Contagious Calmness: a Sense of Calmness in Acute Care Settings

Contagious calmness: a sense of calmness in acute care settings

Mar)1 HJ. Proudfoot, R.N., C.S., M.N. AVE YOU EVER been in a situation Psychosocial Nurse Practitioner Hwhere it seemed that sorneones Woodway Counseling Associates anxiety was affecting you or other memo Edmonds, Washington bers of a group, that the person's nervous' ness was catching? Or have you known a person whose presence alone was verv ! calming? We are all familiar with situations where one person's anxiety is able to affecr either another individual or a group but it is also possible for one person's calmness to affect others.

These effects are difficult to measure in a I rigorous scientific manner, but are acknowledged in many clinical settings Staff members on psychiatric units observe the escalating group discomfort and aCtinF . I out when one person is upset. In obstetrICS. a patient may seem more apprehenSive after being examined by an anxious nurSE Observation of family reactions ro illn~SS may reveal the effects of an anxious famJ\ member on the other members of the. family. On the other hand, the presence of a calm nurse during a painful procedur~ may decrease the patient's perception or

pain. The calmness of the crisis interven- increased anxiety during circumstances 19 cion staff in emergencies often produces a where others are reacting with anxiety. In sense of calm in the overall situation. And addition, if the setting is one where there (he introduction of relaxation. techniques are many practitioners in training this sense can often influence the rotal family unit of anxiety may be heightened. during prenatal education. Another general societal attitude that is supported by the hospital environment is PRESSURES WITHIN THE what several authors have called "hurry SYSTEM sickness. ,,1,2 This term describes the ten- dency to move through all aspects of Despite some of the acknowledged and everyday living with speed of action, rather intuited benefits of relaxation and calm- than the slowness required to pay attention ness for the clinician and the client, the to the' task at hand. One reason for this environment of the acute care hospital hurrying is competition (for advancement, does not reward "calmseeking" behavior. recognition or other rewards). Rushing is To begin with, relaxation takes some prac- not conducive to seeking relaxation or tice, which takes time and a place of inner calmness. relative quiet. Many nurses have been able There are two major aspects of a calm to use their breaks as a time ro practice and environment. These are the external envi- either the utility room or the bathroom as a ronment and the individual's own internal place to practice. All too often even this environment. The external environment brief time off is unavailable due to patient includes the work setting, coworkers, staff care responsibilities. Second, when an atti- members, patients and patients' families. rude of calmness is maintained in a given Some changes can be made in this environ- situation, there may not be the appearance ment. Soundproofing can be added to of as much activity as when compared with decrease noise. Furniture and equipment frantic, anxious bustling. The calm nurse can be arranged to allow for a more orderly mayeven be asked why tasks are not being flow of movement in the unit. Patient and handled quickly. In actuality, the calm staff education can be conducted to nurse who appears to be performing slowly decrease anxiety related to lack of informa- may be saving time in the long run. In tion. A more relaxing setting can be cre- many situations an alert calmness allows ated through interior decorating. All of for improved perception of subtle factors these changes may not be possible, and all in the environment or prevents increased problems will not be eliminated by these anxiety for the patient. changes. A general societal opinion about calm- The second aspect, the internal environ- ness is expressed in the statement, "If you ment, refers to those elements of calmness can keep your head while everyone around within the individual. This is the area with YOu is losing theirs you probably don't the greatest potential for change, since the understand the situation." The social pres- individual has the most control here. For Sureto react in ways similar to coworkers example, the author counseled a woman mayproduce a feeling of internal panic or who worked in the hectic complaint TOPICS IN CLINICAL NURSING / OCTOBER 1983

20 department of a nationwide company. The with the imaginary line serving as the woman wanted to learn relaxation tech- center point. niques for use on the job. Her desk was in Each experience may be different an area where there was a lot of noise from because each person has a unique symbolic other people and from ringing telephones. way of creating and understanding internal The telephone calls were almost always images. Some people get a sense of center- complaints. This woman had no ability to ing as being in a particular place in the change the external environment, but she body. Others form an image from a partic- was very successful in changing her inter- ularly relaxing experience in their past. It nal environment. Her successful technique seems helpful at first to suspend all mental consisted of using the ringing telephones impressions of what centering might be as a reminder to relax. Each time the phone and allow a mental image or a feeling state rang she let it ring one extra time. During ro arise spontaneously. One may question that small space of time she rook a couple whether the image is valid. In the author's of deep breaths and checked her shoulders experience, the first, spontaneous image for tension, relaxing them if necessary. In that occurs often is accompanied by a this way she used an environmental irritant to help her accomplish inner calmness. It seems helpful at first to suspend all CALMNESS IN THE INTERNAL mental impressions of what centering ENVIRONMENT might be and allow a mental image or a feeling state to arise A sense of internal calmness is thought spontaneously, to be present in all people. In those people who are calm, or who create a calming effect, this ability may be more developed than in an anxious person. This calmness sense of "fit"-a sense that this image does can be strengthened through the use of indeed have meaning for the individual. centering techniques. A helpful way to There are many ways to describe the begin to understand the concept of cenrer- experience of cenrering, all partly inad~' ing is to quietly sit and ask yourself what quate due to the limitations of words 10 centering means to you personally. The conveying an internal occurrence. Hen- author's first impression was that of a sense dricks and Wills had children describe the of stillness with a mental image of quiet. feeling of centering, and their answers The mental image was that of a line included: "Being lined up just right. Feel' running vertically through the cenrer of the ing solid. Not thinking-just feeling· body. The idea of centering for the author Being right on. Being balanced."? was to feel balanced around this line. The Kushel expresses his inner state of cen .!irst impression was that of swaying wildly, tering as becoming "aware of who I am .. ' even though remaining physically fairly [with] ... a deep and abiding sense of in~er still. Gradually, after sitting quietly for a calm.:" Kunz calls centering an inner stIll- longer time, there came a sense of stability ness free from emotional disturbances and CONTAGIOUS CALMNESS

mental hangups;' internal stability is the to help center, especially during hectic 21 term used by Hendricks and Roberts to times. Both Kunz and Kushel suggest the convey the essence of centering.? Richards, use of images from nature as a way to a potter, likens centering in a person to the reac h the centenng. experi.ence.":lOll Some 0f act of stabilizing clay on a spinning potter's the elements to consider in choosing an wheel prior to beginning work (p. lr She image include the following. describes the experience further as "a sense • Does the image have elements of of a quiet inner unity, a unity within me" peacefulness, quiet, flexibility, growth, (p. n) in which a person "senses himself as stability? pOtentially whole" (p. 24). The most inclu- • It this an image that seems to be a sive description of centering is offered by personal symbol of inner calm? Krieger. • Does this image exclude any details that might produce tension? Centering refers to a sense of self-relatedness Some possible images include a tall, that can be thought of as a place of inner being,a place of quietude within oneself where straight, growing tree; a flowing brook; an one can feel truly integrated, unified, and ocean beach with rhythmic waves; or a focused, ... the act of centering does not flourishing mountain meadow. ~'1volvane exertion of effort, ... centering is a conscious direction of attention inwards, an Relaxation as a component of 'eff0i1lesseffort' that is conceptual but that calmness canalso be experiential," Physical and mental relaxation combine A beginning exercise for introduction to with centering to form the basis for a sense centering is presented by Krieger as fol- of inner calmness. A wide variety of relaxa- lows: tion and stress management techniques can 1. Sit comfortably, but in postoral alignment, contribute to developing this sense of whiledoing this test. quietude. (A list of suggested readings is 2. Relax. To assure this, I suggest that you included at the end of this article as checkOutyour favorite tension spots and relax available resources.) A combination of those areas of your body. If your neck or some form of physical relaxation (pro- shoulder muscles are in tension, strongly gressive relaxation, exercise, autogenics, depress your shoulders-that is, push your biofeedback), mental relaxation (visualiza- shouldersdown so that they are not hunched tion exercises, sensory awareness, changing up toward your neck. chronic worrying habits, cognitive focus- 3.Inhale deeply and gently. ing) and breathing techniques seems to be 4. Slowly exhale. especially helpful. S. Inhale again-and there you are! It is just here,in this state between breaths which you arenow experiencing, that a state similarto the Meditation techniques centering experience can be simulated. It isthis Over time, practicing centering leads to stateof balance, of equipoise, and of quietude an increased awareness of the difference thatmarks the experience of cenrering." between a momentary disturbance and the It may be helpful to use a mental image inner stillness." A variety of meditation TOPICS IN CLINICAL NURSING / OCTOBER 1983

22 techniques can promote a feeling of meditation exercise makes it difficult to increased connection with this inner calm. realize what the broader field is all about. Benson has noted some of the beneficial In the long run, it is necessary to invest effects of meditation and has developed a time and hard work for beneficial effects in basic meditation technique designed to either area. And the point of doing medita- appeal to many who are being exposed to tion exercises is for the effect it wIll the idea of meditation for the first time. He produce within one. This effect, of suggests that the individual sit in a com- increased inner calmness, usually occurs fortable position in a quiet environment slowly. The increase in calmness may be and establish a passive attitude. Then the hard to perceive, much as developing mus- individual can relax and begin to concen- cles are hard to notice. However, one does trate on breathing. Along with this concen- expect some change over time. tration, a mental focus on repeating the To continue the comparison of medita- word one while breathing out has been tion and physical exercise, one would not shown to elicit the relaxation response." expect the same program of exercises to The term meditation is used to describe work for everyone. Therefore, each indi· many different practices, which may seem vidual needs to find the combination of to be very different. Some techniques emphasize concentration on certain thoughts, while others stress the decrease The point of doing meditation of any intellectual activity. What they do exercises is for the effect it will have in common is the pursuit of a certain produce within one. This effect, of calm state of mind. Naranjo and Ornstein increased inner calmness, usually point Out that "All meditation is a 'dwell- occurs ~lowly. ing upon' something ... the importance of dwelling upon something is not so much in the 'something' but in the 'dwelling upon'i?" It is only through the experience meditational techniques that seems most of practicing this dwelling-upon state of appropriate for him - or herself. mind for a while that an actual understand- Certain meditation exercises seem to be ing of what it is can be gained. helpful for people who are beginning to LeShan compares a good program of explore the process of meditation. In addi· meditation with a good program of physi- tion to the technique presented by Benson cal exercise.'? Both are fairly hard to (discussed previously), there are three recb describe verbally and may even seem silly if niques that are usefuL an individual exercise is looked at by itself. Breath counting, as outlined by LeShan. LeShan comments, "What could be more is one way to begin.16 Start by getting intO foolish than to repeatedly lift twenty a comfortable position to decrease the pounds of lead up and down unless it is interference of bad v sensations. A timer. J ~ counting your breaths up to four, over and muffled by a pillow, can be set for 5 to L over again-a rneditational exercise?" (p. minutes. Then close the eyes to tune O\l~ -3). Doing just one physical exercise or one visual stimuli. Begin counting silently; for CONTAGIOUS CALMNESS

each exhaled breath, count from one ro for a few minutes before thinking more 23 four. Repeat the process over and over for about how the mind wanders. the allotted time. The goal is to keep the The third type of meditation involves a mind concentrated on the counting alone. more reflective frame of mind. The think- The mind wanders, however, so gently ing processes are observed as they concen- bring it back to the task of counting. trate on a concept or thought. Again, The second technique is somewhat simi- begin by getting comfortable. Pick a con- lar, although it involves an extern~l focus. cept or thought to explore. Some sugges- Hendricks and Roberts entitle this exercise tions include specific qualities (courage, "The Centered Mind."17 The purpose of joy, serenity), symbols (of peace, caring, this exercise is to observe the mind and to strength) or thoughts (making haste slow- practice mental awareness. Individuals ly, the sound of one hand clapping)." Then often do two things at once. One may be concentrate the mind on the concept or driving a car while thinking of something thought and contemplate the various entirely different, such as the crisis just left aspects of the topic and what it means. at work or the vacation planned for next When the mind wanders, gently bring it year. back to the topic under consideration. To increase the ability of the mind to Over time, with practice, meditation tech- focus on one thing, it is useful ro observe niques can help the individual develop a where the mind goes when it moves from a deeper sense of calmness so that the inner here-and-now focus. The mind uses imagi- stability is easier to call up when needed. nation in several ways ro withdraw from direct awareness. Memories of past events arise, fantasies of things that did not hap- Contagious calmness defined pen or that might happen in the future Contagious calmness is a term that occur and internal "talk" goes on frequent- describes the total process of internal ly. To do this exercise select an object to calming and the methods used to convey concentrate on, such as a flower, a candle calm to others. The main components of or even a cup, and obtain a piece of paper communicating calmness include speech and a pencil. On the paper, make three content, voice tones and pacing, and body columns marked memories, fantasy and language. Speech content that reflects an talk. Get in a comfortable position, then inquiring attitude, a sense of having the look at and concentrate softly on the situation under control, or the ability ro chosen object. Any time the mind wanders call on the necessary resources is often from that object make a mark in the quieting. Crisis intervention literature pres- column that best describes what the mind ents many aspects of this issue. One atti- was doing (e.g., thoughts of a pleasant tude the author has found helpful in work- vacation for next year require a mark under ing with clients is that of not being fantasy), then gently return to focusing on shocked by anything that people say about _ the object. Continue this exercise for three themselves or a situation, and gently ask- or four minutes, observing the object and ing for further information. A soft, clear noting the action of the mind. Then relax voice tone with slow pacing, accompanied TOPICS IN CLINICAL NURSING / OCTOBER 1983

24 by appropriate facial expressions, transmits Integrating techniques the sense that the speaker is remaining relaxed. Body language further confirms The integration phase of using contag- this impression when body muscles are ious calmness is perhaps the most difficult. relaxed and the gestures used are flowing It involves the development of successful and gende. habits for integrating calmness into every- This attitude of contagious calmness day life. To strengthen the use of calming COntrasts with two extremes of interac- skills, it is helpful to use reminders in the tional behavior." One extreme finds a work environment. At first a few neutral person who hurries through life trying to objects can be the reminders-a picture of be efficient. It seems as if this person is a beach or a favorite camping spot, or even having one emergency after another. When a wall clock. Events such as waiting for an an actual emergency occurs he or she may elevator can also be chosen. Many people not even recognize the situation as a real find that placing round, colored adhesive emergency. The other extreme is the per- dots on objects that will be seen frequently son who is so self-absorbed (even in calm- works well. Then, for a period of at least ness) that he or she may not even sense three weeks, practice relaxing each time when a genuine emergency has happened. one of these reminders is observed. After a Important information passes this person while these cues to relax begin to operate by and he or she does not notice. The as conditioned stimuli. That is, each time person who is contagiously calm attempts the cue is seen relaxation will automatically to gather as much information as possible occur. and then to act calmly and capably. Of Once relaxation occurs automatically, course, one acts in any of these three ways on cue, it is time to practice calmness, depending on factors such as fatigue level, employing something that is tension pro- skill in particular areas, current emotional ducing. Identify those things in the en- state and level of mental preoccupation vironment that lead to tension symproms. with other things. However, the range of (For example, the woman in the noisy situations where one acts in a calm manner office chose the ringing telephone as a can be expanded with practice. tension-producing cue for herself.) Those tension-producing cues can also be used as CALMNESS IN THE HOSPITAL reminders to relax. Again, practice for at ENVIRONMENT least three weeks, relaxing and calming each time the chosen cue occurs. It is After practicing some of the techniques amazing how effective this simple tech- for increasing internal calmness, the indi- nique becomes with time and practice. The vidual will automatically exhibit an only difficult thing about using it is the increase in contagious calmness. In addi- initial practice time when one is learning to tion to this spontaneous occurrence, there consciously relax each time the cue occurs. are several ways of triggering relaxation in Some cues that have been effective for- the work setting, and methods to enhance some of the author's clients are ringing the use of these techniques with patients. telephones, clanging fire sirens and the CONTAGIOUS CALMNESS

annoying, tuneless whistling of a cowork- on out thtough the feet by the time the 25 er. Some people have found that they count of four is reached. could relax consciously each time they These techniques can be practiced in 30 walked through the door of their supervi- seconds or less and are quite effective in sor's office; others use their own stress ptoducing a feeling of relaxation. They can symptoms as reminders to relax. Surpris- even be done in the midst of a variety of ingly, once they have been able to relax crisis situations. For example, a resuscita- during these events, the events themselves tion code might trigger several cues that often cease being stressful. The woman could be chosen as reminders to relax. who used the whistling of a coworker as a Practice, in the imagination, taking a few relaxation cue reported that she even breaths while wheeling the crash cart down stopped being aware of the whistling after the halL If withdrawing medication for a few weeks. injection has been a relaxation cue, the Along with the use of reminder cues, relaxation will occur automatically even several breathing techniques help to pto- during the code. If checking the time is a duce relaxation quickly. Some people find relaxation cue, then any time that is done that taking two deep breaths with ernpha- during the code, there will be some amount of calming. Another critical situation where conta- Along with the use of reminder cues, gious calmness can be especially helpful several breathing techniques help to involves a hostile or angry response on the produce relaxation quickly_ part of a patient, a patient's family member or another team member. The most useful skill in these situations seems to be the sis on breathing with the diaphragm works ability to relax and take a few deep breaths well. Others pair the deep breaths with the while the other person is speaking. This checking and relaxing of their usual ten- ptoduces a calm appearance, which can sion holding SpOts. Still others choose a actually contribute to calming the other visual image that is meaningful for them person. Kunz suggests that in these situa- and briefly think of that image while tions it may be helpful to momentarily taking a deep breath. shift the mental focus away ftom the Stroebel suggests a technique called the person who is angry; think for a moment quieting response," When tension is felt, of someone special, then return full atten- stop and say some calming words such as non. to the angry person. 21 Stop, relax, slow down, and then smile. A technique that many nurses have After that, take a deep breath while found helpful involves the use of a visual- counting to four and breathe out to a ization to assist them in imagining and COuntof four. Take a second deep breath, practicing a feeling of contagious calm- again counting to four and then breathe ness. Visualizing a deep, royal blue, cobalt out. While breathing out this time, count blue or sapphire blue color is found by to four and imagine warmth Bowing from many people to result in a feeling of the head or neck down through the body calmness. When the author first tried this TOPICS IN CLINICAL NURSING / OCTOBER 1983

26 exercise it took a while to be able to "see" This is also true when applying these the color in the mind's eye. Having a jar methods in patient care. made of blue glass helped to picture the blue color mentally. This visualization involves imagining the blue color as clearly Using techniques with patients as possible and thinking of a stream of One of the most effective ways of using calming blue radiating Out to the person contagious calmness techniques with who is upset. This is a useful technique to patients is by modeling calmness. Model- use before entering the room of a difficult ing calmness involves using calm body patient, or before a particularly difficult language, voice tone and facial expres- meeting. This visualization can also be sions. Gentle, easy body movements do used in combination with the nature image not take much time and can make a great used for centering. Many psychiatric staff difference in a patient'S response. Relaxed members have used this combination of muscles and body posture communicate imagining the blue color and thinking of a quite a bit, and small changes in voice tone nature image, such as a tree, before and pacing can transmit a sense of calm in entering the psychiatric unit. They have many situations. Facial expressions espe· found it to be an effective technique to cially convey a sense of internal feelings. In improve their perception of contagious addition to allowing the sense of internal calmness and have noted an increase in calmness to be expressed, a nurse can their ability to project a sense of quiet after actually portray the impression of calmness _ entering the unit." even when somewhat tense. A useful rech nique is. acting as if one is calm. When using this acting technique one imagines Choosing techniques and then consciously performs actions as if In addition to noticing aspects of the actually relaxed. This play acting is helpful environment in choosing techniques, it is in developing a sense of calm, because the helpful to take stock of one's own abilities more one acts in a particular way, the more and inclinations, and then select those likely the feelings are to follow the exercises that have the highest probability actions. for success. For example, frustration may Besides rnodeling, more direct discUS' develop during a visualization exercise sion with patients about relaxing can be because it is hard to keep a stable image. If productive, even in short interactions. practice does not improve the situation, it Avoiding having a set image of the patje~t is better to try another approach than to allows a better assessment of the patient 5 have the underlying frustration. Remern- self-calming skills." For instance, someone brances of a pleasant feeling may be more who appears too hostile or rigid to accept successful, or "hearing" music in the imag- relaxation exercises may use some personal ination may enhance relaxation. It is some- visual imagery that is very helpful to him or limes a trial-and-error, or better yet, a her. A general question such as, "What al~ trial-and-success, process to find the tech- some of the things you do to help yoursel niques that work well for an individual. feel better (get well, become calm)?" can CONTAGIOUS CALMNESS

often allow the patient to express what has Before using calming techniques with 27 worked in his or her own unique language clients it is necessary for the nurse to have and belief system. Listening to the patient's practiced these techniques thoroughly and answer gives the opportunity for assessing to have selected the words and elements of some of the following factors. the relaxation systems that he or she is • Does the person use hearing, seeing or comfortable with and that fit his or her feeling words to describe relaxation own uniqueness. The author's words or practices? ' elements of relaxation, used by someone • Is the client comfortable talking about else, may seem awkward and nonfunction- these relaxation practices? al. So, before adopting any of the follow- • Did he or she mention any particular ing suggesrions and applications, question tension symptoms that have been them and modify them as necessary. noticed? • What information has been gained Progressive relaxation about the patient's belief system Relaxation techniques can be shortened related to relaxation? to apply in many health care situations. • Was there enough time for the person The patient with insomnia may benefit to explain what is helpful? from introduction to progressive relaxa- Based on this information, select tech- tion, and it takes only about five minutes niques that seem to fit with what the client to explain the method. The explanation is already doing, or with what he or she should include the following important thinks about relaxation. This process of points. matching a technique with a patient takes • If the patient tenses a muscle first and some practice, and again the nurse will then relaxes it, it will be easier to feel learn by trial and success. the relaxation. Many of the relaxation techniques • Focusing on the relaxing muscle also require a lot of time if they are applied in a helps the mind to become occupied. formal way, involving all the elements of • Relaxing the muscles from head to the method. However, it can often be very toes creates a general relaxed state." effective to choose only one element of a It may be helpful to make an audio tape for method to use with a patient. For example, use by patients when time is limited. the system of Lamaze breathing is most Progressive relaxation can also be used effective if practiced before the onset of by patients in pain. What seems to be labor. At times, a particular patient may find one breathing technique, or just the focal point concentration to be helpful if presented during labor. Since the time Progressive relaxation can also be involved in trying these mini segments of used by patients in pain. What seems relaxation is fairly short, there is nothing to to be helpful for them is to focus the lose by trying. At the veri least the patient relaxation in a part of the body not isaware that the nurse is interested enough involved in pain. to attempt something that might work. TOPICS IN CLINICAL NURSING / OCTOBER 1983

28 helpful for them is to focus the relaxation concentrate on an image. If a patient has in a pan of the body not involved with the localized pain it is sometimes useful to use pain. Most people tend to tense their a combination of touch and visualization. shoulders, jaw muscles or forehead when The nurse can put one hand on the area in pain, so using one of these muscles as a where the patient is experiencing pain and focus may work. Use of one of the auto- ask the patient to use the hand as a focal genic phrases may seem more attractive to point. The client can then imagine breath- someone who does not want to focus on ing out through that spot, breathing out muscles. Using the first concept of heavi- the tension and pain. As the client imagines ness the person repeats, "my right arm is the pain draining away, ·the nurse can heavy," three times. This is followed by remove the hand from the tension Spot. If repeating, "my left arm is heavy," "my the pain is in the shoulder area the patient right leg is heavy," "my left leg is heavy" may want to imagine the pain draining and "my neck and shoulders are heavy," down her arm. The author has found this

each three times slowly to produce relaxa- particular visualization combination to be I cion." Both of these technigues and the very effective. People seem to relate the

imagery or visualization techniques work image to themselves easily and to elaborate I best for people who are able to concentrate on it in their own way. If there is a trash can for at least short periods of time. close to where they usually sit, clients will often say that they want to imagine the

pain flowing out of their arms and into the I Imagery trash can. If the patient seems ready ro The imagery techniques of visualizing a discuss his or her internal feelings it may be pleasant scene can often be suggested helpful to present the idea of letting an quickly. Most people have some memory image represent internal calm. of a pleasant time or a place in their past that they can remember. If they can focus on that image long enough, it can help Breathing them relax. What often occurs if the per- Breathing techniques are used quire fre· son is experiencing sadness or grief is a guently in the acute care setting. Using a release of emotions by crying, followed by few deep breaths to decrease pain percep- a sense of relief in many cases. When the tion during difficult diagnostic procedures patient is unable to hold a mental image, is often done. Breathing has been very either because he or she does not usually effective for patients in labor, and suggest- think in images or because of pain or ing that an anxious patient take a few deep anxiety, suggesting the image of a color breaths works well many times. These may work. procedures are often the only ones that are For many patients with pain caused by successful in producing some relaxation terminal cancer, imagining a cloud of when the patient is anxious or afraid. To --calming blue col or entering their bodies as increase the likelihood of relaxation, some they breathe in, eases their pain. Other things can be added to the instructions. It" people need a tactile focus to be able to the person is extremely upset, the simplest CONTAGIOUS CALMNESS

way to present breathing suggestions is to person. In addition, the patient often feels 29 ask the person to breathe with the nurse. that willingness to listen is a measure of Take slow, even breaths so that the patient interest and caring. can see the breathing rate. Another tech- • • • nique is to use the tactile focus presented above. An anxious or tense patient often Within the acute care setting there are experiences a feeling of tightness in the many factors that promote an increase in stomach area. If the patient agre,es to try tension for the staff members and the the exercise, place one hand over the patients. Some environmental stresses can patient's solar plexus area and ask the be decreased, but the major area for patient to imagine breathing the tension change is the development of internal calm out through the hand. Then, as the patient by nurses and patients. There are many breathes out, move the hand away from the practical advantages of developing a sense stomach as a focal point for the patient to of contagious calmness including an concentrate on. Any practice with deep increased sense of comfort for the individ- breathing will be helpful for patients in ual staff member; increased efficiency in many situations. solving crisis situations, especially of an With all of the preceding techniques it is interpersonal nature; improved self-confi- useful to allow time for the patient to give dence in being able to stay calm in a variety feedback on his or her reaction to the of situations; decreased patient anxiety; exercises. Even if the method was not and enhanced patient learning. All of these successful or if the patient experienced benefits can be gained with practice and some discomfort with the exercises, the experimentation using a mixture of tech- nurse will have gained information about niques appropriate to the individual staff what might be more appropriate for that member, patient, setting and situation.

REFERENCES

l. Friedman, M., and Rosenrnan, R.H. Type A Behavior 8. Krieger, D. The Therapeutic Touch: Haw 10 Use YOlJr and Your Heart. Greenwich, Conn.: Fawcert Publica- Hands 10 Help or 10 Heal. Englewood Cliffs, NJ.: tions, 1974. p. 213. Prenrice-Hall, 1979, pp. 36-37. 2. Easwaran, E. Meditarion: An Eighl. Point Program. 9. lbid .. 40-41. Petaluma, Calif.: Nilgiri Press. 1978, pp. 93-97. 10. Kunz, Counseling Workshop. 3. Hendricks, G., and Wills, R. Tht Cenuring Book. 11. KusheL Cmtering, 66. Englewood Cliffs, NJ.: Prenrice-Hall, 19n, p. 10. 12. Kunz, Counseling WOr'rGhop. 4. Kushel, G. Cmlering: A Six. Sup Guide 10 Brtaking 13. Benson, H. The Relaxation Response. New York: tbe Vnhappinm Habit. New York: Pinnacle Books, Avon Books, 1975, pp. 159-63. 1979, p. 8. 14. Naranjo, C, and Ornstein, R.E. On The Psychology of S. Kunz. D. Counseling Workshop. Theosophical Soci- Meditation. New York: Viking Press, 1971, p. 10. ety in Seartle. Seatde, Washington, June 16, 1982. 15. LeShan, L. Haw to Meditate. New York: Bantam 6. Hendricks, G., and Roberts, T.B. The Second Center- Books, 1974. ing Book. Englewood Cliffs, NJ.: Prentice-Hall, 1977, 16. Ibid., 13-14. p. 1. 17. Hendricks and Roberrs, The Second Centering Book, _ 7. Richards, M.C. Cenrering in Pal/try. Poetry, and tb« 2-4. Person. Middlerown, Conn.: Wesleyan University 18. Assagioli. R. The Act of Will. Baltimore, Md.: Pen- Press, 1962, p. 9. guin Books. 1973, pp. 78,223. TOPICS IN CLINICAL NURSING / OCTOBER 1983

30 19. Easwaran, Meditalion, lOS. 22. Kunz, Counseling Workshop. 20. Stroebel, e. QuieTing Response Training. New York: 23. Ibid. BMA Audio Cassettes, 1981. Sound cassette. 24. Coates, T J" and Thoreson, c.E. Hour TO Sleep Better. 21. Kunz, D., and Peper, E. "Fields and their Clinical Englewood Cliffs, NJ-: Prenrice-Hall, 1977, pp. 111- Implications. Parr Ill: Anger and How it affects 15. Human Interactions." American Theosophist 71, no. 6 25. Mason, LJ- Guide to Stress Reduaion. Culver City. (1983) 199-203. Calif.: Peace Press. 1980, p. 26.