Acupuncture's mechanisms and effectiveness in pain management

Nursing
This study has the following limitations; the chosen location, the chosen industries, the population, environmental factors and several uncontrollable variables; which are briefly outlined below. The chosen location is Houston, Texas United States. Since the hypothesis is the measurement of nurses' health habits, the population is near 120 RNs, all are females, 85% of them are Caucasians, with their ages ranging between 22 to 47-year. Another limiting factor is the collection of the needed data all at once. Still, another limiting factor is the chosen location as the study cannot be carried out across different locations due to the short time frame allocated to the study.

Major Generalizations of the study

There is an assumption that nurses' health habits rubs off positively on the hospital environments. Additionally, the outcome of this thesis has the capacity of affecting future studies on the same topic.

Section B:

Every individual has felt some pain at one time or the other in life. Imagine a situation where you have consistent pains without any remedy in site. Relief from pain is not too far from you when there is acupuncture. The result of this, if found to be true, would contradict several scientists, who are reluctant to admit the efficacy of acupuncture in the management of pain.

Acupuncture uses your energy within your body system to get rid of pains and does not come with the side effects that come with the use of drugs. Though the mechanism by which acupuncture relieves pain is not yet very clear, but with technological advancements, scientists have found that it stimulates the veins that are linked to the brain which results in the body responding to the acupuncture treatment. The meridians vary in number; the range is from 14 to 20 with about 2000 acupuncture points. (nccam1) Out of several theories available, one suggests that acupunctures work by stimulating the nerve fibers which are responsible for the transmission of impulses to both the brain and the spinal cord, thereby activating the human central nervous system.

Though, according to studies, acupuncture has the ability to modify the human perception of pain and its interpretation by the brain. Scientists are able to see the changes that occur in brain's pain centre through genomics and neuro-imaging. Scientists have observed molecular transformations in the immune and nervous system. Few side effects have been linked to the use of acupuncture, against the side effects that comes with managing pain with drugs. Generally, it won't be wrong to say that the best way for pain management cannot be the use of acupuncture since it does not get rid of the pain, but only intercepts its perception by the body.

Section C:

Justice means giving all opinions the same treatments. What determines the success or failure of any study is its validity and authenticity.

The smallest level of illegality can turn the whole study into a wasted effort. The validity of any data depends on the integrity, depth, and capacity of the gathered information as well as the sample of study and the unbiased strategy used by the scholar. In this research, the researcher used the survey method (semi-structured interviews and questionnaire) using the same procedure for all the topics in the sample. This made the discrepancies found in the responses to be personally genuine: which eliminates the chances of disapproving the methodology on the grounds of impartiality and being subjective in any way (Trochim, 2006).

Saunders et al. (2002) was of the opinion that to minimize the chances of having inappropriate responses, the scholar must take into consideration the extent to which the research would be strong and feasible while drawing the research map. Reliability in researches can be defined as the possibility that other studies carried out by other researches using the same methods and devices will arrive at the same inference. The truth remains that, reliability issues reveal dilemmas and problems in both accuracy and precision of the calculating/measuring device used for the study (Bouma, 2010)

Part 2: Holistic Nursing Care

Case Study A: map

Using two holistic nursing ideologies, an in-depth account of my approach to the care of this patient is outlined below.

First principle: Role Models for Wholesome and Healthy Living

Holistic nurses work hard to be models of healthy and wholesome behavior through the creation of optimal health in every area of their lives-mentally, physically, spiritually and emotionally. Achieving the best health conditions in every aspect of the lives of their patients is nurses' lifelong struggle. Low self-esteem, resistance to change, self-doubt, can hinder the journey to optimal health conditions. Paying attention to these hindrances is important for the identification and understanding of possible resistance sources. Most of these beliefs and behaviors are as a result of social modeling and childhood experiences that are naturally not applicable to adulthood. The willingness to explore what may be found beneath the surface is essential for the creation of wholesome and healthy lifestyles (Thornton, 19998). For this patient, who has just had a stillbirth at 36 and beliefs she can't get another chance at childbirth, I will work on her mentality by letting her understand that she can still get another baby. I will encourage her to believe it is possible for her to get pregnant again with the baby that will survive, guiding her through the importance of a healthy diet, regular exercises, and adequate sleep, and prayer / reflection times in the recovery process.

Principle 2: Acknowledging the Infinite and Sacred Nature of Being

The infinite, spiritual and sacred nature of humans is acknowledged by holistic nursing. According to Florence Nightingale, human beings are reflections of the spiritual forces with physical, intellectual and metaphysical attributes (McCrae, 1995). According to Martha Rogers, unitary human beings are infinite energy fields (Thornton, 1999). From the viewpoints of theorists and holistic nursing, human beings are energy fields that are both sacred and infinite. This orientation changes our method of approach to each other. It makes changes in our modes of speaking, listening, relating with others, as well as interactions. Outlined below is my approach to caring for him following holistic nursing care ethics.

• Before entering the patient's room, pause for a moment • Drop all worries about the past, present or future. They can be picked up on your way out of the room. •Close your eyes very gently. Take slow and deep breaths. • Tell yourself that you are here for the greater good of the patient-therefore all my attention is here now, repeat this several times. • Pay attention to your heart, focus on the things and people you love the most. • Once you are fully in connection with that feeling of love and compassion, say to remind yourself that you are here for the moment. • This whole process should last between 5 and 10 seconds.

Case Study B:

Outlined below is my detailed approach to the patient's care following holistic care ethics.

For an 86-year-old diabetic patient, working on his mind is of utmost importance if he must be encouraged to manage his ailment effectively. I will make him understand that he can still live for many more years if the diabetes is managed well, with the right foods and lifestyles.

Principle 1: Being a Caring and Healing Presence

The major aim of holistic nursing is to return caring and healing to health care. The first approach to achieving this aim is for nurses is to learn how to care for and love their patients. They will learn to care for their patients deeply by paying attention to nurturing them emotionally, physically, spiritually, and mentally. When this is done, it helps us come to the realization of their wholeness and makes healing presence known to these patients. Being a nurse in charge of this specific case, my major concern is the role of nurses (e.g., administering treatments, changing dressings, looking out for important signs, etc.)

Getting acquainted with clinical nursing procedures and treatments is important to help this patient recover and heal from his sickness. But, my personality, my inner feelings, and my attitude all have very notable effects on my patient.

As a matter of fact, outlined are some of the questions that are useful in exploring the different facets of my patient's life: • Physical: How adequate is the diet? Does his food include mostly natural and whole foods? How adequate is his daily sleep and rest? Does he partake in helpful movements and daily exercises? Does the way he breaths promote overall well-being? • Mental: How is his mentality towards life; problem-solving or victim mentality? What are his attitudes and thoughts towards school works; positive or negative? Is he humorous? How is his self-awareness level-does he object to my possibilities, strengths and limitations? Can he perceive reality clearly? • Emotionally: What is his level of love and acceptance for himself and others? Can he give and accept love from me and other people? Can he express his personal truth? Can he have deep feelings of sympathy, identification, and affection for other people? • Social/relationship: Does he get involved in loving and wholesome relationships? Does he get involved in relationships that enhance his growth and the growth of others? Can he set healthy margins with other people? Does he take part in meaningful works? • Spiritual/energetic: Can he connect effectively with God/higher powers/spirit/universe? Does he partake in regular prayers/meditations/quiet reflections? Is he aware that love is the essence of self? How deep is his respect for others?

Part 3: Cultural Care

Case Study A:

By keeping in mind the circumstance mentioned above, the nursing staff is provided with the framework that would help them in dealing with the psychiatric clients who require the kind of care being given to them to be relevant to their culture through the Campinha-Bacote (2002) model of the "Cultural Competence"

General data about a patient or client is gathered when he/she is admitted initially. This general data includes the age, ethnicity, hobbies, general appearance, memory impairment as well as disabilities. At this particular stage the cultural challenge which was observed was the different culture that the client belonged to. It is very important to get all the essential data regarding the cultural and religious beliefs of the patient, the language he/she speaks, appropriate clothing, spiritual believes as well as the practices that can have an impact on the care that needs to be provided to the client. All this information and data can help in ensuring that proper treatment is given to the patient (Streltzer, 2008).

According to Tseng and Streltzer (2004) language is such a tool that expresses the culture. The underlying attitude, conception and values are communicated by a person through language as all these things can be very different in different cultures. Therefore, it can be very difficult to comprehend the culture of a person merely through their language especially if the language spoken by that person is very different from your own. However, through genuine interest and by remaining non-judgmental the probability of accumulating information that is relevant can be assured.

Case Study B:

Generally speaking the Muslims don't usually have an opinion regarding males acting as care providers. But the amount of importance that is given to modesty in Islam, it is preferable that female patients are not taken care of by the male nurse and vice versa. Nursing is considered to be a very intimate profession and the reason for this is the fact that in this profession we see and touch body parts that aren't usually seen in other professions.

The possibility of male nurse being turned away by a female patient is very high if that nurse gets assigned to a female patient who is Muslim. In such a case there is no need for the male nurse to get offended as, the Muslim females cover themselves (head-to toe) from the men. Therefore, it is essential to remember that in case of Muslim patients it's a rule of thumb that there should be male nurses for male patients and female nurses for the female patients.

The protoplasm of the Muslims is similar to all the other human beings. They should be treated like the rest of the patients. In case that they refuse to be provided with care by one nurse, it's okay for the nurse to let someone else treat them. As, it doesn't happen very often in the world therefore, it is important that the nursing instructors don't waste there and the students' time by giving them examples of such scenarios, in fact they should train them regarding situations that would help the students in being able to provide their patients with better care.

If a nurse or care provider starts to worry about the customs and traditions of Muslims then he/she should also start learning how to take care of the shinot, Sikhs wiccans, Buddhists, scientologists, the flying spaghetti monster, the nation of Yahweh, nuwaubians, followers of the Prince Philip movement etc. Although, nuwaubianism is somewhat similar to the Muslim culture so it might not be that difficult to get accustomed to that. Therefore, if this is the kind of approach that a nurse wants to take then he/she needs to start studying and a lot for that matter since this world is full of people who are very sensitive!

Part 4: Ethical Considerations in Nursing Practice

Answer A: Ethical Principles

Beneficence

The ethical theory is guided to do what is good and right according to the principle of beneficence. An ethical perspective along with a probable solution to an ethical dilemma is provided by this approach which gives priority to "doing good." The principle of utility is also quite similar to this principle as, it also states that attempts should be made by us to increase the ratio of good over evil as much as possible. This is the same thing that we have observed in the scenario mentioned in the case study as well, where each and every effort was made by the physicians and care takers to treat the patient and make his condition better; and with time it was realized that his condition was such that could hardly improve but could only be maintained. Therefore, according to this principle the ethical theories should try to do as much good as possible as it is this good that the people benefit from.

It is the utilitarian ethical theory that this principle associates with, this theory is present in the following section in this paper. The practice of medicine clearly shows an example of "doing good" as, by getting treated by a physician a patient gets better. Therefore, in my opinion this principle of beneficence wasn't violated here as, the doctors did take complete history of the patient and treated him with as much care as they could provide. It was the family's fault that they forgot to mention the fact that R.J's cousin once had a reaction to the anesthesia as well. If that fact was mentioned in the medical history, the condition that followed could have been easily avoided.

Least Harm

It is to a certain extent similar to beneficence; however, here we deal with the scenarios in which neither of the choices is beneficial.

In my opinion this principle wasn't violated by the doctors either as, they had no reason to believe that R.J's surgery won't be successful since all the tests were clear and he appeared to be in good health. Therefore, there was no real risk of doing any harm and the doctors were only trying to do their job by treating R.J for his gall stones.

Respect for Autonomy

According to this theory the people should have some control on themselves and they should be able to make decisions regarding their own lives. Therefore, according to this the people need to have as much control over their lives as they possibly can as, nobody else knows it better than them what they are going through or what path they have chosen and for what reasons.

According to the case study this principle wasn't violated either as; it is only after the consent of the patient that the doctors can operate. Yes, it is true that R.J was feeling some anxiety before the operation but the doctors can't be held responsible for not delaying the procedure or taking some action as, they felt that it was only because R.J had never been to a hospital before because of which he is feeling this anxiety and none of the tests showed anything wrong that would have made them postpone the procedure.

Justice

According to the justice ethical principles, actions prescribed by ethical theories should be such that they should be fair for all the people involved.

What this means is that there is a need for the ethical decisions to be consistent with ethical theories except for in a scenario where extenuating circumstances exist in a case and those too which can be justified.

I believe that the justice principle wasn't violated by the doctors either as, the patient had good pension and health insurance, he was also given excellent treatment prior to the surgery as all tests were done on him to see if he was ready for the surgery. Even after his brain damage he was being given nutrition in liquid form and all his needs were taken care of. Therefore, in my opinion the patient and his family were being treated by the hospital staff in a justified manner and the impatient behavior of the family and their lack of confidence in the hospital staff is understandable as, they felt it was the hospital's fault that they couldn't stop all this from happening to R.J.

Answer B:

In light of the fact that actions can have negative as well as positive impacts the only recommendation here would be to follow the deontological theory. According to this theory when the analysis of an ethical dilemma is carried out by the people it is important that they remain focused on the duties and obligations that they have. Therefore, in the light of this theory, upholding your own duty is very important so a person will stick to his/her duties even when they go to another place which has a different culture. Decisions of very consistent nature will be made by a person who follows this theory as, that individual's set of duties will be the basis for those decisions.

Part 5: professionalism

For me, nursing professionalism is a demonstration of person's moral values and inner beliefs and person's perception of human welfare. Nurses work for the welfare of human beings and also take care of ones who are sick or ones who are breathing their last few breaths. Demonstration of professional attitude towards patients and their family members is a must for nurses during treatment or education. It is essential for one to respect other person's dignity and moralities. Nurses together coordinate with other professionals in order to encourage better cures for patients. Promotion of educations along with learning courses and awareness for advanced procedures to accomplish old tasks is a staircase to excellence. Nurses should make efforts and struggle for the success and advancement of their profession. Profession of nursing holds responsibility for society. These responsibilities can be held more appropriately by practicing professional standards. Setting professional standards and their implementations are two of the major functions performed by any professional organization. The purpose of setting such standards is to make nurses liable for what they are doing in their jobs (Blais & Hayes, 2011). Nurses should follow and stick firmly on the regulations of the Nurse Practice Act. In order to safeguard the profession of nursing, nurses are suppose to stay firm on moral values like dignity, coordination, autonomy, selflessness, social justice and excellence. For patient's care, nurses shall maintain competencies suitable without losing the art of nursing.

There is always a wide scope for perfection in any profession, may it be a for a person who weekly collects garbage or the nurse who is taking care of a person suffering from cancer and is about to die. Person's steps towards perfection are extremely significant. Highest priority should be given to the field of education to enhance skills and sustain competency for patient's treatments and care.

Nurses are supposed to indulge in the development of their profession. Maister (1997) believed that it should be a key requirement of all professionals to contribute towards the success of others.

As a nurse, one has to team up with others to work for the betterment of the profession of nursing and also have to make efforts and find new ways of improvement, whether it is by creating high tech computer charts or by finding new cures for patient having urinary tract infection. Everyone has opinions to give and ways for the profession's improvement. Our ideas need to be perceived.

Part 6: Mission and Philosophy of the Division of Nursing

Division of Nursing Mission

According to the mission statement of Immaculata University, The division of nursing makes effort to develop a person who is truly educated and value oriented and also commits himself to the qualities of truthfulness, justice, peace along with service. Immaculata University's division of nursing looks forward to encourage the development of personal and professional awareness through creating perceptions within environments which are Christ based.

The RN to BSN program is planned for graduates of associate degree and also for nursing's diploma programs to facilitate their educational mobility. Structured on the basis of sciences and liberal arts, this program encourages the expansion of knowledge, growth of professional skills and intellectual inquiry. This program trains students for graduate study and how to cope up with challenges faced by them in this vast health care system prevailing for the global community. The structure of the MSN program baccalaureate nursing education and train nurses for their role play in advance practices of educational, managerial and doctoral study. Structured on the basis of liberal and art sciences, it endeavours to offer opportunities and to incorporate knowledge with the help of logical and critical thought along with practical experiences, independent study and awareness about culture and aesthetics.

The MSN program coaches students about the procedure of scientific investigations and progress of research for the expansion of nursing knowledge. Students studying this program are challenged to build themselves as leaders and innovators who influence the profession of nursing and the dynamic health care system. Nursing faculty at Division of nursing believes that education is an academic and intellectual voyage that included critical thinking, professional practices, problem solving skills and intellectual inquiries. According to the statements which are stated in university goals, the nursing faculty has a perception that a most important service which a university could offer its students is preparing them for life up ahead. The faculty at nursing division believes that this program must build on the potential of diploma and associate degree programs of nursing and also on the skills, knowledge and experience that students possess on an individual level. Masters in nursing program ought to build on the BSN education. Immaculata, being a catholic liberal university, have an ideal and ultimate setup to educate professionals for betterment of society. Moreover it's an institutional commitment to provide students with Christ based academic community and environment. The faculty also acknowledges every student's unique skills and makes efforts to create an environment which motivates the development of the whole person considering aspects of human nature such as physical, intellectual, spiritual, moral, aesthetic and social. Faculty has a perception that nursing practice is an art science that combines with physical, social, humanities and psychological sciences.

Nursing as an art is the practice of how to assist patients in promoting, restoring and maintenance of their health or giving comfort to patient so that he can breathe his last breath with dignity. Art of nursing requires sense of freedom, justice, morality, team work, community welfare and encompassing environment. According to faculty, art of nursing has scientific foundation which is derived from researches. All nursing inquiries and therapeutic actions are viewed on the basis of critical thinking. Profession of nursing is also recognized as legally certified practice. According to Pennsylvania Nurse Practice Act nursing art is diagnosing and treating human responses to potential health issues with the help of services like case finding, health teaching and counselling, provision of care supportive or restoring of human's life or well being (Professional Nursing Law, 1987).

Nursing faculty holds a holistic Christian worldview which says that all human beings are made up of mind, body and spirit. And have a belief that this composition is inseparable. Faculty also embraces a view that all human being posses unique qualities and have worth and moralities and all of them interact continuously with the varying environment. However, environment comprises of internal and external systems. Internal system includes spiritual, psychological, somatic and cultural settings which develop one's personhood. External system includes physical, cultural, political and social setting which depicts a person's humanity. Person and his environmental settings cannot be separated. And faculty believes that understanding of this bonding is essential to know the human condition.

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