Nursing care and external applications I Fear I Palliative care

Therapeutic nursing measures are quite valuable in the treatment of fear and anxiety because of the human closeness of the practitioner, the quality of touch, and the substances used. Their effectiveness is experienced quickly and directly by the patient and can lead to a relevant improvement of the fear symptoms and thus the patient’s quality of life.

Anxiety with tension, mental strain

Rhythmical Einreibung treatment of the feet

with Solum oil WALA or Cuprum metallicum praeparatum 0.4% ointment WELEDA or Red Copper Ointment WALA.

Anxiety with inner tension is often accompanied by cold hands and feet. Copper has an easing, calming and warming effect.
Rhythmical Einreibung according to Wegman/Hauschka can only be learned in seminars, but even a simple gentle rubbing of the feet with a little Solum oil or copper ointment can help.

Rhythmical Einreibung treatment of the hands

with Aurum/Lavandula comp. ointment WELEDA.

When Aurum/Lavandula is used, patients become calm and often fall asleep during the treatment. This application has proven itself in cases of sudden anxiety attacks—especially at night—and for dying patients who would like their hands to be touched. This application results in an intensive encounter with the patient; it should be administered very carefully.

Rhythmical Einreibung treatment of the back

with Solum oil WALA.

Instructions: see: http://www.pflege-vademecum.de/rueckeneinreibung_solumoel.php?locale=en

Lavender foot bath

with Lavendula Oleum aethereum 10% WALA (also sold as Oleum aethereum Lavandulae 10%, Lavender massage oil)

Lavender has a warming, relaxing, calming, sleep-inducing, antispasmodic and invigorating effect. The footbath should preferably be used before going to bed. To do this you fill a wash bowl with water that is pleasantly warm to the patient and add some of the lavender bath supplement. The feet are placed in the bath for about 10 minutes (depending on the sense of well-being of the patient), dried and wrapped in a dry towel. The feet can also be rubbed with an oil after the footbath.

Tinkling washing

Instructions:
Slightly elevate the upper body, dip each hand and foot one after the other into a washing bowl with warm water (if necessary, add lavender bath milk and use a figure-eight motion to mix it in), then scoop water onto the hand or foot rhythmically, dry it well and wrap it in a towel or blanket.

The tinkling washing can be done with or without a washcloth instead of basic care of the hands and feet (intimate care is provided separately). The face can be included and then serves as a starting point for the wash.

Fear with a depressive mood and despondency

Morning footbath

with Rosmarinus, Oleum aethereum 10% Badezusatz WALA or Rosmarin Aktivierungsbad WELEDA (bath product).

A morning footbath with the addition of rosemary has a stimulating, refreshing effect and strengthens the morning connection between the body and the “I” and sentient organizations.

Instructions: see: http://www.pflege-vademecum.de/rosmarin_bad.php?locale=en

Heart ointment compress

with Aurum/Lavandula comp. ointment WELEDA (also sold as Aurum/Lavender/Rose ointment) or Aurum comp., Unguentum WALA: place on the heart region daily for the night.

Instructions: see http://www.pflege-vademecum.de/aurum_lavandula_salbe.php?locale=en

Efferent Rhythmical Einreibung treatment of the calves and feet

Instructions : see: http://www.pflege-vademecum.de/rhythmische_fusseinreibung_lavendeloel.php?locale=en

Yarrow liver compress

Instructions: see: http://www.pflege-vademecum.de/schafgarben_leberwickel.php?locale=en

Fear with shortness of breath

Rhythmical Einreibung treatment of the hands

with Aurum/Lavender/Rose ointment WELEDA or Copper Ointment WALA.

Copper ointment, which was already discussed, is best used for very tense, often “clenched” patients with cold hands. It has a calming, warming, loosening and relaxing effect.
In contrast, when treating with Aurum/Lavender, patients become calm and often fall asleep during the application. This treatment has proven itself in cases of sudden anxiety attacks—especially at night—and for dying patients who would like their hands to be touched. This application results in an intensive encounter with the patient; it should be administered very carefully.
For the hand application, the nurse sits down by the patient’s bed, takes the patient’s hand into her own hands and administers the Rhythmical Einreibung treatment in a relaxed and slow manner, using a circling motion in opposite directions on either side of the hand. Then she treats the fingers. This application must be learned in a Rhythmical Einreibung course.

Rhythmical Einreibung treatment of the lungs

with Plantago Bronchialbalsam WALA (in pneumonia-related dyspnea), Lavandula, Oleum aethereum 10% WALA (for agitation, irritated throat, also sold as Oleum aethereum Lavandulae 10%, Lavender massage oil), Thymus, Oleum aethereum 5% WALA or Eucalyptus, Oleum aethereum 10% WALA (to dissolve mucus).

This application needs professional handling. It induces deeper breathing, eases bronchospasm, and provides a freer feeling to the patient’s breathing.

Rhythmical Einreibung treatment of the calves

with Lavandula, Oleum aethereum 10% WALA (also sold as Oleum aethereum Lavandulae 10%, Lavender massage oil) or Cuprum metallicum praeparatum (ointment) 0.4% WELEDA or Copper Ointment WALA.

Rhythmical Einreibung treatment of the calves draws the anxious and agitated sentient organization into the limbs in cases of dyspnea. Lavender calms, copper has a warming and relaxing effect.

Instructions: see: http://www.pflege-vademecum.de/rhythmische_fusseinreibung_lavendeloel.php?locale=en

Oil compress

with Lavandula, Oleum aethereum 10% WALA (also sold as Oleum aethereum Lavandulae 10%, Lavender massage oil) or

with Thymus, Oleum aethereum 5% WALA.

The oil compress has a warming, relaxing, calming, sleep-inducing, antispasmodic and invigorating effect. Applied to the thorax, it can have a positive effect on a nagging cough.

Thyme stimulates the warmth organization and has a mucous-loosening and antispasmodic effect in cases of inflammatory respiratory disease (bronchospasm). It is used in dyspnea caused by respiratory infections.

Instructions:

  • Drizzle a cotton cloth with essential oil (with the drops spread out like stars in the sky) and place in a plastic bag.
  • Place a warming cloth and the plastic bag with the oil cloth between 2 hot water bottles (approx. 70°C).
  • Wrap an outer cloth around it all and allow everything to warm up for approx. 10 minutes.
  • Remove the cotton cloth from the plastic bag and place it on the patient’s chest. Cover it with the warming cloth.
  • Then wrap the chest with the outer cloth—or simply use a T-shirt or pajamas to fix it in place.
  • The oil compress should be allowed to work for at least 20 minutes.

This application is also well suited for staying on for longer (e.g., overnight), since the compress does not get cold.
It is important to keep the patient’s feet warm. If the feet are to be warmed with a hot-water bottle before the application, the oil compress can also be placed there during pre-warming. No other heat sources, such as hot water bottles, should be on the body during the application.

Oil neck compress

with Aconite Nerve Oil WALA.

The compress can also be quickly prepared and applied in acute situations. Another advantage is that the patient can sit and does not need to be placed in bed. The compress should remain on for at least 20 minutes but can also remain as long as the patient wishes, as it does not get cold.

Instructions: see: http://www.pflege-vademecum.de/aconitoel-_schulter_nackenwickel.php?locale=en

Fear of “losing one’s center”

Rhythmical Einreibung treatment of the whole body

with Solum Oil WALA

Solum oil contains moor extract, equisetum and horse chestnut as well as lavender oil. It can be applied to patients who need a “sheath” and warmth to better center themselves.

Tinkling washing

In addition to this indication, tinkling washing can also be used in cases of agitation, weakness of the life organization and for dying patients.

Instructions:
Slightly elevate the upper body, dip each hand and foot one after the other into a washing bowl with warm water (if necessary, add lavender bath milk and use a figure-eight motion to mix it in), then scoop water onto the hand or foot rhythmically, dry it well and wrap it in a towel or blanket.

The tinkling washing can be done with or without a washcloth instead of basic care of the feet and hands (intimate care is provided separately). The face can be included and then serves as a starting point for the wash.

Heart ointment compress

with Aurum/Lavandula comp. ointment WELEDA (also sold as Oleum aethereum Lavandulae 10%, Lavender massage oil). Spread the ointment thinly on a cloth and apply it each night to the heart region.

Instructions: see: http://www.pflege-vademecum.de/aurum-lavandula-herzauflage.php?locale=en

Rhythmical Einreibung treatment of the hands

with Cuprum metallicum praeparatum 0.4% ointment WELEDA or Copper Ointment WALA.

Copper is used for very tense, often “clenched” patients with cold hands. It has a calming, warming, loosening and relaxing effect.

For the hand application, the nurse sits down by the patient’s bed, takes the patient’s hand into her own hands and administers the Rhythmical Einreibung treatment in a relaxed and slow manner, using a circling motion in opposite directions on either side of the hand. Then she treats the fingers. This application must be learned in a Rhythmical Einreibung course.

Copper has an easing, calming and warming effect.

Pentagram Rhythmical Einreibung treatment

Fear with anxiety

Heart ointment compress

with Aurum/Lavandula comp. ointment WELEDA (also sold as Oleum aethereum Lavandulae 10%, Lavender massage oil). Spread the ointment thinly on a cloth and apply it each night to the heart region.

Instructions: see: http://www.pflege-vademecum.de/aurum-lavandula-herzauflage.php?locale=en

Gold combines the qualities of light and gravity and harmonizes the experience of soul and spirit.
Lavender has a harmonizing and relaxing effect and leads to a gentle warming up. The fragrance has a calming effect that eases respiration. The relaxing effect—even for patients who are afraid of falling asleep and fear the night—occurs immediately after applying the ointment. The patient’s mood becomes brighter, they feel calmer and more centered. This application is also prophylactically effective against anxiety-inducing situations (e.g., operations, interventions and stressful examinations, radiation therapy, chemotherapy).

Rhythmical Einreibung treatment of the feet or calves

with Arnika-Hypericum Massage-Öl LICHTERDE (Arnica-hypericum massage oil).

Fear is often perceived as “rising” and going up into the neck. “Nervous blotches” or red patches in the upper thorax, neck and face are the visible expression of inner experience. The sentient organization can be freed from this dynamic and returned to the limbs via Rhythmical Einreibung treatment of the calves and feet. This relieves the fear, the patient experiences mental liberation and can be more centered in facing the fearful experience.

Instructions:
Rhythmical Einreibung treatments of the feet or calves are used as an “efferent” therapy for agitated anxiety. They can draw the inner tension and agitation that are constricting the thoracic cavity into the motor-metabolic system. Rhythmical Einreibung treatment of the calves regulates the breathing rhythm.

Swaddling

Starting at the right and left of the iliac crest and continuing along the trouser seam downwards, we simultaneously “bind and loosen” both sides. The patient does not have to undress. We work very slowly and emphasize the loosening. The person feels his boundary and thus feels held and protected. The calming effect occurs very quickly. Swaddling is easy and no materials such as oil or supports are required.

1 Batschko EM. Einführung in die Rhythmischen Einreibungen. 2. Aufl. Stuttgart: Verlag Johannes M. Mayer; 2011.

2 Fingado M. Rhythmische Einreibungen. Handbuch aus der Ita Wegman Klinik. 3. Aufl. Dornach: Verlag am Goetheanum; 2012.

3 Heine R (Hg). Anthroposophische Pflegepraxis. Grundlagen und Anregungen für alltägliches Handeln. Berlin: Salumed Verlag; 2017.

4 Kolbe-Alberdi Vallejo C, Lange B. Die pflegerische Patientenbegleitung im Umkreis des Sterbens. Der Merkurstab 2015;68(4):272-274.

5 Riehm C, Kaschdailewitsch E. Pflegegesten in der anthroposophischen Pflege von Krebskranken. Der Merkurstab 2017;70(5):405-415.

6 von Dach C, Heine R, Heiligtag HR. Anthroposophische Pflege von Krebskranken. Der Merkurstab 2009;62(4):330-343.