Caring for the Caregiver: A Bird’s eye view of health and healing

1. Caring for the Caregiver: A Bird’s eye view of health and healing Jo Robins, RN, PhD, ANP-BC, AHN-C, CHTP VCU School of Nursing

2. Overview: What am I offering you today • A different perspective • Both personal and professional • Path to self-care and renewal

3. A Broader View: My Story

4. Setting Down Roots for Self-Care • NECESSARY for health and well-being • Own and honor therapeutic presence • Be an authentic example: walk the talk • Complete and balance the cycle of giving AND RECEIVING

5. COMPLEMENTARY THERAPIES AND HOLISTIC CARE • The Placebo Response • Innate healing ability • Holism- Mind, Body, Spirit • Self-care • Personal/Professional • Treating/Curing/Healing Partnership • Integrative Practice

6. nccam.nih.gov • 1-888-644-6226 • Outstanding resource • Currently sponsored clinical trials include the areas of acupuncture, herbs, dietary supplements, and massage in the areas of arthritis, neurological disorders, cardiovascular disease, and cancer

7. Categories of Use- NIH NCCAM • Alternative Systems: TCM, Ayurvedic,Homeopathy • Biological:Diet, vitamins, supplements, herbs • Manipulative/Body based:Chiropractic, massage, Trager… • Mind-Body:Psychoneuroimmunology,Breath work, Guided imagery, meditation, tai chi, yoga, humor, .… • Energy:Healing Touch, Therapeutic Touch…

8. Ayurvedic Medicine • Focus is on person as energetic entity, balance, breath, diet, exercise, mind-body techniques, yoga • Wisdom of Healing; Return to Wholeness by David Simon, MD

9. Mind-Body Constitution or Dosha • http://doshaquiz.chopra.com/ • http://www.whatsyourdosha.com/ • Vata = Air • Pitta = Fire • Kapha = Water

10. Traditional Chinese Medicine • Ancient eastern system of medicine focusing on balance, energy flow • Meridians • Ying/Yang • 5 elements: fire, water, air, wood, earth • Acupuncture, Massage (Tui Na) , Herbs, Nutrition, Qi Gong (vital energy)

11. Balancing Yin and Yang • Yang is the “daylight”, the “active”, the “doing”, the “producing”. • Yin is the “nighttime”, the “stillness”, the “contemplative”, the “refilling”.

12. Balancing Yin and Yang • The flame is the yang; the wax is the yin. • The battlefield is the yang; the fort is the yin. • Doing is the yang; being is the yin.

13. Biological-Based • Diet: Primary focus for maintaining, rebuilding health. Food is Information. • Some truths about Vitamins, Supplements, and Herbal therapies: Buyer Beware Markeplance: GMP • State of the Science

14. Resources for Vitamins, Supplements, Herbal Products • Herbal PDR • Commission E Monograph • Herb Contraindications and Drug Interactions by Brinker • Natural Medicines Database • South River Compounding Pharmacy

15. Resources for Vitamins, Supplements, Herbal Products • Metagenics • Perque • Phytopharmica • Xymogen • New Chapter • Numerous others

16. Manipulative/Body Based • Massage: Effective for stress management, reducing and eliminating a variety of pain syndromes. • Trager-Effective in helping manage Parkinson’s disease.

17. Mind-Body Therapies • Generally focused on engaging the relaxation response • Breathing and mindfulness- basis for most therapies • Wide variety of therapies including mindfulness based stress reduction (Kabat-Zinn), aromatherapy, music therapy, yoga, tai chi, etc… • Really whatever allows you to remember that the mind is given to you, you are not given to the mind

18. Energy • Fully developed framework • Era I, II, III Medicine • Healing Touch and Therapeutic Touch help decrease pain and anxiety; improve sleep quality, and well-being

19. Evaluating CAM Therapies • 1. Evaluate the therapy itself- can you assess whether the therapy is probably harmless, possibly dangerous, or potentially helpful in some significant way (ie, does it operate in a plausible way, is there scientific literature?).

20. Evaluating CAM Therapies • 2. Evaluate the practitioner offering the therapy-training, reputation within professional networks (patients/colleagues), Do they have expertise treating your condition? Do they make any claims regarding outcomes? Can they integrate with your conventional therapy? Is the practitioner worthy of your trust?

21. Evaluating CAM Therapies • 3. Evaluate the quality of the service including delivery, cost, and quality of service being rendered.

22. Holistic Nursing • State of mind, a way of being. • 5 Core Values: Philosophy, Theories, Ethics; Education and Research; Nurse Self-Care; Communication, Therapeutic Environment, Cultural Diversity; Caring Processes • 2 levels of certification • Holistic Nursing: A Handbook for Practice

23. The Art and Science of Holistic Nursing • American Holistic Nurses Association www.ahna.org • Holistic Nursing: A Handbook for Practice by Dossey, et al., (2005) (4th edition). Also developed Core Curriculum. • Foundation for Holistic Nursing is based on 5 “Core Values”

24. 5 Core Values • Holistic Philosophy, Theories, and Ethics • Holistic Education and Research • Holistic Nurse Self-Care • Holistic Communication, Therapeutic Environment, and Cultural Diversity • Holistic Caring Processes

25. Holistic Nurse Certification • www.ahncc.org • 3 step process: apply for certification after practicing as a holistic nurse and completing required CEU’s; qualitative exam; quantitative exam

26. Functional Medicine • Functional Medicine Institute www.functionalmedicineinstitute.org • Biochemical individuality describes the importance of individual variations in metabolic function that derive from genetic and environmental differences among individuals.

27. Functional Medicine • Patient-centered medicine emphasizes "patient care" rather than "disease care.” • Follows Sir William Osler’s admonition that “it is more important to know what patient has the disease than to know what disease the patient has."

28. Web-like interconnections of physiological factors • An abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems, rather than individual systems functioning autonomously and without effect on each other.

29. Many Professional Organizations • American Holistic Nurses Association (www.ahna.org) • American Holistic Medical Association (www.ahma.org) • American Association of Integrative Medicine (www.aaimedicine.com)

30. Peer Reviewed Journals-Nursing and Medicine • Journal of Holistic Nursing • Holistic Nursing Practice • Journal of Complementary and Integrative Medicine

31. Peer Reviewed Journals • Evidence Based Complementary and Alternative Medicine • Alternative Therapies in Health and Medicine • Journal of Alternative and Complementary Medicine

32. Further Exploration • Plethora of magazines, books • Tremendous local network of licensed providers • Natural Awakenings magazine

33. What I have learned Be an authentic example: time to walk the talk

34. What Have I Learned Own and honor therapeutic presence

35. Perception The mind is given to you, you are not given to the mind.

36. Stressor Factors Person Factors STRESSOR T Social- Environmental Factors STRESSOR Norepinephrine NKC Epinephrine B Cortisol Mn/MN DHEA Spleen Cerebral Cortex IL-2 IL-6 TNFa Limbic System IL-1 IL-3 Hypothalamus CRF CRF PVN CRF Locus Ceruleus Pituitary Proopiomelanocortin: b-endorphin, ACTH, ANS a-melanocyte stimulating hormone Lymphoid Tissue ACTH Adrenal Cortex Adrenal Medulla IL-2 Thymus Enkephalins TNFa , IL-1, IL-6 Met-enkephalin Interferons b-Endorphin IMMUNE SYSTEM

37. What is “Stress” ? • Overused, non-specific • Typically viewed as negative • Promotes adaptation, growth, learning

38. Stress Response • Brain integrates and coordinates behavioral and neuroendocrine responses to “stress” and normal diurnal rhythms. • Remarkable individual differences in coping related to genetics, early development, behaviors, experience…. • Neuroendocrine and behavioral responses programmed to adapt for homeostasis, allostasis. Must efficiently turn on and off.

39. Short-Term Adaptive Responses • CV-catecholamines (CAT) increase HR, BP, Vasoconstriction to be upright, active • Brain-Adrenal hormones (AH), CAT increase awareness, memory retention • Immune- AH & CAT promote cell trafficking; modulate cyto-,chemokines

40. Potentially Damaging Long-Term Effects • CV- prolonged BP elevations accelerate atherosclerosis and with metabolic hormones lead to Type II DM • Brain- HPA overactivity, excitatory neurotransmitters reduce neuronal excitability and atrophy, hippocampal brain cell death • Immune-Immunosuppression and immune overactivity (autoimmune, inflammation)

41. Allostatic Load: McEwen & Stellar, 1993 • “Hidden cost of chronic stress to the body over long time periods, which act as a predisposing factor for the effects of acute, stressful life events.” “Wear and Tear” • “Presents a model showing how individual differences in the susceptibility to stress are tied to individual behavioral responses to environmental challenges that are coupled to physiologic and pathophysiologic responses.” (p. 2093) • Cumulative result of allostasis, allostatic state

42. 4 Types of Allostatic Load • 1. Repeated events over a long period of time (sustained economic hardship) • 2. Failure to adapt to a repeated stressor (never adapting to flying or public speaking) • 3. Failure to shut off hormonal stress response or return to normal trough (sleep deprivation) • 4. Inadequate hormonal stress response allowing other systems to be overactive (autoimmune)

43. “Thinking for a Change” (Maxwell, 2003) • “We would rather be comfortable than correct; we would rather stay in a routine than make changes.”

44. “Thinking for a Change” (Maxwell, 2003) • “The difficulty lies not so much in developing new ideas as in escaping the old ones.” • “Even when we know changes are going to be better for us and our patients we don’t make them because we feel uncomfortable or awkward.”

45. “Thinking for a Change” (Maxwell, 2003) • “Until we can get used to living with something that is not comfortable we cannot get any better.” • Most people change when they hurt enough they have to; learn enough they want to; receive enough that they are able to.

46. Let thy food by thy medicine(Hippocrates) • Encourage diet history- Awareness • Adequate daily hydration • Eat regularly-do not skip meals! High quality protein • Organic when possible • 5-10 servings of fruits & vegetables daily • Limit white sugar and flour, processed food

47. Healing Foods • Consider high quality protein shakes • Consider high quality multivitamin/multimineral, highly absorbable calcium and magnesium, vitamin D, essential fatty acids particularly omega 3 (fish oil, flax, borage, evening primrose), and antioxidants

48. EXERCISE • Makes everything better • Do not overdo • Tailor exercise to level of energy, fitness • Find a way to stay active doing what you love--dancing, gardening, etc…

49. BREATHING- The Basis of Health and Healing • Breath=Spirit • Begin by observing breathing patterns • Three deep breath upon arising and before sleep • Promotes relaxation-de-activates SNS (impacts neuroendocrine, cardiovascular, and immune systems • Dr. Andrew Weil audiobook “Breathing”

50. Creating Change • It is a process-the beauty and glory are in the process of growing and evolving, not necessarily the “getting there”