A provenance of…


Come down drenched, at the end of May,
with the cold rain so far into your bones
that nothing will warm you
except your own walking
and let the sun come out at the day’s end
by Slievenaglasha with the rainbows doubling
over Mulloch Mor and see your clothes
steaming in the bright air. Be a provenance
of something gathered, a summation of
previous intuitions, let your vulnerabilities
walking on the cracked sliding limestone
be this time, not a weakness, but a faculty
for understanding what’s about
to happen. Stand above the Seven Streams
letting the deep down curent surface
around you, then branch and branch
as they do, back into the mountain
and as if you were able for that flow,
say the few necessary words
and walk on, broader and cleansed
for having imagined.

The Seven Streams – David Whyte


Hope has a place


hope.jpg image by dramadiva_photo

Red is the colour of love and compassion.


Happy Canada day!

Pain: Physical and Emotional


 Classifications of Pain:


  • acute: sudden onset with a typical duration of less than 6 months, usually associated with injury


  • chronic: constant pain that persists more than 6 months, usually associate with a particular injury, cause or illness


  • cancer pain: often due to the compression of peripheral nerves or meninges. May also be due to cellular and tissue damage following surgery, chemotherapy, radiation or tumor growth.


Pain Description:


  • transient

  • burning

  • shooting

  • sharp

  • dull

  • aching


note: Pain is classified by mode of origin and transmission


Nociceptive pain: is due to the stimulation of nerve fibers that transmit signals

in a normal way from nerve endings to brain centers.


Somatic pain: pain originating from muscle, soft tissue or bone. It is usually

well localized and described as deep, aching, or boring. It may be worse with

movement. Some examples are bone metastases, osteoarthritis, and

muscle/tissue damage.


Visceral pain: pain originating from internal organs or viscera surrounding

them. It is usually less well localized and can be referred. Often described as

deep aching, cramping, or squeezing. Some examples are bowel obstruction,

brain tumour, and appendicitis.


Neuropathic pain: is the abnormal sustained stimulation of the nerve fibers that

transmit signals from the nerve ending to brain center and/or from a dysfunction

in the central nervous system.


  • dysesthetic pain: described as burning, electrical sensations or pins and needles and/or lancinating pain, described as stabbing, shooting, or hot poker


examples of neuropathic pain: pain

  • post-herpetic neuralgia

  • spinal cord compression

  • diabetic neuropathy

  • plexopathies

  • phantom limb

  • central pain from a stroke


Emotional pain: the essence of this pain is the feeling of brokenness or shattered self. When perceived this pain is often avoided or hidden beneath self protective strategies. Unlike physical pain, that can be alleviated with pain medications, emotional pain must be first approached (acknowledged, validated) by the individual. Secondly, it must be reprocessed and assimilated into the individuals cognitive structures and view of self. This process allows for emotional awareness, a means to address the emotional arousal and finally regulation of the emotional pain itself.


Bolger, Elizabeth and Greenberg, Leslie G. 2001. An Emotion-Focused Approach to the Overregulation of Emotion and Emotional Pain. Journal of Clinical Psychology. 57 (2) 197-211.


Weber, Janet, R. 2008. Nurses Handbook of Health Assessment. 6thed. Missouri: Wolters Kluwer.

Stress: coping and management skills


 Stress stress


a stressor is defined as a disruptive force acting within or on any system.


Reaction to a stressor (physical or psychological stress):

  1. Alarm phase (fight or flight)

  • increased blood glucose

  • increased levels of epinephrine

  • increased heart rate

  • increased level of alertness

  1. Adaptation

  • body stabilizes and restores homeostasis ( resting or normal hormone levels, heart rate)

  1. Recovery or Exhaustion

  • if stressor is still present and no adaptation has occurred individual enters exhaustion

  • exhaustion: energy levels to resist stress and maintain adaptation are depleted

  • body is no longer able to defend itself against the impact of the event (trauma, immunologic insult)


NOTE: prolonged stress can cause illness


  • increased levels of fight or flight hormones over long duration can change biological and physiological processes

  • coping mechanisms such as lack of sleep, increased caffeine intake, use of tobacco, alcohol have negative effects on metabolism and cellular processes

  • stress may cause an individual to neglect warning signs of oncoming illness and exhaustion or forget or ignore prescribed medications or other treatments.


Psychological Stress Reaction

  1. Primary appraisal

  • the individual evaluates the event

  • event or circumstance classified as:

  • harm

  • loss

  • threat

  • challenge


  1. Secondary appraisal

  • individual focuses on possible coping mechanisms

  • Crisis Theory states reappraisal of original situation classification

  • result: coping behaviors constantly change as new information is gained


  1. Copingcoping

  • the individual’s efforts to manage psychological stress

  • effectiveness of strategies depend on individual’s needs

  • therefore, coping mechanisms may vary for individuals as well as for different stresses

  • stress type, personal beliefs, goals, support networks and resources influence a person’s ability to cope with stress


  1. Ego-defense mechanisms

  • psychological adaptive behaviors to cope with the stress

  • mechanisms may be task oriented, involoving direct problem solving to cope with threat(s)


Stress management techniquesrelaxation

  • regular physical excercise

  • support systems such as family and friends

  • time management

  • guided imagery or visulization techniques

  • meditation

  • progressive muscle relaxation (such as massage)

  • assertiveness training

  • journal writing


Perry, A, G, Potter, P, A, Ross-Kerr, J, C and Wood, M, J. 2006. Canadian fundamentals of nursing. 3rded. Toronto: Elselvier.

Erik Erickson’s Developmental Stages


baby Erik Erickson’s Developmental Stages

cognitive developmental theories
1) Trust vs Mistrust: Infancy (birth – 1 year)

learns to trust others
trust achieved as caregiver meets needs
assurance that caregiver will return when disappears from site (achieved when caregiver is able to move out of sight without undo distress)
the “sensorimotor” phase connecting with the world through touch, taste etc.
If needs not met we may end up with a deep-seated feeling of worthlessness and a mistrust of the world in general. 

2) Autonomy vs Shame and Doubt: Toddler (1-3 years)

begins to learn to become independent
self-confidence develops
Independence achieved through accomplishment of self care activities (walking, feeding, toileting)
Inability to accomplish independence creates feelings of shame and self doubt
Autonomy developed through choice making (controlling own behavior)
3) Initiative vs guilt: Pre-school age child (3-6years)toddler

learns to initiate own activities
accomplishment in this teaches child to seek challenges later in life
use of fantasy and imagination to explore environment
explores limits
encountering limits placed on behavior
limits may cause conflict and lead to frustration and guilt
4) Industry vs Inferiority: middle childhood (6-11 years)

develops competence in physical, cognitive and social skills
inability to learn new skills may result in sense of inadequacy and inferiority
success in skill acquisition may lead to positive outlook on work in adulthood
5) Identity vs role confusion: adolescent (12-18 years)
experiment with roles
form unique identity
sense of self identity crucial to later life decisions such as marriage and career choice
inability to solidify sense of identity results in inability to form meaningful attachments and may result in isolation
6) Intimacy vs Isolation: young adult (18-35 years)

form close personal relationships (friends, romantic partners)
community involvement
time to start a family

7) Generativity vs self absorption and stagnation: middle adult (35-65 years)couple1portrait600
assistance and mentoring younger individuals, succeeding generations
ability to expand one’s own personal and social involvement critical to fulfillment
ability to see beyond own needs
accomplishment of societal needs
dissatisfaction with own achievements leads to self-absorption and stagnation

8) Integrity vs Despair: Older adult (65-death)
reflection on life accomplishments
satisfaction or dissatisfaction
physical and social losses may result in status and functional loss (retirment, illness)
Integrity: fulfillment achienved through meaningful sense of contribution to society, sense of purpose and meaning to life
Dispair: unfulfilling experiences, perceived failures, lack of contribution to societal networks


Perry, A, G, Potter, P, A, Ross-Kerr, J, C and Wood, M, J. (2006). Canadian fundamentals of nursing (3rd ed.). Toronto: Elselvier.

The Grieving process



The four tasks for living and dying

William Worden has described ‘the four tasks of mourning’ facing a bereaved person:

1. To accept the reality of the loss.

2. To experience the pain of grief.

3. To adjust to the new situation (life without the deceased).

4. To withdraw emotional energy from the loss and to put it into a new relationship or situation.