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The Mechanics of Deep Breathing – The diaphragm is a dome-shaped structure that not only assists in breathing, but also acts as a natural partition between our heart and lungs on the one hand, and all of the other internal organs on the other. The top of the diaphragm, located about one and one-half inches up from the bottom of the sternum, actually supports the heart, while the bottom of the diaphragm is attached all the way around our lower ribs and connects also to our lower lumbar vertebrae. When we breathe, the surface of our diaphragm generally moves downward as we inhale and upward as we exhale. (See if you can sense these movements periodically throughout your day.) When we breathe fully and deeply, the diaphragm moves farther down into the abdomen and our lungs are able to expand more completely into the chest cavity. This means that more oxygen is taken in and more carbon dioxide is released with each breath. Deep breathing takes advantage of the fact that the lungs are larger toward the bottom than the top.

The Impact of Deep Breathing on Our Health – Deep breathing can have a powerful influence on our health. To understand how this is possible, we need to remember that the diaphragm is attached all around the lower ribcage and has strands going down to the lumbar vertebrae. When our breathing is full and deep, the diaphragm moves through its entire range downward to massage the liver, stomach, and other organs and tissues below it, and upward to massage the heart. When our breathing is full and deep, the belly, lower ribcage, and lower back all expand on inhalation, thus drawing the diaphragm down deeper into the abdomen, and retract on exhalation, allowing the diaphragm to move fully upward toward the heart. In deep, abdominal breathing, the downward and upward movements of the diaphragm, combined with the outward and inward movements of the belly, ribcage, and lower back, help to massage and detoxify our inner organs, promote blood flow and peristalsis, and pump the lymph more efficiently through our lymphatic system. The lymphatic system, which is an important part of our immune system, has no pump other than muscular movements, including the movements of breathing.

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Deep Breathing for Relaxation

Many of us breathe too fast for the conditions in which we find ourselves, that is, we actually hyperventilate. This fast, shallow breathing expels carbon dioxide too quickly and has many bad effects on our physical and emotional health. When our breathing is deep, however–when it involves in an appropriate way not only the respiratory muscles of the chest but also the belly, lower ribcage, and lower back–our breathing slows down. This slower, deeper breathing, combined with the rhythmical pumping of our diaphragm, abdomen, and belly, helps turn on our parasympathetic nervous system–our “relaxation response.” Such breathing helps to harmonize our nervous system and reduce the amount of stress in our lives. And this, of course, has a positive impact on our overall health.

F. Prayer/Spiritual Practices

The practice of spiritual healing is very common. The use of spiritual healing practices, especially prayer, and energy healing practices is growing (Eisenberg et al., 1998). The practice of spiritual healing is not limited to any one religion. Spiritual healing can involve such activities as going to a church or mosque, worshipping an idol or a mountain, using prayer wheels, (such as in Buddhism), visiting a hospital chapel, and meditating. It can also involve spiritual interventions, such as going to a group bible study or prayer group; reading the Bible, Koran, or other religious book; receiving pastoral visits in a hospital; confessing; and any other spiritual activity or intervention intended for the purpose of worshipping, fellowshipping with a group, or individual healing.

Spiritual healing practices can be found in every culture (Jonas & Crawford, 2003). These holistic practices allow devoted practitioners to transcend the ordinary world to a space where they are able to communicate with a higher being. Spiritual healing practices are sometimes examined in the same context as energy therapies, and the NCCAM often classifies these therapies together.

Spiritual healing practices are therapeutic healing practices that have been in existence since the beginning of civilization. They are a part of every culture’s healing practices (Jonas & Crawford, 2003). These practices are holistic because they are designed to connect the body with the mind and spirit. In addition, spiritual healing practices allow devoted practitioners to transcend the ordinary world to a place where they are able to communicate with a higher being, such as God, or the object of their belief.

Spiritual healing is sometimes referred to as faith, energetic, mystical, and shamanic healing. However, shamanism is not simply spiritual healing. In many cultures, shamans are herbalists and community leaders that fulfill certain social and cultural non-health-related obligations. Although shamanism is not a religion, it is a form of spiritual tradition that addresses key elements, such as marriage, rites of passage, death and dying, and parenting. In many cultures, shamans operate based on a state of consciousness. They may also be called imaginative healers, voodooists, native doctors, wise men, priests, and witch crafters, among other names. Some of these names have resulted in shamans being perceived in a negative light (Rankin-Box, 2001; Hung-Youn, 1999; Townsend, 2001).

Spiritual healing practices and religions are not one and the same. Every religion, however, has specific ways of practicing spiritual healing. The majority of the time, such practices are guided by the beliefs and assumptions of that particular religion, and not all citizens of a particular culture share the same religious beliefs. The relationship between spirituality and spiritual healing practices and health has been an integral part of the nursing profession since its inception. Although the use of spiritual healing practices started during the time of Florence Nightingale and these practices were popular in the nursing care approaches of early nursing schools, only recently, with the resurgence of NAC therapies, have they begun to gain increasing attention in modern nursing and medicine.

Of all the spiritual healing practices, prayer is the one most commonly used. Prayer is defined as “healing intentions or appeals directed toward a higher being, force, or power” (Ameling, 2000). To pray is to ask for something with earnestness or zeal or to supplicate, beg, or give thanks to an object of worship. Prayer can also be defined as “the act of asking for a favor with earnestness or a solemn petition addressed to an object of worship.” It can take place in public or private.

Prayer is not unique to one religion; it is practiced by most of the world’s major religions, including Christianity, Judaism, Islam, Hinduism, and Buddhism. In these various religions, beliefs do not always relate to the same god. Some religions may worship more than one god or another higher power. In addition, some religions are guided not by the word of God but by prophets, religious founders, and the traditions of the cultures in which they originated. True prayer with dedication can help to achieve moments of transcendence.

Online Resources for Prayer/Spiritual Practices:

· Energy Healing:  http://thefourwinds.com/energy-medicine-training/?gclid=COiF0vWpicoCFZEXHwodDk4Kiw

· Spiritual Healing:  https://www.spiritual-healing-for-you.com/spiritual-healing.html

2. Biologically Based Therapies

Biologically based therapies include the use of dietary supplements such as vitamins, minerals, herbs or other botanicals; amino acids; and substances such as enzymes, organ tissues, and metabolites. With the proliferation of literature on herbal remedies and the accessibility of the products, increasing manage symptoms. Purchasing over-the-counter medications allows people to bypass a visit to a health care provider, thereby eliminating the cost and inconvenience of a visit, as well as the real or perceived stigma on the part of the health care provider and others of a psychiatric label. PMH-APRNs need to be aware of therapies available and in common use, and they must also consult state board of nursing regulations.

A. Diet and Nutrition

Because psychiatric illness affects the whole person, it is not surprising that clients with mental illnesses frequently have nutritional disturbances. Often their diets are deficient in the proper nutrients, or they may eat too much or too little. Obesity and diabetes coexist at a greater than average rate in people with psychiatric disorders. Nutritional states may also cause psychiatric disturbances. Anemia, a common deficiency disease, is often accompanied by depression.

It is essential that PMH-APRNs assess the client’s nutritional status and practices and address this area in health teaching. Assess for the use of nutrients such as vitamins, protein supplements, herbal preparations, enzymes, and hormones that are considered dietary supplements. These dietary supplements are sold without the premarketing safety evaluations required of new food ingredients. Dietary supplements can be labeled with certain health claims if they meet published requirements of the U.S. Food and Drug Administration (FDA) and may contain a disclaimer saying that the supplement has not been evaluated by the FDA and is not intended to diagnose, treat, cure, or prevent any disease.

Some nutritional supplements interact with medications. There are well-known interactions with vitamins (e.g., vitamin E and anticoagulants), but interactions with other supplements are not as easily recognized. PMH-APRNs should specifically ask about the use of supplements during the assessment and should not expect clients to share this information without being asked. PMH-APRNs can review the use of the supplements and the potential interactions with foods, drugs, and other supplements to reduce risks. An example of a serious hypertensive reaction can occur when a client who is taking a monoamine oxidase inhibitor (MAOI) for depression ingests a food that contains tyramine, such as aged cheese, pickled or smoked fish, or wine.

Megavitamin therapy, also called orthomolecular therapy, is a nutritional therapy that involves taking large amounts of vitamins, minerals, and amino acids. The theory is that the inability to absorb nutrients from a proper diet alone may lead to the development of different illnesses. The earliest use of megavitamin therapy was for the treatment of schizophrenia, for which niacin was recommended.

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