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Stress Management In Heart Failure

Shiny Bieju (Diploma in Wellness Coaching Skills)

 

As a result of increased prevalence of preventable illness and multiple health-related international meetings, an increased focus on the importance of health has occurred over the past few decades (Edlin & Golanty 2009). Furthermore, information regarding the specific relationship between personal behaviour and health outcomes has also increased. Due to these developments, health promotion programmes focusing on wellness have been emerging and gaining increased attention since the mid-1970s. There are numerous definitions existing for the word wellness – however the truth is wellness is a tough word to define. Wellness is a multidimensional state of being describing the existence of positive health in an individual as exemplified by quality of life and sense of wellbeing (Edlin & Golanty 2009). Likewise wellness is an active process of becoming aware of and making choices toward a more successful existence. Moreover, wellness is more than just a state of physical health, it also encompasses emotional stability, clear thinking, the ability to create, embrace change, exercise intuition and experience a continuing sense of spirituality also closely associated with the lifestyle (Alexander 2011). A wellness orientated lifestyle encourages a person to adopt habits and behaviours that promote better health and an improved quality of life. Therefore wellness is a positive approach to living and an approach that emphasizes the whole person.  It is the integration of the body, mind and spirit.

The business of wellness is multidimensional and the development towards do-it-yourself (DIY) healthcare is growing. One of the main reasons is that many people live with chronic or acute illnesses and this prompts individual to pursue the solutions to make life easier. The role of a wellness coach is very vital in the wellness industry in terms of transmuting knowledge into personalised coaching programmes (Alexander 2011). The purpose of this assignment is to consider and evaluate the DIY healthcare market of stress management in heart failure.

Around 900,000 people in the UK have heart failure (HF) and increasing rapidly with age also 30-40%  of them die within a  year but thereafter the mortality is found to be less than  10%  per year (NICE 2010). The hallmark of HF is exercise intolerance and activity restriction, most commonly due to symptoms of dyspnoea and fatigue. These symptoms are debilitating and result in low functional capacity and progressive physical disability, often requiring intensive medical management, follow-up, and hospitalization (Young & Mills 2004).

In addition to physical decline, these patients often report depressed mood, anxiety, and increased hostility. The patients who were depressed required a greater number of inpatient hospital days (Nicholson 2008 & Ward & Witham 2009). According to the American Psychiatric Association, a major depressive episode consists of 5 or more symptoms. One of these symptoms must be depressed mood or loss of interest in usual activities, and the symptoms must cause significant distress in social, occupational, or other areas of functioning. Encouraging patients to engage in activities such as walking or reading while they are hospitalized may also reduce depressive symptoms. A study that evaluated quality of life of HF patients reported that functional status, depression, and hostility were significant indicators of quality of life among these patients.

Miller (2008) states the early manifestations of heart failure may be mental changes secondary to the physiologic stress. Stress is a normal physical response to events that makes the person feel threatened or upsets their balance in some way and can affect anyone at any time during their life. However, the body doesn’t distinguish between physical and psychological threats (Lori 1998). Long-term exposure to stress can lead to serious health problems like high blood pressure, suppression of the immune system, an increase in the risk of heart attack and stroke and can leave people vulnerable to anxiety and depression. Anyone who is feeling stressed is encouraged to talk to someone – be it their doctor or a friend and try to find ways to relax each day, doing something enjoy such as going for a walk in the park, meeting friends for a cup of tea or attending a yoga class. Relaxation can help to relieve the symptoms of stress (Lori 1998). It can help to calm down and take a step back from a stressful situation. Although the cause of the anxiety won’t disappear, the person feels more able to deal with it once they released the tension in their body and cleared the thoughts. All relaxation techniques combine breathing more deeply with relaxing the muscles.

Relaxed Breathing

In order to do the relaxed breathing the person needs to find a quiet place where they would not disturbed. Also to wear loose clothes and remove any tight clothes such as shoes or jacket. Sit in a comfortable chair which supports head and arms or lie on the floor or bed. If lying down, stretch out legs, keeping them hip width apart or slightly wider. Then starts with focusing on breathing and to do this breathe in through the nose and out through mouth slowly and in a regular rhythm. Fill up whole lungs with air without forcing. Keep doing this until feels calm.

Deep Muscle Relaxation

This technique takes around 20 minutes. It stretches different muscles in turn and then relaxes them, to release tension from the body and relax mind. The person has to lay or sit with eyes closed in a warm, quiet and comfortable place and begin by focusing on breathing. If there are muscles that find difficult to focus on, spend more time on relaxing other parts. Some may want to play some soothing music to help relaxation. As with all relaxation techniques, deep muscle relaxation will require a bit of practice before start feeling its benefits. For each exercise, hold the stretch for a few seconds and relax. Repeat it a couple of times. It’s useful to keep to the same order as work through the muscle groups:

  • Face: push the eyebrows together, as though frowning, then release.
  • Neck: gently tilt the head forwards, pushing chin down towards chest and slowly lift again.
  • Shoulders: pull them up towards the ears and relax them down towards the feet.
  • Chest: breathe slowly and deeply into the diaphragm. Then breathe slowly out, allowing the belly to deflate as all the air is exhaled.
  • Arms: stretch the arms away from the body reach and relax.
  • Legs: push the toes away from the body, then pull them towards body, then relax.
  • Wrists and hands: stretch the wrist by pulling the hand up towards, and stretch out the fingers and thumbs, then relax.

Self-management is another crucial dimension in managing chronic heart failure. Knowledge, attitudes and beliefs, relating to both illness and wellness are strongly influenced by culture and ethnicity, impacting upon an individual’s capacity to engage in self-care behaviours (Kucia & Quinn, 2010).

A study conducted by New York Heart Association finds that the overarching strategy for managing depressive symptoms is “taking my mind off of it”.  Patients engaged in activities such as exercise, reading, and by using positive thinking, spirituality, and social support managed to take off their stress. Helping patients find enhanced social support may also be important (Dekker et al 2009). Finally, helping patients’ significant others provide enhanced social support may be an important method for reducing depressive symptoms in patients with heart failure.

Wellness coaching methodology is very client centred. Coaches help their client to take their inventory of their health and wellness then get clear about their own vision of what living a healthy and a well life looks like (Alexander 2011). Addressing the disparity or gap between where the client is now (current health status) and where they want to be (vision) help the client to form a wellness plan made up of areas they want to focus on to improve their lifestyle. Wellness coaching is not simply a process of goal setting, it is whole life planning and the heart of it are the clients values (Alexander 2011 & Dolan 2011).

References

  • Alexander L (2011). How to Incorporate Wellness Coaching into your Therapeutic Practice, London, United Kingdom.
  • Dekker R.L, Peden A.R, Lennie T.A, Schooler M.P & Moser D.K (2009). Living with Depressive Symptoms: Patients With Heart Failure, American Journal of Critical Care, 2009:18, pages 310-318
  • Dolan S.L (2011). Coaching by values, a guide to success in the life of business and the business of life.Bloomington, U.S.A.
  • Edlin G. & Golanty E – (2009). Health and Wellness, 10th Edition, United States of America.
  • Kucia A.M. & Quinn T. (2010). Acute cardiac Care, A practical Guide For Nurses, Blackwell Publishing Ltd, Singapore.
  • Lori A. L.R. (1998). A Mind Body Spirit Approach to the Emotional and Physical Healing, A Stress Management Handbook, Strategies for Health and Inner peace. United States of America.
  • Miller C.A. (2008). Nursing For Wellness in Older Adults, 5th Edition, United Kingdom.
  • National Institute for Health and Clinical Excellence (2010). Chronic Heart Failure: Management of Chronic Heart Failure in adults in Primary and Secondary Care.
  • Nicholson C. (2008). Heart Failure, A Clinical Nursing Handbook, Padstow, United Kingdom.
  • Ward Christopher & Witham M (2009). A Practical Guide to Heart Failure in Older People, Chippenham, United Kingdom.
  • Young J.B. & Mills R.M (2004). Clinical Management of Heart Failure, 2nd Edition, New York, United States Of America.

 

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