Page 6 • DNA Reporter November, December 2017, January 2018 Yoga: A Body, Mind, Spirit Approach Kim Blanch, RN, LMT Karen Avino, EdD, RN, MSN, AHN-BC, HWNC-BC Kim began her health and wellness career at Baltimore School of Massage over twenty years ago. She pursued her ADN at Southern Maine Technical College and began her nursing career at Mercy Hospital in Portland, Maine. In her time there Kim represented Massage Therapy on the hospital’s Integrative Health Board, as well as Peggy Huddleston’s ‘Prepare for Surgery, Heal Faster’ program. Her interest in mind body therapies led to intensive studies in Myofascial Release, Healing Touch, Health Coaching, and Ayurveda Yoga Specialist certification. Kim now lives in coastal Delaware, operates a thriving wellness practice and enjoys her nursing role in a patient-centered, transitional care program in Population Health at Beebe Healthcare. Kim can be reached at firstname.lastname@example.org. For Karen Avino’s complete bio See Guest Editor on page 1 Kim Blanch The benefits of yoga span the entire human dimensions of the body, mind, and spirit. Studies on the benefits of yoga have shown its efficacy in the reduction of stress-related symptoms as well as establishing its ability to prevent, reduce, or alleviate structural, physiological, emotional, and spiritual pain, suffering, or limitations (Woodyard, 2011). Yoga continues to be widely used as a self-care tool practiced by millions of people globally. It is important for healthcare providers to possess knowledge of the fundamentals of yoga and its many therapeutic effects not only for patient care but also for self-care. This article will focus on yoga’s impact on stress, anxiety, and chronic pain, and associated symptoms of cancer treatment among other conditions. History Yoga, a tradition over 3,000 years old, is recognized by the National Center for Complementary and Integrative Health (n.d.) under the National Institutes of Health as one of the top 10 Complementary health approaches used in the U.S. and is commonly regarded as a holistic method for health promotion. The word yoga comes from Sanskrit, the language of the Hindu culture. Translated to English, it means yoke or union of mind, body, and spirit. Patanjali, an ancient Hindu sage, defined yoga as an 8-limb path and taught a progressive path of practices: yamas, the universal ethical principles; niyamas, the individual self-restraints; asanas, the physical postures; pranayama, the breath/energy regulating techniques; pratyhara, control/quieting of the senses; dharana, the aspect of concentration; dhyana, the meditation practices; and samadhi, the state of elevated consciousness (Satchidananda, 2012). Engaging the principles of these components is believed to bring an individual to a state of mental, physical, emotional and spiritual balance. Stress and Anxiety The morbidity and mortality due to stress-related illness is alarming. Emotional stress is a major contributing factor to the six leading causes of death in the United States: cancer, coronary heart disease, accidental injuries, respiratory disorders, cirrhosis of the liver, and suicide (Salleh 2008). Statistics from the American Institute of Stress (AIS) (2017) reported that 77% of U.S. citizens regularly experience physical symptoms caused by stress, and 73% regularly experience psychological symptoms that are stress-induced. Fatigue was the number one symptom for 51% of those surveyed, and the annual cost to employers in stress related health care and missed work is noted as 0 billion (AIS, 2017). It is the practice of the physical postures of yoga with which Westerners are most familiar, and what has been most often studied. Hayes and Chase (as cited in Diamond, 2011) found evidence that the regular practice of yoga helps reduce anxiety and stress. Yoga increases vagal stimulation and turns off the hypothalamic-pituitary-adrenal (HPA) axis, thereby decreasing the sympathetic nervous system’s stress response and increasing the parasympathetic nervous system’s relaxation response. Daruna (2012) reported that as the parasympathetic response is induced, heart rate lowers, respiratory rate decreases, blood flow is directed toward the organs, and serotonin and dopamine levels rise. This creates a state of rejuvenation and cellular repair. Under stress, white blood cell counts are adversely affected. Given the importance of the body’s ability to use its natural killer cells in antigen production and disease prevention, Daruna (2012) suggested that managing stress is paramount to achieving an overall state of wellness. It is common knowledge that nurses experience stress related symptoms that can lead to implications for patient care and work-life balance. Regular yoga practice was found to improve sleep quality and reduce work stress in staff nurses (Fang & Li, 2015). Alexander, Rollins, Walker, Wong, and Pennings (2015) reported that an 8 week yoga intervention with nurses found significantly higher levels of self-care and less emotional exhaustion and feelings of depersonalization. The American Nurses Association (ANA) Healthy Nurse Healthy Nation Challenge 2017 encourages nurses to include physical activities in daily living. Yoga will care not only for the body, but the mind and spirit of the nurse as well. Chronic Pain Studies have shown that asana (a sitting posture), meditation, or a combination of the two reduced pain and disability while improving flexibility and functional mobility in people with arthritis, Carpel Tunnel syndrome, back pain, and other chronic pain conditions (McCall, 2007). Chang, Hart, Sklar, & Groessl (2016) reported on yoga’s effect of pain medication frequency and dosage reduction in addition to enhanced gait function and mitigation of age-related gait changes. According to Chang, Hart, Sklar, Groessl (2016) yoga can reduce pain and disability, can be practiced safely, and is well received by participants. Cancer Yoga’s effects on cancer patients showed a decrease in post-chemotherapy induced nausea frequency, intensity, anticipatory nausea, and anticipatory vomiting (Raghavendra, Nagarathna, Nagendra, Gopinath, & Srinath, 2007). A meta-analysis of 18 studies by Harder, Parlour, and Jenkins (2012) reported positive effects for treatment-related side effects in favor of yoga interventions, with the greatest impact on global quality of life scores and emotional well-being. One of the main goals of yoga is to achieve tranquility of the mind and create a sense of well-being, feelings of relaxation, improved self-confidence, improved efficiency, increased attentiveness, lowered irritability, and an optimistic outlook on life. The practice of yoga generates balanced energy, which is vital to the function of the immune system (Arora, 2008). To date, research provides convincing evidence of yoga’s numerous therapeutic benefits and its potential to improve health outcomes. References Alexander, G. K., Rollins, K., Walker, D., Wong, L., & Pennings, J. (2015). Yoga for selfcare and burnout prevention among nurses. Workplace health & safety: Promoting environments conducive to well-being and productivity. AAOHN, 63(10), 462 – 470. doi: 10.1177/2165079915596102 American Institute of Stress (AIS) (2017). Stress Research. Retrieved June 26, 2017 from https://www.stress.org/stress-research/ Arora, S., & Bhattacharjee, J. (2008). Modulation of immune response in stress by yoga. International Journal of Yoga, 1, 45–55. Chang, D.G., Holt, .J.A., Sklar, M., & Groessl, E.J. (2016, January 1). Yoga as treatment for lower back pain: A systemic review of the literature. Journal of Orthopedics and Rheumatology, 3(1) 1-8. Diamond L. (2012, March). The benefits of yoga in improving health. Primary Health Care, 22(2), 16-19. Daruna, J. (2012). Introduction to psychoneuroimmunology. Burlington, MA: Elsevier Academic Press. Fang, R. & Li, X. (2015). A regular yoga intervention for staff nurse sleep quality and work stress: A randomized controlled trial. Journal of Clinical Nursing, 24: 3374–3379. doi:10.1111/jocn.12983 Harder, H., Parlour, L. & Jenkins, V. (2012) Randomized controlled trials of yoga interventions for women with breast cancer: A systematic literature review. Supportive Care in Cancer 20(12), 3055- 3064. doi:10.1007/s00520-012-1611-8 Hayes, M., & Chase, S. (2010). Prescribing yoga. Primary Care, 37(1), 31-47. McCall, T. (2007). Yoga as medicine. New York: Bantam Dell/ Random House Inc. National Center for Complementary and Integrative Health. (n.d). Yoga as a complementary health approach. National Institute of Health. Retrieved from https:// nccih.nih.gov/news/multimedia/infographics/yoga Raghavendra, R.M., Nagarathna, R., Nagendra, H.R., Gopinath, K.S., Srinath, B.S., Ravi, B.D., … Nalini, R. (2007). Effects of an integrated yoga programme on chemotherapyinduced nausea and emesis in breast cancer patients. European Cancer Care, 16, 462– 74. Salleh, M. (2008, Oct). Life event, stress and illness. Malaysian Journal of Medical Science, 15(4), 9-18. Satchidananda, S. S. (2012). The yoga sutras of Patanjali. Buckingham, VA: Integral Yoga Publications. Woodyard C. (2011, Jul-Dec). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga, 4(2), 49–54.
November, December 2017, January 2018 DNA Reporter • Page 7 Nurses Need Rest Sarah Lewis, RN Sarah is a Clinical Nurse III at Beebe Healthcare in Lewes, Delaware. She provides inpatient care on a medical-surgical unit, specializing in the care of oncology/hematology patients. Sarah is an active part of shared governance within the workplace and is a part of several initiatives to improve patient care and staff satisfaction, Sarah Lewis especially through holistic research and practices. She is a graduate of the Margaret H. Rollins, School of Nursing and will complete her BSN degree from the University of Delaware this coming Fall. Sarah is a member of the Delaware Nurses Association and the Oncology Nursing Society. Presently, Sarah’s passion for holistic health allows her to serve her peers and her community through health promotion practices. Sarah can be reached at slewis@ beebehealthcare.org. Perhaps you’ve heard the idiom, “no rest for the weary.” This saying might accurately describe what many nurses today are experiencing: sleep deprivation and insufficient or ineffective rest habits resulting in chronic fatigue. Fatigue is associated with a decline in judgement and the ability to navigate situations; slowing of motor responses and reaction times; impaired mood and ability to effectively communicate; and weakening of ability to cope (Antill, 2016). In a recent survey, 85% of nurses claimed that work is heavily associated with fatigue and 98% of nurses stated that nursing is difficult, both mentally and physically (Brooks, 2017). In fact, 93% of the nurses surveyed also suggested feeling mental and physical fatigue at the end of a shift (Brooks, 2017). Research has identified that shift work can have negative long-term effects on health, especially healthcare workers who work night shifts. Brooks (2017) identified several key concerns amongst nurses related to working 12 hour shifts (versus 8 hours) that may potentially contribute to accidental patient harm, such as not being able to take breaks during shifts, lack of adequate sleep between shifts, and anxiety related to fatigue. A combination of any or all of these common occurrences can contribute to burnout and other physical or mental health problems. Blasche, Pasalic, Bauböck, Haluza, and Schoberberger (2017) found strengthening the nurse’s intention to take a break during work may help increase rest-break behaviors to avoid the buildup of fatigue and distress over a workday. Presently, it is commonly known that on the job, nurses take a break at their own discretion. This means that work-related fatigue and well-being are also individually determined. However, if organizations want to enhance performance and well-being of their employees, policies should be made to ensure there is support available to encourage self-care and rest breaks during the workday. The American Nurses Association (ANA, 2017) issued the grand challenge, Healthy Nurses Healthy Nation, and rest has been identified as a significant health domain. Themes featured on the nurseled discussion boards included questions such as “what is rest?”, “why is getting adequate rest so challenging?”, “do you feel you get enough rest?”, “is your workplace conducive or supportive of obtaining adequate rest,” and the list goes on. While the ANA’s grand challenge has given a voice to nurses as they commit to empowering themselves to find the answers to these “rest” questions, it is important that nurses understand rest practices and have the resources available to obtain adequate rest consistently in a way that will improve their overall health. There are many definitions, opinions, ideas, and concepts surrounding the topic of rest …it can lead people to wonder: is there a perfect recipe for rest out there? Nurses could be the first to admit that they need a “rest for dummies” crash course. While there probably isn’t a perfect way for everyone to rest, individualized best rest practices can be discovered and crafted into daily living. There are three different types or classifications of rest, including total, passive, and active rest (Brandon, 2014). Total rest is most commonly associated with sleeping and going through R.E.M. cycles during sleep (Brandon, 2014). However, total rest can also include complete mental and physical rest from all activities such as working, exercising, watching television, or socializing; this type of rest allows the body to “reset” itself, promoting healing and cellular repair (Brandon, 2014). Passive rest, commonly associated with the term “relaxation” is associated with improved quality of life (Hogan, 2016). This type of rest causes our parasympathetic system (the system responsible for “resting and digesting”) to take charge (Hogan, 2016). During relaxation, thought processes are diverted, even if only for a short period of time, and can significantly reduce stress hormone levels in the body (Brandon, 2014). If an individual is fairly active, passive rest can simply be a change in activity such as finishing a run and then taking a yoga class. Other ideas to consider for passive rest include: reading, walking, listening to music, meditating, practicing mindfulness awareness, taking a shower or bath, or spending time with a loved one. Active rest can be defined as a “reduction in work load” and is basically a planned slowing-down of normal daily activity (at work or during leisure time) (Brandon, 2014). Athletes might be familiar with active rest by means of designating significantly less intense workout day’s in-between high intensity work out days (Brandon, 2014). This same principle applies to everyone: engaging in active rest allows an opportunity for the body to re-energize and relax on planned “less busy” days so that health can be maintained amidst the more stressful, hectic days. Ultimately, individuals need to find what works best for engaging in healthy self-care practices to achieve a state of contentment and relaxation. Though individuals tend to view rest as a “waste of time” and may associate rest with feelings of guilt, rest is as essential to the body as food; life cannot be sustained without rest (Atkinson, 2010). True relaxation is not a state of laziness; rather it is being proactive to continue to achieve a state of wellness and health in your body, mind, and spirit (Hogan, 2016). Developing healthy rest habits is just as important as maintaining healthy sleep routines. Rest and sleep go hand in hand; it is important to any healthy lifestyle to develop healthy self-care practices within all the domains that Healthy Nurse Healthy Nation addresses (ANA, 2017). Together, as a community, nurses can continue to encourage and support one another as they join this movement to promote health through rest practices. Perhaps then nurses can reserve the nursing diagnosis of “self-care deficit” for their patients and become role models for “self-care adequacy.” References American Nurses Association (ANA) (2017). Rest. Retrieved from https://engage.healthynursehealthynation.org/rest Atkinson, L. (September, 2010). Why rest is as good as sleep as long as you don’t just slob out in front of the TV. Retrieved from http://www.dailymail.co.uk/health/ article-1313812/Why-rest-good-sleep-long-dont-justslob-TV.html Blasche, G., Pasalic, S., Bauböck, V., Haluza, D., & Schoberberger, R. (2017). Effects of rest-break intention on rest-break frequency and workrelated fatigue. Human Factors, 59(2), 289-298. doi:10.1177/0018720816671605 Brandon, L. (November, 2014). Dr. Quiet’s three types of rest. Retrieved from https://chekinstitute.com/blog/drquiets-three-types-of-rest/ Brooks, M. (March, 2017). Nurses love what they do but battle fatigue, survey shows. Retrieved from http:// www.medscape.com/viewarticle/879761 Christensen, D. (2016). Balance perfectionism and compassion with a meditation exercise. Retrieved from https://voice.ons.org/news-and-views/balanceperfectionism-and-self-compassion-with-a-meditationexercise?utm_campaign=Healthy%20Nurse,%20 Healthy%20Nation&utm_content=52467135&utm_ medium=social&utm_source=facebook Hogan, K. (December, 2016). The different types of rest you need and how to get them. Retrieved from https://www. mindbodygreen.com/0-28061/the-different-types-ofrest-you-need-how-to-get-them.html
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