Page 500 - Encyclopedia of Nursing Research

ShIVeRIng n 467

and provide support to caregivers have been of life, including an emphasis on education
tested, in particular, psychoeducational pro- and employment, is an important outcome of
grams for families (Schulze & Rossler, 2005), treatment in addition to symptom manage- S
but widespread adoption of family interven- ment. An effective therapeutic relationship
tions has been slow (lehman et al., 1998). The with health care professionals, including
national Alliance for mental Illness, a grass- nurses, remains paramount to good care
roots consumer-based organization, contin- (Ware, Tugenberg, & Dickey, 2004). Finally,
ues to provide important support services to cognitive behavioral therapy is effective with
families. persons with SmIs (leclerc, lesage, Ricard,
Theoretical perspectives of treatment lecomte, & Cyr, 2000).
have shifted in the last ten years to focus less In summary, the disabling effects of the
on management of SmI as a chronic condition illnesses, including impact on physical health
to a focus on recovery. Recovery is defined status, are significant. There are encouraging
as “a journey of healing and transformation trends, however, in the shift to a focus on
enabling a person with a mental health prob- recovery rather than chronicity. Community-
lem to live a meaningful life in a community based care, with nurses at the forefront, has
of his or her choice while striving to achieve an important role in achieving optimal qual-
his or her full potential” (U.S. Department ity of life for these patients. more research is
of health & human Services, 1999). From needed to build a science of effective recovery
the patients’ perspectives, a recovery model interventions. Finally, research to address the
of care includes the following components: needs of family caregivers that is feasible and
an attitude of hope, empowerment, holism, cost effective and ultimately benefits patients
strength based, peer support, respect, non- with SmI in need to be conducted.
linear progress, self-responsibility, and
empowerment (president’s new Freedom Linda Rose
Commission on mental health, 2003; U.S.
Department of health & human Services,
1999). The model emphasizes collaboration
between patients and practitioners (Anthony Shivering
& greenley, 1993; Jacobson & greenley, 2001).
This recovery model of care will have a major
impact on nursing research in the foresee- Shivering is defined as involuntary shaking
able future. Contemporary nursing practice of the body and is the adult human’s primary
that focuses on the support and educational defense against the cold and is character-
needs of persons with SmIs will do so within ized by a protracted generalized course of
a recovery framework. Research evidence is involuntary contractions of skeletal muscles
scant, however, on the specific interventions that are usually under voluntary control.
that will achieve the goals of recovery for Thermoregulatory shivering differs from
patients with SmIs. transient tremors or “shivers” associated
new avenues for research are emerging. with fear, delight, or other forms of sympa-
Social support is important for patients with thetic arousal. Shivering occurs when heat
SmIs, but recent studies suggest that women loss stimulates specific heat-loss sensors
in particular have reported a need for recip- in the skin, spinal cord, and brain. Sensory
rocal relationships in feeling socially con- impulses are received and integrated at the
nected (Chernomas, Clarke, & marchinko, preoptic area of the hypothalamus. Shivering
2008). Interventions recognizing the different is stimulated when integrated thermosen-
needs of men and women with SmI are being sory impulses indicate body temperature is
tested (Kelly, Wellman, & Sim, 2009). Quality falling below optimal “set point” range (see