NCHP week 2

Assessment of Spiritual Health

• Be sure to discuss what is meaningful and relevant to your patient

• Encourage them to discuss their personal beliefs and faith traditions

• Explore the meaning that their illnesses have on their lives, based on their faith beliefs

Potential Nursing Diagnosis related to Spirituality

• Risk for spiritual distress

• Spiritual distress

• Readiness for enhanced spiritual well-being

• Decreased spiritual distress

• Hopelessness

Spirituality

• An awareness of one’s inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself

• Includes personal beliefs that help a person maintain hope and get through difficult situations

• The human spirit is powerful, and spirituality has different meanings for different people

• The concepts of spirituality and religion are often interchanged, but spirituality is a much broader and more unifying concept than religion

• Nurses need to be aware of their own spirituality to provide appropriate and relevant spiritual care to others

Factors Affecting Spiritual Health

When illness, loss, grief, or a major life change occurs people often use spiritual resources to help them cope and search for meaning

Spiritual distress

“the absence of inner peace and connectedness to loved ones, an inability to accept what is happening or find meaning in life and any hope for the future”

• Causes people to question their identities

• Feel doubt, lose faith, and feel alone or abandoned

Acute Illness

reates an unanticipated scramble to integrate and cope with new realities 

• People often look for ways to remain faithful to their beliefs and value systems

• Anger is common

• Strength of their spirituality influences their ability to cope with the sudden change

Chronic illness

• threatens a person’s independence → causes fear, anxiety, and spiritual distress

  • Feel powerless as they depend on others for routine self-care needs

  • May take a long term plan to adapt

Terminal illness

• causes fears of physical pain, loss of independence, isolation, the unknown and dying

  • Spirituality helps these patients find peace in themselves OR it could bring fear about the uncertainty of death

Near-death experience

patients normally describe it as feeling totally at peace, having an out-of-body experience, being pulled into a dark tunnel, seeing bright lights, and meeting people who preceded them in life

• They learn that it's not time for them to die 

• May be reluctant to discuss it for fear of not understanding

• Those who discuss it openly are no longer afraid of death and have a decreased desire to achieve material wealth

Circadian rhythm

• the 24 hour, day-night cycle

  • Biological time clocks

Sleep regulation

• Sleep involves a sequence of physiological states maintained by CNS activity

• Major sleep center in the body is the hypothalamus

  • Secretes hypocretins, acetylcholine, and glutamate that promote wakefulness and REM sleep

    • Reticular activating system (RAS) receives stimuli and contains specific cells that maintain alertness and wakefulness

  • Prostaglandin D2, adenosine, melatonin, serotonin, L-tryptophan, and growth factors control sleep

Process S

homeostatic process → regulates the length and depth of sleep; and circadian rhythms

Process C

circadian rhythm → influences the internal organization of sleep; the timing and duration of sleep-wake cycles

• Operates simultaneously

Nonrapid eye movement (NREM) → 75% of night

• N1: 

  • Stage of lightest level of sleep, lasting a few minutes

  • Decreased physiological activity begins with gradual fall in vital signs and metabolism

  • Sensory stimuli such as noise arouse sleeper

  • If awakened, person feels as though daydreaming has occurred

• N2: 

  • Stage of sound sleep during which relaxation progresses

  • Arousal is still relatively easy

  • Brain and muscle activity continue to slow

• N3: 

  • Called slow-wave sleep

  • Deepest stage of sleep

  • Sleeper is difficult to arouse and rarely moves

  • Brain and muscle activity are significantly decreased

  • Vital signs are lower than waking hours

Rapid eye movement (REM) → 25% of night

• Vivid, full-color dreaming occurs

• Stage usually begins about 90 minutes after sleep has begun

• Stage is typified by autonomic response of rapidly moving eyes, fluctuating heart and respiratory rates, and increased or fluctuating blood pressure

• Loss of skeletal muscle tone occurs

• Gastric secretions increase

• It is very difficult to arouse sleeper

Sleep cycle

• Pre-sleep period: first 10-30 minutes

• Three stages of NREM (N1, N2, N3) and REM sleep for a total of 90-110 minutes

• The number of sleep cycles depends on the total amount of time that the person spends sleeping

Functions of sleep

• Functions as a time of restoration, memory consolidation, and preparation for the next period of wakefulness

• Sleep restores biological processes

  • Ex: during NREM stage 3 sleep, the body releases human growth hormone for repair and renewal of epithelial and specialized cells such as brain cells

  • Protein synthesis and cell division for the renewal of tissues occurs

  • The basal metabolic rate lowers during sleep, which conserves the energy supply of the body

• The benefits of sleep often go unnoticed until a person develops a problem resulting from sleep deprivation

• Dreams

  • Occur in NREM and REM sleep

    • The dreams of REM sleep are more vivid and elaborate

  • Important for learning, memory, and adaptation to stress

Hypnotics

• Interfere with reaching deeper sleep stages

• Provide only temporary (1-week) increase in quantity of sleep

• Eventually cause “hangover” during day; excess drowsiness, confusion, decreased energy

• Sometimes worsen sleep apnea in older adults

Antidepressants and stimulants

• Suppress REM sleep

• Decrease total sleep time

Alcohol

• Speeds onset of sleep

• Reduces REM sleep

• Awakens person during night and causes difficulty returning to sleep

Caffeine

• Prevents person from falling asleep

• Causes person to awaken during night

• Interferes with REM sleep

Diuretics

nighttime awakenings caused by nocturia

Beta-adrenergic blockers

• Cause nightmares

• Cause insomnia

• Cause awakening from sleep

Benzodiazepines

• Alter REM sleep 

• Increase sleep time

• Increase daytime sleepiness

Nicotine

• Decreases total sleep time

• Decreases REM sleep time

• Causes awakening from sleep

• Causes difficulty staying asleep

Opiates

• Suppresses REM sleep

• Cause increased daytime drowsiness

Anticonvulsants

• Decrease REM sleep time

• Cause daytime drowsiness

Health risks associated with inadequate sleep

• Obesity

• Diabetes

• Heart disease

• Cancer

• Dementia

Health promotion activities related to sleep

• Environmental controls

• Promoting bedtime routines

• Promoting safety

• Promoting comfort

• Promoting activity 

• Stress reduction

• Bedtime snacks

• Pharmacological approaches

Sleep assessment

• Most people can provide a reasonably accurate estimate of their sleep patterns

• Usually, patients are the best resource for describing sleep problems and how they are a change from their usual sleep and waking patterns

• In addition, bed partners can provide information about patients’ sleep patterns that help reveal the nature of certain sleep disorders

• When caring for children, seek information about sleep patterns from parents or guardians

Insomnia

symptom experienced when patients have chronic difficulty in falling asleep, frequent awakenings, or short/nonrestorative sleep

Sleep apnea

individual is unable to breathe and sleep at the same time

Sleep history: ask patient questions about..

• Description of sleeping problems

• Usual sleep pattern

• Physical and psychological illness

• Current life events

• Emotional and mental status

• Bedtime routines

• Bedtime environment

• Behaviors of sleep deprivation