The publisher makes no representation generic 100mg kamagra polo amex injections for erectile dysfunction cost, express or implied generic 100 mg kamagra polo with visa erectile dysfunction doctor cape town, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made purchase kamagra polo online from canada laptop causes erectile dysfunction. The right of Steven B Kayne to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act, 1988. Contents Preface vii About the editor ix Contributors x 1 Introduction to traditional medicine 1 Steven Kayne 2 Traditional European folk medicine 25 Owen Davies 3 Aboriginal/traditional medicine in North America: a practical approach for practitioners 44 John K Crellin 4 Traditional medicine used by ethnic groups in the Colombian Amazon tropical forest, South America 65 Blanca Margarita Vargas de Corredor and Ann Mitchell (Simpson) 5 Traditional medical practice in Africa 82 Gillian Scott 6 Traditional Chinese medicine 119 Steven Kayne and Tony Booker 7 Indian ayurvedic medicine 195 Steven Kayne 8 Japanese kampo medicine 225 Haruki Yamada vi | Contents 9 Korean medicine 257 Seon Ho Kim, Bong-Hyun Kim and Il-Moo Chang 10 Traditional medicines in the Pacific 270 Rosemary Beresford 11 Traditional Jewish medicine 293 Kenneth Collins Index 317 Preface My good friend, Dr Gill Scott, and I were sitting in the gardens of the Mount Nelson Hotel (affectionately known as ‘The Nellie’) in Cape Town discussing Traditional African Medicine. We both thought that it would be good to bring descriptions of a representative number of traditional medical systems together in one text, aimed at academics, students and interested members of the public. Over one-third of the population in developing countries lack access to essential medicines. Countries in Africa, Asia and Latin America use tradi- tional medicine to help meet some of their primary health care needs. In Africa, up to 80% of the population uses traditional medicine for primary health care. The provision of safe and effective Traditional Medicine Therapies could become a critical tool to increase access to health care. Migration, both within countries and across continents, means that host communities, in particular health care providers working in multicultural environments, may well come into contact with unfamiliar practices. A compact yet wide ranging source of knowledge such as that provided in this book will help them understand the basics of medical systems that are being used by patients, often concurrently with western medicine. However, health care providers need more than just knowledge, for it is necessary to understand and effectively interact with people across cultures. With this in mind a method by which orthodox health care providers can approach patients using their traditional practices in a sympathetic manner is introduced in Chapter 3. Although it specifically refers to North American aboriginal medicine it can be adapted to other health care environments. This book covers medical systems practised on five continents, chosen to offer readers an awareness of different approaches to health care around the world. For example, Traditional Chinese Medicine and Ayurvedic medicine, two complete health systems that form the basis of almost all Asian medi- cine, are covered in detail, using material derived from both observation and published literature. Medicine from the Amazonian region of Colombia is presented through a series of fascinating interviews with local healers that viii | Preface emphasises the importance of ritualistic practice. Chapters on Japanese, Korean and Traditional Medicine in the Pacific provide an insight into the way other cultures have contributed to the development of their health care practices. Two chapters on folk medicine are also included: one covers the history and practice of secular and ecclesiastical practices with their origins across the continent of Europe, while the other seeks to demonstrate the wide ranging influence that a global religion can have on the health care of its believers. As well as authoring, editing and contributing chapters to many books, Dr Kayne has written numerous papers and journal articles on a variety of topics associated with health care and has presented at conferences as an invited speaker on four continents. Associate Dean of Graduate Studies in Health Sciences, and finally Associate Dean of phar- macy admissions and undergraduate programmes before retiring in 2008. Dr Beresford’s many academic and other contributions to the pharmacy profession in New Zealand were recognised by her appointment as an honorary member of the Pharmaceutical Society of New Zealand in 2004 and acceptance into the International Academy of History of Pharmacy in 2005. She was created an Officer of the New Zealand Order of Merit ‘for services to medicine’, in 2007. Dr Beresford currently holds honorary appointments as Associate Professor at the Universities of Hong Kong and Auckland. He works as a practitioner in several clinics in Kent and maintains his own Chinese herbal dispensary integrated within an allopathic pharmacy. He has a particular interest in the treatment of debilitating conditions such as multiple sclerosis and rheumatoid arthritis. He is President of the Register of Chinese Herbal Medicine and, since 2005, has sat on the Herbal Medicines Advisory Committee. Professor Chang has written more than 120 research papers, 22 book chapters and monographs, including Treatise on Asian Herbal Medicines (9 volumes, 8804 pages). He is a Research Fellow at the Centre for the History of Medicine at the University of Glasgow and has written widely on medical ethics, the medical aspects of Jewish immigration, and the medical practice of the great mediaeval physician and philosopher Rabbi Moses Maimonides. Blanca Margarita Vargas de Corredor Blanca Margarita Vargas de Corredor has spent over 30 years working on traditional medicine and conservation projects with different indigenous groups such as Uitotos, Muinanes, Andokes, Yukuna-Matapi, Tikuna, Cocama in the Caquetá medio region of the Colombian Amazon rain forest. He currently teaches complementary and alternative medicine at the Faculty of Medicine, Memorial University of Newfoundland. His papers and books span a variety of topics, but with a sustained interest in the history of therapy from the eighteenth century onward, both conventional and complementary/alternative. Owen Davies PhD Owen Davies is Professor of Social History and Associate Head of School (Research) at the University of Hertfordshire, England. Much of his research has concerned the belief in the supernatural in the early modern and modern periods, which has led to work on popular medicine and interdisciplinary research applying anthropological and biomedical knowledge to historical topics. He has written chapters in several books and his latest book, published by Oxford University Press, is Grimoires: A history of magic books. His teaching specialisms include popular religion in Reformation Europe, crime and society in early modern England, landscape history and the history of European witchcraft, and custom and community in nineteenth-century England. Since 2004 he has been a Research Associate at Professor Il-Moo Chang’s laboratory, Natural Products Research Institute, Seoul National University. He is Research Associate at Professor Il-Moo Chang’s laboratory, Seoul National University and is an expert on Sasang Oriental Medicine, which is a unique theory of traditional medicine. She has worked since 1995 as a consultant in the field of African traditional medicines conserva- tion, industrial development and application in formal healthcare. As an honorary research associate in the Department of Botany, University of Cape Town, she publishes regularly on aspects of traditional medicine research. Contributors | xiii Haruki Yamada PhD Haruki Yamada is the Director and a Professor at the Kitasato Institute for Life Sciences, and the Dean of the Graduate School of Infection Control Science, Kitasato University in Japan. He is well known in the field of the scientific elucidation of Kampo medicines, and the bioactive polysaccharides from medicinal herbs. The practitioners include traditional midwives (parteras), herbalists (herbalistos), bone-setters (hueseros) and spiritual healers (curanderos or prayers). Countries in Africa, Asia and Latin America use traditional medicine to help meet some of their primary healthcare needs. In Africa, up to 80% of the population use traditional medicine for primary healthcare. Over one-third of the population in developing countries lack access to essential medicines. The provision of safe and effective traditional medicine therapies could become a critical tool to increase access to healthcare. In this book the term ‘traditional medicine’ is used to describe: Health traditions originating in a particular geographic area or ethnic group and which may also have been adopted and/or modified by communities elsewhere. Disciplines such as aromatherapy, medical herbalism, homoeopathy and others, usually known collectively as complementary and alternative medicine, are described in detail in a companion volume. The distinction between traditional medicine and what is known as folk medicine is not clear cut and the terms are often used interchangeably.
Hypoxia may also lead to brain injury from impairment of ventilation during chest squeezing cheap kamagra polo 100 mg on-line doctor for erectile dysfunction in kolkata, suffoca- tion buy 100mg kamagra polo fast delivery erectile dysfunction quran, or strangulation (26) kamagra polo 100mg mastercard erectile dysfunction best medication. Retinal hemorrhages are strongly suggestive of abuse when accompanied by intracranial injuries and in the absence of a confirmed history of severe accidental injury. Unilateral or bilateral retinal hemorrhages are present in 75– 90% of cases of shaken baby syndrome (36). Retinal hemorrhages can also be found after severe closed chest injury, asphyxia, coagulation disorders, carbon monoxide poisoning, acute hypertension, sepsis, meningitis, and normal birth (usually disappearing by 2 weeks, rarely persisting to 6 weeks). When shaking injuries are suspected, retinal examination is essential and should include di- rect and indirect ophthalmoscopy preferably by an ophthalmologist. Subhyaloid hemorrhages and local retinal detachment occur earliest, are often peripheral, and are found only by indirect ophthalmology. When intraocular injury is present, subdural hemorrhage is likely, and the presence of retinal detachment and multiple hemorrhages may indicate additional cerebral lacerations or in- tracerebral hemorrhages (35). Children with acute intracranial injury may present with fits, lethargy, irritability, apnea, unconsciousness and signs of shock, a tense fontanelle, increasing head circumference, and low hemoglobin. Children with chronic subdural hematomas may present with poor feeding, failure to thrive, vom- Nonaccidential Injury in Children 173 iting, increasing head circumference, and fits. The presentation may suggest sepsis, meningitis, encephalitis, or toxic or metabolic bone disease. The find- ings of retinal hemorrhages, other signs of abuse, and blood-stained cere- brospinal fluid may assist with the differential diagnosis. Milder forms of shaking may go undetected or present with nonspecific signs that may be minimized by physicians or attributed to a viral illness (36). Injuries arise mainly from blunt trauma (punching, kicking, trampling, or stamping) or sudden acceleration/deceleration injuries (swinging or throw- ing a child into a solid object) and include contusion, laceration, and rupture of solid or hollow viscera. Fabricated or Induced Illness The fabrication or induction of illness in children by a caregiver is referred to by several different terms, most commonly Munchausen syndrome by proxy, factitious illness by proxy or illness induction syndrome. In the United States, the term pediatric condition falsification is being adopted by the American 174 Thomas Professional Society on the Abuse of Children. The American Psychiatric Association’s Diagnostic and Statistical Manual has proposed using the term factitious disorder by proxy for a psychiatric diagnosis applicable to the fabri- cator (40). Fabricated or induced illness is a persistent fabrication of a child’s ill- ness either simulated or produced by the child’s parent or caretaker. There are three main ways of the caregiver fabricating or inducing illness in a child: • Fabrication of signs and symptoms. This form of child abuse is uncommon but severe and carries a high mortality and morbidity. International research findings suggest that up to 10% of children die and approx 50% experience long-term morbidity. There is a high incidence of reabuse and harm to siblings, commonly requiring separa- tion of the child from the abusing parent (41). The range of fabricated illness is wide and can be complicated further by multiple medical investiga- tions. Among the most common presentations are fits, apnea, bleeding, diar- rhea, vomiting, fever, and rash (42). Suffocation, poisoning, drug administration, and lying are mechanisms of fabricating illness. Emotional abuse is associated in almost all cases with considerable overlap with other forms of abuse. Covert video surveillance can play an important role in detection, offering definitive evidence, but this approach must be a carefully coordinated, multiagency and multidisciplinary approach, with the surveillance undertaken by the police (40,43). Young children and infants are at par- ticular risk, and there is often an overlap with other forms of abuse. A multidisciplinary approach aimed at early intervention, support for families, improvements in parenting styles, and prevention of mortality and morbidity in the child is essential to safeguard the welfare of children. Development After Physical Abuse in Early Childhood: a follow-up study of children on the child protection registers. Operating the child protection system: a study of child protection practices in English local authorities. Referrals, assessments and children and young people on child protection registers year ending 31 March 2002. Multiple fractures of the long bones of infants suffering from chronic subdural hematoma. Ocular and cerebral trauma in non-accidental injury in infancy; underlying mechanisms and implica- tions for paediatric practice. Procedures, placement, and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning, and non- accidental suffocation. Covert video recordings of life- threatening child abuse: lessons in child protection. This type of control has also been used by criminals to subdue the individual in acts such as rape, robbery, and murder. The possibilities are vast, and detection of their use can be obvious, such as that with traditional tear gas or pepper spray, or may take forensic test- ing in cases where the person was sedated or otherwise drugged. Modern chemical crowd-control agents were first employed in the early months of World War I, when the French launched tear gas grenades against the German army. The Germans first used chlorine gas in the spring of 1915 against the French Army at Ypres. The chlorine gas formed a cloud that was mistaken as a smoke screen behind which the German Army would advance. Instead of evacuating the area, the French army entrenched itself, readying for an attack. Unlike chlorine, which wafted in a cloud described as a greenish-yellow smoke, mustard gas was nearly odorless, and its effects took much longer to manifest. Although chlorine was an immediate choking agent, rendering severe respiratory distress and death, the full effects of mustard gas take 12–24 hours. Because mustard is an oily substance, it persists in the environment in which it is released, extending its From: Clinical Forensic Medicine: A Physician’s Guide, 2nd Edition Edited by: M. Mucosal membranes, such as the eye, respiratory tract, and skin, develop blisters, slough, and can fully incapacitate the individual for long time periods. It should be noted that the term gas may not be completely correct because many of these agents are not true gases but rather are solid particles that can be dispersed. The effective- ness of the crowd-control agent depends on the delivery of adequate amounts and sufficient contact with susceptible surfaces so that the desired effect is achieved. Therefore, temperature, wind conditions, method of delivery, for- mulation and potential barriers (such as clothing, masks, and eye protection), and ability to decontaminate interject variability into the response.
Husserlian ﬂows from the postulates kamagra polo 100 mg on line impotence erecaid system esteem battery operated vacuum impotence device, principles purchase kamagra polo 100 mg mastercard erectile dysfunction pills buy, and concepts phenomenology as a rigorous science provides just relevant to the conceptual system kamagra polo 100 mg without a prescription diabetic erectile dysfunction icd 9 code. Creativity, mystical experiences, tran- the ﬁndings in a way that is consistent with Rogers’ scendence, sleeping-beyond-waking experiences, notions of unpredictability, integrality, and nonlin- time experience, and paranormal experiences as earity. Emerging interpretive evaluation methods, they relate to human health and well-being are also such as Guba and Lincoln’s (1989) Fourth of interest in this science. Feelings and experiences Generation Evaluation, offer an alternative means are a manifestation of human/environmental ﬁeld for testing for differences in the change process patterning and are a manifestation of the whole within and/or between groups more consistent (Rogers, 1970); thus, feelings and experiences rele- with the Science of Unitary Human Beings. Discrete stages of theory development, designs that generate particularistic biophysical phenomena are usually descriptive and explanatory knowledge are relevant not an appropriate focus for inquiry because to the Science of Unitary Human Beings. New concepts with power have been found with anxiety, chronic that describe unitary phenomena may be devel- pain, personal distress, and hopelessness (Caroselli oped through research. For example, the metaphor (Butcher, 2002b), caring (Smith, 1999), and energy “I feel at one with the universe” reﬂects a high de- (Leddy, 2003; Todaro-Franceschi, 1999) are exam- gree of awareness of integrality; “I feel like a worn- ples of concepts that have been reconceptualizied in out shoe” reﬂects a more restricted perception of one’s potential (Johnston, 1994; Watson et al. Future research may focus on developing an Researchers need to ensure that concepts understanding of how human ﬁeld image changes and measurement tools used in the inquiry in a variety of health-related situations or how are deﬁned and conceptualized within a human ﬁeld image changes in mutual process with unitary perspective. Diversity is inherent in the evolution of the a way congruent with Rogers’ principles and postu- human/environmental mutual ﬁeld process. Researchers need to ensure that concepts and evolution of the human energy ﬁeld is character- measurement tools used in the inquiry are deﬁned ized by the creation of more diverse patterns re- and conceptualized within a unitary perspective. Two major concepts— lected patterning modalities designed to foster har- “my motor is running” and “my ﬁeld expansion”— mony and well-being (Hastings-Tolsma, 1992; are rated using a semantic differential technique Watson et al. Examples of indicators of higher veloped within and unitary science perspective that human ﬁeld motion include feeling imaginative, vi- may be used in a wide variety of research studies sionary, transcendent, strong, sharp, bright, and ac- and in combination with other Rogerian measure- tive. Indicators of relative low human ﬁeld motion ments include: include feeling dull, weak, dragging, dark, prag- matic, and passive. The tool has been widely used in • Assessment of Dream Experience Scale, which numerous Rogerian studies. Together, the researcher and Carboni (1992), which is a creative qualitative the participants develop a shared understanding measure designed to capture the changing con- and awareness of the human/environmental ﬁeld ﬁgurations of energy ﬁeld pattern of the healing patterns manifested in diverse multiple conﬁgura- human/environmental ﬁeld relationship. Carboni encouraged to use methods developed speciﬁc to (1995b) also developed special criteria of trustwor- the Science of Unitary Human Beings. Three meth- thiness to ensure the scientiﬁc rigor of the ﬁndings ods have been developed: Rogerian Process of conveyed in the form of a Pandimensional Unitary Inquiry, the Unitary Field Pattern Portrait Research Process Report. Each method a way of creatively measuring manifestations of was derived from Rogers’ unitary ontology and par- ﬁeld patterning emerging during coparticipation of ticipatory epistemology and is congruent with the the researcher and participant’s process of change. The method’s purpose is to investigate the Unitary Process of Inquiry and was derived directly dynamic enfolding-unfolding of the human from the criteria of Rogerian inquiry. Rogerian symphonic pattern manifestations emerging from Process of Inquiry transcends both matter-centered the pandimensional human/environmental ﬁeld methodologies espoused by empiricists and mutual process as a means to enhance the under- thought-bound methodologies espoused by phe- standing of a signiﬁcant phenomenon associated nomenologists and critical theorists (Carboni, with human betterment and well-being. Rather, this process of inquiry is evolution- eight essential aspects in the method, as described centered and focuses on changing conﬁgurations of here. Each aspect is described The ﬂow of the inquiry starts with a summation here in relation to the essential processses. Initial engagement is a passionate search for a re- purpose and researcher’s understanding of search question of central interest to under- Rogerian science. Next, the researcher focuses on standing unitary phenomena associated with becoming familiar with the participants and the human betterment and well-being. A priori nursing science identiﬁes the Science of ﬁeld perspectives are identiﬁed through observa- Unitary Human Beings as the researcher’s per- tions and discussions with participants and spective. It guides all processes of the research processed through mutual exploration and discov- method, including the interpretation of ﬁndings. Immersion involves becoming steeped in the re- the Healing Human Field–Environmental Field search topic. The researcher may immerse him- Relationship Creative Measurement Instrument self or herself in any activity that enhances the (Carboni, 1992) as a way to identify, understand, integrality of the researcher and the research and creatively measure human and environmental topic. Pattern manifestation knowing and appreciation ﬁgurations of the pattern manifestations emerg- includes participant selection, in-depth dialogu- ing from the human/environmental mutual ﬁeld ing, and recording pattern manifestations. The Participant selection is made using intensive dialogue is taped and transcribed. Patterning manifestation searcher maintains observational, methodologi- knowing and appreciation occurs in a natural cal, and theoretical ﬁeld notes, and a reﬂexive setting and involves using pandimensional journal. Any artifacts the participant wishes to modes of awareness during in-depth dialoguing. Unitary ﬁeld pattern proﬁle is a rich descrip- process section of the practice method are used tion of the participants’ experiences, percep- in this research method. All the tion and knowing is on experiences, percep- information collected for each participant is tions, and expressions associated with the synthesized into a narrative statement reveal- phenomenon of concern. The researcher also ing the essence of the participant’s descrip- maintains an informal conversational style while tion of the phenomenon of concern. Mutual processing involves constructing the thereby lifting the unitary ﬁeld pattern por- mutual unitary ﬁeld pattern proﬁle by mutu- trait from the level of description to the level ally sharing an emerging joint or shared pro- of unitary science. Scientiﬁc rigor is main- ﬁle with each successive participant at the end tained throughout processes by using the cri- of each participant’s pattern manifestation teria of trustworthiness and authenticity. For exam- findings of the study are conveyed in a ple, at the end of the fourth participant’s Unitary Field Pattern Report. The joint construction (mutual Cowling (2001) recently explicated the processes unitary ﬁeld pattern proﬁle) at this phase of Unitary Appreciative Inquiry as a method would consist of a synthesis of the proﬁles of grounded in Rogerian science for “uncovering the the ﬁrst three participants. After veriﬁcation wholeness and essence of human existence to in- of the fourth participant’s pattern proﬁle, the form the development of nursing science and guide proﬁle is folded into the emerging mutual the practice of nursing” (p. Pattern manifes- may be used with individuals, groups, or commu- tation knowing and appreciation continues nities and includes appreciative knowing, partici- until there are no new pattern manifestations patory, synoptic, and transformative processes. If it is not possible to either share the dinary and extraordinary forces characterized by pattern proﬁle with each participant or create unknowable mystery. The researcher and partici- a mutually constructed unitary ﬁeld pattern pant are equals in a participatory mutual process proﬁle, the research may choose to bypass the where outcomes are not imposed and change un- mutual processing phase. The unitary ﬁeld pattern portrait is created by amines all pattern information synoptically by identifying emerging unitary themes from viewing all experiences, perceptions, and expres- each participant’s ﬁeld pattern proﬁle, sorting sions as interrelated in a way that reﬂects the inher- the unitary themes into common categories ent wholeness of a phenomenon or situation. The and creating the resonating unitary themes of elements of the approach in unitary appreciative human/environmental pattern manifestations inquiry (Cowling, 2001) include: through immersion and crystallization, which involves synthesizing the resonating themes 1. The scientist/practitioner seeks out to explore a into a descriptive portrait of the phenome- life situation, phenomenon, or concern from a non. Describe the endeavor with the aim of appreciat- and accurate aesthetic rendition of the univer- ing the wholeness, uniqueness, and essence sal patterns, qualities, features, and themes of the particular situation, phenomenon, or exemplifying the essence of the dynamic kalei- concern. Approach participants as partners in a coequal preted from the perspective of the Science of participative appreciative endeavor. Information is collected in the form of dialogue, evolutionary interpretation to create a theoret- discussion, interview, observation, or any prac- ical unitary ﬁeld pattern portrait of the phe- tice that illuminates the underlying human life nomenon. Documentation of the experience, perceptions, retical structure of the phenomenon from the and expressions can be accomplished through perspective of Rogers’ nursing science.
The caring model is basis for the emerging ideas in relation to our own consistently one of the nursing caring theories used “theories and philosophies of professional nursing as a guide cheap 100mg kamagra polo mastercard erectile dysfunction treatment news. Nursing thus ironically is interacting with the caring model to transform now challenged to stand and mature within and/or improve practice? The it mean to be human purchase kamagra polo on line impotence in men over 50, caring best buy for kamagra polo erectile dysfunction herbal medications, healing, becoming, future already reveals that all health-care growing, transforming, and so on? For example, practitioners will need to work within a in the words of Teilhard de Chardin:“Are we hu- shared framework of caring relationships and mans having a spiritual experience, or are we human-environment ﬁeld modalities, pay at- spiritual beings having a human experience? Participants were invited to explore Transpersonal However, nursing’s future holds promises of Human Caring Theory (Caring Theory), as taught caring and healing mysteries and models yet and modeled by Dr. Jean Watson, through experi- to unfold, as opportunities for offering com- ential interactions with caring-healing modalities. Nursing has a critical role to play Returning from the retreat to the preexisting in sustaining caring in humanity and making schedules, customs and habits of hospital routine new connections between caring, love, and was both daunting and exciting. Caring Theory, and not as a remote and abstract philosophical ideal; rather, we had experienced car- ing as the very core of our true selves, and it was the call that led us into health-care professions. Our experiences throughout the re- treat had accentuated caring as our core value. Caring Theory could not be restricted to a single Application of area of practice. Nursing within acute care inpatient hospital set- Theory of tings is practiced dependently, collaboratively, and independently (Bernardo, 1998). Bernardo de- scribes dependent practice as energy directed by Human Caring and requiring physician orders, collaborative prac- Terri Kaye Woodward tice as interdependent energy directed toward activities with other health-care professionals, and independent practice as “where the meaningful role and impact of nursing may evolve” (p. Transpersonal Caring Theory and the caring Although Bernardo’s description of inpatient nurs- model “can be read, taught, learned about, studied, ing captures the composite and fragmented role researched and even practiced: however, to truly ‘get it,’ one has to personally experience it—interact and grow within the philosophy and intention of 1 See Watson,J. This section of Model® integrating theory, evidence and advanced caring-healing the chapter provides a look into Transpersonal therapeutics for transforming professional practice. Watson’s clinical caritas of deep respect for humanity and all life, of wonder processes are listed, as well as an abbreviated ver- and awe of life’s mystery, and the interconnected- sion of her guidelines for cultivating caring-healing ness from mind-body-spirit unity into cosmic throughout the day (Watson, 2002). Gadow (1995) describes written in Caring Theory language, expresses our nursing as a lived world of interdependency and intention to all and reminds us that caring is the shared knowledge, rather than as a service pro- core of our praxis. Caring praxis within this lived world is a Second, a shallow bowl of smooth, rounded praxis that offers “a combination of action and re- river stones is located in a prominent position at ﬂection... A sign posted by the stones iden- and a relationship with the wider community” tify them as “Caring-Healing Touch Stones” invit- (Penny & Warelow, 1999, p. Caring praxis, ing one to select a stone as “every human being has therefore, is collaborative praxis. These stones serve as a reminder of our ca- in our endeavors to translate Caring Theory into pacity to love and heal. They reveal the nonlinear process and smooth cool surface, let its weight remind you of relational aspect of caring praxis. Share in the love openness to unknown possibilities, honor the and healing of all who have touched this stone be- unique contributions of self and other(s), and ac- fore you and pass on your love and healing to all knowledge growth and transformation as inherent who will hold this stone after you. These key elements support the Third, latched wicker blessing baskets have been evolution of praxis away from predetermined goals placed adjacent to the caring-healing touch stones. Through collaboration and cocreation, staff to offer names for a blessing by writing the we can build upon existing foundations to nurture person’s initials on a slip of paper and placing the evolution from what is to what can be. Every Monday through Friday, Our mission, to translate Caring Theory into the unit chaplain, holistic clinical nurse specialist praxis, has strong foundational support. Staff and families, our environment, and our caring tries not to enter patient rooms unless summoned. This book emphasizes that patients, the unit as evidence of our commitment to caring parents, and families are members of the health values. Depicting pictures of diverse families at the center, Sixth and most recently, the unit chaplain, child- the poster states our three initial goals for theory- life specialist, and social worker have organized a guided practice: (1) create caring-healing environ- ments, (2) optimize pain management through 2 Written by Terri Woodward. In order for these expressions to be deliberate Gathering,” offered every Thursday morning. It is actions of praxis, the centrality of caring as our core held in our healing room—a conference room value was clearly articulated. Caring Theory is the painted to resemble a cozy room with a beautiful ﬂexible framework guiding our unit goals and unit outdoor view3 and redecorated with comfortable education and has been integrated into our im- armchairs, soft lighting, and plants. Goodies and plementation of an institutional customer service Gathering extends a safe retreat within the hospital initiative. Reﬂective of the to staff, these professionals provide snacks to feed broader institutional mission statement, each unit the body, a sacred space to nourish emotions, and is encouraged to develop a mission statement and their caring presence to nurture the spirit. Care as the core of praxis • Advocacy differs from the centrality of cure in the medical • Respect, research model. The unit on pain management has been expanded Large signs are currently being professionally to include use of caring-healing modalities. A new produced and will be hung at various locations on interactive session on the caritas processes has been our unit. The added that asks participants to reﬂect on how these largest, posted conspicuously at our threshold, processes are already evident in their praxis and to identiﬁes our unit as the home of the Attending explore ways they can deepen caring praxis both in- Caring Team. In ad- Giving ourselves a name and making our caring dition to changes in phase classes, informal “clock intentions visible contribute to establishing an hours” are offered monthly. Clock hours are de- identity, yet may be perceived as peripheral activi- signed to respond to the immediate needs of the unit and encompass a diverse range of topics, from conﬂict resolution, debrieﬁng after speciﬁc events, 3 Artwork created by and generously donated by artist Cynthia and professional development, to health treatment Telsey. Offered on the unit at varying hours Placing Caring Theory at the core of our praxis to accommodate all work shifts, clock hours pro- supports practicing caring-healing arts to promote vide a way for staff members to fulﬁll continuing wholeness, comfort, harmony, and inner healing. Building practice on awareness choose their attitude, work environments caring relationships has led to an increase in both improve for all. Previously, care conferences were called as caring, they become opportunities for authentic a way to disseminate information to families when human-to-human connectedness through I-Thou complicated issues arose or when communication relationships. Now, these conferences are offered proac- nurses, and volunteers—complete with marching tively as a way to coordinate team efforts and to music, hats, streamers, ﬂags, and noise makers— ensure we are working toward the families’ goals. This ﬂamboyant coordinate continuity of care, share insight into the display lasts less than ﬁve minutes but invigorates unique personality and preferences of the child, co- participants and bystanders alike. In addition to ordinate team effort, meet families, provide them being vital for children and especially appropriate tours of our unit, and collaborate with families. When our parade therapeutic touch, guided imagery, relaxation, visu- marches, visitors, rounding doctors, all present on alization, aromatherapy, and massage. Patients are invited to bring their pillows and fa- Caring Theory guides us and manifests in innu- vorite stuffed animal or doll and come dressed in merable ways. Our interview process has meals, staying late to care for patients and families, transformed from an interrogative threestep proce- and refusing to give off-going report until their on- dure into more of a sharing dialogue. We are adopting another intentionality towards caring and healing meeting style that expresses caring values. Narrative and exploration: Toward a poetics other health-care teams, and promoting staff in of knowledge in nursing. The Attending Nurse Caring “let the Ideal go if you are not trying to in- Model®: Integrating theory, evidence and advanced caring- corporate it in your daily life” (Vivinus & healing therapeutics for transforming professional practice.