n eDITorIAl

Time Well Spent

For nurses, nursing instructors, and nursing students, there is nothing as valuable as time well spent. Nurses are constantly under pressure to meet standards of care, to increased acuity of patients, make up for vacancies that have remained unfilled, and manage the consequences of short staffing. Nursing instructors are struggling to graduate enough new students to address the nursing shortage. Nursing schools are challenged with admitting qualified students, improving patient outcomes, and introducing processes such as the PICOT approach to evidence-based practice (EBP). The articles in this volume of the Journal reflect and address the importance of improving processes to recruit and retain a knowledgeable, skilled, and healthy nursing workforce.

The American Nurses Association (ANA) Code of Ethics for Nurses was revised in 2015 to include the prioritization of self-care for nurses. In the article “Self-Care as a Nurses Right and Responsibility,” the author emphasizes that traditional occupational stressors, such as short staffing, are now appended to modern stressors, such as environmental electromagnetic field (EMF) and electromagnetic radiation (EMR) emitted from electronic devices, both which have impacts on health and resilience. However, stressors can be counteracted by limiting exposure to EMF and EMR and implementing specific health and nutrition practices. With this knowledge, nurses can equip themselves to handle certain environmental stressors and the tolls of toxins on their bodies in order to maintain optimal health.

In the article “NCLEX-RN First-Time Passing Predictors,” the authors seek to uncover factors that can predict nursing students’ chances of passing the NCLEX-RN on the first attempt. Correlation studies reveal that the success of nursing students, such as the core nursing program, correspond to increased chances of passing the NCLEX-RN. They find that coaching and mentoring on core programs by nursing instructors help students achieve their goals and help meet student and school goals of passing the NCLEX-RN on the first attempt.

Prevention of decubiti is the topic of “Preventing Hospital-Acquired Sacral Pressure Injuries With Silicone Foam Dressing,” the last article featured in this volume of the Journal. Despite decades of effort to improve procedures, skin care remains a critical topic in addressing quality of care and patient outcomes. The author’s report shares the results of one surgical intensive care unit’s success in reducing sacral ulcers from 2.6% to 0%. Working collaboratively, the researcher and nursing staff initiated specific decubiti prevention measures within 24 hours of patients’ admissions, including performing regular team reassessments and ensuring the availability of supplies. Positive outcomes from this study can be used to better meet the challenge of improving lasting skin integrity for patients.

Nursing’s power in all settings includes reliance on perseverance, the ongoing search for process improvements, and using evidencebased practice. Through collaboration at all levels of education and practice, across-the-board collaboration results in increased individual nurse empowerment, improved self-care, elevated advocacy, and strengthened resilience.

Anne Bové, MSN, RN-BC, CCRN, ANP Audrey Graham-O’Gilvie, DNP, RN, ACNS-BC, CCRN-k Meredith King-Jensen, PhD, MSN, RN Alsacia L. Sepulveda-Pacsi, PhD, DNS, RN, FNP, CCRN, CEN Coreen Simmons, PhD(c), DNP, MSN, MPH, RN

Self-Care as a Nurse’s right and responsibility

Carol Lynn Esposito, EdD, JD, MS, RN-BC, NPD

n Abstract

Self-care for nurses is not an indulgence. It is a right and a responsibility. It is an expression of one’s deep and personal conviction of one’s priorities. It is engaging in behavior that seriously protects one’s mental health, energetic capacity, physical condition, and worth in order to restore and sustain inner balance. It is a commitment to oneself to uphold a regular, daily practice to stay healthy.

In this literature review paper, the author discusses how nurses can honor their personal and ethical commitment by engaging in daily self-care strategies in response to a workplace replete with potentially harmful stressors—including electromagnetic fields (EMF) and electromagnetic radiation (EMR), which have become a substantial new pollution source in modern civilization—so that they can ultimately better care for others.

Keywords: Self-care, nurse, electromagnetic fields (EMF), electromagnetic radiation (EMR)

Introduction

More than 4 million registered nurses comprise the largest and one of the most trusted groups of healthcare professionals in the United States today. In 2022, the American Nurses Association (ANA) published an updated Bill of Rights for Nurses outlining the inherent rights that must be afforded to nurses in the workplace to protect them and the patients entrusted to their care. Those rights include (American Nurses Association [ANA], 2022):

1. Full authority for nurses to practice at the top of their license, credentials, and professional standards without barriers, and in a manner that fulfills their obligations to society, patients, and communities.

2. Continuous access to training, education, professional development, as well as pathways for nurses to be recognized as leaders and in roles to direct shared decision-making on nursing practice, resources, staffing concerns, and patient safety issues.

3. Work and practice in environments that ensure respect, inclusivity, diversity, and equity with leaders who are committed to dismantling systemic racism and addressing racist behaviors that negatively impact nurses of color.

4. Just care settings that facilitate ethical nursing practice, standards, and care in accordance with the Code of Ethics for Nurses With Interpretive Statements.

5. Safe work environments that prioritize and protect nurses’ well-being and provide support, resources, and tools to stay psychologically and physically whole [emphasis added].

6. Freedom for nurses to advocate for their patients and raise legitimate concerns about their own personal safety without the fear of

Carol Lynn Esposito, EdD, JD, MS, RN-BC, NPD Nursing Education and Practice, New York State Nurses Association, New York, New York

retribution, retaliation, intimidation, termination, and ostracization [emphasis added].

7. Competitive compensation consistent with nurses’ clinical knowledge, experience, and professional responsibilities and that recognizes the value and rigor of nursing practice.

8. Collective and individual rights for nurses to negotiate terms, wages, and work conditions of their employment in all practice settings.

Self-care as a nurse’s right is embodied in provisions 5 and 6 above as one of the most imperative of nurses’ rights. The ANA Code of Ethics for Nurses states that nurses must practice self-care and, according to the ANA, there are seven areas of self-care: mental, physical, emotional, spiritual, social, personal, and professional (Gruzd, 2021). Provision 5 of the ANA (2015) code articulates, “The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal professional growth.” Provision 5.2 of the code’s Interpretive Statements articulates:

As professionals who assess, intervene, evaluate, protect, promote, advocate, educate, and conduct research for the health and safety of others and society, nurses have a duty to take the same care for their own health and safety. Nurses should model the same health maintenance and health promotion measures that they teach and research, obtain health care when needed, and avoid taking unnecessary risks to health or safety in the course of their professional and personal activities…. To mitigate these effects, nurses should eat a healthy diet, exercise, get sufficient rest, maintain family and personal relationships, engage in adequate leisure and recreational activities, and attend to spiritual or religious needs. These activities and satisfying work must be held in balance to promote and maintain their own health and well-being. Nurses in all roles should seek this balance, and it is the responsibility of nurse leaders to foster this balance within their organization. (p. 19)

Self-care reduces stress, replenishes a nurse’s capacity to provide compassion and empathy, and improves the quality of care provided to patients. The literature has shown that in addition to reducing stress and anxiety, self-care can also improve concentration, minimize frustration and anger, increase happiness, improve energy, and more. From a physical health perspective, self-care has been linked in the literature to reductions in heart disease, stroke, and cancer. From a spiritual perspective, self-care has been shown to help keep nurses in tune with their sense of a higher power and/or a higher meaning and sense of worth in life (Glowiak, 2020).

Sources of occupational Stressors for Nurses

For practicing nurses, some of the commonly reported occupational stressors include: protecting patients’ rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; surrogate decisionmaking; greater patient acuity; unpredictable and challenging workspaces; violence; increased paperwork; reduced managerial support; and role-based factors such as lack of power, role ambiguity, and role conflict (Blum, 2014). These are not the only stressors nurses face on the job, however.

Rapid technological advancement in the past 30 years has vastly increased human exposure to ionizing radiations. High exposures to electromagnetic fields (EMFs) and electromagnetic radiation (EMR) can occur when near certain medical devices in the hospital environment. Some medical devices use high levels of EMF and EMR for diagnostic or therapeutic aims. Recent technological advances have increased the diversity and potential strength of EMF and EMR emitted from medical sources and therefore raise questions about occupational safety and bodily stressors due to current awareness that EMF and EMR of sufficient strength can have negative and consequential biological effects (Stam & YamaguchiSekino, 2018).

Self-care reduces stress, replenishes a nurse’s capacity to provide compassion and empathy, and improves the quality of care provided to patients.

electromagnetic Fields vs. electromagnetic radiation

EMF are associated with electricity; they originate from sources either natural (such as solar and star radiation and thunder) or man-made (phone chargers, mobile phones, televisions, computers, printers, electrical cables, and antennas for telecommunications). EMR, on the other hand, consists of waves of electric and magnetic energy. Visible light is an example of electromagnetic radiation we can see. But there are many more wavelengths on the EMR spectrum than are invisible to the human eye, and they are potentially harmful, such as X-rays and gamma rays (see Figure 1 and Figure 2). Some examples of medical devices emitting EMR are magnetic resonance imaging (MRI), laser lithotripsy, X-rays, computed tomography (CT), radiation therapy, chemotherapy, immunotherapy, and positron emission tomography (PET). Both EMF and EMR are invisible areas of energy (Batool et al., 2019).

There are two general kinds of EMR: ionizing radiation and nonionizing radiation. Ionizing radiation is powerful enough to knock electrons out of their orbit around an atom. This process is called ionization. Ionizing, high-level radiation has the potential for cellular

Figure 2

Electromagnetic Waves and Common Radiation Sources With Frequency Ranges

Figure 3

Possible Pathways Leading to Behavioral Dysfunction and Other Biological Effects With EMF and EMR Exposure

Note. From “Microwave Radiation and the Brain: Mechanisms, Current Status, and Future Prospects,” by S. Mumtaz, J. N. Rana, E. H. Choi, and I. Han, 2022, International Journal of Molecular Sciences, 23(16), p. 9288 (https://doi.org/10.3390/ijms23169288).

and DNA damage. Non-ionizing radiation has enough energy to move atoms in a molecule around and cause them to vibrate, which makes the atom heat up, but not enough to remove the electrons from the atoms. Non-Ionizing, low-level radiation is generally described in the literature as harmless to humans (Yari et al., 2019).

However, due to certain aspects of man-made EMF and EMR (such as polarization), they are more bioactive and potent than naturally occurring EMF and EMR. For the most part, our body’s cells can respond negatively to man-made fields. The EMR effects on human body cells acts by removing calcium ions. Cells become distressed and trigger a defense response to the repetitive stress of EMF and EMR. Constant stress responses release masses of highly reactive free radicals, which have been shown to cause cellular dysfunction and inflammation, pain, and interfere with the body’s DNA repair processes. This in turn can lead to a weakened immune system, fetal abnormalities, mental disorders, cardiovascular diseases, disturbances of the nervous system, skin diseases, visual and hearing disturbances, and even tumors (see Figure 3) (Batool et al., 2019; Hu et al., 2021).

occupational exposure to electromagnetic Fields and radiation From Devices Found in the Workplace

EMF and EMR generated by medical sources in the hospital environment can be roughly divided into two categories: sources of static and low-frequency fields (i.e., frequencies from 0 Hz to 100 kHz) and sources of high-frequency fields (i.e., frequencies from 100 kHz to 300 GHz). Frequency is measured in the unit hertz (Hz), referring to a number of cycles per second. One thousand hertz is referred to as a kilohertz (kHz), 1 million hertz as a megahertz (MHz), and 1 billion hertz as a gigahertz (GHz). The range of the radio spectrum is considered to be 3 kHz up to 3,000 GHz. Low-frequency EMF and EMR that are sufficiently strong can stimulate sensory organs and nervous or muscle tissue via magnetic induction of internal electric fields in electrically conductive body tissues. Depending on the strength of the fields, this may lead to retinal stimulation (magnetophosphenes), vestibular disturbances, tingling sensations, pain or muscle contractions. High-frequency EMF and EMR that are sufficiently strong can lead to excessive heating and tissue damage (see Table 1) (Batool et al., 2019; Stam & Yamaguchi-Sekino, 2018).

Note. From “Radiofrequency Electromagnetic Radiation-Induced Behavioral Changes and Their Possible Basis, “ by S. N. Narayanan, R. Jetti, K. K. Kesari et al., 2019, Environmental Science and Pollution Research, 26, pp. 30693–30710 (https://doi.org/10.1007/s11356-019-06278-5).

Three main EMF and EMR applications in medicine are magnetic resonance imaging (MRI), radiofrequency ablation (RFA) used in cardiology and tumor therapy, and localized dielectric heating (short wave diathermy) used in physiotherapy. The strongest sources of lowfrequency EMF and EMR are devices for magnetic stimulation of brain, nerves, or muscles as a diagnostic or therapeutic tool (Hallett, 2007; Stam & Yamaguchi-Sekino, 2018). Most other sources of low EMF and EMR (frequencies from 50 Hz to 60 Hz) in the hospital environment come from cardiac monitors, wireless data, mobile phones, wireless telemetry, microwaves, stimulation devices, low-frequency pain relief devices, and laptops (Stam & Yamaguchi-Sekino, 2018).

Strong high-frequency EMF and EMR are used deliberately to heat patient tissues in therapeutic diathermy and hyperthermia. Electrosurgery and ablation are common techniques for procedures such as endometrial excision or arrest of bleeding in the hospital operating room by applying high-frequency electrical currents. Other high-frequency EMF and EMR have been developed more recently, such as radar applications used to monitor vital functions like heart rate and respiration and for imaging of tumors, by exploiting varying surface reflections and differences in

1

Medical Devices Frequency Ranges and Potential Biological Effects

f = 0 low frequency

Affecting vestibular organs and large blood vessels, resulting in disturbed equilibrium, reduced blood flow, cardiac arrhythmia

• MRI (static field)

As the static magnetic field of an MRI scanner is always on, MRI personnel moving around the scanner will be exposed to timevarying extremely low frequency magnetic fields that induce electric fields and currents in their bodies.

0 < f < 105 [0-10 kHz] low frequency

Affecting sensory organs, resulting in vertigo, nausea, metallic taste, magnetophosphenes, nerve and muscle stimulation

• MRI (movement within static fields)

0 < f < 105 [0-10 kHz] low frequency

Affecting musculoskeletal and nervous system, resulting in stimulation and potential damage

• MRI (switching gradient fields 500-5000 Hz)

A magnetic field gradient refers to a variation in the magnetic field across space. High-performance gradient systems of rapidly switching, large magnetic fields on the human body can induce peripheral nerve stimulation.

• Magnetic stimulation

0 < f < 50-60 Hz

Affecting the heart and blood vessels by causing a histopathological changes and disturbances in the functions of the organs of the cardiovascular system resulting in arrythmia, MI

MRIs produce a strong magnetic field that forces protons in the body to align with that field. When a radiofrequency current is pulsed through the patient, the protons are stimulated, and spin out of equilibrium, straining against the pull of the magnetic field.

• Magnetotherapy (chronic pain Rx)

Magnets are placed close to the body in order to effectuate bones to heal faster, relieve pain, and induce other therapeutic effects.

• Power frequency equipment

Typically used to describe electrical equipment operation, such as cardiac monitors.

105 < f < 1011 [10 kHz-10 GHz]

Heating affecting tissues, resulting in tissue damage

• MRI (radiofrequency field generated by imaging coils)

• Diathermy

• Electrosurgery (ablation)

• Hyperthermia

• Microwave imaging (thermoacoustic echography)

• Radar monitoring (heart rate, respirations) therapeutic ultrasound

Note. MRI produces three different fields to generate images: (1) a static magnetic field of zero frequency; (2) low power time-varying magnetic field gradients (100 Hz to 1kHz); and (3) RF fields (10 to 400 MHz). From “The Use of Electromagnetic Fields in Medicine and its Effect on Patient and Health Care Workers,” RF Toolkit–British Columbia Centre for Disease Control/National Collaborating Centre for Environmental Health, 2013 (http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20 and%20Forms/Guidelines%20and%20Manuals/EH/EH/Section7Final06062013.pdf) dielectric properties of healthy and diseased tissues. Microwave-induced thermoacoustic echography uses modifications of the reflection of acoustic waves by thermal expansion (Stam & Yamaguchi-Sekino, 2018).

Table adapted from “Exposure to Electromagnetic Fields Induces Oxidative Stress and Pathophysiological Changes in the Cardiovascular System,” by A. E. Azab and S. A. Ebrahim, 2017, Journal of Applied Biotechnology and Bioengineering, 4(2), pp. 540–545 (https://doi.org/10.15406/jabb.2017.04.00096) and “Occupational Exposure to Electromagnetic Fields From Medical Sources,” by R. Stam and S. YamaguchiSekino, 2018, Industrial Health, 56(2), pp. 96–105 (https://doi.org/10.2486/ indhealth.2017-0112).

Literature Review

Stress is a critical issue within nursing. Stress that occurs in an individual’s place of work is occupational stress, and in nursing is strongly associated with absenteeism, illness, diminished capacity to deliver quality patient care, and staff turnover. When the demands placed on the individual exceed their ability to cope, a stress response is generally triggered. As a result, the individual moves along a continuum from feelings of eustress to moderate stress to severe distress. Severe distress is a negative response to the environment resulting in negative physical and psychological adaptation (O’Donovan et al., 2013).

The physical capacity for performing a job is determined primarily by cardiovascular, pulmonary, nervous, musculoskeletal, endocrinal, and other regulating body systems. Work-related stress can modify an individual’s physiological functions which, in turn, can be additionally affected by exposure to EMF and EMR, which affects the electric field in the body through the movement of ions, heat, neuromuscular stimulation, and various other effects. The biological effects of these waves depend strongly on the waveform, frequency, and angle between the applied fields and the Earth’s magnetic field, as well as their continuity or pulsation. The effects of low-frequency EMF are different from the effects of high-frequency fields. This is because at low frequency, the voltage of the current is higher. Electromagnetic fields with different frequencies and high intensities have been considered a significant factor in the environment.

According to the frequency range, EMFs are divided into very low frequency (VLF) and extremely low frequency (ELF) ranges. Generally, the ELF region of the electromagnetic spectrum is defined as frequencies from 3 Hz to 3,000 Hz. These fields are generated by telecommunication devices (such as phones, TV, radio, computers, and the internet) and human exposure to low frequencies without protection occurs on a daily basis. The effects of low-frequency EMF are different from the effects of high-frequency fields (Moslemi et al., 2023). Electromagnetic energy is absorbed by the body where it is converted to thermal energy. If the energy absorption rate exceeds roughly 4 watts per square meter, it increases the body temperature by 1 to 2 °C (1.8 to 3.6 °F). Frequencies of about 50 to 80 Hz

Table 2

Health Risks Due to Long-Term Exposure to EMF From Telecommunication Devices

Device

Health risk

Mobile phone Fatigue, headache, dizziness, sleep disturbances, vision changes, hearing loss, memory loss

Wi-Fi DNA fragmentation, oxidative stress in kidney, fall in brain antioxidants

Microwaves Hyperactivity, sleep disorders, emotional instability

TV, cell phones Leukemia, tumors, cardiovascular problems, skin diseases, irritability, visual disruptions, hearing problems, depression are usually the most dangerous, since at these frequencies, even very small currents cause significant biological effects (Yari et al., 2019). The health problems and long-term effects of EMF and EMR from telecommunication and biomedical devices (see Table 2) have been addressed by the World Health Organization (WHO), Federal Communication Commission (FCC), and International Commission on Non-Ionization Radiation Protection (ICNIRP) in their recommended safety guidelines for the protection of all living beings (see Centers for Disease Control and Prevention, EMF, https:// www.cdc.gov/niosh/topics/emf/default.html).

Note. Table adapted from “Benefits and Hazards of Electromagnetic Waves, Telecommunication, Physical and Biomedical: A Review,” by S. Batool, A. Bibi, F. Frezza, and F. Mangini, 2019, European Review for Medical and Pharmacological Sciences, 23, pp. 3121–3128 (https://www.europeanreview.org/wp/wp-content/uploads/ 3121-3128.pdf).

Similarities in biological effects between Workplace Stressors and exposure to em F and emr

Occupational stress resulting from a demanding job with poor concomitant support, shortages of resources and staff, difficult relationships with patients and families, complicated relationships with other staff, and low institutional commitment to nursing are some of most-reported causes of physical and mental illnesses for nurses in the literature. Short-term exposures to these stressors can lead to a variety of disorders, such as burnout, chronic fatigue, depression, muscle aches, headaches, anxiety, lack of appetite, and lack of concentration. Extreme, long-term exposures to these stressors can lead to unhealthy and dysfunctional behaviors, such as smoking, excessive drinking, poor eating habits, diminished interest in former activities, and lack of exercise. Symptomatically, nurses exposed to these long-term stressors may experience physical and mental illnesses, chest pains, palpitations, sleep disturbances, increased susceptibility to respiratory infections, aggression, mood swings, and job dissatisfaction (Blaug et al., 2007; O’Donovan et al., 2013).

Similarly, some of the reported effects of short-term EMF and EMR on the body include sleep disturbances, lethargy, headaches, depression and depressive symptoms, fatigue, dysesthesia, palpitations, lack of concentration, memory changes, dizziness, and anxiety (Batool et al., 2019). Indeed, school nursing records often indicate an increase in one or more common symptoms among students and staff following the installation

Figure 4

Effects of Extremely Low-frequency EMF

Neurological diseases

(Alzheimer’s, dementia, etc.)

Suicide and depression

Spontaneous abortion and other e ects in women

Genital abnormalities in men of wireless systems: headaches, tachycardia, bloody noses, ear bleeds, skin rashes, nausea, tinnitus (loud ringing in the ears), vertigo, inability to concentrate, depression, anxiety, lack of energy, fatigue, flu-like symptoms, and insomnia (Belyaev et. al., 2016; Doucette, n.d.).

Other more significant effects of long-term exposure to EMF and EMR include increased cancer risk, cellular stress, increase in harmful free radicals, genetic damages, structural and functional changes of the reproductive system, learning and memory deficits, neurological disorders, changes in heart rhythm, damage to erythrocytes, disturbed glucose metabolism in the brain, and negative impacts on general well-being in humans (Hedendahl et al., 2015). Still other effects of long-term exposure to EMF and EMR described in the literature are shown in Figure 4 and Table 3.

Non-cancerous e ects of extremely low frequency

Discussion

Heart disease and palpitations

ALS syndrome

Blood diseases

Note. From “Biological Effects of Electromagnetic Waves With Emphasis on Radio and Microwave: An Environmental Carcinogen,” by S. Yari, A. F. Asadi, A. M. Jarrahi, and M. Nourmohammadi, 2019, Asian Pacific Journal of Environment and Cancer, 2(1) (http:// waocp.com/journal/index.php/apjec/article/view/308).

Table 3

WHO defines self-care as the ability to prevent disease, promote and maintain health, and cope with stress, disability, and illness. WHO recommends self-care interventions as a means by which individuals can take accountability and manage their health and well-being. Self-care interventions promote individuals’ active participation in their own health care and constitute a push toward greater self-determination, self-efficacy, autonomy, and engagement in health (World Health Organization [WHO], 2022).

Self-care interventions are tools which support self-care. Self-care interventions include evidence-based behaviors, actions, and strategies that go beyond a conventional health-sector response and which can be provided fully or partially outside of formal health services. Available, accessible, affordable, acceptable, and good quality self-care interventions are core components of promoting and protecting a nurse’s right to health.

Research Studies Showing Correlation Between EMF and EMR Exposure and Illness Study Description Finding

“Long-Term Exposure of 2450 MHz Electromagnetic Radiation Induces Stress and Anxiety-Like Behavior in Rats,” by S. K. Gupta, S. K. Patel, M. S. Tomar, S. K. Singh, M. K. Mesharam, and S. Krishnamurthy, 2019, Neurochemistry International, 128, pp. 1–13 (https://doi.org/10.1016/j.neuint.2019.04.001)

“Health Implications of Electromagnetic Fields, Mechanisms of Action, and Research Needs,” by S. Sarika Singh and N. Kapoor, 2014, Advances in Biology, (https://doi. org/10.1155/2014/198609)

Researchers investigated the effects of repeated exposure of discrete frequencies of EMR in experimental animals.

Literature review on studies conducted to determine whether increased exposure to electromagnetic fields (EMF) decreases melatonin production with a concomitant effect of increasing the likelihood of developing tumors.

Long-term exposure of EMR (2450 MHz) induced anxiety-like behavior, deregulated the hypothalamic pituitary adrenal (HPA) axis as observed by increase in plasma corticosterone levels apart from decreased corticotrophin releasing hormone-2 (CRH-2) and glucocorticoid receptor (GR) expression in amygdala, and impaired mitochondrial function and integrity.

Melatonin is highly accepted for its antioxidant and tumor-inhibiting properties. Continuous exposure to EMF emission produced noticeable depression in melatonin and corticosterone levels in multiple studies.

“Genotoxic Effects in Human Fibroblasts Exposed to Microwave Radiation,” by V. Franchini, E. Regalbuto, A. De Amicis, S. I. De Sanctis et al., 2018, Health Physics, 115(1), pp. 126–139 (http://doi.org/10.1097/HP.0000000000000871)

Study evaluated the potential genotoxic and cellular effects associated with in vitro exposure of human fetal and adult fibroblasts to microwave radiation at the frequency of 25 GHz.

Increased exposure to microwave radiation resulted in aneuploidy induction due to chromosome loss. Errors in chromosome segregation led to aneuploidy, a state where the number of chromosomes in a cell or organism deviates from multiples of the haploid genome. Aneuploidy arising through chromosome mis-segregation during meiosis is a major cause of infertility and inherited birth defects.

Table 3 (continued)

Research Studies Showing Correlation Between EMF and EMR Exposure and Illness

“Biological Effects of Electromagnetic Waves With Emphasis on Radio and Microwave: An Environmental Carcinogen,” by S. Yari, A. F. Asadi, A. M. Jarrahi, and M. Nourmohammadi, 2019, Asian Pacific Journal of Environment and Cancer, 2(1) (https:// doi.org/10.31557/APJEC.2019.2.1.35-41)

This study evaluated the correlation between human tissue damage and proximity to EMF and EMR.

Electromagnetic energy is absorbed by the body and converted to thermal energy, which increases the body temperature by 1 to 2 °C if the energy absorption rate exceeds about 4 watts per square meter, and also increases nerve stimulation. Frequencies of about 50 to 80 Hz are usually the most dangerous frequencies for the body. At these frequencies, even very small currents cause significant biological effects and tissue damage.

“Extremely Low-Frequency Electromagnetic Fields Cause DNA Strand Breaks in Normal Cells,” by C. T. Mihai, P. Rotinberg, F. Brinza, and G. Vochita, 2014, Journal of Environmental Health Science & Engineering, 12(1), p. 15 (https://doi. org/10.1186/2052-336X-12-15)

“Microwave Radiation and the Brain: Mechanisms, Current Status, and Future Prospects,” by S. Mumtaz. J. N. Rana. E. H. Choi, and I. Han, 2022, International Journal of Molecular Sciences, 23(16), p. 9288 (https://doi.org/10.3390/ ijms23169288)

The aim of this study was to evaluate late effects of normal Vero cells that were exposed to extremely lowfrequency electromagnetic fields (100 Hz, 5.6 mT) for 45 minutes.

The analysis of the registered comet indices and of cell cycle showed that extremely low-frequency electromagnetic field of 100 Hz and 5.6 mT had a genotoxic impact on Vero cells. Exposed samples presented an increase of the number of cells with high damaged DNA as compared with nonexposed cells.

“Effects of Radiofrequency Electromagnetic Radiation on Neurotransmitters in the Brain Front,” by C. Hu, H. Zuo, and Y Li, 2021, Public Health, 9, pp. 1–15 (https://doi.org/10.3389/ fpubh.2021.691880)

This study analyzed the interactions of microwaves with biological systems and the effects of microwave radiations on the brain, specifically learning and memory capabilities, as well as the mechanisms of brain dysfunction.

This study evaluated the effects of EMR on the metabolism and receptors of neurotransmitters (dopamine, norepinephrine, epinephrine, serotonin, amino acid, acetylcholine, peptides) in the brain.

EMR has an impact on molecular ions and electrons, as well as ROS, protein, and DNA/RNA levels. Furthermore, the EMR has cytotoxic effects on cells by causing degeneration, apoptosis, and necrosis. EMR has a strong impact on the central nervous system, reproductive system, cardiovascular system, and hematological system. The constant and long-term exposure of EMR to a biological system raises tissue temperature, which is a frequent effect of different stimuli.

Because of the complex diversity of neurotransmitters in the brain, the interaction, co-transmission and co-regulation of neurotransmitters make it difficult to distinguish the primary and secondary changes of each neurotransmitter. However, there are impairments to cognitive functioning and structural and functional changes in the nervous system.

“Radiofrequency Electromagnetic Radiation-Induced Behavioral Changes and Their Possible Basis,” S. N. Narayanan, R. Jetti, K. K. Kesari et al., 2019, Environmental Science and Pollution Research, 26, pp. 30693–30710 (https://doi. org/10.1007/s11356-019-06278-5)

“Measurement of Personal Radio Frequency Exposure in Japan: The Hokkaido Study on the Environment and Children’s Health,” by K. Yamazaki, A. Ikeda-Araki, C. Miyashita, N. Tamura, T. Yoshikawa, T. Hikage, M. Omiya, M. Mizuta, M. Ikuyo, K. Tobita, T OnishI, M. Taki, A. Watanabe, and R. Kishi, 2022, Environmental Research, 216(Pt 1), p. 114429 (https:// doi.org/10.1016/j.envres.2022.114429)

“Electromagnetic Hypersensitivity (EHS, Microwave Syndrome)—Review of Mechanisms,” by Y. Stein and I. G. Udasin, 2020, Environmental Research, 186, p. 109445 (https:// doi.org/10.1016/j.envres.2020.109445)

This study evaluated the effects of EMF and EMR on learning, memory, anxiety, and locomotion.

Exposure to EMF and EMR induces an imbalance in the oxidant/ antioxidant defense system in the brain indicating that the internal environment of each brain cell was getting disturbed by the insult from EMF and EMR.

This study evaluated the association between EMF and EMR and inattention/hyperactivity among children aged 10–15 years.

Positive correlations were noted between the associated increases in the use of mobile phones, video viewing, text messaging, and online gaming and inattention/hyperactivity.

This study explored the association between electromagnetic hypersensitivity and non-specific multiple organ symptoms.

Repeated exposures to EMF and EMR resulted in impaired detoxification systems that become overloaded by excessive oxidative stress and changes in calcium signaling cascades, signification activation of free radical process and overproduction of reactive oxygen species in living cells. Also noted were neurological and cognitive functions and disruptions in the blood-brain barrier.

Self-care is a part of a holistic approach to health and well-being. Selfcare allows nurses to take account of their circumstances, needs, and desires across a lifetime, as well as in the environments in which they live and work. Self-care places real power in the hands of the individual to prevent and treat stressors that can result in diseases. While self-care does not replace the healthcare system, it does provide irreplaceable additional options for optimal well-being (WHO, 2022). Nurses who commit to upholding the ANA’s imperative to actively participate in self-care and who adopt quality, evidence-based self-care interventions on a daily basis, can reduce mortality and morbidities and improve health and well-being.

evidence- based Self-Care Strategies and Actions for Protection Against Stress- related Illnesses

Internal inflammation is pervasive in our modern lifestyles. It plays a major role in many diseases, including in the onset of heart disease, in the incidence of depression, and in the onset of cancer. With such widespread

Table 4

Plants and Herbs as Self-Care Tools*

Source (common name)

Aegle marmelos (Indian bael, Japanese bitter orange, wood apple)

Ageratum conyzoides (billygoat-weed, chick weed)

Amaranthus paniculatus (red amaranth)

Aphanamixis polystachya (pithraj tree)

Centella asiatica (gotu kola, Indian pennywort)

Emblica officinalis (Indian gooseberry)

Gingko biloba

Hippophae rhamnoides (sea buckthorn, seaberry)

Mentha arvensis (wild mint, corn mint, field mint)

Mentha piperita (peppermint)

Osimum sanctum (holy basil)

Panax ginseng (Asian ginseng)

Phyllanthus amarus (gale of the wind, carry me seed)

Piper longum (long pepper)

Podophyllum hexandrum (Himalayan may apple)

Resveratrol (red wine, blueberry, raspberry, blackberry)

Syzigium cumini (Java plum, black plum)

Tinospora cordifolia (heart-leaved moonseed)

Vaccinium myrtillus (European blueberry, bilberry, whortleberry)

Zingiber officinale (ginger) inflammation and such powerful negative effects, finding effective and easily accessible ways of reducing or combating internal inflammation is of huge importance in self-care for nurses.

Internal inflammation may be caused by a number of things. Two major categories of internal inflammation have been highlighted in this article: workplace stressors and exposure to EMF and EMR. There are, however, other sources of internal inflammation, such as consuming processed meats, exposure to pollution, alcohol consumption, recreational and prescription drugs, and a lack of exercise.

Plants, Herbs, and Supplements as Self-Care Tools

There is an old adage, “You are what you eat.” Many supplements, plants, and herb-based foods have been documented in the literature as having anti-inflammatory, antioxidant, antimicrobial, immunomodulatory, and free radical scavenging or anti-stress properties. This means that to reduce systemic inflammation, one should include a diet with lots of

Protective effect

Micronuclei, free radicals, radiation-sickness, gastrointestinal (GI) and diarrhea-related deaths, lipid peroxidation, glutathione (GSH), colony forming units (CFU), villus height, crypt cells, goblet cells

Radiation-sickness, GI and diarrhea-related deaths, DPPH radical

Survival, CFU, spleen weight, lipid peroxidation, GSH, improves learning

Aberrant cells, chromatid breaks, chromosome breaks, dicentrics, acentric fragments and total aberrations, antitoxin

Weight loss, taste aversion, skin conditions, wound healing

Survival, weight loss, respiratory disorders, fatigue, malaise

Brain edema, clastogenic factors (those agents that break the chromosome and cause mutation)

Survival, CFU, adrenocorticotropic hormone, micronuclei, cardiovascular system, cancer, antioxidant

Radiation-sickness, GI and diarrhea-related deaths, asthma, inflammation

Hematological constituents, serum phosphatase, CFU, spleen weight, goblet cells/villus section and chromosomal damage

Survival, CFU, chromosome damage, lipid peroxidation, glutathione, respiratory ailments, skin diseases, GI

Survival, CFU, apoptosis, testicular enzymes, antioxidant, anti-inflammatory

White blood cells, superoxide dismutase (SOD), catalase, GST, GSHPx, glutathione reductase, antiviral

WBC, α-esterase, glutathione pyruvate transaminase, alkaline phosphatase, lipid peroxidation, GI, respiratory system, spleen

Survival, GI damage, nervous system of developing mice, GST, SOD, tumor inhibitor (antimitotic)

Oxidative stress, immune response

Micronuclei, respiratory system, GI, ulcers

Survival, CFU, blood cells, bone fracture, tumors, GI

Blood glucose levels, inflammation, vision, CV system, brain function, ulcerative colitis, vision

Radiation-sickness, GI and diarrhea-related deaths, free radicals, GSH lipid peroxidation inflammation-fighting foods. Targeted nutritional support works to reduce symptoms of chronic stress and EMF and EMR sensitivity, and bolster the body’s natural protection while concomitantly actively combating physical and mental damage. Sources of anti-inflammatory food interventions are noted in Tables 4 and 5.

Note.* If you choose to incorporate an herbal remedy into your daily diet, be sure to talk to your doctor first. Table adapted from “Radioprotective Potential of Plants and Herbs Against the Effects of Ionizing Radiation,” by J. C. Jagetia, 2007, Journal of Clinical Biochemistry and Nutrition, 40(2), pp. 74–81 (https://doi.org/10.3164/jcbn.40.74).

The addition of any herbal supplement should first be discussed with a doctor beforehand, as herbal therapies can interact with other medications and cause side unexpected side effects. According to Reddy (2021), caution and good judgment need to be exercised when taking herbs:

 The formulations available are not regulated or studied in the same way as prescription medications. Although there have been studies done to evaluate the claimed benefits of some herbs, most remain debatable.

Table 5

Supplements as Self-Care Tools*

Supplement (natural food source of supplement)

Curcumin (mango ginger, curry)

Ginseng

Glutathione (onions, garlic, cruciferous vegetables)

Green tea

Iodine (seaweed, yogurt, dried prunes)

Kombucha (black tea)

Magnesium (legumes, nuts, dark chocolate over 70%, leafy green vegetables)

Melatonin (exposure to sunlight)

Molecular hydrogen-enriched water

NADH (vitamin B3)

Olive leaf

Polygonum (knotweed)

Propolis (bee honey)

Pycnogenol (maritime pine)

Reishi mushroom

Self-Care as a Nurse’s Right and Responsibility

 Possible side effects can be mild or severe, ranging from allergies to effects on the liver and heart to thinning of the blood.

 Many current formulations have more than one ingredient, which can increase the chance of side effects or interactions.

 Combining herbal therapy with prescription medications increases the potential for interactions and side effects.

 The dose of herbs required for the claimed effect remains largely unknown.

Natural Food Sources as Self-Care Tools

Food provides not only essential nutrients required for life, but also bioactive compounds useful in maintaining good health and preventing

Protective effect

Immune function

Physical stamina, concentration, memory, immune function, respiratory and cardiovascular (CV) disorders, diabetes mellitus (DM)

Oxidative stress, brain function, liver function, cell repair

Immune function

Metabolism, cell repair, free radicals

Gut microbe

Calcium channel blocker, mitochondria/cellular energy

REM sleep

Free radicals, glutathione peroxidase

Brain cells, nervous system

Anti-inflammatory, CV, DM, weight loss, antibiotic, antioxidant

Blood cells, GI, antioxidant, LDL oxidation inhibition, antiulcer, analgesic, anti-inflammatory, antimicrobial, cytotoxic activity

Wound healing, oxidative stress, inflammation, virus, vision

UVB ray, anti-inflammatory, skin cancer

Immune function

Rosemary REM sleep, brain function

Turmeric

Vitamin C and vitamin E

Zinc (pumpkin seeds, turkey, lentils, cashews, seafood, grass-fed beef)

Blood cells

Free radicals, oxidative stress, cell membranes

Lipid peroxidation in brain

Note.* If you choose to incorporate supplements into your daily diet, be sure to talk to your doctor first. Used properly, dietary supplements can be beneficial, but dietary supplements have not proven to be totally safe under all circumstances. Side effects from dietary supplements happen when people take high doses or take them with certain prescription medications. Remember, most of what you hear or read about supplements is based on anecdotal evidence (personal experience or opinion evidence) rather than research. Also remember, supplements do not have to get approval from the Food and Drug Administration. Use good judgment when choosing which supplement you want to add to your diet. Talk with your healthcare team about any supplements you are taking or are thinking about taking. Your doctor or pharmacist can tell you about any known interactions with medicines you may be taking. Lastly, keep in mind that with new medicines and supplements, interactions may not yet be known. Table adapted from “13 Powerful Healing Supplements to Protect Against the Effects of EMFs,” by Conscious Spaces, September 3, 2020, (https://consciousspaces.com/blogs/science/13-powerful-healing-supplements-to-protect-againstthe-effects-of-emfs) and “How To Protect Yourself From Electromagnetic Frequencies (EMFs),” by the Restorative Wellness Center, May 28, 2020 (https://www.restorativechiro.com/ blog/2020/4/5/how-to-protect-yourself-from-electromagnetic-frequencies-emfs).

Table 6

Best sources of Food Antioxidants Using ORAC Score

disease. Foods that score high in an antioxidant assay, called oxygen radical absorbance capacity (ORAC), may protect cells and their components from damage by oxygen radicals. The ORAC unit, ORAC value, or ORAC score is a method developed by scientists at the National Institutes of Health (NIH) to measures the antioxidant capacity of different foods. Considerable epidemiological evidences suggest that consumption of food rich in antioxidants can prevent cell damage caused by free radicals as well as degenerative diseases such as cancer, cardiovascular disease, cataracts, brain dysfunction, and immune dysfunction. Foods with higher ORAC scores have greater antioxidant capacity, and more effectively neutralize harmful free radicals (Apak et al., 2013; Cao et al., 1998; Holford, 2021; Vinson et al., 1998; Wu et al., 2004). Researchers in the area of ORAC and antioxidants state that the body can effectively use 3,000 to 5,000 antioxidant or ORAC units per day. Any amount ingested over 5,000 ORAC units will simply be excreted by the kidneys with no greater beneficial effect. The best sources of food antioxidants found in the literature are shown in Table 6.

Nrf2 Foods as Self-Care Tools

The nuclear factor erythroid 2–related factor 2 (Nrf2) is known as the “master regulator” of the body’s antioxidant pathway. When the Nrf2 pathway is activated, it creates more antioxidant proteins. These proteins control how certain genes that help protect cells from damage caused by free radicals (unstable molecules made during normal cell metabolism), are expressed. Free radicals may play a part in cancer, heart disease, stroke, and other diseases of aging. The Nrf2 pathway is essential for battling injury, disease, inflammation, and any kind of cell-level oxidative damage in the body.

The Nrf2 pathway can be activated by eating certain kinds of foods and supplements. NrF2-boosting foods and supplements include vitamin D, hydrogen water, cauliflower, bok choy, broccoli, brussels sprouts, apples, quercetin, curcumin, cloves, garlic, ginger, cinnamon, red grapes, oregano, thyme, dark chocolate, and berries. Essentially, anything that contains a lot of polyphenols, a type of phytonutrient with a range of antioxidant and anti-inflammatory properties, will activate the Nrf2 pathway (Anderson Stewart, 2020).

Other Self-Care Tools

There are further lifestyle changes that can be made in order to achieve and maintain optimal health. One natural way to detox is through grounding (earthing). We are extremely fortunate to live on the biggest negative ionic charge of all: the Earth. That’s why grounding is a great way to detox from

Note. Table adapted from the articles “Methods of Measurement and Evaluation of Natural Antioxidant Capacity/Activity (IUPAC Technical Report),” by R. Apak, S. Gorinstein, V. Böhm, K. Schaich, M. Özyürek, and K. Güçlü, 2013, Pure and Applied Chemistry, 85(5), pp. 957-998 (https://doi.org/10.1351/PAC-REP-12-07-15); “Know Your Antioxidant Rating,” by P. Holford, 2021 (https://www.patrickholford.com/ advice/know-your-antioxidant-rating/); and “Lipophilic and Hydrophilic Antioxidant Capacities of Common Foods in the United States,” by X. Wu, G. R. Beecher, J. M. Holden, D. B. Haytowitz, S. E. Gebhardt, and R. L. Gebhardt, 2004, Journal of Agricultural and Food Chemistry, 52, pp. 4026–4037 (https://doi.org/10.1021/ jf049696w).

EMF and EMR exposure. Walking barefoot on natural ground, such as grass, sand, and rocks, allows your body to absorb electrons and help banish electromagnetic radiation right into the earth.

Some additional lifestyle changes refer to changes in personal habits (see Figure 5), while other changes refer to our surroundings (see Table 7). A healthy, well-rounded lifestyle will help you thrive throughout life. But most importantly, don’t forget to make time for yourself so you can maintain a healthy outlook. Stay in touch with family and friends, be involved in your community, maintain your curiosity, and continue to engage in lifelong learning. Take that quilting class you say you never have time for. Join that book club. As hard as it may be, advocate for yourself for balance in your life as vigorously as you advocate for your patients.

Conclusion

In the words of Leslie K. Lobel (2001): “You cannot keep giving to others if you do not give to yourself, first. It is like pouring water from a vessel: You cannot pour and pour without ever refilling it—eventually it will run dry.” It’s important to monitor yourself and make sure to realize when you’re feeling overwhelmed or overworked. Keep it all in perspective. Try to stay focused on maintaining health with mind, body, and spirit. That can be easier said than done. By striving to be your best through good nutrition, exercise, time with loved ones, fun moments and laughter, the bad days can be better, and the good days can be amazing.

Effective Self-Care Habits

Disconnec t from social media, especially before sleep.

Strive for 7 to 9 hours of sleep each night.

Table 7

Effective Self-Care Environment

Avoidance

Do 30 minutes of yoga or mindfulness 3 times per week.

Substitution Utilize

Consider using earthing products such as grounded blankets or mats. Turn off your Wi-Fi router at night. Replace all dimmer switches in your home with simple on/off switches. Buy an EMF blocking cover for your home’s Smart Water Meter.

Don’t carry your phone against your body. Use only incandescent near infrared saunas rather than LED lighted infrared sauna.

Limit your use of smart devices. Use an air tube headset rather than a wireless headset. Switch off circuit breakers to specific rooms at night (kitchen, TV, and computer room).

Limit Wi-Fi calling and Wi-Fi options for smart appliances. Use ethernet cables for connectivity needs. Use an EMF blocking phone case. Get rid of all LED and fluorescent light bulbs. Put phone on airplane mode if you need to keep it next to your bed.

Unplug or move anything that is within five (5) feet of your bed. Use a hot water bottle rather than electric heating pad for pain.

Do not place your computer, cell phone, or Wi-Fi -connected watch next to your body. Use analog monitors (baby monitor, video monitor) rather than digital or wireless.

Use an EMF blocking pad underneath your computer.

Use electric stoves/ovens as opposed to induction stoves/ovens.

Use the speaker function on your phone.

Do not sleep with an electric blanket on. Replace silver tooth fillings with ceramic. Place house plants in your rooms. Plants can help absorb radiation.