Exploring Integrative Medicine: The Story of a Large, Urban, Tertiary Care Hospital
Lori L. Knutson
Nurse Healer OBJECTIVES
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Theoretical
Discuss the integrative approach to health care.
Analyze the components of a healing environment assessment.
Clinical
Integrate holistic nursing in the acute care hospital setting.
Initiate practice changes that integrate holistic therapies into the care of patients.
Determine the relationships required for successfully changing the culture of the hospital environment.
Model relationship-centered care in professional partnerships and in the care of the patient.
Personal
Determine whether you can approach leadership in a changing organizational culture with passion and fearlessness.
DEFINITIONS
Integrative medicine: A philosophy of healthcare practice that emphasizes the “whole person” view of health and healing and, in practice, blends conventional, alternative, and complementary interventions to optimize curing and healing.
Integrative nurse clinician (IM nurse clinician): A certified holistic nurse who performs needs assessments of patients and the clinical environment and initiates appropriate healing interventions to enable positive changes in health. An IM nurse clinician is certified as a holistic nurse through the American Holistic Nurses Certification Corporation (AHNCC)1 by completing training in a healing modality, spending a minimum of 5 years in conventional acute care nursing practice, and learning a dedication to personal self-care. The responsibilities of the IM nurse clinician include the following:
Inpatient holistic health assessments
Patient, staff, and community education
Providing healing therapies for inpatients
Quality initiatives and program development
▪ INTRODUCTION
Changing the healthcare environment is an endeavor to change the culture of a tertiary hospital. Whether we speak about the internal or external elements, or the physical or psychological elements, the foundation of change is based on the interconnectedness of relationships, with
the primary focus on the balance of healing and curing. Abbott Northwestern Hospital in Minneapolis, Minnesota, is redefining its culture to embrace changes that best serve the patients and support the practice of the health professionals involved in that care. The dynamics of changing a culture are continuous and require an openness to honor both the successes and the perceived failures. Blending the multiple responsibilities of the acute care hospital with the concepts of healing and utilizing a broad range of nonmedical services is based in simple relationships. The interconnectedness of relationships is the foundation of all transformative efforts. One strategic initiative that stimulated the change of culture was the development of an integrative medicine department in this hospital.
the primary focus on the balance of healing and curing. Abbott Northwestern Hospital in Minneapolis, Minnesota, is redefining its culture to embrace changes that best serve the patients and support the practice of the health professionals involved in that care. The dynamics of changing a culture are continuous and require an openness to honor both the successes and the perceived failures. Blending the multiple responsibilities of the acute care hospital with the concepts of healing and utilizing a broad range of nonmedical services is based in simple relationships. The interconnectedness of relationships is the foundation of all transformative efforts. One strategic initiative that stimulated the change of culture was the development of an integrative medicine department in this hospital.
▪ THE SETTING: A LARGE, URBAN, TERTIARY CARE HOSPITAL
Abbott Northwestern Hospital is the largest not-for-profit hospital in the Minneapolis area. Each year, the hospital provides comprehensive health care for more than 200,000 patients and their families from the Twin Cities area and throughout the upper Midwest. More than 5,000 nonmedical employees, 1,600 physicians, 2,000 nurses, and 550 volunteers work as a team for the benefit of each patient. Abbott Northwestern Hospital is a part of Allina Hospitals and Clinics, a family of hospitals, clinics, and care services in Minnesota and western Wisconsin. The services available at Abbott Northwestern Hospital include the following:
Complete medical, surgical, and critical care for patients age 12 years and older
Twenty-four-hour emergency services
Multispecialty care and clinical expertise in behavioral health services, cardiovascular services, medical and surgical services, neuroscience, oncology, orthopedics, rehabilitation, spine care, and women’s health
Outpatient care in more than 50 specialty areas
Innovative and individual pain treatment
Education programs, support services, and public health screenings
Outreach programs to improve the health of the community
▪ INITIATING THE CHANGE OF CULTURE
The nurturing of relationships provides a catalyst for change and is essential to renewing and enhancing the spirit within the hospital. To strengthen and heal relationships, three components of holistic philosophy were introduced to staff: (1) relationship-centered care; (2) presence and intention; and (3) psychoneuroimmunology. The initial focus for education was with the nurses, who by virtue of their role and sheer number have the greatest impact in changing the organic aspects of the environment.
Relationship-centered care (see Chapter 1) serves as a guideline for addressing the biopsycho-social-spiritual dimensions of individuals in integrating caring, healing, and holism into health care.2 The framework, which consists of patient-practitioner relationship, community-practitioner relationship, and practitioner-practitioner relationship, provided the concrete criteria that staff could begin to integrate into practice. The introduction of the concepts of presence and intention to the nursing staff engaged them in revisiting their purpose, reminded them of their personal impact on the healing process of the patient, and provided them with skills in mindfulness.3 The science of psychoneuroimmunology was incorporated to provide a scientific basis to the power of thought and its impact on their personal self-care.
Developing a common language is one of the first steps in success. The two most important concepts to understand are integrative medicine and holistic nursing.
Integrative Medicine
Integrative medicine is a comprehensive, primary care system in which wellness and healing of the whole person are the major goals, as opposed to the basic suppression of symptoms of disease.4 However, integrative medicine is not CAM (complementary and alternative medicine). Integrative medicine is patient-centered, healing-oriented care that emphasizes the patient-caregiver relationship. It focuses on the least invasive, least toxic, and least costly methods to promote health by blending the practices of CAM and conventional Western medicine. Central to integrative medicine is the
view of the whole person as a dynamic being interrelating with his or her environment, both internal and external, with this interrelationship as the key to health and well-being. The goal is to move medicine to include not only its fundamental platform of science but to create a health system that broadly focuses on the well-being of our patients as well as its practitioners.5
view of the whole person as a dynamic being interrelating with his or her environment, both internal and external, with this interrelationship as the key to health and well-being. The goal is to move medicine to include not only its fundamental platform of science but to create a health system that broadly focuses on the well-being of our patients as well as its practitioners.5
▪ EMBEDDING CULTURAL CHANGE
The Integrative Medicine Initiative at Abbott Northwestern Hospital is a demonstration of the process involved in embedding change into a system. Exhibit 27-1 lists the key embedding components in this model developed by Schein and described by Nellen.6
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