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CHIROPRACTIC MEDICINE a form of alternative medicine> diagnosis, treatment & prevention of mechanical disorders of the musculoskeletal system---> affect general health via the nervous system "cheiros"--- hand "praktikos"--- practice " Science with no drugs" Chiropractic PHILOSOPHY Holism Conservatism Homeostasis Purpose to revive the ability of thebody to self-heal uses manual therapy as well as exercises, and lifestyle counseling Three types of care Relief Preventative Wellness History Chiropractic was founded in 1895 by magnetic healer Daniel David (D.D.) Palmer in Chiropractic was founded in 1895 by magnetic healer Daniel David (D.D.) Palmer in Davenport, IowaHarvey Lillard1898- Palmer began teaching it to a few students at his new Palmer School of Chiropractic Bartlett Joshua (B.J.) PalmerDavenport, Iowa Harvey Lillard 1898- Palmer began teaching it to a few students at his new Palmer School of Chiropractic Bartlett Joshua (B.J.) Palmer folk medicine of bonesetting vitalism and spiritual inspiration Philippines 27 years Dr. James Uy in 1986 Jan 2014- 25 Chiropractors • Straight chiropractors • Mixer chiropractors Central nervous system Consists of brain and spinal cord BRAIN Monitors every function in body SPINAL CORD Transmits every message from brain to the rest of the body and vice versa SPINE Protects spinal cord and nerves to reach every cell, tissue and organ in your body. SUBLUXATION Vertebral joint misalignments Pinched nerves Swelling Interferes with the nerve transmission Affects muscles, organs, movement Pressure on Nerve The pressure equal to the weight of one penny on a nerve is enough to reduce the transmission of that signal up to 60%.(University of CO) Spinal Degeneration Starts to occur within a couple weeks of the joint restriction. Not age specific. Medicines

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CHIROPRACTIC MEDICINE a form of alternative medicine> diagnosis,

treatment & prevention of mechanical disorders of the musculoskeletal system---> affect general health via the nervous system

"cheiros"--- hand "praktikos"--- practice " Science with no drugs"

Chiropractic PHILOSOPHY Holism Conservatism Homeostasis

Purpose to revive the ability of thebody to self-heal uses manual therapy as well as exercises, and

lifestyle counseling Three types of care

Relief Preventative Wellness

History Chiropractic was founded in 1895 by magnetic

healer Daniel David (D.D.) Palmer in Chiropractic was founded in 1895 by magnetic healer Daniel David (D.D.) Palmer in Davenport, IowaHarvey Lillard1898- Palmer began teaching it to a few students at his new Palmer School of Chiropractic Bartlett Joshua (B.J.) PalmerDavenport, Iowa

Harvey Lillard 1898- Palmer began teaching it to a few students

at his new Palmer School of Chiropractic Bartlett Joshua (B.J.) Palmer folk medicine of bonesetting vitalism and spiritual inspiration

Philippines 27 years Dr. James Uy in 1986 Jan 2014- 25 Chiropractors • Straight chiropractors • Mixer chiropractors

Central nervous system

Consists of brain and spinal cordBRAIN

Monitors every function in bodySPINAL CORD

Transmits every message from brain to the rest of the body and vice versa

SPINE Protects spinal cord and nerves to reach every

cell, tissue and organ in your body.SUBLUXATIONVertebral joint misalignments

Pinched nerves

Swelling

Interferes with the nerve transmission

Affects muscles, organs, movement

Pressure on Nerve The pressure equal to the weight of one penny on

a nerve is enough to reduce the transmission of that signal up to 60%.(University of CO)

Spinal Degeneration Starts to occur within a couple weeks of the joint

restriction. Not age specific.

Medicines Over the counter pain Medications and Anti-

inflammatory just mask these symptoms.Detection

Usually detected by- x-rays- Tenderness- Misalignment- range of motion

Indications for Chiropractic Treatment: An Overview1. Safety

Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the parts of the body that were treated.

There have been rare reports of serious complications such as stroke.

Chiropractic Treatment Modalities Manual therapies – joint manipulation,

mobilization, and soft tissue therapies; Electrotherapeutic modalities – ultrasound,

inferential current or low level laser; Rehabilitation strategies – exercise and

behavioural modifications.

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Manual and manipulative therapy Spinal manipulation/adjustment describes

techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues. It is the most common and primary intervention used in chiropractic care

Chiropractic manipulative techniques Activator technique

◦ alternative to manual manipulation of the spine or extremity joints

Neuro Emotional Technique (NET ◦ It is an holistic approach to well-being

focusing on imbalances in the structure of the skeletomuscular system, unresolved "negative emotional blocks", toxins in the body, and deficiencies in nutrition.

Craniosacral therapy (CST)◦ is a form of bodywork or alternative

therapy focused primarily on the concept of "primary respiration" and regulating the flow of cerebrospinal fluid by using therapeutic touch

Upper Cervical Specific Chiropractic TRANSCULTURAL NURSING IN THE

COMMUNITYEffective community nursing practice must reflect accurate knowledge of the causes and distribution of health problems and of effective interventions that are congruent with the values and goals of the community. An epidemiologic model can be used by the community nurse to collect, organize and analyze information about high-risk groups that are encountered in community practice.

A Transcultural Framework identifying subcultures and devising specific community based interventions A transcultural framework for nursing care helps

the nurse to identify subcultures within the larger community and to devise community based interventions that are specific to community health and nursing needs.

A Transcultural FrameworkIdentifying and analyzing various components of the

community A cultural approach allows the nurse to identify

cultural health care systems, which are made up

of individuals who experience illness as well as those who provide care for them.

Each cultural health care system can have as many as three recognized sectors referred to as popular, folk and professional.

A Transcultural FrameworkIdentifying the values and cultural norms of a

community Values often serve as the foundation for a

community’s acceptance and use of health resources or a group’s participation in community-based intervention programs to promote health and wellness.

Cultural Issues in Community Nursing Practice Nurses who work in community settings must

understand cultural issues as they relate to individuals and families as well as communities.

Cultural Issues in Community Nursing PracticeCultural influences on individuals and families

1. Family roles2. Health beliefs and practices3. Patterns of daily living4. Social networks5. Ethnic, cultural and national identity6. Nutritional practices7. Religious preferences and influences8. Behavioral styles

Cultural Issues in Community Nursing PracticeCultural factors within communities

The community health nurse must consider social and cultural factors on a community level to respect cultural values, mobilize local resources and develop culturally appropriate health programs and services.

Cultural Issues in Community Nursing PracticeMaintenance of traditional cultural values and practices

An important aspect of transcultural nursing is the collection of cultural data and the assessment of traditional values and practices and how they are maintained over time. Spector (2003) suggests that a person’s health care and behavior during illness may well have roots in that person’s traditional belief system.

Cultural Issues in Community Nursing PracticeAccess to health and nursing care for diverse cultural groups

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Access to care is often determined by economic and geographical factors. Community nurses who focus on the care of aggregates face the challenge of promoting the health of populations with new cases of mortality and underserved populations who are more likely to experience health problems.

Assessment of Culturally Diverse Communities All successful cultural assessments have at their

foundation extensive data to help them better understand and address the specific health needs and interests of their target populations. A community nursing assessment requires gathering relevant data, interpreting the database and identifying and implementing

Assessment of Culturally Diverse CommunitiesBasic principles of cultural assessment

1. All Cultures must be viewed in the context in which they have developed.

2. The underlying premises of the behavior must be examined.

3. The meaning and purpose of the behavior must be interpreted within the context of the specific culture.

4. There is such a phenomenon as intracultural variation.

Assessment of Culturally Diverse CommunitiesComponents Of Cultural Assessment

1. Family and Kinship systems2. Social life3. Political systems4. Language and traditions5. Worldwide, value orientations and cultural norms6. Religion7. Health beliefs and practices

Community Nursing InterventionsCultural Competence In Health Maintenance And Promotion

Community nurses who have direct access to clients in the context of their daily lives should be especially aware of the importance of cultural knowledge in promoting and maintaining health because the promotion and maintenance of health occurs in the context of everyday lives rather than in the doctor’s office or in a hospital.

Cultural Competence in Primary, Secondary and Tertiary Preventive Programs

The major aim of community-based preventive programs is to reduce the risk for the population at large rather than to prevent illnesses in specific individuals.

Using Cultural Competence at The Primary Level of Prevention

The community health nurse should target for change certain high-risk behaviors during pregnancy, such as smoking, using drugs, consuming alcohol, and maintaining poor nutritional habits.

Nursing interventions at the secondary level of prevention should focus on the implementation of healthful lifestyle changes that will ultimately decrease the complications of certain disease. The choice of words as well as the emphasis is important.

It includes a component that focuses on helping clients manage a chronic disease – an aspect of tertiary prevention. Community health nurses are in the advantageous position of assessing clients and families in their own homes and neighborhoods.

HERBSHistory

◦ Complementary and alternative medicine (CAM)◦ Herbal medicine at least 5,000 years old◦ CAM interest grown over past two decades◦ Over 31 million visits to CAM practitioners 1998

(Thomas et al, 2001)◦ One in five Britons seeks complementary or

alternative therapy.◦ Perceived to be ‘safe’◦ Research lagging behind◦ Health care professionals are thought to know◦ The first medical records date from ancient

Assyria, China, Egypt and India.◦ William Turner was the first person to study

plants scientifically in the sixteenth century. He travelled widely throughout Europe and grew plants in his gardens in south-west London (later the Royal Botanical Gardens, Kew).

What is CAM?◦ Complementary and alternative medicine. The

treatment of disease using methods other than recognised/conventional medicine.

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◦ Use of homeopathic, herbal, aromatherapy and over the counter vitamin supplements to treat conditions

◦ Often not adequately clinically trialled◦ Might not have a product licence

Homeopathic and Herbal medicine◦ Homeopathy: Homeos (Similar) Pathos (disease)◦ Like cures like – remedy mimics symptoms◦ The greater the dilution – the greater the

therapeutic effect (serial dilution)- hardly any or no trace of active ingredient

◦ Manufacture controlled by Medicines Act 1968◦ Medical claims cannot be made for remedies◦ However, leaflets can be displayed nearby◦ Medical homeopaths (medically qualified and

regulated by GMC)◦ Non Medical homeopaths (regulated by different

bodies/Fellowship of homeopaths etcTheory

◦ Traditionally, the herbalist has recognised four clear stages when offering treatment for any particular condition, individualising the prescription according to holistic methodology to take account of their patients’ particular needs:

1. Cleansing the body. 2. Mobilising the circulation. 3. Stimulating digestion. 4. Nourishment and repair.

Effects on patients◦ Limited evidence with regard to adverse drug

reactions◦ Little evidence with regards to drug interactions

Herbal medicines◦ Plant derived medicines at pharmacological doses

where effects can be measured◦ Symptom based approach to diagnosis

Influencing Factors◦ Clinical status of the patient◦ Considerations of cost and value for money◦ Pressure from P’ceutical Industry◦ New drug development◦ Patient preference◦ Local formulary or prescribing policies

Why do people use herbal medicines?◦ Used in developing countries where cost of drugs

is prohibitive, poor accessibility to drugs in rural areas, shortage of physicians

◦ Perception that natural = safe◦ “More” ADRs reported with conventional

medicines than herbal preparations

◦ Provide a sense of control, a mental comfort from taking action e.g. cancer, AIDS

◦ Cultural & religious beliefs◦ Use differs by ethnic group, income, age &

educational levelProblems Associated with Use of Herbal Medicines

◦ Lack of QC & standardisation◦ Adulteration with other plants, pharmaceutical

drugs or heavy metals◦ Inappropriate use / misleading claims◦ Type A & B ADRs◦ Potential for drug interactions ◦ Lack of knowledge re: interactions, ADRs

Problems Poor manufacturing process Adulteration to include toxic substances and

conventional drugs Misidentification of herbs Substitution of herbs Varying strengths of preparations Incomplete labelling Incorrect dosage and instructions

The H.E.R.B.A.L. Mnemonic © Robert Bonakdar MD H ear the Patient out with respect E ducate the patient R ecord and document B eware A gree to discuss L earn about new and popular supplements

FOODSFood Habits and Cultural Patterns

Personal food habits develop as part of one’s social and cultural heritage, as well as individual lifestyle and environment.

Cultural Development of Food Habits Food habits grow from many influences

Personal Cultural Religious Social Economic Psychological

Food habits are learned through everyday living and family relationships.

Food habits are primarily based on food availability, economics, personal food beliefs

Cultural background and customs largely determine what is eaten.

Foods may take on symbolic meaning.

Religious Dietary Laws Jewish

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Different dietary laws depending on orthodox/conservative/reform beliefs

Dietary laws are called Rules of Kashruth; foods prepared according to these laws are kosher

Meat should come only from animals that chew their cud and have cloven hooves; no pork or birds of prey

Meat and milk products are not mixed Shellfish and crustaceans are avoided

Muslim Dietary laws dependent on restriction or

prohibition of some foods, promotion of other foods

Ramadan: 30-day period of daylight fasting

Milk products are permitted at all times Fruits, vegetables are permitted unless

fermented Breads, cereals are permitted unless

contaminated Seafood, land animals are permitted Pork and alcohol are prohibited

Spanish Influences Mexican

Basic foods include dried beans, chili peppers, corn.

Only small amounts of meat and eggs are used.

Fruit consumption depends on availability and price.

Puerto Rican Food pattern is similar to Mexican Tropical fruits and vegetables are added. Basic foods include viandas (starchy

vegetables and fruits), rice, beans Indian and Alaska Natives

Many diverse groups Groups all have a spiritual devotion to the

land. Food has great religious and social

significance. Food differs according to what can be

grown locally, harvested or hunted on the land, or fished from local waters.

African-Americans Food patterns developed through creative

ability to turn basic staples into memorable food

Traditional breads include hot breads (biscuits, spoonbread, cornbread)

Wide variety of vegetables and leafy greens (turnip, collard, mustard) are used

Pork is a common meat French Americans

Cajuns in southern Louisiana are descendents of the French colonists of Arcadia (now Nova Scotia).

French culinary background blended with Creole cooking around New Orleans

Foods are strongly flavored, spicy Seafood is abundant.

Chinese Use a wok for quick stir-frying with little

fat Vegetables and rice are staples Meat, eggs, tofu are sources of protein

Japanese Rice is basic grain Many varieties of fish and shellfish are

used. Vegetables are usually steamed. Diet is high in sodium, low in milk

Southeast Asian: Vietnamese, Indonesian, Cambodian, Laotian

Rice is a staple. Soups are common. Fish, shellfish, pork, chicken, and duck are

common. Red meat is eaten only once or twice a

month. Italian

Bread and pasta are basic ingredients. Cheese, meats, poultry, fish, sausages,

cold cuts, and vegetables are commonly used.

Olive oil, garlic, herbs, and wine used in cooking

Greek Bread is the center of every meal. Cheese, yogurt, vegetables, rice, lamb,

and fish are commonly used.

Social Influences Social structure

Groups may be formed by economic status, education, residence, occupation, family

Group affiliation influences food attitudes and choices.

Food and social factors Food symbolizes acceptance and warmth

in social relationships.

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Certain foods trigger childhood memories.

Psychological Influences Diet patterns

Food has many personal meanings. Many psychological factors rooted in

childhood Food and psychosocial development

Food relates closely to psychosocial development.

Toddlers may become “picky eaters” in order to control parents.

Food neophobia (fear of unfamiliar foods) is normal developmental factor

Economic Influences Family income

o Low-income families suffer extreme needs.

o Illness, hunger, and malnutrition are more common in this group.

o Food habits more likely to be manipulated by media

o Food assistance programs can help low-income families develop better food habits.

Food Misinformation and Fads Fad: any popular fashion or pursuit without

substantial basis that is embraced fervently Food fads: scientifically unsubstantiated beliefs

about certain foods that may persist in a given time or community

Unscientific statements may mislead consumers and contribute to poor food habits.

Food Fad Claims Food fad claims may center on

Food cures for specific conditions/illnesses

“Harmful” foods to be omitted from the diet

Certain food combinations may promote health, weight loss

“Natural” foods can prevent disease Food fad claims tend to focus on foods, not the

specific nutrients in foodDangers of Food Fads

Danger to health/failure to seek appropriate medical care

Money wasted on fad supplements Lack of sound knowledge that counteracts

scientifically based health information Distrust of the food market/unwarranted

rejection of all modern food production

Vulnerable Groups Elderly persons Young persons Obese persons Athletes and coaches Entertainers

10 Red Flags

Factors Determining Food Choices Physiologic factors

Allergy Disability Health-disease status Heredity Needs, energy, or nutrients Therapeutic diets

Psychological factors Habit Preference Emotions Cravings Positive or negative

experiences/associations Personal food acceptance

VITAMINS Nutrients that our body does not make on its

own. Thus we must obtain them from the foods we eat, or via vitamin supplements.

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They are essential for providing good health and are necessary for many life functions.

Should I get my vitamins from food or supplements? A diet high in fiber and low in fat is the best way

to meet daily nutritional needs. If you closely follow the “food pyramid” then you

should meet the RDA (Recommended Dietary Allowances) for vitamins and nutrients.

Supplements are best when accompanied by a well balanced diet.

Supplements should not replace a healthy diet. Food provides calories and energy that are

required for daily activities; vitamin supplements do not provide energy or calories.

Do I need a multivitamin supplement? It does not hurt to get a little to take a

multivitamin daily to ensure proper nutrition. Most college students are not eating a well

balanced diet and could use the added nutrition of a multivitamin.

When choosing a supplement, select one that meets 100-300% of the RDA.

What do Multivitamins contain? A multivitamin should contain fat-soluble vitamins

A, D, E; water-soluble vitamins B1, B2, B6, B12, niacin, pantothenic acid, biotin, folic acid , and Vitamin C.

They will also usually have minerals such as zinc, magnesium, copper, and calcium in them.

What does RDA mean? Recommended Dietary Allowances These are suggested levels of essential nutrients

considered adequate to meet nutritional needs of healthy individuals.

What are antioxidants? Defn: Substances that fight off free-radicals in our

bodies. Free radicals are compounds within our bodies

that may lead to chronic disease and/or are involved in cell tissue damage.

Examples of vitamins that contain antioxidants are… C, E, and Beta Carotene.

What is the difference between fat-soluble and water-soluble vitamins?

Fat-soluble are stored in the liver and fatty tissues. These are not readily excreted from the body.

Water-soluble vitamins travel in the blood and are stored in limited amounts. These are readily excreted from the body through urine.

What factors should I consider before taking a vitamin supplement?

Do you eat foods high in vitamins and minerals?

Are you dieting? Do you follow the Food Guide Pyramid? Do you smoke and/or drink regularly? Are you pregnant? Are you over 50 years old? Are you taking prescription drugs?

Supplements that aid in suppressing stress Increasing serotonin levels in the brain wards off

stress related symptoms like depression, irritability, and frustration.

The mineral magnesium can help to regulate serotonin levels.

Antioxidant supplements can also break up free radicals that cause harm to your body.

TRANSCULTURAL PSYCHIATRYo It is a branch of psychiatry concerned with the

cultural context of mental disorders and the challenges of addressing ethnic diversity in psychiatric services.

Importance of Transcultural Psychiatry

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• Boundaries between normality and pathology vary across cultures

• Thresholds of tolerance for specific symptoms or behaviours differ across cultures.

• A given behaviour is abnormal or not and whether it requires clinical attention depends on cultural norms.

• Cultural meanings, habits, and traditions contribute to either stigma or support.

• It provides coping strategies and suggests help seeking options.

How is mental health and illness seen before?o In the 18th and early 19th centuries, people with

mental illness could be cast out from society. If harmless, they were ignored and left to cope as best they could; if considered dangerous, they were confined, sometimes in degrading conditions. Confinement was a way of removing them from society; treatment was rudimentary and mechanical restraint was sometimes necessary.

How does culture contribute to mental illness?1. Pathogenic effects o Cultural beliefs, values, traditions and norms are

seen to have direct effect.2. Pathoselective effectso Through enculturation & socialization some

individual members of a given society select culturally influenced reaction patterns, which may be pathological.

3. Pathoplastic effect o Manifestations of symptoms are highly influenced

by the culture settings of the society in question.4. Pathoelaborating effects o Situations where the cultural context exaggerates

behaviours which otherwise are normal 5. Pathofacilitative effects o Culture influences the frequency at which a

particular problem occurs.6. Pathoreactive effects o How society and individuals react to

psychopathology, and thereby affect the expression, course and outcome of psychopathology.

How do other cultures perceived mental health and illness?BLACKS

o Blacks perceived persons hospitalized for mental illness as different and inferior to normal people and believed these patients should be restricted to protect society

o Mental illness was associated with shame and embarrassment, and both the affected individual and the family hid the illness

o Mental illness is frequently stigmatized and misunderstood

o They tend to rely on family, religious and social communities for emotional support, rather than turning to health care professionals

o They underestimate the impact of mental disorders- depression “are just the blues”

NORTH AMERICAN INDIANSo View mental illness as a form of supernatural

possession and imbalance and disharmony with the inner and outer natural forces of the world

o The cure was to call in the shaman, or medicine man, who would invoke different magical spells to drive out the evil spirits causing the mental illness

o High rates of Alcoholism, Suicide among youth, Domestic Violence and Homicide

o Ideas about health and illness place emphasis on dysfunction of the body than is typical of biomedicine and more on relationship within society

o Relates spirituality to mental illnesso Traditional self-care prevention measures may

include religious or traditional magical elementsHISPANIC AMERICANS

o Mental Illness evokes shame and signifies a weakness in character

o Prefers to treat mental illness as family problem rather than a psychiatric illness

o Create culturally defined labels associated with mental illness that often diminish help-seeking behavior

ASIAN AMERICANSo View mental illness as shameful, evil spirit, soul

loss, wrong doing, and punishmento In the traditional belief system, mental illnesses

are caused by a lack of harmony of emotions or , sometimes, by evil spirits

MIDDLE EASTERNo Mental illness is a major social stigma; somatic

complaints most likelyo Mental illness may also be perceived as a test or

punishment from Allah

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How do we provide culturally competent care for clients with mental illness?CROSS CULTURAL COMMUNICATION

o Ability to understand and state an issue or problem as it is perceived from the client’s perspective

o Reducing resistance and defensivenesso Recognizing that everyone makes interactive

mistakes from time to timeSELF REFLECTION AND AWARENESS

o Learning about your own cultural orientation and about yourself

PAIN in Transcultural Nursing• An unpleasant sensory and emotional experience

associated with actual or potential tissue damage, or described in terms of such damage.

• A major symptom in many medical conditions, and can significantly interfere with a person's quality of life and general functioning.

TYPES of PainNociceptive Pain

• It is caused by stimulation of peripheral nerve fibers that respond only to stimuli approaching or exceeding harmful intensity (nociceptors), and may be classified according to the mode of noxious stimulation.

Neuropathic Pain• It is caused by damage or disease affecting any

part of the nervous system involved in bodily feelings.

Phantom Pain• Pain felt in a part of the body that has been lost or

from which the brain no longer receives signals. It is a type of neuropathic pain.

Psychogenic Pain

• Also called psychalgia or somatoform pain, is pain caused, increased, or prolonged by mental, emotional, or behavioral factors.

Breakthrough Pain• Pain that comes on suddenly for short periods of

time and is not alleviated by the patients' normal pain management.

Categories of Culturally-based Responses to Pain:Stoicism

• People from cultures that value stoicism tend to avoid vocalizing with moans or screams when they are in pain. They may strive to keep their faces "masked," trying not to show their pain even by grimacing.

• Northern European and Asian backgrounds Expressivity

• Indeed, some cultural groups believe that one of the best ways to cope with and relieve pain is to groan or scream.

• Members of these groups may prefer not to be alone when they're in pain.

• Hispanic, Middle Eastern, and Mediterranean backgrounds

RELIGIOUS and SPIRITUAL ASPECTS OF PAIN • In one case, a Nigerian refugee to the U. S.

suffered a severe knee injury and underwent arthro-miscroscopic surgery. His American nurse waited for him to request pain medication, but he never did. Being Muslim, he offered his pain to Allah in thanks for the good fortune of being allowed the special surgery.

• In a similar case, a Filipino patient hospitalized for shoulder surgery admitted to his nurse that he was in severe pain. However, he wasn’t taking his pain medication because he believed it was God’s will that he had such pain, and God would give him the strength to bear it.

• A similar stoicism in the face of pain may be common among Buddhists who believe acceptance of suffering leads to spiritual growth.

• Among some Native Americans, the blessing of medications by a tribal medicine man puts a patient more at peace with the creator which in turn makes the medicine “stronger”.

Cultural Perceptions On PAIN TREATMENTS• Are shots more effective than pills?• Does a bigger pill work better than a smaller one?• Is bitter medicine stronger and more effective

than medicine that tastes good?• Answers to questions like these are indeed often

dependent upon cultural background.

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Decisions About Managing Pain• Pain from the same source may be perceived by

one person as an expected part of life• By another as a harbinger of a serious health

problem• And by still others as deserved punishment, a

character- or karma-building opportunity• Others assume that their health and well-being

are largely in their own hands. • In contrast, other groups tend to be fatalistic and

believe they can exert little influence over the future, including matters of health, illness, and pain.

• Some cultures teach that it's rude to tell health care practitioners about pain.

• In the Western biomedical culture, medications are the first line of defense.

• Whereas Eastern cultures tend to prefer medicinal herbs, touch, and energy therapies such as acupuncture and yoga.

PROBLEMS Complicating Pain Management• Language and interpretation problems• Nonverbal communication problems• Culturally or linguistically inappropriate pain

assessment tools• Underreporting• Reluctance to use pain medications• Access to pain medications• Providers' fears of drug abuse• Prejudice and discrimination

Culturally Comfortable Pain Management• Cultural values and practices that are beneficial to

the patient's health and well-being…• Cultural practices that are neither helpful nor

harmful to the patient's health and well-being…• Cultural practices that are harmful to the patient's

health and well-being…• Because culture is such an important part of a

person's identity…Respecting cultural normsfeeling of being valuedimproved communicationimproved pain outcomes.

• One very effective way to educate the patient is through the classic LEARN model. Listen,Explain, Acknowledge,Recommend,Negotiate

CONCLUSION• RESPECT clients as individuals by recognizing that

clients can hold different beliefs about pain.

• RESPECT clients’ responses by recognizing that clients have the right to respond to pain in the way they learned is appropriate.

• RESPECT clients by recognizing that expressions of pain vary widely and no expression is good or bad.

• Never stereotype a person on the basis of culture. Expressions of pain vary BETWEEN cultures and WITHIN cultures.

QIGONGQigong means "working with the qi." It is a powerful system of healing and energy medicine from China. It is the ancient Chinese art and science of using:

Breathing techniques, Gentle movement, and Meditation

Tributaries of QIGONGQigong is like a great river fed by four major tributaries:

Shamanism,Spirituality, Medicine, and Martial arts

Shamanism and Spirituality Qigong-like exercises and meditations are used by

shammans to commune with nature and natural forces and to increase their powers of healing and divination.

The Buddhist emphasis on tranquillity, awareness, and diligent practice.

Qigong was the ideal way for Taoists to realize their goal of :

• wuji, • xing ming shuang xiu ,

Medicine and Martial Arts Chinese medicine includes acupuncture,

herbalism, massage, diet, and qigong. The major early text on qigong is the Dao-yin Tu

-"Dao-yin Illustrations" (168 B.C.). Hua Tuo (second century A.D.) was one of the

great early qigong masters Five Animal Frolics

Crane, Bear, Monkey, Deer, and Tiger

Martial artists looked for ways to increase speed, stamina, and power, improve balance, flexibility, and coordination, and condition the body against injury.

BENEFITS

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People do Qigong to maintain health, heal their bodies, calm their minds and reconnect with the spirit.

“adding life to your years” Clear & tranquil mind, happy attitude Deeper, restorative sleep, increased vitality &

sexuality Comfortable warmth Clear skin, efficient metabolism Bright eyes Intuition, Creativity, Spiritual Effects Therapeutic balancing of the meridians and

functions of the body. Changes in Blood Chemistry in Hypertensive

Patients Improvements in heart functioning,

microcirculation and cardiovascular function Reversing symptoms of senility (anti-aging) Increased blood flow to the brain It can be used by the seriously ill. It prevents injury to joints, ligaments and bones. It speeds up recovery time from injuries &

operations. It builds athletic and martial arts power.

Implications to Transcultural Care o It assists clinicians and health care providers by

providing a framework or baseline for learning. o Becoming fully familiar with the normative

cultural values affecting interactions with patients practicing forms of alternative or complementary medicine from different cultures is a process that takes time and experience.

o It enables one to reflect on patient’s choice or option to health care services – comparing and contrasting cultural views that can be integrated with the patient’s practices, ensuring that it is safe and effective.

REIKI THERAPY• form of alternative medicine/oriental medicine• developed by Mikao Usui, a Japanese Buddhist in

1922• a spiritual practice making use of the technique of

palm healing or hands-on-healing • There are two main branches:

– Traditional Japanese Reiki– Western Reiki

• Reiki – From the Japanese word Reiki meaning

“mysterious atmosphere”– From the Chinese word Linngi which

means “supernatural influence”

• Rei – Spirit, miraculous, divine

• Ki – “gas, vital energy, breath of life,

consciousness • Made Reiki while performing Isyu Guo • Isyu Guo

– Buddhist training course held on Mount Kurama

– Involved meditation, fasting, chanting and prayer.

• Usui Reiki Ryōhō Gakkai – “Usui's Spiritual Energy Therapy Method

Society“ – First clinic

Teachings

• Inexhaustible• Used to induce a healing effect.

• Anyone can gain access to this energy by means of an attunement process carried out by a Reiki Master

• holistic therapy (healing on physical, mental, emotional and spiritual levels.)

• energy will flow through the practitioner's hands whenever the hands are placed on, or held near a potential recipient

• stress the importance of the practitioner's intention or presence in this process

• others claim that the energy is drawn by the recipient's injury to activate or enhance the natural healing processes.

• the belief is that the energy is "intelligent“, meaning that the Reiki knows where to heal, even if a practitioner's hands are not present in the specific area

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Training• Western Reiki

– commonly divided into three levels/degrees

• Traditional Japanese Reiki – taught intensively under Usui's guidance– weekly meditation meetings to supply

Byosen-hō (an energetic diagnosis) First degree

• Shoden ("Elementary/Entry Teachings“)– basic theories and procedures– A number of "attunements" are given to

the student

– learn hand placement positions– can then treat themselves and others

with Reiki.– Course duration is dependent on the Reiki

Master Teacher ( four sessions spread over a number of days or two sessions over two days)

Second degree• Okuden (“Inner Teachings")

– use of symbols to enhance the strength and distance over which Reiki can be exerted

– use of symbols to form a temporary connection between the practitioner and the recipient

– Another attunement is given to further increase the capacity for Reiki to flow through the student, and empower the use of the symbols.

– can perform ‘distant healing’ • work without being physically

present with the recipient Third degree

• Shinpiden ("Mystery Teachings")– "master training“– student becomes a Reiki Master– one or more attunements can be carried

out and the student learns a further symbol.

– can attune other people to Reiki and teach the three degrees.

– Two types of Master:• Master Teacher - Master of Reiki

and also has the ability to teach (i.e., attune others)

• Master Practitioner - Master of Reiki but does not teach

Western Reiki• works in conjunction with the meridian energy

lines and chakras through the use of the hand-positions which correspond to the seven major chakras on the body.

• Usui used only five formal hand-positions focused on the head and neck then to specific areas where imbalances were present.

CHAKRA• Chakra is a Sanskrit word which means wheel.• A chakra is a wheel-like spinning vortex that

whirls in a circular motion forming a vacuum in the center that draws in anything it encounters on its particular vibratory level.

• The use of the chakras is widespread within Western Reiki, though not as much within

• Traditional Japanese Reiki, as it concentrates more on treating specific areas of the body after using techniques such as Byosen-hō and Reiji-hō, which are used to find areas of disease (discomfort) in the auras and physical body.

Healing• Usui Reiki Ryōhō

– does not use any medication or instruments

– uses looking, blowing, light tapping, and touching

– Used the technique “palm healing” ("tenohira“),

• Believed to transfer universal energy (reiki) in the form of ki through the palms that allows for self-healing and a state of equilibrium

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Treatment Approaches• Recipient lies down and relax using loose,

comfortable clothing.• The practitioner might take a few moments to

enter a calm or meditative state of mind and mentally prepare for the treatment, that is usually carried out without any unnecessary talking.

• Practitioner placing the hands on the recipient in various positions or use a non-touching technique and kept in a position for 3-5 mins before moving to the next.

• General coverage of the head, the front and back of the torso, the knees, and feet

• 12 - 20 positions are used• 45 to 90 minutes • Many Western practitioners use a common fixed

set of 12 hand positions• The intuitive approach might also lead to

individual positions being treated for much shorter or longer periods.

• The use of the 12 hand positions are believed to energise on many levels, by:

• physical level through the warmth of the hands,

• mental level through the use of the Reiki symbols,

• emotional level through the love that flows with the use of the symbols,

• energetic level though the presence of an initiated practitioner as well as the presence of the Reiki power itself

What do patients feel?• feels warmth or tingling in the area being treated,

even when a non-touching approach is being used• A state of deep relaxation• General feeling of well-being - most noticeable

immediate effect • emotional releases can also occur

How long is the treatment?• instantaneous "cures" of specific health problems

are not normally observed• Chronic condition

– three or more treatments with 1-7 day intervals

• Maintaining Well-being– regular treatments on an on-going basis– Intervals of one to four weeks, except in

the case of self-treatment where daily practice is common

• involves the practitioner's hands being held on or near a specific part of the body for a varying length of time

• Usually used for recent injuries

• 20 minutes is typical• 'hands-on work,' compared to distant or "absent

healing. Breathing

• central to many styles of Japanese Reiki• often a neglected topic in Western Reiki.• Joshin Kokyū-hō

– "the breathing method for cleansing the spirit,“ / "Goddess Breath Method“

– performed by sitting straight, with the back aligned, breathing in slowly through the nose. As the practitioner inhales, s/he also breathes the Reiki energy in through the crown Chakra in order to purify the body and make it fit for the flow of Reiki, and is drawn down into the tanden.

Three pillars• Along with the five Reiki principles, Usui based his

Reiki system on three other practises: – Gasshō – Reiji-hō – Chiryō

Gasshō• “two hands coming together“• Meditative state • both palms of the hands are placed together• practised each time at the beginning of Usui's

Reiki workshops and meetings• One technique of Gasshō is to concentrate on the

pads where the two middle fingers meet Reiji-hō

• "indication of the Reiki power method“• means of connecting with the Reiki power by

asking it to flow through the practitioner three times, and is commonly split into three parts

First part• Ask the Reiki power to flow through the

practitioner entering either through the ff:– crown chakra (as this is the highest

ascension)– heart chakra (as indicated by the pure

love of Reiki)– hands (as the palms are attuned with

specific Reiki symbols)Second part

• To pray for the recovery of the person if a specific ailment is being healed, or for the general health of the person if otherwise

Third part• To place both hands, palms facing each other, to

the third eye (the area in between the two eyebrows), and ask the Reiki power to guide the hands to where energy is needed.

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• Reiji-hō – relies specifically on intuition of where to

heal• Byosen-hō

– scans for areas with the hands, feeling for subtle changes in the aura of the practitioner's hands and the aura of the recipient

Chiryō• “medical treatment”• dominant hand on the crown chakra and wait for

hibiki ("feedback") in the form of an impulse or inspiration, which the hand then follows.

• gives free rein to the hand, touching painful areas of the body until the area no longer hurts or until the hands move on their own to another area

INFLUENCES OF RELIGION TO THE HEALTH BELIEFS AND PRACTICES

BUDDHIST FAITH COMMUNITY • Central to its doctrines are the teachings of the

Four Aspects of Reality, which are also known as the Four Noble Truths.

• Buddhism is one of the four largest religions in the world. It focuses on spiritual practices based on its scriptures written in various languages of the world.

Health and illness

Birth • For Buddhists, to be born into human life is

considered an important and auspicious event that is rare and difficult.

Death • For some Buddhist followers, the time of death is

considered to be the transition point to the next life.

ROMAN CATHOLIC • The Roman Catholic Church, the most populous

Christian church, is headed by the Pope of Rome • It maintains the basic Christian tenets of faith,

including the Holy Trinity and the effect of Adam and Eve’s fall from their original sinless state at creation.

• The Catholic Church believes it has the authority and responsibility to be a conduit for God’s grace of salvation, healing and wholeness through prayer and the Sacraments, such as Baptism, Confirmation, Reconciliation, Anointing of the Sick and the Eucharist.

Health and illness • When people need healing, they are encouraged

to request the prayers of other Christians and the saints (especially the Virgin Mary) who they believe are in Heaven and have been given grace to request God’s help for the gift of healing.

• Physical healing is seen as only part of the healing we all seek for body, soul and mind. True healing includes spiritual healing and brings us closer to God and more in union with Christ, the Son of God who, together with the Father, is the author of life and immortality.

Some Buddhists believe a spiritually

focused person can respond to sickness more

peacefully. When illness occurs, some believe

spiritual balance can help them

through the illness.

Buddhists strive to develop the

mind to its fullest potential, which means one puts compassion and

wisdom into practice. They

strive to understand and

work with suffering and

illness so it can bring about the most good for their spiritual

growth.

Buddhists believe men and women

are equal but because mothers are responsible

for bringing children into the

world, they should be

respected with a deep feeling of

gratitude.

The importance of mindful

awareness of all of life's

experience may affect patients' or family members' decisions about

pain medications, out of worry that analgesics may

unduly cloud awareness.

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Hinduism • Hinduism is among the oldest religions of the

world. • Hindus believe in one Universal Supreme Being,

called Parmātmān in Sanskrit language • Hindus believe there are different paths to realize

the same Universal Supreme Being. The three Prime manifestations of Parmātmān are Deities known as Brahmā, Vishnu and Shiva

• These three Deities together represent the Hindu Trinity. The ultimate goal of a Hindu is to refine the spiritual level in every lifetime and ultimately achieve the state of Moksha

Medical Treatment• In Hinduism, mercy killing, assisted suicide and

suicide are against traditional religious values. • The preferred method of handling terminal illness

is to allow nature to take its course. When it comes to artificially prolonging life, there is no prohibition and it is left to the individual to make the decision.

• Because of their belief in the law of karma, Hindus do not believe in abortion, even in the case of rape or disability.(Depending on the person, this may not be true in Western culture.) Every life is sacred and has to fulfill its destiny

ISLAM • The basis for doctrine is found in two main

sources: the Quran, and Sunnah • Muslims believe in Jesus’s virgin birth, the

holiness of his mother Mary, and his miracles. They believe he was a prophet like all other prophets, not the Son of God.

Health and illness • Muslims believe their bodies are given to them as

a trust by God to use appropriately for the attainment of salvation.

• Islam affirms human sexuality as a gift from God when enjoyed legitimately.

• Illness is often regarded in Islam as a trial sent by God with the outcome being dependent on individual attitude.

• Muslim family members often tend to buffer a sick family member from knowing the whole truth about the situation.

• Some Muslim cultures are expressive about pain, especially in the presence of family or people whom they trust.

• Psychiatric problems can be a challenge as family members often do not wish to accept such diagnoses.

• While in the hospital, many Muslims may still wish to perform their 5 daily prayers.

Birth • After worshipping God, taking care of one’s

parents is the second most important duty of a Muslim.

Death • In Islam, death is considered an unavoidable

event that can occur at any time.

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JEHOVA’S WITNESS • They believe Jehovah is the personal name of

Almighty God, as found in the Holy Bible, and Jesus Christ is God’s Son.

• Witnesses believe God’s kingdom mentioned in the Lord’s Prayer is a heavenly government that will rule the earth and restore paradise conditions.

Health and illness • Jehovah’s Witnesses seek quality medical care

and accept the vast majority of medical treatments.

• For Bible-based religious reasons, they do not accept allogeneic blood transfusion

• They also refuse to pre-donate and store their own blood for later infusion.

Death and Grief• There may be a funeral or a memorial service but

there are no last rites or mourning rituals. • They believe death is a state of total

unconsciousness. • They also believe in a resurrection of the dead at

a future. • Decisions about autopsy are a private family

decision. Cremation and burial are equally satisfactory.

JEWISH FAITH • Jews believe in the existence of one indivisible G-

d by whose will the universe and all that is in it was created

• G-d has a covenant relation with humans. The Jews accepted this covenant and try to be an example to all.

• Those commandments are found in the written Torah, the five books of Moses.

Birth • Male babies are circumcised at eight days unless a

medical condition warrants delay. A baby girl gets a baby-naming ceremony in synagogue.

• . A baby girl gets a baby-naming ceremony in synagogue.

Death • Burial takes place 24-48 hours after death;

amputated limbs must be buried with the body