Category Archives: Self-care

Self-Massage:  Guided Instruction for Body & Mind- Free workshop

The recording of this offering is now available by clicking here.

 A Free 1 hr Online Workshop

Saturday, May 2 at 9:15am PT/12:15pm ET to 10:15am PT/1:15pm ET

In these challenging times, while all strive to stay well and sane, we are inevitably missing a vital source of health:  touch and massage.  This free online workshop guides participants through applying techniques on themselves or another.  The workshop leaders will lead you through massaging three areas:  Hands, feet, and shoulder/back.  This workshop is set up for full participation; no prior experience with massage is needed.  It is not necessary for attendees to share their own cameras.

Location: Via Go To Meeting ~  https://www.gotomeet.me/LuannFortune/mindfulness-meditation-moments   

Questions? Contact Luann Fortune and lfortune@saybrook.edu

* Come prepared with clean hands and by wearing comfortable clothes; have massage oil or cream on hand (you can use what you have in your kitchen); and for an optional technique, bring two tennis balls and a sock.

** Please mute your line when entering the online meeting space.  

*** We will be recording this session. By joining the session, you acknowledge you understand that the session will be recorded. 

Workshop Leaders

Luann Fortune, LMT, NCBTMB, MA, PhD is faculty at Saybrook University’s College of Integrative Medicine and Health Sciences where she teaches Mind-Body Medicine.  She has been practicing and teaching massage for almost 30 years.

Jenny DeDecker, LMT, NCBTMB, MS is a doctoral student at Saybrook University’s College of Integrative Medicine and Health Sciences.  Jenny owns and runs Full Moon Rising in Norway, MI where she practices massage and teaches yoga and meditation.

 

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Tilting Our Homeostatic Balance for COVID-19 Prevention (Part 2): Mind-Body Practices

By Luann Fortune, PhD & Shannon McLain Sims, PhD

 Mind-body medicine can help minimize risk to COVID-19 (see Tilting Our Homeostatic Balance for COVID-19 Prevention-Part 1). Mind-body therapies and practices encompass a full spectrum of activities that promote healing and well-being.  A diverse group of procedures or techniques can be administered or taught by qualified practitioners (NIH, 2018).  Many also can be applied as self-initiated practices, sometimes with foundational training, e.g. meditation and yoga.

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Prevention.  Evidence demonstrates multiple positive effects of mind-body practices that enhance wellness.  By mitigating the stress response, beneficial outcomes range from improved management of chronic conditions (Russo & Fortune, 2016) to healthier approaches to managing stress, pain, and mental states (McGrady & Moss, 2018).  As part of a COVID-19 prevention strategy, mind-body practices used daily can strengthen immune response to resist infection by controlling inflammatory response (Alschuler et al., 2020), like reducing levels of pro-inflammatory cytokines, and also improving health markers for existing chronic conditions that appear to worsen COVID-19 symptoms.

Recovery Support:  In addition to supporting COVID-19 resistance, mind-body practices can help those who get infected.  In a clinical study just released, the mind-body practice of progressive relaxation was found to reduce anxiety and improve sleep quality in COVID-19 patients, thus aiding their recovery. While further studies are needed, current evidence indicates that various mind-body practices could support COVID-19 patients even in active stages of infection.  Yet if introduced using sound clinical standards, some practices such as guided imagery could be introduced to patients in active stages of infection using passive means.

Mind-Body Practices

 A wide range of practices come under the mind-body umbrella. Some more widely used evidence-supported practices are chunked together.  Here is a summary of the main categories.

Evidence Based Mind-body Practices for Better Health

Self-Care Practice Percentage*
Yoga 92%
Hypnosis 91%
Biofeedback 90%
Meditation 86%
Qi Gong 86%
Tai Qi 83%
Relaxation Response Training 79%
Imagery 68%

 *Percent of patients benefiting from integrative health practices who would benefit from this particular intervention. Based on Russo & Fortune (2016)

Breathing. Controlled breathing is the primary and foundational mind-body practice.  Techniques can be learned to regulate breath flow and rate.  Breath practices are rooted in ancient traditions, such as prana yoga (Kupershmidt & Barnable, 2019), and foundational to contemporary mindfulness. Specific to COVID-19 prevention, experts recommend diaphragmatic breathing, deep and slow. Conversely, once infected with COVID-19, patients should adopt shallow breathing; this allows the lung tissue time to rebuild and heal (Peper & Harvey, 2020).  Those who contract the virus outdoors might end up with a milder case, but those they infect back in their close quartered homes seem to get worse cases (Peper &Harvey, 2020).  With this in mind, it may be helpful to keep fresh air circulating indoors.

Yoga. Multiple research results show that yoga improves fatigue, balance, mood and anxiety. It also slows the aging of the brain. While strenuous exercise is contraindicated for COVID-19 infection, gentle movement and postures of yoga can support immune functions for prevention and in later stages of infection recovery (Field, 2011).

Meditation and mindfulness. A vast body of research demonstrates positive outcomes with a range of mindfulness traditions and methods.  Meditation slows brain aging, reduces stress, anxiety and depression, improves mood and mental functions.  Specific to COVID-19, mindfulness meditation can have positive impact on inflammatory markers (Black & Slavich, 2016).

Tai Chi and Qi Gong.  Both practices involve postures and gentle movements that are accompanied by practiced breathing and mental focus, accomplished while moving or stationary. Research supports positive outcomes for musculoskeletal issues, pain management, and mental health (NCCIH, 2016).  Since these practices require sufficient strength and stamina for movement, these practices are more appropriate for prevention and later stages of recovery.

Relaxation response training: Autogenics and progressive muscle relaxation (PMR) are most researched practices with slight differences. Both can be guided practices that are adopted to individual use.  Autogenics directs awareness to explore different areas of the body, while PMR focuses on relaxing specific muscles in a progressive protocol.  In a recent study, PMR improved anxiety levels and sleep in COVID-19 patients (Liu et al., 2020).

Biofeedback. Biofeedback uses visual and auditory feedback to direct involuntary body functions including heart and pulse rate, blood pressure, and muscle tension.  It can involve sophisticated monitoring equipment, but the essential skills begin with channeling breath and somatic awareness.  Biofeedback has been linked to positive outcomes in a range of conditions including reduction of migraine symptoms, reduced hypertension, improved TMJ dysfunction, improving attention, and enhanced immune function (McGrady et al., 1992).  Specific to COVID-19, the foundational breath work in biofeedback could support respiration and pulmonary recovery.

Guided imagery. Various studies have shown it to mitigate symptoms of multiple conditions.  In a recent white paper, Mau (2020) introduces a guided imagery script specific to COVID-19 patients.  Because guided imagery is accessible and highly mobile, it offers possibilities for supplementary support while in confinement and otherwise non-ambulatory.

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Conclusion

COVID-19 poses a powerful threat.  Beyond damage from infection, the fear, anxiety, and daily living disruptions can result in multiple levels of dis-ease and distress.  The stress we feel, in both mind and body, can be harmful to the immune system, resulting in countless secondary infections and conditions.

Mind-body practices can improve immunity for better resistance and potentially support recovery.  For the COVID-19 patient, these can potentially provide comfort and support and at the least, do no harm.  For the many who are resisting infection, and particularly those on the front lines under unimaginable strain, mind-body practices can help with emotional regulation and mental balance.  Adopting mind-body practices during this crisis could lead to long-term adoption of practices that have been demonstrated to improve quality of life and overall health. These same practices can promote more mindful leadership at a time when it is most needed.

 

Luann Fortune, PhD, LMT is on faculty at Saybrook University in the Department of Mind-Body Medicine, where she also coordinates the specialization in Mindful Leadership in Healthcare. Her research focuses on integrative health and wellness.

 Shannon McLain Sims, PhD holds degrees Mind-Body Medicine from Saybrook University’s College of Integrative Medicine and Health Sciences where she currently serves as a post-doctoral fellow.

 

References

Alschuler, L., Weil, A., Horwitz, R., Stamets, P., Chiasson, A. M., Crocker, R., & Maizes, V. (2020). Integrative considerations during the COVID-19 pandemic. EXPLORE, 26. https://doi.org/10.1016/j.explore.2020.03.007

Black, D. S., & Slavich, G. M. (2016). Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Annals of the New York Academy of Sciences1373(1), 13.

Field, T. (2011). Yoga clinical research review. Complementary Therapies in Clinical Practice17(1), 1-8.

Kupershmidt, S., & Barnable, T. (2019). Definition of a yoga breathing (pranayama) protocol that improves lung function. Holistic Nursing Practice33(4), 197-203.

Kupershmidt, S., & Barnable, T. (2019). Definition of a Yoga Breathing (Pranayama) Protocol That Improves Lung Function. Holistic Nursing Practice33(4), 197-203.

Liu, K., Chen, Y., Wu, D., Lin, R., Wang, Z., & Pan, L. (2020). Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complementary Therapies in Clinical Practice, 39, 101132.https://doi.org/10.1016/j.ctcp.2020.101132

Mau, F. (2020). No need for a hammer A guided imagery process for patients suffering from COVID-19. Retrieved from http://0102.nccdn.net/1_5/000/000/05f/b06/Mau-2020-No-Need-for-a-Hammer-revised-4-2-20.pdf

McGrady, A., Conran, P., Dickey, D., Garman, D., Farris, E., & Schumann-Brzezinski, C. (1992). The effects of biofeedback-assisted relaxation on cell-mediated immunity, cortisol, and white blood cell count in healthy adult subjects. Journal of Behavioral Medicine15(4), 343-354.

McGrady, A., & Moss, D. (2018). Integrative pathways: Navigating chronic illness with a mind-body-spirit approach. Springer.

National Center for Complementary and Integrative Health (NCCIH). (2016, October).  Tai chi and qi gong: In depth.Retrieved from https://www.nccih.nih.gov/health/tai-chi-and-qi-gong-in-depth

Peper, E. & Harvey, R. (2020, April 4). Reduce initial dose of the virus and optimize your immune system. Retrieved from  https://peperperspective.com/2020/04/04/can-you-reduce-the-risk-of-coronavirus-exposure-and-optimize-your-immune-system/

Russo, R., & Fortune, L. D. (2016). Six evidence-based integrative health practices to manage eight common chronic conditions and promote self-care: A review with findings inspired by a workplace wellness case study. SM Journal Community Medicine, 2(2), 1018.

 

 

 

 

 

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Self-Care & Mind-Body Medicine: Structure, Function, and a Thoughts of a Tattoo

Tattoo Self-care conversations are expanding as we seek strategies for advancing better wellness and transforming healthcare.  We live in increasingly challenging, divisive times and healthcare costs continue to escalate.  Drawing nurturing attention inward helps us connect daily with our humanity and corporeal presence.  It seems like almost anything can qualify as self-care.  My practice experience has taught me that each individual must find their own path to well-being.  My advocacy work has exposed me to the music of collective steps that can remodel entire systems.  Self-care energy could be animating a rhythm of hope for a better way of being human on this planet.

In theory, integrative medicine loves self-care.  This multi-disciplinary genre of healing has earned a place in our lives as well as at the Academy.  At my day job at Saybrook University, I get to teach and research a growing collection of practices that inspire and enhance self-care, from guided imagery to mindfulness.  Various techniques and therapies, captured under the umbrella of complementary and integrative healthcare, including mind-body medicine, are increasingly supported by evidence and availability.

Ever ready to share the good news of integrative medicine and self-care, I recently gave a TV interview where I was asked to summarize my views in 5 minutes or less.  Much to my surprise, I found myself stuck on the simple question, “what exactly is mind-body medicine?”.  Even though I teach and champion this subject every day, I failed to deliver a cogent message.  In order to enlighten and advocate, I needed to first define: What exactly is mind-body medicine?  (And what does a tattoo have to do with it?)

Structure

Faced with higher costs and reduced satisfaction, patients increasingly seek solutions through what was initially termed alternative medicine (Moss, 2003).  In 2015, NIH revised the lexicon and complementary-alternative medicine (CAM) became complementary and integrative health reflecting its improved acceptance into conventional healthcare systems (NCCIH, 2018).  Beginning in the 1990s and continuing to today, surveys reported use of complementary therapies and practices in majority of populations and in increasing numbers (Eisenberg et al., 1993; Eisenberg et al., 2016).  One assortment of complementary practices is labeled mind-body medicine.

Reflecting a sort of medical science colonialism, mind-body medicine is defined by its position in the prevailing healthcare delivery system, situated offsides in the realm of complementary therapies and practices.  According to NIH, mind-body interventions remain “a large and diverse group of procedures or techniques” that are administered or taught by qualified practitioners (NIH, 2018).  By logical extension, the individual can then continue to practice what they learn independently, thus perpetuating prevalence (McGrady & Moss, 2018).  But the debate over what constitutes a mind-body therapy and where it sits in healthcare’s hierarchy remains under-developed.

Function

Even in the imprecise language defining complementary therapies and practices, mind-body medicine definitions are vague.  Mind-body services and procedures are described by what they are not:  they are not typically found in primary care physicians’ medicine bag.  Researchers and clinicians, striving for a standard taxonomy, lumped together as mind-body a wide variety of interventions not otherwise connected in foundational tenets or practice conventions.  Initially, these included psychotherapy, hypnosis, biofeedback, dance and movement therapies, massage and body work, mediation and prayer, biofield therapies, and homeopathic remedies (Lake, 2003; NIH, 2018).  It seems like almost anything could qualify as mind-body medicine.

Gradually, some of these became elevated to sub-disciplines, such as psychotherapy, now a mostly reimbursable mental health treatment.  This raises the issue of legitimacy through economic valuation or demonstrated return-on-investment.  I will save this consideration for another discussion.

Mind-body medicine remedies share a common function: they initiate a change in one realm to affect a positive change in equilibrium of the whole.  Thus, our mental states can affect our physiology and susceptibility to illness.  Mind-body therapies and practices encompass a full spectrum of activities and all promote healing and well-being through the mechanisms of the psycho-neuro-immunological system (PNI) (Litrell, 2008).  Initially understood as how the mind influenced biological functions, the PNI is now seen as a complex, bi-directional system where mind and body physiology mutually influence the whole (Yan, 2016).

Changes attributed to mind-body interactions can be viewed from every crevice of physiology, behavior, and attitude.  Research now well establishes that environmentally-based perceptions are linked to illness as well as well-being.  For instance, stress impacts quality of life and is also a primary factor in cardiac conditions, the foremost global disease (Kivimäki & Steptoe, 2018).  Further, bodily generated effects influence the mind, e.g. research on the gut-brain axis links digestive microbes to mental states such as depression (Rieder, Wisniewski, Alderman, & Campbell, 2017).  Evidence abounds demonstrating positive effects of mind-body approaches (Russo & Fortune, 2016), including mitigation of pain and addiction (Hart, 2016).

Yet aside from how mind-body interventions function in healing, and plentiful examples supported by evidence, we lack a concise definition of what exactly is mind-body medicine.

Thoughts on a Tattoo

I asked a colleague who practices as a primary care physician how he defines mind-body medicine.  He referenced the PNI interactions and provided some anecdotes on related illness triggers he has witnessed.  Pressed to define mind-body medicine based on mutual interconnectivity of states and systems, we agreed that mind-body practices can refer to just about anything that one undertakes on behalf of improving their well-being.  For instance, I suggested that reading a good novel could trigger a positive PNI reaction.  He agreed and shared his own unexpected story.

By accident, he discovered that receiving a tattoo initiated for him a state of deep relaxation, with a subsequent ripple effect of improved well-being.  Recent studies have linked the practice of tattooing with non-suicidal self-injury (NSSI) behavior (Solís-Bravo et al., 2019).   Findings indicate that NSSI activities relieve tension and induce positive feelings. He was aware of research linking tattoo-ing with risk of self-injury and assured me that he did not present with such indications.  However, he was equally certain that the process of receiving a tattoo induced a deeply healing state on a physical and possibly a spiritual level:  Tattoo Medicine.

Theoretically, the experience of tattoo medicine could be a mind-body intervention.  In the anecdote provided, it sits in the structure of non-conventional approaches.  Functionally, it appears to have invoked the relaxation response and triggered PNI reactions.  In addition, the exact symbol used in the tattoo could have influenced the experience if it conveyed emotional or spiritual meaning.  Clearly, more research is indicated about the prevalence of this phenomenon and its place in the collection of mind-body medicine practices.

Implications

 When considering the possibility that tattoo practice is a mind-body intervention, perhaps defining mind-body medicine is ultimately all about intentions.  Alternatively, the mismatched components and practices now termed “mind-body” might simply be in a taxonomy holding-space, awaiting more informed and sophisticated knowledge systems to define, examine, and apply more precise terms.  If practices as apparently unconnected as tattoos and meditation can be grouped together for the greater good, what indeed is in a name.  Certainly, healthcare and well-being can use an incentive to empower uncommitted individuals to step into their own self-care path.

Based on popularity and the potential to infuse self-care with creative options, the practice and research of mind-body medicine is timely.  Proponents need to be articulate and clear about applications and relevance, even if that includes acknowledging that the definitions are still under construction.  Under any name, better tools for health and wellness are needed now.

So, scholars and practitioners can roll up our sleeves and get to work on this.  In the meantime, consider a recent statement from the World Health Organization calling for quality self-care: adopting evidence-based practices that the individual undertakes with or without the support of a healthcare professional.  Consider also how NIH recently defined mind-body medicine as large collection of procedures and techniques that are administered or taught by qualified practitioners to affect healing (NIH, 2018).   Self-care and mind-body medicine seem like a perfect match, even minus the tattoo.

References

Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R., & Delbanco, T. L. (1993). Unconventional medicine in the United States: Prevalence, costs, and patterns of use. New England Journal of Medicine328(4), 246-252.

Eisenberg, D. M., Kaptchuk, T., Post, D. E., Hrbek, A. L., O’Connor, B. B., Osypiuk, K., … & Levy, D. B. (2016). Establishing an integrative medicine program within an academic health center: Essential considerations. Academic Medicine: Journal of the Association of American Medical Colleges91(9), 1223-1230.

Hart, J. (2016). Chronic pain, addiction and complementary therapies. Alternative and Complementary Therapies, 22(3), 117-119. https://doi.org/10.1089/act.2016.29058.jha

Kivimäki, M., & Steptoe, A. (2018). Effects of stress on the development and progression of cardiovascular disease. Nature Reviews Cardiology15(4), 215.

Littrell, J. (2008). The mind-body connection: not just a theory anymore. Social Work in Health Care46(4), 17-37.

Lake, J. (2003). Complementary, alternative, and integrative medicine. In D. Moss, A. McGrady, T. Davies, & I. Wickramasekera (Eds.), Handbook of mind-body medicine for primary care, (pp. 57-68). Thousand Oaks, CA: Sage.

McGrady, A., & Moss, D. (2018). Integrative pathways: Navigating chronic illness with a mind-body-spirit approach. Cham, SZ: Springer.

Moss, D. (2003).  Mind-body medicine, evidence-based medicine, clinical psychophysiology, and integrative medicine.  In D. Moss, A. McGrady, T. Davies, & I. Wickramasekera (Eds.), Handbook of mind-body medicine for primary care, (pp. 3-18). Thousand Oaks, CA: Sage.

National Center for Complementary and Integrative Health (NCCIH). (2018, July).  Complementary, alternative, or integrative health: What’s in a name? Retrieved from https://nccih.nih.gov/health/integrative-health

Rieder, R., Wisniewski, P. J., Alderman, B. L., & Campbell, S. C. (2017). Microbes and mental health: a review. Brain, behavior, and immunity66, 9-17.

Russo, R., & Fortune, L. D. (2016). Six evidence-based integrative health practices to manage eight common chronic conditions and promote self-care: A review with findings inspired by a workplace wellness case study. SM J Community Med2(2), 1018.

Solís-Bravo, M. A., Flores-Rodríguez, Y., Tapia-Guillen, L. G., Gatica-Hernández, A., Guzmán-Reséndiz, M., Salinas-Torres, L. A., … & Albores-Gallo, L. (2019). Are tattoos an indicator of severity of non-suicidal self-injury behavior in adolescents?. Psychiatry investigation16(7), 504.

World Health Organization (WHO) (2019, April 2).  Self-care can be an effective part of national health systems. Retrieved from https://www.who.int/reproductivehealth/self-care-national-health-systems/en/

Yan, Q. (2016). The translation of psychoneuroimmunology into mind–body medicine. In Psychoneuroimmunology:  Systems biology approaches to mind-body medicine (pp. 121-129). Cham, SZ: Springer.

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Self-Care: Pursuing the Ultimate Path to Optimal Well-Being

September 8, 2019

The past months I have been engaged in a lot of conversations about self-care.  I sense a self-care zeitgeist arising in communities and healthcare settings.  A spirit is gaining momentum to educate and empower individuals, strengthen communities, and also stem the tide of escalating healthcare costs.  More so, from the humanistic perspective, self-care offers each individual a path to improve their life-quality and become the best they can be.

Self-care topics beckon researchers to reframe medical science and healthcare studies. I am inspired by excellent work done by my students and colleagues along with a wider proliferation of wellness scholarship.  Translating evidence to practice demands inter-professional collaboration and interdisciplinary worldviews, appropriate to an increasing number of scholar-practitioners.  My own self-care workshops and presentations have received enthusiastic responses from healthcare professionals as well as people simply wanting more from everyday living. I see this as a further shift, moving healthcare consciousness from providing cures to promoting optimal well-being.

There is no shortage of information.  One can hardly log onto the internet without encountering news and products to improve wellness.  Myriad educational and commercial offerings flooding inboxes can lead to information overload.  Now is a good time to reflect on how the self-care movement is authentic and meaningful both personally and professionally.

Why Self-Care

Self-care is the collection of actions and attitudes intentionally taken to promote and maintain health, prevent disease, and cope with illness and disability when it occurs.  It functions at several levels: for each individual, as family, and within community.   Self-care practices can be undertaking with or without the support of a healthcare professional.  As well, I see opportunities for healthcare settings to engage in quality education.

To borrow from the World Health Organization (2019), “Just as high quality healthcare is important, high quality self-care is too.”  Quality self-care is particularly important when healthcare access is limited and, in some cases, not available.  Self-care can also be a preferred option in some situations, allowing autonomy and agency, particularly for vulnerable populations.  Self-care is equally important for healthcare providers who are experiencing burnout and lack of well-being at unprecedented rates (Kuhn & Flanagan, 2017).

Key ingredient:  An Appropriate Framework

As a practical matter, adopting a self-care model or framework is key (WHO, 2019).  Plentiful sources are ripe with self-help ideas, possibilities, and solutions, from community programs to self-help articles, from workplace wellness to wellness tourism.  The self-care explorer can easily become inundated by the latest research or practice recommendations.  From a cognitive as well as an idiosyncratic level, it makes sense to first adopt a framework that considers readiness to change, provides integration of various practices, and is rewarding (Prochaska, Redding, & Evers, 2015).  A framework that matches with individual beliefs, preferences, and understanding provides a skeletal structure to support exploring, adopting, and developing practices.

A model is a framework, based on theories and principles, that provides structure.  It allows sense-making, in terms of which practices to adopt and when.  There are various scholarly-based, thoughtful models available.  The best self-care models reach beyond monitoring exercise frequency and whole food eating. Individualization can allow for flexibility according to each individual’s biochemistry, life-style, and preferences.

Here are two models that I find helpful for practice translation as well as suggesting avenues for further research.

The 7 Sources of Health (7SOH)(SoHL7x. com) is an original framework to teach and develop self-care skills and support community health systems.  Drawing from seven sources (Life Purpose, Body, Mind, Emotions, Creativity, Community, and Environment), the model’s education component offers evidence-based practices that individuals can adopt based on their needs and preferences (Russo, & Fortune, 2016).

The Pathwaysmodel is a behavioral medicine approach that directs individuals to improve self-care through three levels of engagement: self-care and skills acquisition, use of community resources, and with professionally administered treatments.  This model is particularly compatible with complementary-integrative practices and mind-body skills, such as mindfulness, guided imagery, self-hypnosis, and biofeedback (e.g., heart rate variability training) (McGrady & Moss, 2018).

Call for Action

In addition to supporting individual self-actualization, quality self-care is a sustainability issue.  Self-care is a need for those who live in communities, who fuel organizations and businesses, and also for the professionals who address healthcare needs.  While the path to better well-being is individual, there is a broader opportunity for collaboration.  Consider becoming a self-care advocate:  because self-care adopted on a community systems level has implications for shifting the future of healthcare.

References

Kuhn, C. M., & Flanagan, E. M. (2017). Self-care as a professional imperative: physician burnout, depression, and suicide. Canadian Journal of Anesthesia/Journal canadien d’anesthésie64(2), 158-168.

McGrady, A., & Moss, D. (2018). Integrative pathways: Navigating chronic illness with a mind-body-spirit approach. Cham, SZ: Springer.

Moss, D. (2019, August 30). Self care in palliative care — Pathways model.  Retrieved from https://www.youtube.com/watch?v=MrYpTUk61_A&list=PLUakTEuPjbFDg-IbovVkI_dRwSCFCSZ3s&index=13&t=0s

Prochaska, J. O., Redding, C. A., & Evers, K. E. (2015). The transtheoretical model and stages of change. Health Behavior: Theory, Research, and Practice, 125-148. Retrieved from https://www.researchgate.net/profile/Daniel_Montano2/publication/233894824_Theory_of_reasoned_action_theory_of_planned_behavior_and_the_integrated_behavior_model/links/0a85e53b67d742bc29000000.pdf#page=135

Russo, R., & Fortune, L. D. (2016). Six evidence-based integrative health practices to manage eight common chronic conditions and promote self-care: A review with findings inspired by a workplace wellness case study. SM J Community Med2(2), 1018.

World Health Organization (WHO) (2019, April 2). Self-care can be an effective part of national health systems.  Retrieved from https://www.who.int/reproductivehealth/self-care-national-health-systems/en/

 

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