Nursing

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WAUKESHA, WI, may not seem the likeliest place for the convergence of Eastern and Western medicines, but a hospital there is bringing the two together. Over the last few months, the nursing staff at Waukesha Memorial Hospital has been taking computer courses covering holistic principles, as well as complementary and alternative medicine (CAM) modalities. In April, those nurses will begin introducing patients to alternative therapies as part of a patient-care program. The hospital is planting the seed for an effective integrative medical program, and is using holistic nursing to cultivate it, said Catherine Rapp, RN, MS, AOCN, clinical director of Waukesha Memorial's Regional Cancer Center. Waukesha Memorial this year will offer four new alternative therapies, she said: hand massage, essential oils, healing music, and guided imagery.

While integrative medicine and holistic nursing aren't new, more hospitals and large treatment centers are implementing a holistic approach to patient care, which focuses on treating them not only physically, but mentally, emotionally, and spiritually. Along that line, more facilities are establishing or upgrading holistic nursing programs as part of broader integrative care initiatives. In simple terms, CAM is a diverse group of medical and healthcare systems, practices, and products not considered part of conventional medicine. The combination of conventional and alternative techniques is commonly referred to as integrative medicine. Although CAM therapies do not work for everyone, treatments such as acupuncture and healing touch therapies have been proven to help with nausea, pain, and other side effects of cancer treatment, Rapp said.

Eventually, the integrative platform will extend to all units in Waukesha Memorial and its sister facility, Oconomowoc Memorial Hospital, a 140-bed acute care hospital. Technicians and even receptionists are included in the holistic movement at Waukesha Memorial. Rapp said it isn't just a new philosophy regarding patient care, but a "deepening of the culture."

Barbara Mathison, executive director of Waukesha Memorial's Regional Cancer Center, oversees the integrative medicine initiative. More than a year ago, hospital executives began examining the potential benefits of a holistic program to counter the physical stress of chemotherapy and other treatments, she said. Since the beginning of the year, Waukesha Memorial has given "healing kits" stocked with essential oils, CDs of meditative music, and relaxation guides to chemotherapy patients. Nurses, who deal directly with patients, are well-positioned to answer questions about the purpose and benefits of their contents, Mathison said.

Rapp said planners faced some resistance at the beginning. "If there has been any (resistance), it's been from our physicians group, and that's only been supplements," she said, referring to doctor concerns that certain supplements might interact adversely with oncology drugs.

A growing number of providers recognize that holistic practices are a viable complement to the technological wizardry of Western medicine, said Lisa Anselme, RN, HNC, CHTP/I, RMT, executive director and holistic nurse consultant for Integrative Health Care of Healing Touch International Inc. in Colorado. Complementary therapies include touch healing techniques such as Reiki and acupressure, as well as homeopathy, herbal medicine, food supplements, and aromatherapy. Some providers use tai chi, yoga, meditation, and guided imagery.

While medical advancements prolong lives, Anselme said the human element in patient care is losing ground to a healthcare system marked by automation and efficient clinical assessment. The holistic approach returns the patient to the forefront, she explained. Combined with modern medicine, "it makes high-tech intervention more palatable."

Over the span of two decades, certain CAM therapies, such as aromatherapy, have become accepted in conventional medicine. Other therapies have been proven effective in certain patient studies. The aim of the holistic healthcare model, Anselme said, is not only to comfort patients during treatment, but to encourage their active participation in healing. Because holistic healing—once considered "New Age"—has its basis in preventing disease, it's gaining support among healthcare providers as well as patients, Anselme said.

"Integrative medicine is a prescriptive type of mentality: I'm going to prescribe that you have acupuncture twice a week, and that you're going to have this drug, and all of these things are so beneficial," Anselme continued. "They can be life-saving, and they can be comforting."

Nurses and nurse practitioners are uniquely positioned to explain holistic philosophy and where CAM fits in, Anselme said. The number of holistic nurses is growing. The American Holistic Nurses Association (AHNA) has more than doubled its membership to 4,000 in the last four years. The American Holistic Nurses Certification Corp. (AHNCC), the only national credentialing body for holistic nursing, uses a combination of portfolio review and standardized testing to evaluate holistic nursing candidates for certification. Nurses credentialed through AHNCC use the title "holistic nurse-certified" (HNC).

The AHNA endorses certificate programs, including health and healing reflexology, imagery, aromatherapy, healing touch, and Amma therapy, a form of massage that combines deep tissue manipulation with the application of pressure, friction, and touch to specific points. Also, a growing number of universities and colleges offer whole curricula on holistic nursing. New York University has a master's program for holistic nurses.

IN CAM WE TRUST Nurses are taught "whole" patient care in school, but treating singular symptoms and curing the illness first has taken priority, said Carla Mariano, RN, EdD, AHN-BC, FAAIM, a professor of nursing at New York University and past president of the AHNA.

"Nursing is comprehensive; it's not necessarily holistic," Mariano said. "It doesn't put everything together, and it doesn't put the person at the center. It puts the discipline at the center."

CAM can help the elderly, many of whom manage several chronic conditions, Mariano said. Healthier lifestyles and integrative medicine can improve quality of life for older adults, and can strengthen their bodies' defenses and healing abilities. Holistic nurses can assist the elderly by helping them integrate CAM with conventional therapies, Mariano said.

The same survey found that CAM usage in the United States declines as adults become senior citizens, who are the most likely to suffer with pain. That could be because Medicare often does not cover "alternative therapies," other than chiropractic care. That part of the survey was developed by the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM). Most people must pay for many CAM services themselves because not all health insurance plans offer alternative therapy coverage, according to NCCAM. What coverage does exist, usually for chiropractic, acupuncture, and massage therapy, varies by state and often is limited.

According to Anselme, patients are becoming more aware of the benefits of alternative therapies. "I think (holistic) awareness is being addressed because patients are demanding it," she said. "A patient doesn't want to be considered as just Surgical Case Number 5."

CAM adoption is being driven by the consumer, agrees Diane Wind Wardell, RN, PhD, WHNP-BC, associate professor of nursing at the University of Texas' Health Science Center in Houston. "Looking back over the last 10 years, I thought we never would be where we are right now," Wardell said.

As part of the 2007 National Health Interview Survey, researchers with the National Institutes of Health asked more than 23,000 adults about their use of 36 CAM therapies, including acupuncture, herbal supplements, chiropractic visits, massage therapy, and yoga; and surveyed another 9,400 adults about their children's use. Results show that approximately 38 percent of adults in the United States and 12 percent of children 17 or younger use some form of alternative medicine. (For a list of five less-common CAM therapies, see chart "What is the difference between complementary and alternative medicine?".)

Wardell, who has studied the effect of energy intervention (healing touch) on military veterans with spinal-cord injuries, has been a holistic nursing practitioner for more than 20 years. A growing volume of research is transforming the perception of holistic healthcare from New Age novelty into modern-age legitimacy, she said. "As the field grows and develops, there is more work being published that supports this way of thinking," Wardell said.

Reiki, for instance, is being studied for possible effects on people suffering from fibromyalgia—a disorder marked by chronic widespread pain—as well as advanced AIDS, prostate cancer, and type 2 diabetes.

Harvard Medical School and Massachusetts General Hospital in Boston conducted a study published in December 2007 in the journal Critical Care Medicine that examined changes the body experiences while the patient listens to music. The study looked at ICU patients connected to mechanical ventilators. The test group that listened to Mozart showed decreases in stress hormones and in cytokines—proteins released by the body after it suffers an injury.

Lower stress can mean shorter stays for patients, which is the goal at the Woodwinds Health Campus in Woodbury, MN, a template for CAM and home to one of the best holistic nursing programs in the country. It happened almost by default, said Valerie Lincoln, RN, PhD, AHN-BC, clinical director of integrative services at Woodwinds Hospital, an 86-bed facility that opened in 2000.

"Because of its proximity to (Minneapolis and St. Paul), Woodbury is a progressive community," she said. "The community helped dictate the hospital's integrative agenda. As we expand, that agenda is benefiting our patients greatly."

The hospital offers CAM for almost all care units, including oncology and pediatrics. As a result, patient discomfort is down, and patient satisfaction is up, she said. That has helped the hospital grow. Bed space has grown 16 percent since 2000 at Woodwinds, which expanded two years ago. Lincoln consults with various hospitals in the region whose administrators are interested in implementing holistic nursing programs or some variation of CAM care. One participant is Waukesha Memorial Hospital.

Like many hospitals, Woodwinds is looking for strong nurses. Aside from a solid clinical résumé, candidates applying to Woodwinds must be innovative thinkers when it comes to patient care—always keeping the holistic outlook at the center of their work.

HOLISTIC MEDICINE VS. A TOUGH ECONOMY The economic downturn is forcing some hospitals to cut back on integrative therapies as they struggle to contain traditional patient care costs, said Marion Spector, RN, MS, APRN-BC, a clinical instructor at Bellevue Hospital Center in Manhattan and a holistic nursing consultant to New York College of Health Professions (NYCHP) on Long Island. In 2003, NYCHP received a $600,000 state grant to train 400 nurses at Bellevue in holistic nursing. The college offers a 16-month holistic nursing continuing education program for RNs, which teaches the therapies and principles of traditional Chinese medicine and addresses clinical scenarios common in hospitals. "The plan at that point was to bring it to the forefront," Spector said.

However, hospitals are squeezed by frozen credit markets, higher borrowing costs, investment losses, and a spike in unemployed and underinsured patients. Because the benefits of CAM aren't always immediate, the program's budget shrank. "Now, we have only a handful of holistic nurses," Spector said.

ENTERING A NEW AGE The Cleveland Clinic's Center for Integrative Medicine has gained national exposure for its innovative uses of CAM. However, on the Clinic's main campus, caregivers are taking the model to a higher level. The Clinic copied parts of the best integrative practices around the country to create the Office of Patient Experience one year ago, said Michelle Cameron, RN, BSN, HN-BC, the assistant director of the office. The Office of Patient Experience is focused on transforming healthcare from treating medical conditions to addressing the needs of the whole patient, Cameron said. The office has a healing team consisting of a holistic nurse, a chaplain, touch therapists, a social worker, and physicians who review the needs of patients and their families. Also, "clinical navigators" help new patients understand upcoming clinical procedures. Cameron's office routinely calls upon 25 volunteers to administer CAM therapies to patients. While the initiative comprises only a few specialty care units at the Clinic now, Cameron said it will be offered throughout the campus later this year.

"We include the family and the community of our patient," Cameron explained. "Initially, we find out what is the most important thing to patients, what is the (concern) that is at the forefront of their minds."

Team members ask each patient if he or she has used CAM. If the person's interest leans toward guided imagery, a tutorial on the treatment is presented to the patient via his or her inpatient television monitor.

The Cleveland Clinic also is committed to providing a healthier environment for healthcare providers, including stress-reduction programs, nutrition education, and exercise opportunities. The Clinic and other hospitals use acupuncturists, massage therapists, and Reiki practitioners to care not only for patients, but for nurses as well. CAM relieves stress and increases feelings of energy, stamina, and well-being, Cameron said.

What is the difference between complementary and alternative medicine?

Though the two terms often are used interchangeably, there is a difference. Complementary therapies are used together with conventional therapies. For example, taking a calcium supplement and an anti-osteopororis drug would be considered complementary. Alternative therapies are used in place of conventional medicine. Doing yoga instead of going to a physical therapist is an alternative therapy.

THE FOLLOWING ARE FIVE LESS-RECOGNIZABLE CAM THERAPIES:

Biofeedback uses electronic devices to measure and report about a person's heart rate, blood pressure, and muscle tension. Typically, this is used to treat stress, insomnia, headache, and muscle injuries.

Shiatsu is a natural healing therapy that comes from the same ancient principles as acupuncture. The practitioner uses fingers, thumbs, elbows, and even knees to apply pressure and stretch the energy lines, known as meridians, to stimulate the body's energy flow. The word "shiatsu" is Japanese for "finger pressure."

Guided imagery uses mental images to promote relaxation and wellness or to facilitate healing of a particular ailment. The images can involve any of the senses and may be self-directed or guided by a practitioner, sometimes in a group setting. For example, a person with cancer might be told to imagine an army of white blood cells fighting cancer cells.

Reflexology is based on the principle that every organ and working system within the body has a "mirror" reflex point in the foot, and that by massaging these points it is possible to detect and treat illness, improve levels of health, and give a general feeling of well-being.

Reiki is a technique of Japanese origin in which the practitioner channels energy through his or her hands and into the person's body to promote healing. Used to promote overall health and well-being, Reiki also is used by people seeking relief from disease-related symptoms and the side effects of conventional medical treatments.

Source: National Center for Complementary and Alternative Medicine