DR D Y PATIL COLLAGE OF NURSING PUNE.

1. DYNAMICS OF HEALING
IN CRITICAL CARE UNIT
MR. . ANANT A PAWAR .
II ND MSC NURSING .

2. CCU PATIENT
Sickest client ( multiple diagnosis ,multi-organ failure ,sepsis ,trauma) .
Not ambulant
Malnourished
Associated with complication of Diseases .

3. INTRODUCTION
• Healing –The return towards the natural state of integrity and wholeness of
an individual ; the process of bringing togetherness aspects of ones self
,body mind spirit at a deep level of inner knowing in a way that lead
towards integration and balance ,with each aspects having equal
importance and value.

4. CRITICAL CARE NURSING
The American nurses association defined nursing as;
“ The diagnosis and treatment of human response to actual or
potential health problem ”.

5. TRADITIONAL ICU
• Design s are utilization /sterile ambiance.
• Lack of visual interest or aesthetic appeal
• Noisy and Chaotic
• Limits natural light or window view
• Limits privacy and family presence
• Limits patients control
• Restrictive visiting policy

6. HEALING ICU
• PHYSICAL ENVIRNMENT
• Incorporates colour and architectural interest
• Designed are based on patients need
• Designed to limit noise with carpet and acoustic tiles
• Full spectrum lighting
• Incorporate natural light
• Private room and family wellbeing
• Liberalized visiting policy

7. • SOCILA ENVIRNMENT
• Holistic with active involvement of patient and family
• HEALING MEASSURE
• Integrate complimentary therapy
• Inco prate body ,mind and spirit
• Connects patients experience and treatment through music ,art ,experience and
treatment plan and aromatherapy

8. HEALING MEASURE
Communication therapy and counselling healing
Herbal medicine
Humour and laughter therapy
Hypnosis
Massage
Reflexology
Relaxation and visualization
Therapeutic touch

9. Creating healing environment in critical care unit .
Acupuncture
Aromatherapy

10. HEALING ENVIRMENT IN THE CCU.
• PSYCHOLOGICAL AND PHYSIOLOGICAL CONNECTION OF THE
HEALING PHENOMENON
• -Psychoneuroimmunology refers to the physiologic response of the body
to psychological and environmental stressors .
• -Psychoneuroimmunology research demonstrates that emotions influence
immunological functioning and that too much stress has a negative impact
on the functioning of the body’s immune system.

11. PHYSICAL ENVIRONMENT
• Environmental : Noise Unnecessary noise, or noise that creates an expectation in the mind, is that
which hurts a patient . . . . Such unnecessary noises make aggravation delirium in many case .
e.g. .noxious noises can include the noise of medical equipment; bubbling of chest tubes; staff
conversations; pagers and intercom systems; ringing of telephones; opening and closing of doors,
cabinets, and supply carts; and even the clattering sounds from the wheels of a passing cart.

12. CONT.…
• Environmental : Light Second to their need for fresh air is their need for light . . . it is
not only light but direct sunlight . . . the usefulness of light in treating the disease is all
important.
e.g Photodynamic therapy is being tested at the Baylor Research Foundation in the
treatment of viruses, and light therapy is being used to treat seasonal affective disorder and
insomnia.
• Color in the Environment :Little as we know about the way in which affected by form,
by color, and by light, we do know this— that they all have an actual physical effect . . .
People say the effect is only on the mind.

13. CONT.…
• Environmental Landscape :That patients should be able, without raising themselves
or turning in bed, to see out a window from their beds, to see sky and sunlight at least,
• Air Quality :The first essential to the patient, without which all the rest that you can
do for him is nothing . . . keep the air he breathes as pure as the external air

14. CONT.…
Liberalizing Family Visitation :
• In addition to the effects of the physical environment on a healing
environment in the critical care setting, social support is a key element of
the social milieu. Social support includes emotional and instrumental
support provided by family and friends that is influential in a critical care
patient’s recovery

15. CONT.…
• Aromatherapy :Another healing measure that employs one of the human senses
for healing is aromatherapy.
• The sense of smell can be harnessed to induce a healing atmosphere within the
body, mind, and spirit.
• Aromatherapy and the use of essential oils for healing ailments have been
practiced for many centuries.
• Clinical aromatherapy is the therapeutic use of essential oils to promote
relaxation and healing

16. HEALING MEASURES
Therapeutic Sounds/Music Therapy : In addition to designing critical care units and rooms to
create an atmosphere that is conducive to healing, there are other healing measures to consider.
Therapeutic sound is one example, demonstrating that not all sounds affect patients negatively
Art for Healing :Thoughtful art is another healing measure that can introduce light, color, and
nature into an environment.
Art work in the ICU has not been considered an important element of the essence of a healing
environment .

17. THE BENEFITS OF A HEALING ENVIRONMENT
• Critical care nurses and other personnel can make an environment toxic or
healing based on their behavior.
• A nurse’s attitude toward patients and others influences the overall
environment in the ICU
• Human-to-human contact refers to being present and engaged with the
patient and family

18. MEDIATION
• Grounded in eastern culture by Maharshi Mahesh yogi.
• Purpose : Gain control over your attention.
• Mediation is generally an internal ,personal practice and done without any external
,except perhaps prayer bends to count to prayer, candles flames etc.
• Naadam-imagined sound ,mantra-silentely repeated words or phrases are done during
mediation

19. BENEFITS OF MEDIATION
• PHYSIOLOGICAL EFFECTS
• Learn to control HR and respiration .
• Decreased muscle tension .
• Decreased oxygen consumption and carbon dioxide production .
• Increased peripheral blood flow to the arm and leges .

20. PSYCHOLOGICAL EFFECTS
• Reduces anxiety
• Greater self actualization
• Improved sleep behaviour
• Decreased smoking and drug abuse
• Head relief
• General state of mental health

21. BIOFEEDBACK
• The use of instrumentation to mirror psycho-physiological processes of which the individual is not normally aware and which
may brought under voluntary control.
• BIOFEEDBACK MODALITIES
• Electromyography
• Electroencephalogram
• Galvanic skin response
• Heart rate
• Respiration rate
• Skin temperature

22. BENEFITS OF BIOFEEDBACK
PHYSIOLOGICAL
Effective In Treating.
Asthma.
Spasticity.
Ulcer.
Muscle Spasm.
Stroke ,Migraine ,And Tension .

23. PSYCHOLOGICAL EFFECTS
Improve to
Phobias
Alcoholism
 anxiety
Drug abuse
Sexual dysfunction ,pain

24. DISADVANTEGES OF BIOFEEDBACK
• Availability
• Cost
• Dependence on equipment
• Have to ,learn relaxation technique any way

25. GUIDED IMAGERY
• A technique of using the imagination to visualization a soothing ,pleasant image
• Guided imagery is linked to carl Rogers patient or person cantered therapy which
focuses on the potential to grow and change .
• It focuses and directs the imagination and involves during guided imaginary
• It mobilizes pre-concious and conscious processes to assist with conscious goals.

26. AIMS OF GUIDED IMAGERY
• Relaxation
• Improve learning
• Personality development
• Mental and physical Health

27. PROCEDURE
• Simple imagery suggestion are given are to client by a trained practioner
• Group session are possible
• Breathing IN and OUT and connect the inhale with positive image
• E.g. energy and exhale with a negative image for the anxiety

28. CONT.…
• The image suggestions given to client are related to the main course of the
patient’s problem by providing a direction toward the solution
• Placebo effect
• Body and mind responding bas the image is real
• We are watching a movie and we are traeful and even crying rationally we
are aware that this is only a movie but the physiological response
[tears/laughing and emotional response [sad/happy] is as this is real.

29. EFFECTS OF GUIDED IMAGERY
• Over the past 25 years ,the effectiveness of guided imagery has been
increasingly established by research finding that demonstrate its positive
impact on health , learning and performance
• It was verified that 10 minutes of GI reduce blood pressure ,lower
cholesterol, reduce anxiety and depression symptoms and increases
serotonin level

30. MUSIC THERAPY
• An interpersonal process in which the therapist uses music to help clients
to improve or maintain their health
• Used with individual of challenges and with a variety of condition
• To help patient make changes in their lives so as to adjust better to or
overcome obstacles

31. APPLICATIONS OF MUSIC THERAPY
• Music for its inherent healing qualities .
• Mean for self expression ,interaction within a therapeutic relationship .

32. BIOLOGICAL BASIS OF MUSIC THERAPY
• Listening to music releases neurochemical such as:
• Prolactin
• Oxytocin
• Dopamine
• Specific part of brain involved in perceiving different music elements
• Pitch, harmony , melody, loudness ,rhythm
• E.g. specific neurons in the auditory cortex are tuned to perceived specific pitches
• some of the areas are involved auditory cortex, nucleus accumbent &amygdala, hippocampus & so on.

33. BENEFITS OF MUSIC THERAPY
• Music therapy strengthens memories
• Its improves overall mood and emotional well being
• Its help manage pain without the use of drug
• Its helps increases their social interaction with others
• Promote positive changes the wellbeing of an individual

34. CONT.……
• Stimulates a relaxation response which can therefore lead to physiological
changes in the body
• Processed in both hemispheres of the brain and this stimulation has been
shown to help in development of language and speech function
• Music encourages verbal as well as non verbal communication and
promotes social interaction relatedness

35. ACUPUNCTURE
• AIM: promote health by stimulating the body's self healing power .
• Acupuncture involves the insertion of fine needles into specific pont s on the body
• Acupuncture is used to relief pain , disorders of respiratory ,digestive and nervous system.
• Pain management
• Sport medicine
• Obstetrics
• Oncology

36. ACUPRESSURE POINTS

37. AROMATHEARPY
• A form of therapy using essential oils extracted from plants for therapeutic effect
• Lavender for burn first aids
• Neroli for anxiety .
• Tea tree for antibacterial and antifungal action .
• Alcohol for nervous system tonics , immunostimulant .
• Aromatic aldehydes :Anti-infectious ,immunostimulents .

38. COMMUNICATION SKILLAND COUNSELLING
• Communication is essential component of health care .
• Counselling draws from range of theories –humanistic theories-carl rogers.
Psychoanalytic-Sigmund Freud ,behavioural theories –B. F. Skinner.
Treatment:
NON-VERBAL COMMUNICATION –eye contact ,facial expression ,Appearance , respect.
COUNSELLING SKILL- Accurate listening , silence ,attending ,summarizing ,body language.

39. HOLISTIC CARE
 Body Mind
• Spirituality Nutrition
• Exercise and movement Hunger ,laughter , play
• Relaxation Music therapy
• Imagery
• Music

41. THERAPEUTIC TOUCH
PSYCHILOGICAL EFFECT:-
• Promotes positive mindset
• Relive stress
• Reduces anxiety
• Induces relaxation

42. CONT.….
 Physiological Effect
 Decreased pain
 Improves blood pressure
 Immune enhancement

43. PATIENT EXPERIENCES
• Enhanced positive perspective
• Appreciation of care received
• Enhanced relationship with nurse
• Increased self confidence
• Physiological and psychological effects
• Improve overall sense of wellbeing

44. BARRIERS TO IMPLEMENTATION
• Knowledge and awareness
• Need to increased awareness
• Western medical culture
• Associated with spirituality
• Intangible energy

45. SUMMARY
• A mounting body suggests that humanizing the environment in which
medical and nursing care is provided improves healing and the healing
process for patients, families, and providers.
• Meeting the challenges of reducing environmental stressors in the critical
care unit will potentially avert the adverse effects of being a patient in the
ICU and reduce staff stress.

46. BIBLIOGRAPHY
• Jaya Kuruvilla , “” essential of critical care nursing ,first edition 2007,Jaypee brothers medical publisher
page no 22-25
• Elizabeth Simons , “Critical care nursing practice guide ,second edition” ,Jaypee brothers medical
publisher page no 52-55
• Dona O . carpenter , “ professional guide to complimentary & alternative therapies ” ,springhouse
publication ,.
• Barbara Montgomery Dossey, Lynn Keegan at al , “ Holistic nursing a handbook for practice” ,third
edition ,jones and Bartle publication .
• Mary Elizabeth o ’ brine , “ Spirituality in nursing standing on holy ground” , jones and Bartlet
publication .