What Is Spiritual Health?

What is Spiritual Health?

Spiritual health is about coping and inner strength. Athletes have a pep talk prior to a game. We had pep rallies in high school, the whole assembly would show support and give our team energy for the game. Statistics show a correlation between how well a child does in school, and how much family support they receive. I was told as I was getting married not to forget my girlfriends, when life gets tough they will be there for you. Life doesn’t come with a guide book, babies aren’t born with an instruction manual. Life is designed to be a team sport, we turn to our mothers, grandmothers, girlfriends, sisters, brothers, fathers and friends. No two lives are the same, but challenges are similar and sometimes having someone tell you, “you are strong, you can do this”, is just what you need to get you to the next level, around that next corner. Each challenge won brings new strength and understanding. I admire multi-generational households where the grandparents can provide mental support and say “I’ve been there, done that, you have the strength and ability to get through this”. Children provide physical work and receive the satisfaction that they are valuable, important, and needed.  Having a co-worker say “nice job”, a pat on the back, a hug- can be priceless. Spiritual health is having someone to talk to for strength or guidance when faced with an overwhelming situation, external support from nature or creation. Where do you go to find strength?

Dr. Masaru Emoto in his book “The Hidden Messages in Water,” demonstrates how water molecules respond brilliantly to positive messages.  The human body is composed mostly of water; we should also demonstrate a positive physical response to supportive messages.

What if we don’t have any family, we don’t fit the part, we aren’t pretty, we aren’t good at sports. We don’t have friends, we lost the game, or we lost our job. We were born with a skin condition, we would rather be forgotten by society and ourselves.  What happens when high school is over, we move away, we trying to juggle work, marriage, children, home responsibilities and life. We don’t have time to take care of ourselves and the pressure is on.  Where do we derive spiritual support? 

My co-worker, a medical provider, doesn’t like prescribing narcotics for chronic pain. She’s made the observation that many of her chronic pain patients are lacking external support. They have multiple diagnoses, always come alone,  have many psychosocial complaints. They are consumed by their internal pain and obsessed with the workings of their body. They don’t know how to get outside of themselves. How many times is a pill used to treat a symptom of a bigger problem? What is really the best treatment? I wonder how much of our health care problem is related to treating symptoms and not finding more appropriate solutions. Are we over relying on medication to treat societal problems? 

John Kretzmann and John McKnight, from Northwestern University wrote a  fantastic workbook, “Building Communities From the Inside Out”. It is an excellent workbook. They suggest that “communities cannot be rebuilt by focusing on their needs, problems, and deficiencies. Rather, community building starts with locating the assets, skills, and capacities of residents, citizens, citizens’ associations, and local institutions.” Their workbook is packed with ideas for making connections within a community. They have a Capacity Inventory (pg 19) for helping individuals to identify their skills and talents. If you can walk, talk, hear, or see there is something you can do to support your community and give yourself feelings of self- worth and belonging. Everyone is valuable, sometimes we need to get outside of ourselves to realize that. If you want to build a playground, you find a group of passionate workers, citizens of the community, who will be invested in the project. Not only will they give the project their best effort to complete, but they will take care of it for years to come.

 Rob Bell, a motivational speaker, said the best job for a shy introvert, or someone lacking in feelings of self-worth, is to be a greeter or a bagger in a grocery store. You have to smile and say “Welcome”, people will inadvertently smile and say “Thank You” back. You have people smiling and saying “Thank You” all day long! He also gave me a business card, that says, “ I’m Alive, I’m Awake, and I Feel Great!” he said read this card when you wake up in the morning and you won’t go  back to sleep. 

Hospice does a Spiritual Assessment. They want to provide comprehensive care to meet all of your needs. They ask questions on spiritual awareness: feelings of abandonment, anger, faith, fear/anxiety, forgiveness issues, gratitude, grief, guilt/shame, hope, inner peace, joy, love, preparedness for death, questioning and trust. They want to know where you derive support, they understand that relationships are huge and life is a team sport. They encourage healing relationships.  

I visualize in our future, nurse case managers evaluating all the needs of our clients. Assessing their physical, mental and spiritual needs and providing direction on how to best meet those needs. It might include conventional medicine and pharmaceuticals but it might also include a deeper investigation into the underlying causes of the body’s dysfunction.  It might include skilled practitioners who know how to listen to the body to help it heal itself. Life is a team sport, health involves the whole community.

Importance of Behavioral Health

What If We Include Primary Care Behavioral Health?

It seems logical to me that we would all need psychological help at some point in our lives, if we have ever raised children, experienced divorce, sickness, loss of family members, had a change in job, or moved - we have experienced stress. If merely hearing some bad news can cause the body to leak fluid from our eyes, cause our face to swell, our chest to feel heavy with pressure, making it hard to breath, we might choke or vomit. How can we not believe that stress has physical ramifications? Couldn’t we expect that prolonged stress might have deeper long term damage?  It’s also logical to me that a chemical pill might ease my pain and provide some relief but I still need to figure out how to move forward in my life. In the case of acute crisis, help might include focusing on the present, “I am safe here and now, in this room, in this place”. Healing might include focusing on breathing; count to 3 when I inhale and count to 4 when I exhale. It might be approaching life in smaller pieces - focusing on minute to minute, or hour by hour, rather than day by day. It might include helping to recognize that we all behave differently under stress, and that our thoughts and emotions do not define who we are. 

Some patients get sick from having unhealthy behaviors, others stay sick because they can’t or won’t follow recommendations from their providers. Primary Care Behavioral Health (PCBH) in the clinic can investigate what is preventing patients from improving. PCBH can go into an office visit after the MD has completed his assessment to help draft a plan of care that takes into consideration a patient’s attitudes, beliefs and behaviors. PCBH investigates the patients coping ability, relationships, support, motivations, and ambitions. They use several assessment tools to maximize their time, so they can identify the roots of dysfunction and offer tools for dealing with them. They investigate ways of motivating patients to want to be healthy and they can assist a member in accepting Mental Health services more quickly. They may be able to increase the patient’s willingness to take responsibility for their health, and work with the provider toward optimal health. Patricia Robinson & Jeffrey Reiter in their book - Behavioral Consultation and Primary Care: A Guide to Integrating Services  - report that “up to 70% of Primary Care medical appointments are for problems stemming from psychosocial issues (Gatchel & Oordt, 2003).” They go on to say that “the use of psychotropic medications has gone up dramatically since the mid-1980s amongst all prescribers, and psychotropic medications are now among the most widely prescribed medications in the USA (Pincus et al.,1998).” The antipsychotic drug Abilify has the highest sales of any drug in America according to WebMD. 
Another benefit of PCBH is that their visits in a medical visit, not mental health visit, decreases the stigma of mental health services. Mental health has a large percentage of no show appointments and PCPs are often seeing patients for depression, anxiety and copying issues, when these patients might be better served by mental health. 

Life is a team sport and we all need a little help now and then. Hopefully when I’m down I have friends, family, or spiritual support to help me through this challenging period. PCBH can help define strengths and amplify them, problem solve challenges to deal with them, help me move forward toward a more fluid existence. Remember how it feels to be in love? My husband felt light as a feather, 20 years younger, stronger than a horse, his vision was clearer, hearing more acute, and sense of smell more vibrant; all because I said, “I love you, and I want to be with you”, simple little words. Let yourself feel the value of a smile, a “Good Job!” We all need to be reminded occasionally that challenging days will pass, and the sun will shine again. Help me to understand that others have been through similar pain and challenges, and survived. 

 If we understand the power of emotions and our psyche on health, then it makes sense to me that we need to listen and assess this to achieve Optimal health. When, I worked in the hospital, we expected the primary care provider in the clinic to manage the patients overall health and adjust the plan of care.  As a Home Health nurse, I averaged about 45 minutes per visit, 15 minutes to assess how my patient was feeling today, 15 minutes to evaluate their overall health and assess changes, and the last 15 minutes teaching and updating the plan of care.

 Primary care physicians have only 15-30 minutes total per visit with patients to manage their care, and they have the added disadvantage of seeing their patients out of their natural surroundings and up to 32 patients a day. I can’t understand how a primary care provider can review and assess response to medications, assess overall health, coping ability, diet, bodily functions, answer questions, and chart in a total of 15-30 minutes. Sadly, most providers will admit they can’t finish in 15 minutes so they focus on the top 2 questions, scan the information they have, make a rushed decision and chart after hours on most of their patients. Most of the primary care providers I know are spending at least 1-2 additional hours per day, charting on their own time, after hours or on their days off. Often they accept this as a requirement of the job. It’s a no win situation and it isn’t cost effective. I question if to make sure they aren’t missing anything, providers are ordering additional diagnostic tests including MRIs and CT scans. If providers had more time with patients, they might feel more comfortable watching and waiting to see if patients improve in a few days. If health care is our highest cost expense in the US shouldn’t we be able to expect more as providers and as patients? To put this into perspective, we value our property so much that we pay taxes to have fire and police protection available when needed for as long as it takes to get the job done.  Property is replaceable, the human body = one per person for life! 

Primary Care Behavioral Health is partially designed to address this issue of not enough time to thoroughly evaluate patients. If the problem is at least partially stress induced wouldn’t it make sense to try to remove or treat the stress variable and see if the physical symptoms resolve? Optimal Health Care involves a team approach; no single provider can meet the needs of all of our patients. Working with the strengths of each other, we create a win –win situation for everyone which is more cost effective for the providers, the patient, and the insurance company. 

Nurses provide an important role, by triaging the background of the patient’s problems before the office visit. Nurses can organize service providers to increase efficiency and facilitate comprehensive holistic care for our patients.  

For more information on Primary Care Behavior Health go to:

www.Primarycareshrink.com

www.integration.SAMHSA.gov

www.DrArmandoHernandez.com – Thank you to Dr. Hernandez for your inspiration and resources.

What If It's About Attitude?

What if it’s about Attitude?

When I go to work I leave my personal belongings and my personal life in my car. When I get on the phone with my patient it’s all about them. Why are they calling? What’s really the problem? 

I’m listening to the tone of their voice, back ground noises, and what’s beyond their words. My attitude is I want to help you. I know that if my intentions are good, my words and actions will follow. Over 90% of my patients are stressed. I try to hear what they are saying, knowing that if they are angry or upset their words are often not the whole story. Why are they frustrated and hurting? Often they are losing their ability to cope. They need help and they’re scared. They are losing control. 

I want to get to the root of their problem. I need them to trust me and talk to me. Often they don’t know what they need, I try to help them figure out what they are trying to say. When did you first notice this problem? How did it start? Often a problem doesn’t have a clear starting point, then I look for a gradual progression to the problem: stress that won’t let up, repetitive work or activity. Emotional and mental stress can often lead to physical breakdown. My best friend swears she developed breast cancer due to working in child welfare and having to take children away from their parents. The emotional pain traumatized her “motherhood”. I would swear I developed appendicitis due to being scheduled to work Christmas Eve and Christmas Day at both my jobs while raising a young family. I was stressed to my “core”. As health care providers we try to help our patients identify what’s really wrong. It’s our responsibility to encourage them to want to get better. It’s my goal to give them hope, to see a little light at the end of the tunnel.
“Look what you’ve already accomplished, here’s the next steps.” “Can you see the light at the end of the tunnel? You can get through this.”

Sometimes it’s all about Attitude. I want them to be well. Sometimes they just need to believe someone cares. They need the tools, strength and motivation to get better and they need to take responsibility to do their part in getting well. It’s my responsibility to teach and offer resources. It’s their choice whether they accept my help and  what actions they will take. 

Group Health Cooperative has Primary Care Behavioral Health in their clinics. When I first heard about this I thought, “How am I going to work with Mental Health?” I can appreciate that Behavioral Health workers in the clinic with primary care, could be handy in cases of depression or anxiety or with patients whose health was complicated by other mental health diagnoses. At first, I wasn’t sure how to utilize them. However, over the first year of having them available I’ve come to realize that every diagnosis carries a behavioral component. Now, it seems like an incredibly bright and insightful idea, it’s progressive and important, a step in the right direction. Anytime a patient is not improving, needs more time to talk, or needs help coping, we send them in. Our behaviors and choices affect the food we eat, our stress, our compliance, the risks we take. Our attitude and behavior is a reflection of our sense of personal responsibility.  Often whether we are sick or well, can be a matter of value and self -respect. Sometimes patients need help to find a reason to care. What’s your motivation?

I took care of a young mother in the hospital who had lung cancer. She was smoking 2 packs of cigarettes a day. She loved her children, her husband,  and cigarettes – in that order. She was a very strong and independent woman. She came in for surgery, stayed a few days and went home. We of course told her to quit smoking but she refused. She loved smoking, it was part of who she was. About 6 months later she was back, the cancer was back, and she had pneumonia. She was still a really tough woman; I admired her strength, independence, and determination. She said “This cancer will not kill me, I will beat it, I will not leave my children without a mother”. She was very ill and we were giving her chemo and antibiotics. She was getting so much fluid that she developed generalized edema and her arms, hands, and fingers looked like huge sausages. Her lab values were deteriorating, she was told she had a 50/50 chance of living and the doctor wanted to stop the chemo. She said, “No, I can take it”.  She continued to decline. I called the doctor around 2am on the night shift and said I was worried about her, she was retaining so much fluid and I couldn’t watch her all the time since I had a full load of patients on my medical unit. He transferred her to the ICU. When she left my unit, I was sure she wasn’t going to make it, I was sure I would never see her again. I couldn’t imagine how anyone who was so fluid overloaded, and had so much against her could survive. She continued to decline and was given less than a 20% chance of survival, she was intubated and continued to decline. The doctors pressured her husband to make her a No Code. 

He eventually, reluctantly, agreed. Somehow, in the middle of the night she woke up enough to extubate herself and she lived. She walked out of the hospital a few days later. She did stop smoking. She came back to visit a few months later and brought us baby Jade plants. I was pleased but embarrassed to see her, I had given up on her before she was ready to give up on herself.

She taught me to never give up on my patients until they are ready to quit trying. It’s my job to keep working, searching, and trying until my patients say they are ready to quit. I was working in Palliative Care at the hospital and one of my patients was a Catholic Priest. He had been non-responsive for a couple of weeks, there was a nun who frequently visited and cared for him. I was wondering how much longer he could hold on. She said, “I bet he makes it to Palm Sunday, it was his favorite Mass”. He died on Palm Sunday at 11am, She said, “Just in time to celebrate Mass with Jesus.”

What If We Have Forgotten What Optimal Health Looks Like?

What If We Have Forgotten What Optimal Health Looks Like?

I think nursing schools do a wonderful job of instilling the vision of nursing. Nurses are the gatekeepers, the eyes and ears that see, hear, and assess what is going on with our patients. We are at the patient’s bedside when the physicians and primary care providers are analyzing and interpreting results, and engineering the best course of action. We hold our patients hand, we listen to their fears, and we translate their concerns to the doctor. We also have the critical thinking and technical skills to determine when they are getting into trouble. We often have the opportunity to hear what is in their heart and soul. We develop a broad base of skills and have the ability to use all of our talents. 

Unfortunately in the crunch of modern healthcare, when I am taking care of my patients, the compassion of nursing often gets pushed aside for the technical aspects and I find myself focusing on their Pneumonia and Dehydration. My job description requires I focus on the details of their medications, diet, bowel movements, intake and output, and vital signs. I pass medications, do treatments and chart. I look for trends to determine if my patient is improving or declining. I focus on getting them ready for discharge. What if I am so caught up in the war of fighting disease, infection, cancer, and pain; that I have lost sight of what I am fighting for? What if I have spent so much time taking care of the details, that I have facilitated diminishing the life of the whole organism I am fighting for?

What if we have forgotten what Optimal Health looks like?

What if, as health care providers we change our focus from treating those who are sick, to helping our patients and families stay well. I’m talking about shifting our perspective. What does health look like?

After all, if you don’t have a clear definition of health, how can you work toward achieving it?

My definition of Health:

Healthy is waking up in the morning feeling refreshed, having the physical energy and clarity of thought to easily get through an 8 hour day. Health is fluid movement, and freedom to focus on tasks, and events around us. Health is having the power to dream and the imagination to accomplish those dreams. Health is feeling strong enough to see life as an obstacle course full of challenges, and learning experiences, knowing we have the strength and endurance to tackle them because we are surrounded by family and friends who have been there and can advise us when needed. Life is a team sport and we are all in this together. 

Health is fueling our bodies with healthy foods. Eating and digesting, deriving satisfaction from the taste and wholesomeness from what we put in our bodies, deriving strength and sustenance. A healthy body digests a wholesome meal in 3-12 hours and eliminates the by- products. A healthy person is composed of approximately 85% water and hydrated well enough that what comes out looks like clear water.  

Health is being at peace with God, whatever you believe him to be. Having faith, hope, and love in your life. Optimum health is appreciating, that there is positive energy all around us; we just have to be open to receive it. It’s having a spirit of giving and sharing. It’s feeling a responsibility to leave the planet better than you found it.

Healthy is understanding that everything that touches us has the potential to leave an imprint. What we put in our mind, our heart, in our mouth, and on our skin matters because we can internalize it. 

Treat your body with value and respect.

What if we are settling for less simply because we haven’t been exposed to more? What if we are so busy fighting; disease, cancer, infection, and pain; that we are blinded and deaf to the cause of dysfunction? What if our body has built in self- healing mechanisms? What if we worked at supplying the building blocks and materials our body needs to heal itself? What if we used all aspects of healing; the power of the mind, body and spirit to work together to a form a greater strength, power, and ability to heal? What if we learned to listen and see symptoms of dysfunction, as our body’s way of communicating what it needs? 

What if we are cheating our patients and ourselves by not using more? What would happen if we focused on building, supporting, enhancing what we already have?  What if we didn’t have to stop working at healing until our patients are ready to quit?

What if God didn’t abandon us, what if we lost our way, and we abandoned each other?

A goal of this column will be to educate on health care options to help each and every one of us achieve Optimum health.

Getting back to nurses as being the Gatekeepers, I see Nurse Case Managers as having the ability to look at the whole picture. With education on all aspects of health and wellness, we have the insight and knowledge to work with our patients to achieve optimum health. We can direct patients through all health care services and resources to achieve Optimum Health. We need a broader knowledge of the resources available to us, and how and when to use them. 

What Case Management, Alternative Medicine, Integrative Medicine, and Complementary Medicine Resources do you use?