Total Stress Management Guide For Nurses Dr Shriniwas Kashalikar
Dr. Shriniwas Kashalikar
Right at the outset I would like to pay my humble
tributes to you and your profession and express my
gratitude on behalf of all those whom you serve.
Yours is such a profession where there is almost no
end to the sacrifice that you make. Most of you
work hard; on domestic as well as occupational
front! I really admire your patience and salute you
for the same. Really you are the chosen ones of the
Almighty and hence most privileged.
Secondly I would like to congratulate you for your
success in achieving expertise, which is so valuable
in healing the ailing mankind.
Now before I go ahead I would like to concede the
possibility that you could be knowing much more
than the contents of this book. Also, you may be
practicing Total Stress Management better than me
and you may already be healthier than me in every
possible way. But this is my humble effort to share
with you what I understand and try to practice!
In view of your supreme importance in patient care
and in view of the extremely stressful situations you
have to go through, it is imperative that somebody
cares for you and your health! So kindly appreciate
my concern about your well being and instead of
believing blindly or rejecting blindly, consider these
contents with open mind, verify and accept or
reject on the basis of your own experience.
Total Stress Management For nurses working with
critically ill patients.
It is good to appreciate that Total Stress
Management (Holistic Health Promotion) requires
two aspects to be handled. First; is you and second
is your environment.
Let us consider the first aspect i.e. you.
There are five aspects of your being!
They are, spiritual, intellectual, emotional,
instinctual and physical! It is needless to clarify
that these are not watertight compartments and the
classification is for the purpose of simplicity in
So, the Total Stress Management (Holistic Health
Promotion) involves nurturing these five aspects of
When you work with patients requiring critical
care, you are facing agonies, anxiety, fear, worry
and restlessness. You require tremendous spiritual
strength in such situations. I am sure you do not
lack spiritual strength. But one simple way to
nurture or further develop spiritual aspect is
imbibing the concept of unconditional acceptance,
love and respect for your self. This helps you to
explore the SOURCE OF LIFE i.e. SPIRITUAL
POWER WITHIN YOU. Invoking this power
within you is also called as exploring the healer
Therefore learn to ACCEPT, LOVE AND
RESPECT, yourselves, unconditionally. This is
possible by two means. One is through conscious
efforts and the other is through the traditional
practice of NAMASMARAN i.e. remembering the
name of God or your Guru.
Namasmaran is a simple way of growing from
within. However it is ironical that since it is simple
and inexpensive people [including me] find it most
difficult to practice it! It appears too simple and
hence incapable of nurturing us spiritually! But I
feel that spiritual growth can really be possible
through Namasmaran and it can increase the
healing power within you.
How to assess your spiritual health?
There are few criteria by which you can assess your
spiritual health and develop it further.
One criterion is the perspective of global welfare.
You begin to think and automatically wish the best
for one and all! This in itself strengthens you.
Another criterion is fearlessness. It is true that
through practice and experience most of you grow
fearless even in otherwise dreadful situations. But
fearlessness resulting from spiritual growth is
nondecremental i.e. without any decline and also, it
is devoid of callousness!
Another criterion is your talk.
One of the hallmarks of spiritual growth is
revitalizing words. Your words become naturally
empowering. You do not have to cultivate or
artificially make them so!
One more criterion is your look. Your facial
expression and body language naturally reflect
affection and care. Your mere presence and your
touch begin to heal your patient. In other words
empowering happiness begins to emanate through
every aspect of your existence.
It must be appreciated that depression and
melancholy are infectious. Pain and misery can also
be infectious. They can erode you without you being
aware of it. Hence you require this power within
you to help yourself and everyone around [patients,
their relatives, other patients, your colleagues and
even the doctors] to overcome stress!
Spiritual growth is additionally important because
it gradually reduces two most important causes of
stress viz. pettiness and superficiality. Pettiness and
superficiality create unending dilemmas, which can
really harm you. Hence yet another criterion of
spiritual health is broad mindedness and
profoundness evident in not getting disturbed by
For the spiritual growth or spiritual health or for
exploring the healer within you,
AUTOSUGGESTIONS can also help. But
thoughtless autosuggestions should be avoided; as
you may get trapped in your own petty or even
Following autosuggestions are based on profound
philosophical insight. They are of great value.
A] I shall not get angry or feel sad today because it
is about past which has gone by.
B] I shall not worry or get restless because it about
future which may not come.
C] I shall thank the nature or God for the bounties,
because they are many times concealed and not
D] I shall respect everyone, because global unity is
an objective reality and God is present in every one.
E] I shall do my duty honestly because honesty
means exploring the universally beneficial element
in my work and that would prevent dragging of
mind from getting distracted towards fallacious
and illusive glamour present elsewhere.
You must be familiar with different prayers,
hymns, bhajan, kirtan, pooja, dancing meditation,
laughing meditation and many other forms of
worship. You may or may not practice one or more
of them as per your choice, liking, inclination or
Now let us understand the role of intelligence in
spiritual health by an example.
Imagine a swimming pool, with a facility of a nice
diving board. Imagine beautiful steps to reach that
diving board. Imagine that you can not swim unless
Now, swimming in the pool after diving
wonderfully and enjoying it is like enjoying
spiritual health. The steps to reach that diving
board are like rationality or intelligence.
Those of us who do not climb the steps obviously
cannot swim. Irrationality and blind belief are
hurdles in acquiring spiritual health.
Similarly those who climb the steps and reach the
diving board, but do not jump from it can also not
swim. They get imprisoned in their own intellectual
framework. They do not realize its limitations.
They are blind to millions of possibilities, which are
beyond the range their own intelligence. Such
intellectual imprisonment also is a hurdle in
acquiring spiritual health.
Climbing the steps, reaching the diving board and
jumping from it [getting freed from the enslaving
shackles of one’s own paradigms and intellectual
frames] help one to be spiritually healthier.
Now it must be clear to you how all the other
aspects of your personality would begin to get
nurtured by sound spiritual growth. Spiritual
empowerment is like sap of life. Through your
crystal clear inner core spring; the globally
beneficial thoughts and plans!
For a moment I may sound too theoretical,
hypothetical or even impractical or dreamy.
But as you actually blossom more and more from
within, you would realize the limitless dimensions
of your intellectual and creative potentials. You
increasingly appreciate with clarity the role you can
play in your own way in global welfare. This
consciousness is the fountainhead of intellectual
It creates the intellectual zest and dynamism
intrinsic to intellectual health. Then you stop
undermining yourself in spite of knowing fully well
that the world is so vast.
Now you would start getting involved and
interested in your job to a much greater extent.
You get much more motivated to study the
intricacies of your job. You expertise and efficiency
starts multiplying. In the midst of humility; you get
bolder and inquisitive. Even though asking
questions is a royal way to intellectual health the
reading books and literature pertinent to Total
Stress Management (available for free download on
www.superlivng.net) is extremely important and
Your intellectual empowerment engenders
delegation of increasingly important tasks to you by
your superiors. This process automatically makes
you confident, and smart.
Because of your knowledge; every one begins to
need you, love you, admire you honestly and also
respect you. Since you are knowledgeable, you no
more resent questions of your juniors and your
patients. You no more resent questions from
patients’ relatives. This is how the whole working
atmosphere gets filled with buoyancy, enthusiasm
and above all; cordiality.
However intellectual health can be further
buttressed and blossomed by specifically
conquering the high tech life style, “one up man”
ship, knowledge of diseases such as cancer,
diabetes, hypertension, ischemic heart diseases etc.,
information mania etc, which all increase stress.
1. Adopt high tech life style with due sense of
proportion and with respect to the comfort it would
2. One up man ship or competition should be
adopted for achieving excellence. If there are petty
pursuits, then they can ruin your happiness easily.
3. Knowledge of diseases can produce deep impact
on mind and lead to neuroses and phobias. These
phobias can spoil the life completely. Therefore it is
essential to “ride” over the knowledge! Here
spiritual health can really help you as negative
thoughts are effectively overcome by spiritual bliss,
(though it is not easy!). Secondly you have to learn
to appreciate that every thing we read or know, is
not complete in itself. Even if the information about
the diseases is correct the human spirit is invincible
and is “more correct”! Hence do not get bogged
down and stressed by threatening information
about the diseases published, broadcasted or
telecasted; whether in scientific journals, text books
or in media.
Dealing with information explosion properly,
makes you humble and realistic also!
This is well illustrated in the anecdote of Mahatma
Gandhi’s three monkeys.
After one reads or hears about these three
monkeys, one tends to ask, “Why should I not hear,
see or talk bad if I really am convinced about it?
Does not it amount to being a hypocrite?”
The answer is simple but very useful in acquiring
What we hear and interpret is a function of limited
range of hearing and seeing and limitations of the
processing of that information based on past
experiences, in our brain. Hence to feel that it is the
truth and declare it amounts to being unrealistic
and arrogant. It is fallacious. Therefore we should
and if at all; humbly state as “our impressions” and
not claim it to be absolute truth.
Understanding this scheme gives you the knowledge
of perceptive [intellectual] error that leads to stress
and its correction.
Intellectual health manifests in globally beneficial
perspective, policies, plans and actions in your field,
which would blossom not ny the patients, but
everyone involved in healthcare; directly or
Every one knows the different positive and negative
emotions. It is very easy to say that we should
overcome fear, anger, hatred, depression, jealousy
etc. It is also very easy to advocate positive
emotions such as peace, happiness, love and so on.
But the important difficulty is how to actually be
able to do it?
Human brain itself is such that those parts involved
in emotions are hardly under the control of the
parts instrumental in thoughts! Moreover there is
no clarity about parts of brain [if any] related to
spiritual growth. Hence even as spiritual health and
intellectual health can substantially ward off many
emotional disturbances, most emotions do not
always follow the suit of spiritual and intellectual
processes. They have good deal of autonomy and
volatility. Hence additional specific measures have
to be taken to nurture emotional health.
We have to understand here that emotional health
depends largely on soundness of our limbic system
and autonomic nervous system, though it is
influenced to a certain extent by central nervous
and hormonal activities.
Now what is the practical relevance of these facts?
The relevance is that we can practice following
pranayamas to tone up these parts and acquire
high degree of emotional health!
KAPAL means forehead and BHATI means light
You are supposed to do active and moderately
forceful abdominal expiration and you are
supposed let the inspiration take place passively. Do
it rhythmically but not jerkily. Count the strokes of
expiration. Practice about twenty strokes initially
and gradually increase the number up to five
hundreds to one thousand in comfortable manner.
Do not practice after eating food.
Do not practice if you have wound [e.g. surgery],
hernia, hydrocele, or any inflammatory condition
of your abdomen.
Do not practice in pregnancy.
Initially you may find it little difficult, but a few
days of practice would make you comfortable.
I would not like to make any tall claims. But you
may find out for yourself whether you lose weight,
feel energetic, feel buoyant, feel younger or no. In
addition find out whether you have stopped
palpitating in minor adversities or imaginary fears.
Verify whether unwanted perspiration stops or not.
Find out whether you get any benefits on your lipid
profile or blood sugar. Emotional health has clear
cut positive impact on your instinctual and physical
health. This can be called the byproduct of the
There is scientific explanation for the mechanisms
underlying these and many other benefits, for the
details of which, you can refer to my books
available for free download on
www.superliving.net, but we need not go in the
The meaning of the BHASTRIKA is bellows.
You are supposed to breathe in and out forcefully
mimicking the action of bellows. The rhythm of the
bellows is necessary but it is important to avoid
Do not practice at least five after food.
Do not practice in case of hernia, hydrocele, wound
or inflammation of any nature in thorax or
Do not practice in pregnancy.
KAPALBHATI AND BHASTRIKA if practiced
cautiously may help in early stages of certain
UJJAYI means victory.
Breathe out slowly, forcefully and fully. Now
partially contract your larynx i.e. the region of
voice box and breathe in with a high pitch
There are no precautions and restrictions for
UJJAYI except presence of lesion in respiratory
BHRAMARI means related to BRAMAR, which
means the familiar insect sucking honey from
flowers making typical humming sound while
flying. Since you produce similar sound in this
pranayama it is called BHRMARI.
Hold your index fingers on forehead, middle and
ring fingers on the eyes and little fingers below the
eyes and thumbs pressing on ears and breathe in
maximally without jerk, and then breathe out
slowly through voice box and nasopharynx
producing humming sound through out your
expiration. The vibrations produced from within
have healing and revitalizing effect on everything
within the head!
Breathe in through one nostril and breathe out
through the opposite nostril. Now breathe in by the
opposite nostril and breathe out through the
This is one cycle. You can repeat this ten to twenty
times as per your convenience.
Do not give jerks. Do not practice after food for at
least three hours.
Later three pranayamas can be practiced in
pregnancy or any other condition of the abdomen
or thorax. You can practice them in sitting or any
In this pranayama, since holding of breath is not
advocated you can practice it even when you are
Please practice and verify whether these techniques
make emotional health sound with several
additional benefits on you physical health.
We have to pay attention to our instinctual health
and physical health for overcoming unpleasant
sensations and consequent emotional disturbances
(e.g. nagging, irritating, nauseating, disgusting
sensations arising from within our stomach,
duodenum, ileum, ascending, sigmoid and
descending colon, rectum, anal canal, urinary
bladder, uterus, ovaries, muscles, fascia, tendons,
ligaments, joints, blood vessels, pregnancy,
delivery, lactation, menstruation, menopause etc.)
Few simple tips to which, you can add many more
according to your experience can contribute to your
emotional health even though they are most not
You must sleep well or else you get more irritable
Take adequate rest as other fatigue makes you
depressed, withdrawn and negative.
Observe cleanliness as unclean habits due a variety
of reasons can cause allergies, infections, psoriasis,
lichen planus and other nagging skin disorders.
They can really disturb you peace and make you
Use well fitting, comfortable and suitable clothes as
bad clothing can create difficulty your movements.
It can spoil your body image and self-esteem. Ill-
fitting clothes distract your attention and reduce
your efficiency. Make use of natural perfumes and
pleasant colors to brighten up the atmosphere and
make it cheerful. Ornaments and cosmetics too may
have a “cosmetic” role in acquiring sound
Try to practice following few points and see if you
start feeling better. My experience tells so.
1] You can charge the atmosphere by merely
greeting the people properly and giving them
suitable gifts. For that you have to accept them
unconditionally, love and respect them. Pay
attention to them and their ailments with total
focus. Such bond actually revitalizes you. When you
see the feelings of gratitude and solace, your
emotional health begins to improve.
2] Your patients need your love. They do not
appreciate condemnation, criticism and value
3] Appreciate people. Always complement by words
such THANKKS and GOOD etc. You get
appreciation if you give!
4] Apologize profusely and naturally for even so
called small mistakes and errors.
5] Always say you agree during your dialogue even
if you do not. In the course of well begun dialogue
you can convince your point.
6] Spare time for certain hobbies, such as music,
knitting, painting etc. so that there is no monotony
and you can pleasure of the variety!
7] Find out the degree of pleasure from its intensity,
its duration and its impact on the society. This
certainly helps you to decide what is more
important than the other. This is called
Once a thought or a feeling or an action is judged
as the most important objective it becomes easy to
After you ASSERT just recollect the moments of
ecstasy of maximum intensity, duration and that
simultaneously benefited others.
Relive ASSERTION and CONSOLIDATE your
priorities. This is POSITIVE REINFORCEMENT.
Now recall the thoughts, feelings and actions that
gave you maximum sadness lasting for maximum
duration and hurting or inflicting others. This
would help you to avoid the same on priority basis
and is called NEGATIVE REINFORCEMENT.
When you regularly practice positive and negative
reinforcement the WELLNESS CYCLE begins.
Wellness cycle means increased experience of active
peace, intellectual sharpness, happiness, healthy
instincts and satisfactory physical activities.
WELLNESS CYCLE destroys the deleterious
effects of vicious cycle or distress cycle.
Spiritual, intellectual and emotional health forms
the basis of instinctual health. But you can be
benefited more from the following adjuvant
measures as well!
Biologically speaking, we the humans also inherit
the instincts, which are in mammals and birds.
These instincts are integral to life and largely
related to neurohormone and hormone secretion
and metabolic activities. Hence if instincts are not
satisfied the stress produced is tremendous and far
more dangerous than mere emotional stress and
hence you have to overcome it “instinctual stress”
to acquire instinctual health!
Survival is the most basic instinct. With technology
survival has become easier. But with cut throat
competition, increase in crimes, frauds,
irregularities and corruption, simple person are
getting increasingly insecure. The advertisements of
life insurance, health products, medicines etc
exaggerate the dangers and increase the insecurity
even further. The result is increase in suicides and
murders. It is important to be spiritually,
intellectually and emotionally strong by learning,
teaching and publicizing the Total Stress
Management for conquering the fear of survival
and thereby acquire instinctual health.
2] Hunger and thirst
They are important for survival. We call them
instincts because they are extremely strong drives
determining the behavior. If they are not satisfied
they can unleash violence of unimaginable
magnitude. Secondly eating and drinking behavior
has tremendous influence on your total health!
a] Do not fall prey to the aggressive advertising
campaigns. Use your own discretion and common
b] As far as possible eat home made food,
c] Avoid excessive consumption of any one type of
food such as ice creams, chocolates, deep fried
foods etc. Do not drink excessive soft drinks, beer
or hard liquor.
d] Include wheat, patni, nachani, bajara, jawar,
corn and also neem, karela, bel, Amala, ginger,
pudina, cocum, tulsi, jamun, cow milk, butter milk,
green leafy vegetables, salads, seasonal fruits, methi
sprouts, alfalfa [lucern] sprouts and different oils in
your diet. Let there be variation and moderation.
Odd hours of working, excessive time consumed in
commuting, lack of sleep, lack of security etc. can
adversely affect the sexual drive and capacity.
Frigidity, impotence and such many problems can
arise and spoil your life completely.
It is not possible to discuss every problem in detail,
but I would request you to kindly pay serious
attention towards your and your partner’s sexual
satisfaction (You may refer my books and articles
on sexology available free download on my website
Herd requirement is instinct to live together. The
animals habituated or rather biologically bonded
with instinct to form herd, go haywire if they are
removed from the herd or lost from the herd. Keep
yourself in good company. What is good company?
Good company is one that reminds and reorients
you to your inner power, magnanimity, divinity and
vitality, and never drags you to pettiness and
Habitat in simple words means the over all the
atmosphere to which the animals deeply attached.
We should try to relive our childhood conditions
and keep our roots alive. They nurture us.
Polished cereals, white bread, eggs and other food
stuffs, which do not contain fiber, tend to reduce
the contractility of gastrointestinal tract and may
cause constipation. Sedentary habits further
aggravate the situation.
So use more fiber in diet by using green leafy
vegetables and salads. Take suitable exercise
It is proved by experiments on laboratory animals,
that the restriction on movements causes
tremendous stress. Sedentary individuals suffer
from hypokinetic stress. You can overcome such
stress and acquire instinctual health by walking,
jogging, trekking etc. Practice frequent stroll and
change positions frequently.
What is physical health? Apparently the answer is
very very simple. But Strength, endurance,
flexibility, agility, good body proportions, good
biochemical blood profile, normal working all parts
of body, reserve strength are all important
indicators of physical health. From holistic point of
view, not merely the condition of your body, but the
actions of your body; indicate physical health. So in
short what does your brain do as part of your
body? What do your eyes see or read? What are
ears listening to? What are your hands engaged? So
it is necessary to ask such questions about every
part of body so that you get a clear idea about your
Let us note some tips for excellent physical health.
1] Drink lot of water in morning. You may choose
to drink warm water if you have tendency for
2] Splash your eyes with cold water at least twenty
3] Drink a cupful of herbal juice. Herbal juice
usually contains neem, harada, karela, pudina,
amala, tulsi, adrak and rock salt for taste.
The advantages are many. You have to experience
4] Massage your gums, palates, and rest of the parts
of your mouth. Use ayurvedic tooth paste or
powder for brushing.
5] Bath should ideally be with cold water. It is
rejuvenating. But you can use any water that suits
There are prayers for reciting in morning, during
brushing, during bath and before breakfast. You
can combine physical and spiritual development.
6] Exercises: Jogging, walking, swimming, spot
jogging, dancing [classical as well as western dance]
surya namaskar, yogasana, karate, kung fu, judo,
silk weaving exercises, aikido, sit ups and many
aerobic and anaerobic exercises , sports, trekking,
mountaineering are not available all. But you
choose some of the varieties suitable to you.
There many exercises which we have devised for
sedentary workers. These are vakrasana,
chakrasana, vrukshasana, brahamudra, exercises
involving, neck, shoulders, hands, knees, feet and so
There seven exercises that can be used to improve
eyesight and even get rid of the spects.
a] Start slowly and gradually b] Do not give jerks c]
Take care of your tendons and ligaments d] Be
cautious about your balance so as prevent fractures
e] Do not perspire excessively f] It is safer to be in
g] Take rest for a day or two in a week.
7] Massage is very useful. It has an inseparable
element of emotional soothing. In the evenings the
head massage is especially useful. You can do it
yourself. You can use Brahmi oil and get the
Massage eyes, face etc.
As far as body massage is concerned, it may not be
feasible to take it every day. But at least once in a
week whole body massage can do wonders to your
health. You can use any oil of your choice and also
with consideration to the season. Massage your feet
twice or thrice a week.
Regular massaging ensures flexibility of the small
joints and adequate circulation and micro-
circulation in the feet. This is especially useful in
diabetics who are more to develop vasculopathy
and resultant damage in the feet, in the form of
necrosis and gangrene.
Wash and massage face two or three times a day.
Massage your eyebrows and eyelids. Wash your
mouth at least thrice a day during duty hours and if
feasible brush teeth at least once. Do exercises of
tongue such as rolling the tongue up, down, left
right etc, inside the mouth.
Emotional disturbances are reflected through body
posture. Body posture in turn can affect your
emotions. Therefore erect posture is preferred
whenever possible. It compliments the TSM. It is
important to sit with your back and loin touching
the back of the seat. This reduces undue strain on
your back and reduces the chances of backache.
Practice SIMHAMUDRA which involves opening
the mouth wide open and stretching the tongue out
of the mouth and hold it for 10 to 15 seconds.
Practice BRAHMA MUDRA, in which you turn
your head to all sides similar to Lord Brahamdev.
Practice NASIKAGRA DRISHTI and
BHRUMADHYA DRISHTI in which you focus
your eyes on tip of nose and middle of the eyebrows
Practice jaw relaxation in which you simply allow
the jaw to hang. But it is not simple!
Do flexion and extension exercises of your arms,
elbows, hands, fingers, ankles, knees, hips, back,
abdomen as and when you get time.
To end, the most important is NAMSMARAN and
if you can not do anything else at least practice
NAMASMARAN (To get maximum benefit and to
know more about NAMASMARAN and other
various aspect of Total Stress Management, read
my books available for free download on
www.superliving.net and start practicing and