coping strategies

motivational interviewing

client-centered approach of promoting behavioral change in interpersonal context

explores and resolves ambivalence to decision

provider and pt work together to understand barriers, challenges, and obstacles

4 components of motivational interviewing

empathy

discrepancy - perceptions of pt behavior and whether it matches pt goals/values

reflection - reflect what was said back to pt

supporting self-efficacy - provider empowerment

compassion stress

emotional/behavioral effects felt by people who work w/ others under stress

progressive, signaled by subtle changes in mood

can l/t burnout

can present as poor job performance, impersonality, lack of motivation, and health issues (HTN, insomnia, depression, or addiction)

risk factors for compassion stress

don’t know how to say “no” to demands on their time and energy

assume added responsibility when they are already working at capacity

consistently sacrifice their personal lives for work

lack control in their positions

don’t discuss their problems or feelings

routinely criticize themselves, feel often guilty

haven’t learned how to manage stress effectively

views work as a “calling”

faulty perceptions about compassion stress

i will “fix” the problem

i can do it alone

if i’m strong enough, i can deal w/ the stress

compassion fatigue stages

passionate phase

overwhelmed

irritability phase

withdrawal phase

illness vs renewal/maturation

passionate phase

committed, involved, available

solving problems/making a difference

willingly go the “extra mile”

volunteers w/o being asked

high enthusiasm

overwhelmed phase

intrusive thoughts associated w/ the client’s problems and pain

obsessive or compulsive desire to help certain clients

client/work issues encroahcing on personal time

inability to “let go” of work-related matters

perception of clients as fragile and needing your assistance

irritable phase

begin to cut corners - impulsivity/reactivity

sense of dreading working w/ certain clients

begins to denigrate the people we serve

use of humor is inappropriate

oversights, mistakes, and lapses of concentration

start distancing ourselves from friends and coworkers

sense of inadequacy

increased perception of demand/threat

withdrawal phase

clients become irritants

tired all the time

neglect family, clients, coworkers, and ourselves

loss of humor, energy

isolation

sleep disturbance

change in weight/appetite

tardiness/absenteeism

intervals/prevention for compassion stress

recognize signs

role boundaries/expectations

learning to say “no”

taking control

social professional support

self-care strategies

work/life balance

emotional obstacles

emotional absorption = I feel your pain

boundaries = Should I be doing this?

enabling = Let me do it for you

setting limits and saying “no” = You’re not going to like me

mental illnesses

health conditions involving changes in thinking, emotion or behavior

associated w/ distress and/or probolems functioning in social, work, or family activities

mental illness epidemiology

1 in 5 adults experience

1 in 24 has mental illness

1 in 12 has SUD

mental health d/os and illnesses

addiction disorders

SUD

ADHD

anxiety D/os - generalized, panic, and social

ASD

personality D/os

bipolar

depression

eating D/os

OCD

PPD

PTSD

caring for pts w/ mental health issues

awareness of own biases

empathy, rapport, & trust

non-verbals & approach are critical

identifying info

HPI/CC

past psych, social, fam, med hx

psych ROS

somatics sxs common complaint

depression = most common mental illness

screening hx of mania, psychosis

SIGEMCAPS

sleep changes

interest

guilt

energy

mood

concentration

appetite change

psychomotor

suicidal ideation

mental status exam (MSE)

appearance & behavior

motor activity

speech

mood and affect

thought content

thought process

perceptual disturbances

cognition

insight

judgment

ideas of reference

belief of receiving special messages

illusions

misperception of actual stimuli

delusions

false beliefs

hallucinations

false sensory perception w/o stimulus

auditory most common

olfactory = seizure/temporal lobe epilepsy

depersonalization

feeling like one is standing outside one’s own body