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Nurse’

s Toolbook

for

Promoting

Wellness

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Nurse’

s Toolbook

for

Promoting

Wellness

Carol A. Miller, MSN, RN-BC, AHN-BC

Clinical Nurse Specialist

Care & Counseling

Cleveland, Ohio

Clinical Faculty

Frances Payne Bolton School of Nursing

Case Western Reserve University

Cleveland, Ohio

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DOI: 10.1036/0071477616

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Want to learn more?

To my family—with love and endless appreciation

for the countless ways in which they promote wellness in my life.

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vii

Contents

Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Index of Wellness Teaching and Activity Tools . . . . . . . . . . . . . . . . . . . . . . . xv

PART I: OVERVIEW OF WELLNESS NURSING . . . . . . . . . . . . .1

Chapter 1 Exploring the Wellness Territory . . . . . . . . . . . . . . . . . . . . . . .3

Chapter 2 Fitting Wellness into Practice . . . . . . . . . . . . . . . . . . . . . . . .23

Chapter 3 Fine Tuning Our Wellness Skills . . . . . . . . . . . . . . . . . . . . . .52

PART II: PROMOTING PATIENTS’ WELLNESS

IN THEIR DAILY LIVES . . . . . . . . . . . . . . . . . . . . . . . . .89

Chapter 4 Promoting Wellness-Enhancing Actions . . . . . . . . . . . . . . . .91

Chapter 5 Teaching Patients to Protect Their Health . . . . . . . . . . . . .113

Chapter 6 Teaching Patients to Manage Stress . . . . . . . . . . . . . . . . . .135

Chapter 7 Promoting Spiritual Wellness . . . . . . . . . . . . . . . . . . . . . . .167

Chapter 8 Overview of Complementary and Alternative Medicine . . . .197

Chapter 9 Promoting Responsible Decisions about Biologically

Based Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227

PART III: PROMOTING SPECIFIC ASPECTS OF

PATIENTS’ WELLNESS . . . . . . . . . . . . . . . . . . . . . . . .253

Chapter 10 Nutritional Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255

Chapter 11 Digestive Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .279

Chapter 12 Musculoskeletal Wellness . . . . . . . . . . . . . . . . . . . . . . . . .303

Chapter 13 Sensory Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .329

Chapter 14 Breathing Well . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .364

Chapter 15 Cardiovascular Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . .396

Chapter 16 Urinary Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .412

Chapter 17 Sleeping Well . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .447

Chapter 18 Sexual Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .482

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499

List of Assessment Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499

List of Terminology Boxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501

List of Clinical Resource Boxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . 502

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503

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ix

Contributors

Anita White, MSN, RN, CCRN

Critical Care Nurse Educator, Elyria Memorial Hospital, Elyria, Ohio

Cardiovascular Wellness: Chapter 15

Jill Bormann, PhD, RN

Research Nurse Scientist,Veterans Administration San Diego Healthcare System

A Nurse’s Perspective: A Quick and Easy Stress Reduction Method for Self-Care,

Chapter 6

Wellness Activity Tool 6.1: Frequent Mantram Repetition

Cheryle B. Gartley

President and Founder,The Simon Foundation for Continence

Patient’s Perspectives, Chapter 16

Sister Corinne Lemmer, PhD, RN

Mount Marty College,Yankton, South Dakota

Nurse’s Experiences, Chapter 7

Kathleen Lindell, RN, MS

Doctoral Student, University of Pittsburgh School of Nursing

Resource Box: Case Example of Nursing Interventions for Smoking Cessation,

Chapter 14

Janice E. McGrogan, Spiritual Care Coordinator

Hospice of the Western Reserve, Cleveland, Ohio

Another Perspective on How Nurses Provide Spiritual Care, Chapter 7

A Perspective on Caring for Patients During Times of Suffering, Chapter 7

Nursing Staff

Memorial Medical Center, Springfield, Illinois

Resource Box: Example of a Hospital Protocol for Promoting Sleep Wellness,

Chapter 17

Nursing Staff

St. Charles Medical Center, Bend, Oregon

Resource Box: Application of the Caring Model in a Hospital Setting, Chapter 3

Resource Box: Hospital Protocol for Praying with Patients, Chapter 7

Belleruth Naparstek, LISW, BCD

Psychotherapist, Author, Guided Imagery Expert

Wellness Teaching Tool 4.2: How to Do Guided Imagery with Patients in a Few

Minutes

Wellness Activity Tool 4.1: Using Affirmations for Promoting Health

Barbara Kammerer Quayle

Patient’s Perspectives, Chapter 3

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x • Contributors

Kevin Smith, MSN, RN, CNP

Adjunct Faculty, University of Minnesota School of Nursing and Center for Spirituality and

Healing

Perspective of a Nurse Expert on Humor as a Communication Tool, Chapter 6

Marsha Jelonek Walker, PhD, RN, AHN-BC, LMT

Private Practice, Stress Management Consultant

Resource Box: The HeartTouch Technique, Chapter 6

Tina Weitzel, MA, BSN, RNC

Nursing Quality Specialist, Memorial Medical Center, Springfield, Illinois

A Nurse’s Perspective on Promoting a Cultural Norm of Quiet, Chapter 17

A Nurse’s Perspective: The Sh-h-h-h!!! Project, Chapter 17

ACKNOWLEDGMENTS

In addition to the nurses, patients, and experts who are listed, I extend a special

acknowledgment to the people who shared their perspectives and are identified

by pseudonyms as Graham, Nancy, Marge, and Mary Patricia. Their valuable

insights about their experiences can help nurses respond more sensitively as we

promote wellness for our patients. I also appreciate the valuable contribution of

Dr. Elizabeth Click and nursing students in her health promotion class at

Frances Payne Bolton School of Nursing, Case Western Reserve University.

I am deeply grateful for the advice, assistance, and expertise of the outstand￾ing people at McGraw-Hill. In particular, Quincy McDonald, Senior Editor, has

shared the vision of developing a clinical reference toolbook to help nurses

quickly and easily promote wellness for their patients. Quincy has steadfastly

supported this text since its inception and his expert guidance has been essen￾tial for bringing it to fruition.

On a very personal level, I acknowledge and deeply appreciate the support

from my family and friends through all the challenges of developing this book.

In particular, I am grateful for the never-ending support and encouragement

from Pat Rehm, who is at the top of my list of the many significant people who

promote my wellness.

Copyright © 2008 by The McGraw-Hill Companies, Inc. Click here for terms of use.

xi

Reviewers

H. Lea Barbato Gaydos, PhD, RN, CS, AHN-BC

Associate Professor

University of Colorado

Colorado Springs

Beth-El College of Nursing and Health Sciences

Colorado Springs, Colorado

Mary Knudtson, DNSc, MSN, FNP, PNP

Professor of Family Medicine

Director of FNP Program

University of California, Irvine

Irvine, California

Juanita Manning-Walsh, PhD, RN

Associate Professor

Western Michigan University

Bronson School of Nursing

Kalamazoo, Michigan

Mary Anne Osborne Schwenka, BSN, MS

Family Nurse Practitioner

Woodland Integrative Medicine

Woodland Park, Colorado

Jacqueline L. Wylie, RN, MSN, MA

Retired Nurse Educator

Western Michigan University

Bronson School of Nursing

Kalamazoo, Michigan

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xiii

Preface

A Nurse’s Reflections on Promoting Wellness

When I reflect on my roles as a nurse, I identify my “raison d’ être´”—my most

fundamental reason for being a nurse—as caring about my patients and pro￾moting their wellness. I think about the many ways in which I use my nursing

skills to help bring new life into this world; facilitate healing of body, mind, and

spirit; and provide comfort during times of illness and death.Then my thoughts

focus on the challenge of reconciling my ideals of having time to provide holistic

care with the harsh realities inherent in the hurry and scurry of my job. These

thoughts lead to questions about how I can quickly and easily incorporate well￾ness into my usual care. I even begin to wonder if I ever really “do” wellness nurs￾ing when I care for patients—then I reflect on the many simple ways in which I

use my nursing skills to provide holistic care. For example, when I was assigned

to take care of Mrs. M., I made a conscious effort to promote her wellness, even

though other nurses had warned me that she was likely to complain loudly about

anything I tried to do for her. Before beginning my care I took a moment to cen￾ter myself, then I entered her room, looked straight into her eyes, and caringly

said “Good morning, Mrs. M., my name is Carol and I’ll be caring for you

today. I understand things have been quite difficult for you and I’m hoping you’ll

share your concerns with me so we can find ways of making you more comfort￾able.”After attending to her physical needs, I offered to teach her a simple breath￾ing technique that she could use to reduce stress and she was most receptive to

this. It took only a few minutes to empower Mrs. M. toward a sense of personal

responsibility for her wellness and I gained the satisfaction of knowing that I had

addressed more than her physical needs. Sometimes I hear tangible rewards for

my efforts to promote wellness for my patients, as when a patient recently told me

“I can tell that you really care about me.”

Purpose and Overview

The foundation for this clinical reference is my belief that all people aspire to

have wellness—which I define simply as “I’m OK and I want to be better”—and

that nurses have numerous opportunities to promote wellness by using our skills

to communicate to each patient that “You’re OK and I can help you be better.”

Although promoting wellness is an ideal, nurses often feel that they don’t have

time for tasks that are superimposed upon the already overwhelming demands

that bombard them from many directions. A basic premise of this book is that

nurses can quickly, readily, and routinely provide wellness-oriented care in clin￾ical settings by using the wellness assessment, teaching, and activity tools in this

book to develop a “wellness way of thinking” and improve patient care. I devel￾oped these tools based on both the successful experiences of nurses and the rap￾idly increasing body of knowledge related to many aspects of wellness. Chapter 1

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