Integrating Complementary Therapies Into Nursing Practice
Elizabeth L. Pestka
Susanne M. Cutshall
Complementary therapies are increasingly being offered across the continuum of health care. Nurses are essential for maximizing use of complementary and integrative therapies that support holistic care. The movement toward holism in nursing recognizes the humanistic, caring, healing nature of interventions and often uses many modalities to support the mind-body-spirit on its healing journey (Clark, 2012).
This chapter provides examples of strategies nurses have used to incorporate complementary therapies into their practices. Three health care settings in the Midwest are used to demonstrate the integration of complementary therapies into both inpatient and outpatient hospital nursing practice. The hospitals include one small health campus, Woodwinds Health Campus; one large medical center, Abbott Northwestern Hospital; and one very large health care provider, Mayo Clinic. In addition to traditional nursing roles in hospital settings, examples of nurses incorporating complementary and integrative therapies into community-based care, holistic health and wellness centers, and care provided to military veterans shows the breadth of opportunities for integration into nursing practice.
Health care facilities in the United States are integrating complementary therapies; and this is being done across the world as well. Sidebar 30.1 conveys the use of complementary therapies in Brazil.
Sidebar 30.1. Use of Complementary Therapies in Brazil
Milena Flória-Santos, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
Health care in Brazil includes some traditional medicine that is part of indigenous and popular practices performed by healers and medicine men. Most of these practices provide a search for self-knowledge and focus on the spiritual aspects of culture, religion, and traditions of its users. Brazilian people use these practices because they are easily accessible, have demonstrated relative effectiveness, are congruent with their cultural beliefs, and access to biomedicine is often scarce and expensive in some areas of the country. In western Brazil, traditional practices are undergoing a process of becoming more scientific, specialized, and performed by skilled professionals because they are gradually being disconnected from their traditional cultural context. Use of homeopathy, medicinal plants/phytotherapy, acupuncture, traditional Chinese medicine, anthroposophy medicine, and thermal water therapy are included in the Public Health Unified System.
Spiritist psychiatric hospitals are one example of complementary therapies integrated into care, combining conventional psychiatric treatment and spiritual complementary therapies (Lucchetti et al., 2012). These hospitals include voluntary-based spiritual approaches such as layingon of hands (fluidotherapy), intercessory prayer, and spirit release therapy (disobsession). Nurses may be trained to provide these therapies. The optional nature of these spiritual complementary therapies seems to increase acceptance by patients and their family members. Outcomes from these interventions have not been scientifically studied.
A recent study found that Brazilian nurses, more so than physicians, are interested in complementary and integrative therapies (Thiago & Tesser, 2011). This is likely due to the belief that nurses use more nonpharmacological interventions to deliver care to patients. For both groups of professionals, acupuncture and homeopathy were the preferred complementary strategies, and acceptance was associated with previous contact with the therapies. Acupuncture was more widely used at public health services where nurses and physical therapists, in addition to physicians, were allowed to use this intervention. The 177 health care professionals who responded to the survey identified the following therapies, which are included in practice: homeopathy, Chinese and Ayurvedic medicine, acupuncture, auriculotherapy, massage, chiropractic and phytotherapy, yoga, biodance, relaxation, meditation, dance, and Tai Chi chuan.
Nurses can take elective courses at Brazilian universities and independent courses offered by private organizations to become qualified to use complementary and integrative therapies in their care. More use of complementary and integrative therapies offers growing possibilities for the Brazilian people from individual, health care professional, and health services perspectives.
MEDICAL CENTER SETTINGS
Woodwinds Health Campus
Woodwinds Health Campus located in Woodbury, Minnesota, is an 86-bed not-for-profit facility that opened in 2000. The philosophy of care is based on the creation of an unprecedented healing environment that revolves around the needs of patients and their families, including extensive use of complementary therapies. The vision for the Woodwinds campus of HealthEast Care System was to transform the patient care experience and create compassionate service, holistic care, and a patient-centered care model (Lincoln, 2003). From the spacious main entry to the convenient layout, patients in need of care are easily guided to the area of service they require as quickly and comfortably as possible.
According to Lincoln and Johnson (2009), critical aspects of a healing environment are the relationships and attitudes of health care professionals and administrators in addition to the architectural design elements. The vision of Woodwinds’ healing health care model is to be innovative, unique, and a preferred resource for health care. Leadership as well as staff nurses and other employees personally and professionally commit to supporting the principles of holistic care (Lincoln & Johnson, 2009).
Woodwinds Health Campus offers a variety of healing arts therapies designed to complement medical care. These healing arts therapies are also known as integrative therapies or complementary therapies. Integrative treatments are designed to enhance, not replace, traditional therapeutic measures ordered by a primary provider such as medications, exercise, and therapy. A variety of complementary therapies are offered in order to meet the diverse and individualized needs of each patient. Therapies include essential oils, healing touch/energy-based therapies, guided imagery, healing music, acupuncture, acupressure, and massage (Woodwinds Health Campus-HealthEast Care System, 2012a).
In addition to complementary therapies offered by the staff at Woodwinds Health Campus, an outpatient partnership with Northwestern Health Sciences University provides additional care choices such as
chiropractic, acupuncture, massage, and naturopathy at the Natural Care Center. This broadens the range of complementary therapies available so that each patient can select options that will help most in the healing process (Woodwinds Health Campus-HealthEast Care System, 2012b).
chiropractic, acupuncture, massage, and naturopathy at the Natural Care Center. This broadens the range of complementary therapies available so that each patient can select options that will help most in the healing process (Woodwinds Health Campus-HealthEast Care System, 2012b).
Nurses play an integral role in providing complementary therapies at Woodwinds. Holistic nursing principles are integrated into the vision for the hospital. Woodwinds Health Campus includes components of holistic nursing in job descriptions and ongoing performance evaluations for nursing staff. The facility continues to attract highly skilled nurses; it maintains a low attrition rate and a high level of staff satisfaction; these factors are associated with the premise that holistic nursing is the foundation for practice. The care environment is collaborative, and individual contributions are honored with nurses providing input on how the holistic care model continues to be implemented (Lincoln, 2003). Woodwinds established a Holistic Practice Council composed of nurses from various patient care units to better understand the needs of staff nurses in providing care and also to strengthen interest and participation in evidence-based practice (Lincoln & Johnson, 2009).
Education for all nurses at Woodwinds includes holistic nursing-related courses: one focusing on healing touch and the second including training in other complementary/alternative modalities such as music therapy, guided imagery, and use of essential oils. In addition, nurses are required to complete at least three educational contact hours annually in holistic nursing. Nurses are expected to include what they have learned in these courses in the care provided to each patient (Lincoln, 2003). The “Woodwinds way” requires nurses to take personal and professional steps to practice from a place of healing, compassion, and love, while also performing with high clinical competence (Lincoln & Johnson, 2009).
Nurses are encouraged to use complementary therapies themselves. They are able to use the many healing spaces in the integrative services area at Woodwinds to enhance their own well-being. They can take “spirit breaks” to rejuvenate themselves during their work shifts. For nurses employed at Woodwinds, using integrative therapies becomes an aspect of their own lives (Lincoln, 2003).
Woodwinds’ impact goes beyond its own campus and into the surrounding community. The facility has formed wellness initiatives with local corporations such as 3M and Medtronic. Medtronic has created an Integrative Health Council and invited staff from Woodwinds to conduct a healing harp seminar on their premises (Olson, 2010).
Abbott Northwestern Hospital
Abbott Northwestern Hospital, a part of the Allina Health System, is a 627-bed, tertiary care, not-for-profit hospital in Minneapolis, Minnesota. The nursing department’s philosophy at Abbott Northwestern is supported by
a patient-centered, holistic framework for practice. In 1999, a complementary and alternative medicine program for cardiovascular inpatients was initiated and has grown into a nationally recognized model for providing integrative care (Sendelbach, Carole, Lapensky, & Kshettry, 2003).
a patient-centered, holistic framework for practice. In 1999, a complementary and alternative medicine program for cardiovascular inpatients was initiated and has grown into a nationally recognized model for providing integrative care (Sendelbach, Carole, Lapensky, & Kshettry, 2003).
Abbott Northwestern Hospital, in collaboration with the Minneapolis Heart Institute, identified a mission to provide an exceptional health care experience for patients with cardiovascular disorders, and to support this they established a holistic nursing framework for practice. The prevalence of the public’s use of complementary/alternative therapies identified in the literature, along with an increasing number of patient and family requests for these interventions, motivated Abbott Northwestern Hospital to initiate its original innovative program, which was called “Healing the Hearts” and which include therapeutic interventions such as music and massage (Sendelbach et al., 2003).
Nursing involvement has been critical to the ongoing success of integrative therapies. An Integrative Practice Advisory Board was established in 2001, and one of the three key areas identified for growth was to further develop holistic nursing to complement the interventions received by patients. The interventions were assessed to be congruent with the nursing department’s philosophy and the cornerstones of the patient care model. Work was also focused on enhancing a total healing environment that includes developing positive and collaborative relationships between nurses and physicians because this has been shown to influence patient outcomes (Sendelbach et al., 2003).
With initial success and institutional support, along with continuing education for providers, the inpatient cardiovascular integrative therapy program developed into a national model for not only inpatient care but also for outpatient care, research, and education. The Penny George Institute for Health and Healing is the largest hospital-based program of its kind in the United States and is a role model for enhancing health through an integrative approach. The mission of this innovative program is to transform health care locally by providing outstanding integrative care and to transform health care nationally through development and dissemination of integrative practices that enhance quality, ensure safety, and reduce costs (Allina Health, 2012a).
The Penny George Institute for Health and Healing offers inpatient services that include: acupressure/acupuncture; aromatherapy; energy healing, including Reiki and healing touch; healing arts; Korean hand therapy; mind/body therapies, including relaxation response, guided imagery, and biofeedback; music therapy; reflexology; and therapeutic massage (Allina Health, 2012a). Outpatient services include: Oriental medicine/acupuncture; Ayurveda; energy healing; healing coaching; herbal consultations; integrative medicine physician consultations; integrative nutrition counseling; mind/body therapies, including biofeedback, spiritual coaching, massage therapy, therapeutic yoga,
classes and workshops on aromatherapy, drum circle, and healing through the arts. Integrative therapy practitioners have provided more than 900 interventions to patients in the inpatient setting, as well as 700 appointments including complementary therapies in the outpatient clinic per month. More than 60,000 inpatients have benefited from these services since the beginning of the program in 2003 (Allina Health, 2012b).
classes and workshops on aromatherapy, drum circle, and healing through the arts. Integrative therapy practitioners have provided more than 900 interventions to patients in the inpatient setting, as well as 700 appointments including complementary therapies in the outpatient clinic per month. More than 60,000 inpatients have benefited from these services since the beginning of the program in 2003 (Allina Health, 2012b).
The holistic nurse clinicians and other members of the integrative therapy team provide ongoing education to the staff. Together with the Bravewell Collaborative, Abbott Northwestern Hospital sponsors physician and nurse practitioner training in integrative medicine and advocates for integrative health in health care reform. Education programs are focused on integrative therapies, promoting self-managed health and wellness, community education classes, nurse training programs, and local health care conferences. Ongoing classes and programs for the community on topics including yoga, stress reduction, nutrition, and fitness provide up-to-date information to more than 800 participants a year (Allina Health, 2012b).
Research to measure patient outcomes and identify best practices is also a key to expanding this innovative model. Nurses are involved with ongoing clinical trials using integrative therapies and data analysis to provide evidence for integrating complementary/alternative therapies into clinical practice. The impact of integrative therapies has been documented to provide immediate and beneficial effects on pain among hospitalized patients. Following integrative therapy interventions, the average pain reduction was over 55% (Dusek, Finch, Plotnikoff, & Knutson, 2010).
Mayo Clinic
Mayo Clinic, located in Rochester, Minnesota, is a large tertiary medical center with almost 2,000 hospital beds, as well as affiliated facilities around the nation. Mayo Clinic defines quality as a comprehensive look at all aspects of a patient’s experience (Mayo Clinic: Quality and Mayo Clinic, 2012b). Comprehensive individualized care addresses the mind, body, and spirit to promote healing and wellness with complementary therapies integrated into practice.
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