Body-mind-spirit Care in Psychiatric Ward

2006

Department of PsychiatryQueen Mary Hospital

Kwong Chung Man

Objectives

• Understand Body-mind-spirit well-being

• Physical activity and mental health

• Alternative therapy for insomnia

• 健康 312 經絡鍛煉法• Reduce suicide risk & depression

• Provide spiritual care

Understand Body-mind-spirit

well-being

Body-Mind-Spirit Well-being

Affect

Daily functioning Spirituality

Physicaldistress

BMSWBI(HKU Centre on Behavioral Health)

• Physical Distress

• Daily functioning

• Affect– positive affect state– negative affect state

• Spirituality– Tranquility– Disorientation– Resilience

Physical Distress

• Headache

• Dizziness

• Insomnia

• Blurred vision

• Sore throat and/or hoarse voice

• Difficulty in breathing

• Palpitation

• Chest pain

• Stomach Discomfort• Diarrhea• Constipation• Coldness of hands or

feet • Back pain • Fatigue

Affect

• Happy• Relaxed and at ease• Grateful• Contented • Carefree ( 安心 )• Full of confidence• Fortunate• Tender and loving

Negative Affect State

• Lonely

• Nervous

• Insecure

• Emotionally upset

• Annoyed and irritable

• Worried

• Angry

• Fearful

• Sad

• Helpless

• Each day seems like a year

Daily Functioning

• Physical strength

• Concentration

• Sleeping

• Appetite

• Memory

• Daily work/doing household chores

• Energy level

• Dealing with difficulties

• Work motivation

• Feeling on getting up

Tranquility

• I can be content with whatever comes.

• I can face life with a moderate state of mind.

• I feel calmness and harmony deep in my heart.

• I can take something up, or let go of it.

• I can deal with difficulties methodically

Disorientation

• I have lost direction in life.

• I don’t know how to love myself.

• I don’t understand why predicaments ( 困境 )come to me.

• I blame heaven for being unfair to me.

• I lack the vitality( 動力 ) of life.

Resilience

• To me, facing a predicament is a challenge and a learning opportunity.

• I am grateful to people around me for all the things that they do for me.

• Predicaments can make me stronger.

BMSWB Study

• 9 mental patients• BMS score: mean=0.64, SD=0.08• Physical distress, mean=0.23, SD=0.1• Daily functioning, mean=0.53, SD=0.15• Negative affect, mean=0.36, 0.18• Positive affect, mean=0.49, SD=0.22• Tranquility, mean=0.7, SD=0.21• Disorientation, mean=0.36, SD=0.32• Resilience, mean=0.75, SD=0.19

Common Problems

• Insomnia (mean: 4.89, SD: 3.38)

• Tiredness (mean: 4.22, SD: 2.04)

• Memory (mean: 4.22, SD: 2.53)

• Concentration (mean: 4.22, SD: 2.57)

• Affect: worried (mean: 5.22, SD: 2.82)

• Spirituality: “I don’t know how to love myself”

Physical Activity and Mental Health

• Physical activity is one of the ten leading health indicators used by United States government since 2000 to promote public health.

• adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day

– U.S. Department of Health and Human Services, 2000

• Physical activity is associated to a relief in symptoms of depression and anxiety and it also seems to be beneficial in enhancing self-esteem, producing more restful sleep, and helping people recover more quickly from psychosocial stressors

– (Landers, n.d.).

• Physical activity induces positive moods, such as positive feelings towards others, positive feelings about life, enjoyable interaction with others, joy, elation, bodily well-being, positive body image, self-esteem, achievement, and excitement; and appeared to result in increased happiness – (Hills & Argyle, 1998).

Target Exercising Heart Rate (moderate intensity)

Age Pulse Rate (bpm)20 12025 11730 11435 11140 10845 10550 10255 9960 9665 93

http://health.discovery.com/tools/calculators/hrc/hrc.html

Pat. Days

Max heart rate

(bpm)

Max time

(mins)

Average depression

score(0-10)

Average anxiety score(0-10)

Subjective feeling after

physical activity

A 5 128 30 4.4 4.8joy,

elation, relaxation

B 7 120 20 4.9 5.1

relaxation, elation,

better self esteem

C 4 111 10 7.5 0 Relaxation

D 2 120 5 0 0 No change

Nursing Care Plan (Body)

• Monitor patient’s medication compliance and the effectiveness of medications on level of functioning

• Provide balanced diet and monitor intake & body weight

• Teach physical exercise • Teach breathing exercise • Teach methods to promote sleep • Monitor and redirect patient in maintaining daily

grooming and hygiene• Assist patient in developing a plan for increasing

participation in physical exercise

Alternative therapy for insomnia

• Food therapy• Massage & Acupressure• Acupuncture & moxibustion• Physical exercise• CBT• Hypnosis• Muscle relaxation technique• Breathing relaxation technique• Meditation• Aromatherapy

Hand Massage for Insomnia

Moxibustion

治療方法患者晚上臨睡前用溫熱水泡腳 10 分鐘 , 擦幹後上床仰臥蓋好被褥 , 露出雙腳 , 寧神靜等。由患者家屬將清艾條點燃 , 對準湧泉穴施行溫和灸 , 以患者感覺溫熱舒適不燙為度 , 每穴各灸15 ～ 20 分鐘。每日灸治 1次 ,7 日為一療程。

健康 312 經絡鍛煉法

經絡系統

—經脈

—正經十二（十二經脈）

—手三陰經

—手太陰肺經—手厥陰心包經—手少陰心經

—手三陽經

—手陽明大腸經—手少陽三焦經—手太陽小腸經

—足三陰經

—足太陰脾經—足厥陰肝經—足少陰腎經

—足三陽經

—足陽明胃經—足少陽膽經—足太陽膀胱經

—奇經八脈—十二經別

—絡脈—十五絡脈—孫絡—浮絡

—十二經筋—十二皮部

經絡的功能• 運行全身血氣，滋養器官• 疏通經絡可以祛病健身• 啟動經絡可開發人體潛能

“ ３”指合谷、內關、足三里三個穴位的按摩

• 一般人每天早晚兩次，左右不拘，每次共５分鐘

• 拇指屈曲及垂直按在穴位上，做一緊一鬆的按壓

• 頻率約每分鐘３０次• 按摩時要感到酸、麻、脹

警告：孕婦不宜刺激合谷

合谷( 手陽明大腸經 )

１）一般全身止痛作用，特別適應頭部痛症。

２）消炎﹑退熱﹑發熱汗多

３）口面疾患（面癱﹑眼耳鼻病﹑咽喉痛﹑牙痛 ) 。

４）腹痛﹑臂痛﹑咳嗽﹑感冒﹑經閉﹑引產。

５）高血壓﹑偏癱﹑口眼歪斜﹑流鼻血及鼻炎。

內關( 手厥陰心包經 )

１）心臟衰弱﹑心律不正﹑心搏動過速 / 緩。

２）嘔吐﹑胃痛﹑失眠﹑心悸﹑胸腔痛。

３）高血壓﹑心臟病﹑心絞痛。

４）熱病﹑肘臂攣痛﹑哮喘（發作期）。

足三里( 足陽明胃經 )

１）嘔吐﹑腸胃痛﹑衰弱。

２）胃痛﹑嘔吐﹑腹瀉﹑腹脹﹑便秘﹑消化不良。

３）偏癱﹑膝關節病﹑腰腿酸痛﹑下肢癱瘓﹑痢疾。

４）失眠﹑高血壓﹑頭痛﹑頭暈﹑傳染性肝炎﹑體虛。

（本穴有強壯作用；為保健要穴）

“ １” 是腹式呼吸法• 平卧或端坐，周身放鬆，排除雜念，意守丹田（小腹）。

• 用鼻均勻吸氣，使小腹隆起。用口均勻呼氣，小腹復原。

• 呼吸頻率逐漸減到每分鐘４～５次，每天做１次，每次５分鐘即可。

• 意念不易集中、自然入睡均不影響鍛煉效果。

“ ２”是雙腿活動為主的體育活動

• 可以是跑步、跳繩、慢走、原地踏步及下蹲等。• 卧床病人可在幫助下做雙腿屈伸及腳內收與外展

等活動。• 一般每日１次，每次運動５～１０分鐘即可。• 運動量維持在每次活動之後稍有氣喘，脈搏跳動

在每分鐘１２０次以內，全身感到舒適為最佳。• 對於體質虛弱的人可酌情調整，量力而行，循序漸進。

Reduce Suicide Risk & Depression

NCP (Mind): Reduce Suicide Risk

• Communicate empathy for unbearable psychological pain

• Address vital frustrated psychological needs• Mollifying the vital frustrated psychological

needs• Increase threshold for suffering• Discuss possibilities other than death• Establish a balanced perspective of

psychological needs

NCP (Mind): Reduce Depression

• Administrate the 抑鬱症問卷 , Evaluate the results and give feedback to patient

• Encourage patient to share feelings of depression

• Assist patient in developing awareness of cognitive messages that reinforce helplessness and hopelessness

NCP (Mind): Reduce Depression

• Assign patient to keep a record of daily events and associated dysfunctional cognition and emotions. Challenge dysfunctional thoughts for accuracy, and identify alternative cognitive interpretations that are more positive and realistic

• Reinforce positive, reality-based cognitive messages that enhance patient’s self confidence and increase adaptive action

NCP (Mind): Reduce Depression

• Educate patient about depression and accepting some sadness as a normal variation in feeling

• Assign patient to write at least one positive affirmation statement daily regarding self and the future

• Verbally reinforce patient’s positive self-statements

NCP (Mind): Reduce Depression

• Challenge patient to focus on capabilities rather on disabilities

• Recommend self-help books on coping with depression

• Provide social-recreational activity

• Assist patient in developing a plan for increasing participation in recreational activities

Provide Spiritual Care

Nursing Care Plan (Spirit)

• Arrange religious services• Discuss meaning of life• Discuss meaning of death• Discuss pain and suffering • Promote transcendence (reframing pain in

ways that normalize and confirm the humanity of our clients while also suggesting that pain itself has a healing function)

(Levington C., & Gruba-Mccallister F., 1996)

Culture relevant positive intervention

• Psychological de-centering (selflessness)

• Letting go of fixations

• Personal transformation

• The capacity to endure, even accept, suffering or misfortune

• To construct and reconstruct meaning

• To maintain peace of mind, spirit, and sense of direction, even in the face of misfortune

Proverbs Therapy

• Accepting life as being unpredictable

• Tolerating hardship

• Letting-go of the self and expectations on other

• Self-affirmation and empowerment

• Finding meaning in suffering

• How to love oneself

一個有迫害妄想的病人，可以用那些諺語幫助他 ?

利而不害 為而不爭

少私寡欲 知足知止

知和處下 以柔勝剛

清靜無為 順其自然中國道家認知療法 ABCDE技術簡介

http://info.psychcn.com/enpsy/200506/2949314005.shtml

MEDITATION

• Concentrative meditation– focuses the attention on the breath, an image, or a

sound

• Mindfulness meditation– sits quietly and simply witnesses whatever goes

through the mind, not reacting or becoming involved with thoughts, memories, worries, or images

D. Coleman and J. Gurin (Eds.) (1993). Mind-Body Medicine: How to use your mind for better health. Yonkers, NY: Consumer Reports Books.

Reference

• 《健康 312 經絡鍛煉法》， 祝總驤著 ，中華書局 (香港 )有限公司

• http://www.geocities.com/cmkwong39