A
Total Stress Management Guide
For Nurses

Author

Dr. Shriniwas Kashalikar










Prologue:
Dear sisters
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.

Dr. Shriniwas Kashalikar

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 understanding.
So, the Total Stress Management (Holistic Health Promotion) involves nurturing these five aspects of your personality!

Spiritual health!
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 within you.
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 trivial matters!

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 mean ideas.

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 apparent.
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 faith.

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 you dive!
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.
Intellectual health

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 health!

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 absolutely essential!
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 give you.
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 intellectual health!
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 indirectly!

Emotional health

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!

KAPALBHATI
KAPAL means forehead and BHATI means light or brightness.
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 emotional health!

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 details here.

BHASTRIKA
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 jerk.
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 abdomen.
Do not practice in pregnancy.
KAPALBHATI AND BHASTRIKA if practiced cautiously may help in early stages of certain malignancies.

UJJAYI
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
in-blowing sound.
There are no precautions and restrictions for UJJAYI except presence of lesion in respiratory pathway itself.

BHRAMARI
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!

ANULOM VILOM
Breathe in through one nostril and breathe out through the opposite nostril. Now breathe in by the opposite nostril and breathe out through the original nostril.
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 other position.
In this pranayama, since holding of breath is not advocated you can practice it even when you are traveling.
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 essential.

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 miserable.
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 emotional health!

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 judgment.
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 PRIORITIZATION.
Once a thought or a feeling or an action is judged as the most important objective it becomes easy to ASSERT yourself.
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.




Instinctual health

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!

1] Survival
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 sense.
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.

Sexual instinct
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 www.superliving.net).

Herd instinct
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 superficiality!

Habitat
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.

Defecation
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 regularly.

Movement
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.

Physical health
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 physical health.

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 constipation.
2] Splash your eyes with cold water at least twenty times each.
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 them.
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 you.
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 on.
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 group
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 additional advantage.
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 respectively.
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 thing 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
www.scribd.com/drshriniwas
and
start practicing and teaching others!)