ENGLISH TASK

 
Oleh
Mia Mardiana P
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POLITEKNIK KESEHATAN KEMENKES MALANG

D3 KEPERAWATAN MALANG
Maret 2020
1. Task One
a. Article
keyword : Physiological Consequences of Guided Imagery
https://www.practicalpainmanagement.com/treatments/complementary/biobehavi
oral/physiological-consequences-guided-imagery

What every pain therapist should know about guided imagery.

By David E. Bresler, PhD, LAc

“Imagination is more important than knowledge...” - Albert Einstein

Mental images, formed long before we learn to understand and use

words, lie at the core of who we think we are, what we believe the world is
like, what we feel we need and deserve, and how motivated we are to take care
of ourselves. They strongly influence our beliefs and attitudes about how we
fall ill, what might help us get better, and whether or not any medical and/or
psychological interventions will be effective or even helpful. For these
reasons, learning how to guide our patients’ imagery can be an enormously
helpful tool for modern pain therapists.
A mental image can be defined as a thought with sensory qualities. It is
something we mentally see, hear, taste, smell, touch, or feel. The term “guided
imagery” refers to a wide variety of mind/body techniques, including simple
visualization and direct suggestion using imagery, metaphor and story-telling,
fantasy exploration, game playing, dream interpretation, drawing, and “active
imagination,” where elements of the unconscious are invited to appear as
images that can communicate with the conscious mind.
Once considered “mumbo-jumbo,” or at best, an “alternative” or
“complementary” approach, guided imagery is finding widespread scientific1
and public2 acceptance, and nearly ever bookstore now offers guided imagery,
self-help CDs, or tapes.3 Guided imagery and other mind/body techniques are
now being taught to medical students and residents and, in a survey of 53
medical schools conducted in 2000, 66% taught meditation and relaxation,
37% taught guided imagery, and 34% taught biofeedback.4
Because it is simple and highly cost effective to provide imagery tapes
or CDs, many health professionals have begun recommending or using them
to help relieve their patient’s symptoms, teach stress management and
psychophysiologic relaxation, prepare patients for surgery, enhance tolerance
to procedures, alleviate anxiety and depression, improve sleep, wean patients
from medications, enhance treatment compliance, promote rehabilitation, and
accelerate healing responses in the body.
Pain therapists utilize imagery in nearly every interaction with patients
(whether aware of it or not). Table 1 summarizes the author’s personal list of
what every contemporary pain therapist should know about guided imagery.
1. Historically, more people have been treated using guided imagery
than by any other therapeutic intervention.
2. Patients (and pain therapists) use imagery all the time.
3. Imagery has powerful physiological consequences.
4. Words can evoke healing or hurting images.
5. Guided imagery is a low risk, low cost alternative for helping patients
control painful symptoms.
 6. Guided imagery can greatly enhance pain tolerance.
7. Guided imagery can help better prepare patients for surgery or
invasive procedures.
8. Guided imagery can enhance compliance with treatment
recommendations.
9. Guided imagery can help motivate and track progress of patients in
rehabilitation.
10. Guided imagery is most effective when utilized interactively.

Table 1. What every contemporary pain therapist should know about guided
imagery.

Historical Perspective

Despite guided imagery’s recent emergence as a therapeutic tool, its

roots date as far back as the very first healing prayers and rituals. Such
ceremonies use imagery (either overtly or covertly) to represent and evoke
hopes, beliefs, attitudes, and expectations, so in a sense, imagery can be
considered the oldest and most ubiquitous form of therapy.

The imagery-laden healing rituals of ancient cultures must have had a

certain level of efficacy or they wouldn’t have persisted over time. Today,
while we may dismiss the therapeutic power of “faith healings” as a “placebo
effect,” the benefits are real and measurable with important implications for
our understanding of how healing occurs.

Anton Mesmer’s ‘magnetic passes’ evoked remarkable and well

documented healings in early 19th century France. The scientific basis
underlying these healings was attributed by the French Academy of Sciences
to “the effects of the imagination.” Later, Charcot and his student, Sigmund
Freud, further developed hypnosis and free association as a way of exploring
the subconscious mind.

Modern psychotherapists have since utilized a variety of imagery

techniques to tap the contents of the subconscious. Hermann Rorschach, the
Swiss psychiatrist, used standardized ink-blot designs to examine the
psychological relevance of various non-descript images to his patients’ mental
states. Carl Jung contended that the unconscious was also the repository of our
intuition, creativity, compassion, and our deepest, most positive hopes for
fulfillment and self-actualization, and utilized attention to spontaneous images
as a way of connecting with it’s wisdom. Roberto Assagioli, an Italian
psychiatrist and contemporary of Freud and Jung, developed Psychosynthesis,
which extensively utilizes sophisticated imagery techniques.

Patients and pain therapists use imagery all the time. The most
common way we use imagery is by worrying. Where does worrying occur?
Mainly in your imagination. The two most common worries are regretting the
past and fearing the future. In the first case, we bring images from the past into
our imagination to analyze like an instant replay over and over again. In the
second case, we create fictional future scenarios that only happen in our
imagination. As has been said, “yesterday is history, tomorrow’s a mystery.
Today’s a gift. That’s why it’s called “the present.”

We also use imagery whenever we mentally plan or prepare for

anything. If you’ve ever remodeled a room, or figured out which would be the
fastest way home, you’ve used mental imagery to compare possible
alternatives.

Between worrying and planning, a great deal of attention is focused on

the “movies” we write, produce, direct, and act out in our imagination. It’s
also helpful to remember that whatever you give attention to grows, whether
it’s your garden, your children, or your worries and fears. Thus, instead of
promoting worrying by focusing patients’ attention on what they can’t do
(e.g., by listing disabilities and limitations, writing restrictions, etc.), perhaps
they should be encouraged to imagine all that they might be able to do in time,
over time.

Imagery has powerful physiological consequences. The body tends

to respond to mental imagery exactly as it would to a genuine external
experience. Numerous studies have shown that imagery can affect almost all
major physiologic control systems in the body, including respiration, heart
rate, blood pressure, metabolic rates in cells, gastrointestinal motility and
secretion, sexual function, cortisol levels, blood lipids, and even immune
responsiveness.5

To briefly experience this mind/body connection, take a moment to

imagine that you have a big, plump, fresh, juicy, yellow lemon in your hand.
Notice its heaviness and fresh lemony smell. Now, imagine taking a knife and
carefully slicing into the lemon, cutting out a thick, plump, juicy section. Now
imagine taking a deep bite of the lemon slice and feeling the sudden burst of
flavor as that sour, tart, lemon juice touches your tongue, saturating every taste
bud in your mouth so fully that your lips pucker and your tongue begins to
curl. Imagine that sour, tart, lemon juice swirling all around the back of your
mouth, and down your throat. If you are able to imagine this vividly, you are
probably salivating right now, for your autonomic nervous system understands
and automatically responds to the language of imagery. In the same way, an
erotic thought can produce an immediate and dramatic constellation of
autonomic responses throughout your entire body.

If imagining a lemon makes a person salivate, what happens when they

imagine themselves as helpless, hopeless victims of intractable pain? Doesn’t
that inform their healing systems to simply surrender and give up? Isn’t such
negative thinking likely to create neural and biochemical signals appropriate to
being defeated and depressed? On the other hand, it’s well known that positive
images (such as those evoked by “placebo effects) can stimulate healing in
nearly all bodily systems.6

Words can evoke healing or hurting images. When training medical

students, interns, or residents in pain medicine, the author urges them to
carefully select the words they use in their interactions with patients. Even
while collecting “objective” data, such as a range of motion measurement, a
practitioner’s words can evoke negative images and expectations that can
greatly affect “objective” findings.

For example, when maneuvering a patient’s upper extremity to

measure shoulder range of motion, students typically say, “Tell me when it
hurts” or “Is this painful?” When palpating a traumatized muscle, they might
ask “Is this tender?” or “How much pain does this cause on a 1 to 10 scale?”
The images that these words evoke cause the expectation that even more pain
is on the way, so patients brace, contract their muscles, and tighten their joints
in preparation, limiting their range.

When the author has repeated the exact same examination while saying
“Does this feel OK?” or “Is this comfortable?” or “Can you do this easily?”
strikingly different “objective” findings are obtained. These words evoke more
positive images, expectations, and intentions that encourage patients to relax
their muscles and unlock their joints, and thereby yields a greater range of
motion.

Low risk, low cost alternative for helping patients control painful
symptoms. When weaning patients from pain medications or performing
uncomfortable procedures, guided imagery and other mind/body interventions
are low risk, cost-effective alternatives for helping patients achieve acute
symptomatic pain relief.

A wide variety of guided imagery techniques can be used to help

alleviate painful symptoms.7-8 These include symptom suppression
techniques such as “glove anesthesia,” a two-step imagery exercise in which
patients first are taught to imagine developing feelings of numbness in their
hand, as if it were being placed into an imaginary anesthetic glove. Next, they
learn to transfer these feelings of numbness to any part of the body that hurts,
simply by placing the “anesthetized” hand on it. Glove anesthesia helps to
“take the edge off” the pain sensation, and it provides a dramatic illustration of
the power of self-control since, when patients realize that they can produce
feelings of numbness in their hands at will, they recognize that they may be
able to better control their pain symptoms, too.

Symptom substitution, time distortion, and imagery dialogue

techniques can also be helpful, and researchers are now reporting the benefits
of guided imagery in treating headaches,9,10 arthritis,11 burn patients,12 post-
surgical pain,13 pediatric pain,14 and a variety of other chronic pain
problems.15

Greatly enhance pain tolerance. The author suggests that there are
three major goals of modern pain management: (1) Decrease the pain signal;
(2) Increase pain tolerance, and (3) Teach self-management skills. Many pain
interventions attempt to interfere with transmission of the pain signal by
interrupting it (e.g., nerve blocks) or competing with it (e.g., TENS units).
Others (e.g., opiates) work by increasing a patient’s tolerance to the pain they
experience.
 The author has long believed that endorphins have little to do with pain
and much to do with suffering or a lack of pain tolerance. When patients are
given opiates (which mimic the effect of endorphins), they often state that “it
still hurts, but it doesn’t bother me as much.” Opiates don’t block the pain
signal; they enhance the patient’s tolerance to pain, and thus reduce suffering.

Tolerance can often be assessed by inviting patients to draw a picture

of their pain. When the resulting picture was discussed with the patient (who
was diagnosed with post-laminectomy syndrome), he discovered that it was
the pressure of family demands that was “tightening the clamp” and making
his pain unbearable. With the help of family therapy, his pain tolerance was
greatly improved and his suffering alleviated.

Because of the intimate relationship between imagery and state-

dependent learning, the structured use of memory, fantasy, and sensory
recruitment can also help patients move from affective states characterized by
fear, anxiety, confusion and hopelessness to those incorporating calmness,
clarity, strength and courage— all of which enhance pain tolerance

Guided imagery techniques represent a low risk, cost-effective way to

reduce the pain signal, enhance pain tolerance, and teach patients relaxation,
stress management, emotional control, improved sleep habits, and other
important self-management skills, with the result that more pain therapists are
beginning to use these techniques.

Helping better prepare patients for surgery or invasive

procedures. It is well known that a person’s suggestibility is greatly increased
prior to surgery. When patients are asked to read and sign an Informed
Consent form, one must wonder if the detailed list of potential risks that are so
clearly described might evoke negative images and expectations that could
affect the outcome of the procedure. That’s why it’s a good idea after
obtaining Informed Consent to tell patients, “Now that we’ve reviewed
everything that could possibly happen, let’s discuss what’s most likely to
happen and how by working together we can get the results we both want to
achieve.”

Researchers have found that when patients were given preoperative

suggestions for early return of GI motility, they were discharged 1.5 days
sooner at a savings of $1,200 per patient compared to a control group given
only instructions and reassurance.16 Similar benefits have been reported for
patients undergoing colorectal surgery.17,18 In addition, Blue Shield of
California reported an average savings of $654 per patient who listened to a
guided imagery tape for surgical preparation. These patients also reported
increased satisfaction with their care, and over 80% would recommend this to
a friend or family member. Many pre-recorded surgical preparation tapes and
CDs are now commercially available.3

Enhancing compliance with treatment recommendations. The lack

of a patient’s compliance with their pain therapist’s recommendations is often
the result of an inner conflict between one part of the patient who wants to
 follow orders and get better, and another part that believes that following those
orders will be uncomfortable, time consuming, expensive, and/or unhelpful.

By inviting patients to “allow an image to form for some part of you

that doesn’t want to comply” and then facilitating a dialogue with the image,
you can often quickly determine why resistance is present, and what is needed
to overcome it. Patients can also be given an “Inner Advisor”, “Inner Coach”,
or “Inner Doctor” who lives in their imagination and constantly supports their
plans for getting better.

Helping motivate and track progress of patients in rehabilitation.

It has been said that “you can lead a horse to water but you can’t make him
drink unless you make him thirsty.” When patients in rehab process images of
pain, discomfort, helplessness, and a lack of progress, they often become
discouraged and lose motivation to complete rehabilitation therapy. Helping
patients replace these with positive images of what they may be able to do
upon completion of rehab greatly stimulates their desire to achieve their full
potential.

Imagery can also be used to track a patient’s progress. By comparing a

patient’s drawing of her radicular pain upon admission with her drawing
following treatment, the practitioner can determine relative progress (the first
drawing had heavy, sharp, jagged lines over large body areas as compared to
the ‘after’ drawing showing smaller, lighter, less jagged lines over much
smaller body areas).

Guided imagery is most effective when utilized interactively. Over

the past 25 years, Martin Rossman, M.D., and the author have developed a
variety of ways to utilize imagery “interactively” to teach patients how to draw
on their own inner resources to support healing, to make appropriate
adaptations to change, and to find creative solutions to challenges they
previously thought were insoluble. This Interactive Guided ImagerySM
approach is particularly useful in the current era of managed care, where cost-
effective mind/body medicine, improved medical self-care, and briefer, yet
deeper, more empowering approaches to health care are much welcomed and
greatly valued by patients, providers, and insurers alike.

b. Summary

Mental images, formed long before we learn to understand and use words, lie
at the core of who we think we are, what we believe the world is like, what we
feel we need and deserve, and how motivated we are to take care of ourselves.

A mental image can be defined as a thought with sensory qualities. It is

something we mentally see, hear, taste, smell, touch, or feel. The term “guided
imagery” refers to a wide variety of mind/body techniques, including simple
visualization and direct suggestion using imagery, metaphor and story-telling,
fantasy exploration, game playing, dream interpretation, drawing, and “active
imagination,” where elements of the unconscious are invited to appear as
images that can communicate with the conscious mind.
 Pain therapists utilize imagery in nearly every interaction with patients
(whether aware of it or not). Despite guided imagery’s recent emergence as a
therapeutic tool, its roots date as far back as the very first healing prayers and
rituals. Such ceremonies use imagery (either overtly or covertly) to represent
and evoke hopes, beliefs, attitudes, and expectations, so in a sense, imagery
can be considered the oldest and most ubiquitous form of therapy.

Imagery can also be used to track a patient’s progress. By comparing a

patient’s drawing of her radicular pain upon admission with her drawing
following treatment, the practitioner can determine relative progress (the first
drawing had heavy, sharp, jagged lines over large body areas as compared to
the ‘after’ drawing showing smaller, lighter, less jagged lines over much
smaller body areas).
2. Task Two
a. List keyword
- Relaxation
- Visualization
- Breath slowly
- Favorite Image
- Focus
- Prevent
- Image can help the promote relaxation
- Comfortable potition
b. Comment of the videos
In my opinion this video is very easy to understand, the sound is
clearly not braking. The video is very useful for people who need calm or
relaxation. Eliminate boredom or stress due to work or activities. The right
music selection, makes it easy to carry a calm atmosphere. And also we can
listen to our own breath. Calm, relaxed, the burden of life feels reduced. The
duration of the video is also not so long that the viewer does not get bored
watching and listening.
 3. Tast Three
Dialog

Nurse: good morning, miss. Let me introduce my self, my name is mia, who was on duty this
morning, with who is this sister?
Patient: I am Nia
Nurse: what date were you born?
patient: May 26, 1997 nurse
Nurse: oke miss, how do you feel today after the surgery?
Patient: I have a sore foot
nurse: ohh i see miss nia, this morning I will take guided imagery action Patient: Guided
imagery is what it looks like
Nurse: I will just give you a video and some pictures of you where you can imagine you can
walk to the park and see the scenery outside the room and hopefully reduce the pain that you
feel. I will takes 10-15 minutes which aims to relax you so as to reduce pain after surgery.
Patient: During my time in this room I had never heard of such an action whether it was safe
Nurse: It's safe, sis
Patient: Do you also do this when you are sick?
Nurse: no I use this action when I'm stressed a lot of work just miss niaa and this is very
helpful to me
Patient: what kind of help?
Nurse: helps relax relax the mind
Patient: Then what will I do?
Nurse: You can just see this video every time you feel pain or want to kill something maybe
this can help you to reduce the pain. for the first one I will guide miss. Nia, after that miss.
Nia can do alone or assisted by miss. Nia's family
patient: okay ners, then how will it continue?
Nurse: make sure your body is in a relaxed position, miss?
patient: already ners
Nurse: breathe miss, take it out by mouth. then try to see this video. imagine Ms. nia being in
that place, alone without anyone. Ms. Nia ran to and fro, laughing, and feeling the cool
mountain air. feel the wind blowing my sister's long, loose hair. then came the people who
you love to accompany you there. bantering together, chatting, enjoying the beauty and
coolness there.
patient: waaaah, I really like the air in the mountains ners. I hope I can go there after I
recover. and true word sister. I feel my pain less. thank you very much ners.
Nurse: Thank God you feel helped by this therapy. you can do it yourself later when the pain
arises.
patient: well ners, later I will do it myself. thanks again sus
Nurse: You're welcome, Ms. Sis, are there any other complaints?
patient: not yet ners
Nurse: Yes, Ms. Nia, if Ms. Nia has any complaints. you can ring the bell next to you or one
of your family members can see me in the nurse's office. thank you sis nia, i say goodbye first
patient: you're welcome ners