Journal of IiME Volume 2 Issue 2 www.investinme.org A Severe ME-aware nursing model (continued) ME/CFS is characterized by (Mark 2005) : - malaise following even modest physical activity - delayed reaction to physical and/or mental activity (up till 24 hours and more); - abnormal length of convalescence (out of proportion to level of activity) - varying and fluctuating symptoms during the day, but also in the course of days, weeks and months is very important to ask the right questions and not assume anything, as this Observation and Assessment tool shows (see Table 1) - As the chart shows, in severe ME/CFS sleep/awake times and personal care needs are unlikely to fit into standard patterns. An ME-aware Nursing Model In the author’s experience (Crowhurst 2005) , the most appropriate nursing approach is one that incorporates the Nursing Process (Yura and Walsh 1967) within a self-reflective model of practice . Crowhurst (2005) has outlined how the experiential learning cycle (Kolb and Fry 1975) can be used to underpin ME/CFS nursing practice , encouraging nurses to reflect upon their practice experientially and holistically. Some important areas for practitioner reflection are listed below in Table 2 : An ME-aware approach requires the nurse to be : - particularly conscious of how ME/CFS manifests. - the full range of symptoms. (continued on page 38) Symptom Hyperacusis Table 1 - Severe ME/CFS : Observation and Assessment tool Questions/Observations What is the patient’s response to electrical equipment, noise, telephone, doorbell, washing machine, Hoover ? Hyperesthesia Does the patient flinch, become irritated and depressed ? Is the skin hypersensitive to touch ? May be unable to tolerate massage, stroking, accidental contact. Comments Noise sensitivity can be so great that even a whisper sounds like a shout; it may be painful and it may increase a whole range of symptoms. The patient may find any kind of contact or movement over the skin unbearable. May flinch, may react strongly, verbally, be very distressed by even a slight brushing. The nurse has to be very careful and aware. (Table 1 continued on page 37) Invest in ME (Charity Nr. 1114035) Page 36/74
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