Fundamentals of Nursing Exam 3

• Documentation of Nursing Care

  Purposes of Documentation

  • Written record: Documentation serves as a comprehensive written account of patient care.

  • Reimbursement of costs of care: Accurate documentation is essential for justifying and obtaining reimbursement for healthcare services.

  • Evidence of care: It provides tangible evidence of the care provided to the patient.

  • Shows the use of the nursing process: Documentation illustrates the application of the nursing process, including assessment, diagnosis, planning, implementation, and evaluation.

  • Quality improvement: Documentation facilitates quality improvement initiatives by providing data for analysis and identifying areas for enhancement.

  • Research: Medical records can be used for research purposes, contributing to the advancement of healthcare knowledge.

• Staff performance: Documentation can also be used to evaluate staff performance and identify areas for professional development.

The Medical Record

• Contains comprehensive data regarding a patient's stay within a healthcare facility.

• Addresses crucial aspects of Privacy-Confidentiality: Outlines who is authorized to access the patient's chart, ensuring adherence to privacy regulations and ethical standards.

Methods of Documentation

• Source Oriented

• Problem Oriented

• Focus

• Charting by exception

• Computer assisted

• Case management system (pathways)

Source-Oriented or Narrative Charting

• Organized according to the source of information.

• Utilizes separate forms for different healthcare disciplines.

• Narrative charting requires documentation of patient care in chronologic order.

• Advantages

• Disadvantages

Problem-Oriented Medical Record Charting (POMR)

• Focuses on patient status rather than on medical or nursing care.

• Five basic parts: database, problem list, plan, progress notes, and discharge summary

• Advantages

• Disadvantages

SOAP (IE) Documentation

• S - Subjective: Represents the subjective information provided by the patient, including their feelings, symptoms, and concerns.

• O - Objective: Encompasses the objective data gathered through observation, physical examination, and diagnostic tests.

• A - Assessment data: Involves the interpretation and analysis of the subjective and objective data to identify the patient's problems or needs.

• P - Plan: Outlines the plan of care developed to address the identified problems, including specific interventions and goals.

• I - Implementation: Specifies the actions taken to implement the plan of care.

• E - Evaluation: Describes the evaluation of the patient's response to the interventions and the progress toward achieving the goals.

Focus Charting

• Directed at nursing diagnosis, patient problem, concern, sign, symptom, or event.

• Three components:

  • D: data, A: action, R: response (DAR)

  • OR D: data, A: action, E: evaluation (DAE)

• Advantages & Disadvantages

Charting by Exception

• Based on the assumption that all standards of practice are carried out and met with a normal or expected response unless otherwise documented.

• A longhand note is written only when the standardized statement on the form is not met.

• Advantages & Disadvantages

Computer-Assisted Charting

• Electronic health record (EHR)

• Computerized provider order entry (CPOE)

• How to take a verbal order

• Documentation can be done immediately

• Use of flow sheets with nursing interventions and expected outcomes

• Others use a POMR format to produce a prioritized problem list

• Advantages

• Disadvantages

Characteristics of Documentation

• Factual

• Accurate

• Brevity

• Timely

• Complete

• Legible

• Spelling and Grammar

Factual

• Descriptive objective information about what the nurse observes

• NO vague terms

• Subjective data

Accurate

• Intake of 400ml of water instead of adequate amount of water

• Use of exact measurement establishes accuracy

• COMPLETENESS is more important than brevity

Brevity in Charting

• Articles (a, an, the) may be omitted

• The word “patient” omitted when subject of sentence

• Sentences not necessary

• Abbreviations, acronyms, symbols acceptable to the agency

• Choose which behaviors and observations are noteworthy

Timely

• Date and time

• Military time

• Document when complete

Complete

• Condition change

• Patient’s responses especially unusual, undesired or ineffective response

• Communication with patient family

• Entries in all spaces on all relevant assessment form

• Do not leave blank areas

Legible

• Black ink, clear enough to be read, readable particularly handwriting

• Fixing errors in charting

Spelling and Grammar

• Misspelled words and poor grammar create a negative impression.

• Readers (lawyers and jurors) may infer that a person with poor spelling and grammar is uneducated and careless

Examples of errors found on nursing notes

• Fecal heart tone heard

• Patient observed to be seeping quietly

• Foley draining fowl smelling urine

• “IV infiltrated because nightshift forgot to check it”

• “Patient going into shock, could not reach Dr. Jones per usual”

• Physician Note, “Once again the lab forgot to draw the patient’s PTT this am”

• Physician Note “If the nurses would learn to read medication orders, we would have a lot fewer emergencies around here”

• “Patient received insufficient care today because nurse patient ratio was 1:7”

• Physician Note: “Patient fell due to lax nursing supervision”

• “Patient in extreme pain because previous nurse too busy to give pain meds”

Example Nurses' Notes

• Date & Time 03/21/11 0815

• S C/o nausea and severe abdominal pain of 7 on 0-10 scale.

• O Hypoactive bowel sounds RUQ, no bowel sounds heard in LUQ or lower quadrants. Abdomen firm, distended, and tender to touch. Flexes legs toward abdomen when abdomen touched. No bowel movement charted since admission. VS 148/92, 100.6° F, 114, 24.

• A Possible bowel obstruction. Monitor for continued change of status.

• P Notify doctor of change in status r/t abdominal pain. Monitor VS q hour. Prepare for further diagnostic studies and orders from physician.

Nursing Care Form

• (walking paper, Kardex etc.)

• Summary of client plan of care and status

• Medical diagnoses

• Nursing diagnoses

• Treatments

• Orders

Consent

• Legal document

• participation in decision making

• must know what the consent allows and be able to make a knowledgeable decision

• Informed consent

• Release

The Communication Process

• Communication is a continual circular process involving verbal and nonverbal elements.

• Nonverbal communication includes gestures, body posture, intonation, and general appearance.

Communication Process Elements

• Sender: Initiates the message.

• Message: The information being conveyed (e.g., "Help me move you up in bed by bending your knees and placing your feet flat on the bed.").

• Receiver: The recipient of the message.

• Feedback: The receiver's response to the message (e.g., "You mean put my feet like this?").

• Validation: Ensuring the message was received and understood correctly.

Factors Affecting Communication

• Cultural differences.

• Past experiences.

• Emotions and mood.

• Attitude of the individual.

Cultural Differences in Communication

• Personal space: Varies by culture.

• Eye contact: Norms differ across cultures.

• Meanings of words: Can vary significantly.

• Cultural norms: Influence communication styles.

• Religious beliefs: Impact acceptable topics and communication approaches.

Experience and Communication

How individuals perceive communication depends on:

• Cultural values.

• Level of education.

• Familiarity with the topic.

• Occupation.

• Previous life experiences.

Emotions, Mood, and Attitude

• Anxious patients may misinterpret messages or not hear everything.

• An upset person may speak loudly.

• A depressed person may communicate minimally.

• A person’s attitude affects how a message is received.

Communication Skills

• Active listening: Requires concentration and using all senses, maintaining eye contact.

• Interpreting nonverbal messages: Observing posture, gestures, tone, facial expressions, and eye contact.

• Obtaining feedback: Rephrasing and asking for clarification.

• Focusing: Keeping attention on the task at hand.

Adjusting Communication Style

• Consider the patient's style and pace.

• Allow time for responses.

Therapeutic Communication

• Focused on patient needs.

• Promotes understanding.

• Should be used judiciously.

Therapeutic Communication Techniques

• Silence.

• Open-ended questions.

• Restating.

• Clarifying.

• Touch.

• General leads.

• Offering self.

• Elaboration.

• Giving information/education.

• Alternatives.

• Summarizing.

Blocks to Effective Communication

• Changing the subject.

• Offering false reassurance.

• Giving advice.

• Making defensive comments.

• Asking prying questions.

• Not listening attentively.

• Using clichés.

Challenges for Nurses

• Developing interviewing skills.

• Using the nurse-patient relationship effectively.

• Using empathy.

• Becoming nonjudgmental.

• Maintaining hope.

• Applying the nursing process.

• Communicating with hearing-impaired patients, the elderly, children, and people from other cultures.

First Impressions

• Care partnership begins upon arrival.

• Immediate impression of the quality of the relationship with the nurse.

• First impressions are difficult to change.

Communicating with the Elderly

• Account for hearing and visual deficits.

• Allot extra time.

• Wait for an answer before asking another question.

• Obtain feedback.

Communicating with the Hearing-Impaired

• Speak distinctly.

• Do not shout.

• Speak slowly.

• Get the person’s attention.

• Maintain a good distance (2 1/2 to 4 feet).

• Watch for nonverbal feedback.

• Use short sentences.

• Paraphrase for clarification.

Communicating with Children

• Approach at eye level.

• Use a confident, calm, friendly voice.

• Keep parent in the room when possible.

• Use short sentences.

• Give simple explanations and demonstrations.

• Allow the child to handle equipment.

Communicating with People from Other Cultures

• Determine the language spoken.

• Obtain an interpreter if necessary.

• Enlist the aid of a family member if appropriate.

• Provide printed materials if available.

• Answer questions patiently.

• Be aware of cultural differences in eye contact and personal space.

Communicating with Health Care Team Members

• Nurses’ notes.

• Physician’s orders and progress notes.

• Dietitian’s notes.

• OT, PT, and speech therapy notes.

• Radiology and laboratory findings.

• ISBAR (Introduction, Situation, Background, Assessment, Recommendation).

• Shift report/telephoning MDs.

Assignment Considerations and Delegating

• Clearly define directions, be specific, provide a timeframe.

Computer Communication

• Charting.

• Orders.

• Communication with labs, pharmacy, etc.

Effects of Aging on GI Tract

• Dental caries and tooth loss

• Decreased gag reflex

• Decreased sense of taste

• Decreased muscle tone at sphincters

• Decreased gastric secretions

• Decreased peristalsis

Building a Balanced Plate

• Divide the plate into sections for vegetables, lean protein, and carbohydrates.

• Include fruit and water as part of the meal.

Nutrients

• Building blocks essential for normal functioning.

• One food can contain multiple nutrients.

Proteins

• Function: Essential for the body.

• Types: Essential and nonessential amino acids.

• Daily requirement: 46-56 grams.

• Serving size: 3 oz.

Food Sources of Protein

• Animal sources (complete proteins): Red meat, eggs, milk and milk products, poultry, fish.

• Plant sources (incomplete proteins): Grains, legumes, and most vegetables.

Protein Deficiency

• Marasmus: A form of protein-energy and nutrient malnutrition, often seen in infants after weaning.

• Kwashiorkor: A condition occurring in infants and young children due to protein deficiency.

Protein Excess

• Stressful to the liver and kidneys.

• Can lead to excess fat in the diet.

Vegetarian Diets

• Lacto-ovo-vegetarian: Includes dairy products, eggs, and plant foods.

• Lactovegetarian: Excludes eggs but includes dairy products and plant foods.

• Vegan: Excludes all animal food sources, including honey.

Carbohydrates

• Function: Provide energy to the body.

• Daily requirement: 130 grams.

• Three main types: Simple, complex, and fiber.

Simple Carbohydrates

• Cause a quick rise in serum glucose levels.

Complex Carbohydrates

• Broken down into simple sugars for use by the body.

• Provide a more consistent serum glucose level than simple sugars.

• Recommended intake: 85% to 95% of consumed carbohydrates should be complex carbohydrates.

Fiber

• Increases bulk in the stool.

• May decrease absorption of fat.

• Recommended intake: 21 to 38 g/day.

Fats (Lipids)

• Essential nutrient.

• Function: Made up of fatty acids and glycerol.

• Daily requirement: 25-30% of daily caloric intake or 20-30 grams.

Types of Fats

• Unsaturated fats: Corn oil, safflower oil, canola oil, olive oil, vegetables, nuts, seeds.

• Saturated fats: Animal sources and solid fats.

Omega-3 Fatty Acids

• The most unsaturated form of fatty acid.

• Sources: Salmon, halibut, sardines, tuna, canola oil, soybean oil, chicken, eggs, and walnuts.

• Should be added to the diet as sources of unsaturated fats.

Vitamins

• Essential nutrients.

• Easily absorbed into the bloodstream.

• Water-soluble vitamins: B-complex vitamins and vitamin C.

• Fat-soluble vitamins: A, D, E, and K. Absorbed in the small intestine and stored in the liver.

Minerals

• Inorganic substances found in animals and plants.

• Essential for metabolism and cellular function.

• Must be provided by food sources or supplements.

• Examples: Calcium, magnesium, potassium, sodium, iron, zinc.

Water

• Most essential of all nutrients.

• Adult body is 50% to 69% water.

• Water requirement: 1 mL/calorie of intake.

• General rule: Intake needs to be equal to recorded output plus 500 mL.

Factors Influencing Nutrition

• Age

• Illness

• Emotional status

• Economic status

• Religion & Culture

Nutritional Needs Through the Life Span

Adulthood

• Often rely on fast foods and convenience foods.

• Obesity and hypertension are prevalent.

Older Adults

• Most at risk for inadequate nutrition.

• May need to decrease calories if activity level decreases.

• Consider barriers and how to overcome them.

Nutritional Assessment

• History

• Physical exam

• Height/Weight

  • Normal BMI: 18.5-24.9

  • Waist circumference: Males less than 40 in, Females less than 35 in.

• Lab values

Nursing Diagnosis

• Imbalanced nutrition: less than body requirements.

• Risk for imbalanced nutrition: greater than body requirements.

• Risk for deficient knowledge.

• Impaired swallowing

• Risk for aspiration

Planning Goals

• Examples:

  • "Will consume 2200 calories per day."

  • "Will restrict caloric intake to 1800 calories per day."

  • "Will consume at least 50% of a pureed diet at each meal."

  • "Will provide examples of heart-healthy meals."

Implementation

• General interventions

• Client/Family teaching

Evaluation

• Review goals

• Determine if the client achieved them, partially achieved them, or did not achieve them.

Goals of Diet Therapy

• Treat and manage disease

• Prevent complications and restore health

• Requires a physician's order

• May need assistance with feeding

Therapeutic Diets

• Regular

• NPO (nothing per oral)

• Clear liquids

• Full liquids

• Soft

• Pureed diet

• Calorie restricted

• Low-Fat

• Sodium restricted

• Low-Carb

Health Issues RT Nutrition

• Anorexia Nervosa

• Bulimia

• Obesity

• Pregnancy

• Substance Abuse

Cardiovascular Disease

• Diseases of the blood vessels, hypertension, myocardial infarction, and congestive heart failure

• Management:

  • Reduction of fat

  • Reduction of sodium intake

  • DASH diet

Diabetes Mellitus

• Type 1

• Type 2

• CHO (carbohydrate) diet

Assisted Feedings

• Indicated when a patient is unable to tolerate oral intake.

• Considerations:

  • Dysphagia

  • Aspiration

  • Thickened liquids

  • Pureed Foods

Enteral Tubes

• Purpose: To provide nutrition when oral intake is not possible.

• Types:

  • NG (nasogastric) tube

  • Gastrostomy (PEG) tube

  • Jejunostomy tube

Nursing Process

• Assessment

• Nursing Diagnosis

  • Noncompliance

  • Deficient knowledge

  • Risk for aspiration

• Goals

Nursing Care

• Implementation

• Oral/nasal care

Evaluation

• Review goals

• Determine if goals were met

• Documentation

The Nursing Process

Primary Goals of Nursing

• Determine client/family responses to health problems, wellness level, and need for assistance.

• Provide physical and emotional care, teaching, guidance, and counseling.

• Implement interventions for prevention, client needs, and health goals.

The Patient’s Story

• The "patient's story" includes objective and subjective information about the client.

• Sources for obtaining the patient’s story:

  • Primary source: direct communication with the client and family.

  • Consideration: clients may be unable to verbally communicate their story, but their physical state can provide information.

The Nursing Process Defined

• A way of thinking and acting based on the scientific method.

• A tool to identify patient problems and an organized method to meet patients’ needs.

Components of the Nursing Process

• Assessment (data collection)

• Nursing diagnosis

• Planning

• Implementation

• Evaluation

Critical Thinking and Clinical Judgment

• Critical Thinking:

  • Create and evaluate ideas.

  • Analyze data.

  • Anticipate problems.

  • Use expansive thinking.

  • Reflect on experience.

  • Construct plans and determine desired outcomes.

• Clinical Reasoning:

  • Reliable observations regarding health status and draw conclusions from data.

• Clinical Judgment:

  • Outcome of clinical reasoning.

  • Conclusion/decision made by using clinical reasoning skills.

Priority Setting and Work Organization

• Priority setting (prioritizing): placing nursing diagnoses/interventions in order of importance.

  • High priority

  • Medium priority

  • Low priority

Assessment

• Collecting, organizing, documenting, and validating a patient’s health data.

• Data gathered from:

  • Client (physical assessment and interview)

  • Family

  • Physician

  • Medical record

Analysis of Assessment Data

• Abnormal data drives your nursing diagnoses

• Identify abnormal data

• Related data are grouped or clustered

• Identify missing data

• Inferences are made regarding the patient’s problems

Nursing Diagnosis

• Sorting and analyzing the assessment data.

• Identify potential health problems.

• Problems identified during the process are specific nursing diagnoses.

• Nursing diagnoses prioritized and entered into the nursing plan of care.

Nursing Diagnosis Details

• A nursing diagnosis statement indicates:

  • Client’s actual health status or the risk of a problem developing

  • The causative or related factors

  • Specific defining characteristics (signs and symptoms)

  • NANDA-I nursing diagnoses

Nursing Diagnosis Format

• Complete Statement:

  • PROBLEM: Nursing Diagnosis

  • RELATED TO: Etiology (cause)

  • AS EVIDENCED BY: Defining characteristics (signs/symptoms)

• Example:

  • Constipation R/T medication use AEB infrequent passage of stool and hard, dry stool.

2-part format for POTENTIAL problem

• Since it’s a POTENTIAL problem, there is no AEB (signs/symptoms)

  1. Risk for (problem)

  2. RELATED TO ETIOLOGY

• EXAMPLE:

  • RISK FOR INFECTION R/T BREAK IN SKIN INTEGRITY.

Etiologic Factors

• Causes of the problem

• Signs: abnormalities that can be verified by repeat examination and are objective data

• Symptoms: data the patient has said are occurring that cannot be verified by examination; symptoms are subjective data

Prioritization of Problems

• Problems ranked according to their importance

• Physiologic needs for basic survival take precedence

• After physiologic needs are met, safety problems take priority

Planning

• Nurse and the client in collaboration

• Set priorities and goals to eliminate, diminish, or control identified problems

• Goals should be stated with specific outcomes

• Choose specific interventions to enable the client to meet the specific outcomes listed in the plan of care

Planning Details

• Sets measurable short-term and long-term goals

• MUST be realistic and attainable for the patient

• Goals/outcomes – what we want to achieve through nursing intervention

Format of a Goal Statement

• Subject: Patient

• Action Verb: will demonstrate, describe, apply

• Time: by discharge, within 24 hours

Example Goal Statements

• Will ambulate to the nurses’ station, using cane, unassisted by 2/15/16.

• Will describe system for taking medication by 2/15/16.

• Will verbalize pain level of less than 3 (on a 0-10 pain scale) 30-60 minutes after each pain management intervention.

Planning -Interventions

• Alleviate problems

• Achieve expected outcomes

• Give medications and performing ordered treatments

• Individualize to the patient's needs

Implementation

• Carrying out nursing interventions prioritized during the planning process

• Some interventions may be delegated or carried out by other members of the health care team

Implementation Actions

• Independent nursing actions

• Dependent nursing actions

• Interdependent nursing actions

• Nursing interventions (nursing orders) are carried out

Implementation in Long-Term Care

• Delegation to nursing assistants

• Exercise interventions performed by nursing assistants, physical therapy aides, or restorative aides

• Medications

  • May be administered by LVNs/LPNs or nursing assistants with certification in medication administration

• Nurse performs any invasive or sterile procedure

Documentation of the Nursing Process

• Medications administered, dressings changed, vital signs measured, position changes

• Intervention/procedures not documented are considered not performed

• Each intervention must be documented in the patient’s chart

Evaluation

• Assessing the patient to evaluate his or her response to the nursing interventions

• Evaluate progress toward goal

• Patient/family opinions considered

• Continual process

• Determines if nursing plan of care needs to be changed

Revising the Care Plan

• When goals are met

  • Continue current plan

  • Inactivate

• When goals are not met:

  • revise the plan

Responsibility for the Nursing Care Plan

• If patient admitted to long-term care facility when RN is not available, LPN/LVN may assemble a preliminary nursing care plan that an RN will review and validate as needed the next day

• RN may construct the initial nursing care plan

Constructing a Care Plan

• Collect patient data

• Analyze data for potential problems

• Choose appropriate nursing diagnoses

• Rank the diagnoses in order of priority

• Write goals and expected outcomes

• Select appropriate nursing interventions

• Implement nursing interventions

• Evaluate outcomes

Transcultural Care

• Culture and spirituality significantly impact how patients manage their health and utilize healthcare resources.

• Research indicates that healthcare rooted in a patient's cultural and spiritual needs improves outcomes and quality of care.

• Transcultural nursing: Nursing care acknowledging cultural diversity and sensitivity to patients’ and families’ cultural needs.

Culture

• Shared values, beliefs, and practices of a group

• Influences on lifestyle choices:

  • Nutrition

  • Exercise

  • Stress management

  • Smoking

  • Alcohol or drug use

• Culture's Influence on Lifestyle Choices:

  • Learned and acquired socially

  • Shared by a group

  • Integrated into individual identity

  • Dynamic and subject to change

• Four distinguishing features

Religion and Spirituality

• Often used interchangeably but distinct.

• Religion:

  • Formalized belief and worship system

• Spirituality:

  • Concerns the spirit or soul

  • An element of religion

Major Religions in the U.S. and Canada

• Christianity: Largest religious group

• Islam: Second largest

• Judaism: Third largest

• Eastern Religions: Hinduism, Buddhism, Taoism

Cultural Group Characteristics

• Nationality

• Race

• Color

• Gender

• Age

• Religious affiliation

  • Characteristics: Ethnic groups, subcultures

Developing Cultural Competence

• Cultural awareness

• Cultural sensitivity

• Cultural competence

Barriers to Cultural Competence

• Ethnocentrism

• Stereotype

• Discrimination

• Prejudice

Cultural and Ethnic Differences

• Communication

• View of time

• Family organization

• Nutrition

• Death and dying

• Healthcare beliefs

• Susceptibility to disease

Communication

• Language

• Nonverbal communication

  • Personal space

  • Eye contact

• Learning key phrases

• Using interpreters

View of Time

• Orientation to time varies

• Past, present, or future orientation

Organization of the Family

• Patriarchal

• Matriarchal

• Egalitarian

• Position of the elderly

Nutrition

• Meaning associated with food

• Learn from their family culture

• May be categorized

Death and Dying

• Autopsy & organ donation

• Cultural rituals for preparing the body for burial

• Expressions of grief

Health Care Beliefs

• Beliefs about health, disease, illness, and treatment are culturally based

• Beliefs about illness/health

• Folk or home remedy medicine

Susceptibility to Disease

• Certain diseases are genetic

  • African Americans: HTN, sickle cell disease

  • Hispanics and American Indian are genetically susceptible to DM.

• Be alert for signs of disorders that are common to a particular culture or race.

Major Cultural Groups in the U.S. and Canada

• Asian/Pacific Islander Americans

• Hispanic Americans

• African Americans

• American Indians

• European Americans

• Arab Americans

Culturally Sensitive Nursing Interventions

• Employ an interpreter

• Utilize flashcards or a phrase book for common phrases

• Therapeutic diet with culturally preferred foods

• Incorporate family involvement

• Patient advocate

• Offer quiet time for prayer or meditation

• Respect requests for religious objects

Complementary & Alternative Therapies

Introduction

• Complementary therapies are used in conjunction with or in place of conventional medicine.

  • Example: Guided imagery with narcotic pain medication.

National Center for Complementary and Integrative Health (NCCIH)

• Established to conduct evidence-based research on the effectiveness of various complementary health approaches.

• Provides information to the public.

• NCCIH classifies complementary therapies into two main categories, and a third category for therapies that don't fit in either of the other two:

  • Mind and Body Interventions

  • Natural Products

  • Other Complementary Interventions

Alternative Medicine

• Homeopathic:

  • Symptoms are the body’s attempt to get rid of disease.

  • Stimulates immunity.

  • Uses small doses of illness-inducing substances.

• Naturopathic:

  • Uses natural means to promote health and the body’s healing ability.

  • Involves botanicals, light, and exercise.

• Traditional Chinese Medicine (TCM):

  • Utilizes earth elements and Qi (energy).

  • Looks for imbalances.

  • Incorporates Tai Chi, medicinal plants, and herbs.

Alternative Medicine - Specific Therapies

• Acupuncture:

  • Branch of TCM.

  • Uses fine needles to disperse energy flow.

  • Treats pain and increases immunity.

• Qi Gong:

  • Chinese exercise therapy.

  • Focused on breathing, improving coordination, and promoting relaxation.

• Folk Medicine:

  • Used by many cultures.

  • Views illness as an imbalance.

  • Uses foods, herbs, and natural compounds to treat the physical component of illness.

  • May include a supernatural component.

Mind-Body Intervention

• Eases stress.

• Used to treat chronic illnesses such as headache, IBS (Irritable Bowel Syndrome), and HTN (Hypertension).

  • Techniques include refocusing, conscious breathing, and body awareness.

• Relaxation therapy

• Imagery:

  • Uses visual pictures to decrease stress or promote healing.

• Meditation:

  • Focused attention on a single stimulus; decreases awareness of other stimuli.

  • Induces a restful state, lowering heart rate (HR), blood pressure (BP), respiratory rate (RR), and anxiety.

Mind-Body Intervention - Additional Therapies

• Biofeedback:

  • Patient learns to control physiological processes.

  • Used to manage pain and panic attacks.

• Yoga:

  • Involves exercise, controlled breathing, and mental focus.

  • Regulates BP and HR and helps with pain management.

Biologic-Based Therapy

• Uses natural substances like foods and herbs.

• People may turn to herbal remedies to reduce the cost of medications.

• Many herbal remedies interfere with prescription medications.

• Patients often fail to report their use of herbal remedies.

Manipulative Therapy

• Chiropractic:

  • Manipulation of the spine to decrease pain.

• Massage:

  • Manipulation of tissue to decrease pain, increase circulation, and relieve muscle stress.

Nurse’s Role in Complementary & Alternative (C&A) Therapies

• Be knowledgeable of various types of C&A therapies.

• Question patients about the use of C&A therapies in a nonjudgmental manner.

• Educate patients on the importance of reporting the use of herbal remedies.