Integrative and Holistic Health

1. Integrative and Holistic Health Kamron Keep RN, BSN April 20th, 2011

2. What is Integrative Medicine? • Conventional: Medicine practiced by physicians and allied health professionals. • Complementary: Using complementary and alternative medicine (CAM) together with conventional care. • Alternative: The use of CAM in place of conventional care. • Integrative: Combines conventional and CAM treatments that show evidence of safety and effectiveness. ‘The best of both worlds.’

3. What is a Modality? • A modality is a specific approach to or method for healing. • The National Center for Complementary and Alternative Medicine (NCCAM) divides the various CAM modalities into four categories: • mind-body medicine • biologically based practices • manipulative and body-based practices • energy medicine • Source: www.ahna.org

4. Mind-Body Medicine • Focuses on the belief that interactions between the brain, mind, body, and behavior can affect physical functioning and promote health (Source: www.nccam.nih.gov). • Several mind-body approaches ranked among the top 10 CAM practices reported by adults in the 2007 NHIS. • 12.7 percent of adults had used deep-breathing exercises • 9.4 percent had practiced meditation • 6.1 percent had practiced yoga • Progressive relaxation and guided imagery were also among the top 10 CAM therapies for adults • Deep breathing and yoga ranked high among children • Acupuncture had been used by 1.4 percent of adults and 0.2 percent of children.

5. Biologically Based Practices • Includes use of a variety of herbal medicines (also known as botanicals), vitamins, minerals, and other "natural products." Many are sold over the counter as dietary supplements (Source: www.nccam.nih.gov). • Interest in and use of CAM natural products have grown considerably in the past few decades. The 2007 NHIS found that 17.7 percent of American adults had used a nonvitamin/nonmineral natural product. These products were the most popular form of CAM among both adults and children.

6. Manipulative and Body-Based Practices • Focuses primarily on the structures and systems of the body, including the bones and joints, soft tissues, and circulatory and lymphatic systems. Spinal manipulation and massage are two commonly used therapies that fall within this category (Source: www.nccam.nih.gov). • According to the 2007 NHIS, chiropractic/osteopathic manipulation and massage ranked in the top 10 CAM therapies among both adults and children. • 8.6 percent of adults and 2.8 percent of children had used chiropractic or osteopathic manipulation • 8.3 percent of adults and 1 percent of children had used massage

7. Energy Medicine • Involves manipulation of various energy fields to affect health (Source: www.nccam.nih.gov). • Practices can include qigong, Reiki and Healing Touch. • The 2007 NHIS found relatively low use of energy therapies. • 0.5 percent of adults and 0.2 percent of children had used energy healing/Reiki.

8. Who Uses CAM and Why? • People of all backgrounds use CAM. • In adults, greater use among women and those with higher levels of education and higher incomes. • Motivation for most people is: • A perceived benefit from CAM • A desire to feel more in control of their health • A strong belief in CAM

9. Benefits of CAM • Research has shown that CAM may help: • Improve quality of life and overall wellbeing • Decreased pain • Decrease stress and anxiety • Improve mood • Help with insomnia • Decrease headaches • Decrease side effects and symptoms, such as nausea and hot flashes. • National Center for Complementary and Alternative Medicine at www.nccam.nih.gov.

10. Considerations of Using CAM • While research is becoming more available, rigorous, well-designed clinical trials for many CAM therapies are often lacking. • The safety and effectiveness of many CAM therapies are uncertain. • As with any medical treatment, there can be risks with CAM therapies. These general precautions can help to minimize risks: • Select CAM practitioners with care. Find out about the practitioner's training and experience. • Be aware that some dietary supplements may interact with medications or other supplements, may have side effects of their own, or may contain potentially harmful ingredients not listed on the label. Also keep in mind that most supplements have not been tested in pregnant women, nursing mothers, or children. • Patient’s don’t often tell their health care providers about the CAM practices they may be using. And, health care providers aren’t asking about what the patient may be using. • Source: www.nccam.nih.gov

11. What is the Nurses Role with CAM? • According to a recent survey, while almost 2/3 of people aged 50 and older are using some form of CAM, less than 1/3 of those people talk with their providers about CAM use. (Survey by AARP and NCCAM) • What is your personal belief of CAM? • Ask patients about their use of CAM and document! Be direct and non-judgmental. • Learn more about CAM and/or familiarize yourself with reputable resources and information on CAM: • SLHS Integrative/Wellness Task Force • National Center for Complementary Alternative Medicine • American Holistic Nurses Association

12. CAM at St. Luke’s • MSTI Integrative Medicine Program • Kamron Keep RN, BSN at 706-5410 or keepk@slhs.org. • Wood River Integrative Therapies Program • Mary Kay Foley at 727-8417 or foleym@slhs.org. • McCall Integrative Medicine Program • Comfort Corner Website • C.A.R.E. Channel (74 and 76) • And others…

13. What is Holistic Health and Holistic Nursing? • Holistic: Concerned with the interrelationship of body, mind and spirit in an ever changing environment. • Holistic nursing is ‘all nursing that has healing the whole person as its goal’ (AHNA Definition of Holistic Nursing, 1998). • Holistic nursing is more than modalities • It is a way of being • Relationship Based Care • Relationship with patient/family • Relationship with self • Relationship with colleagues

14. Healing versus Curing • What does ‘healing’ mean to you? • Heal- to be or become whole • From Greek: Halos • From Anglo-Saxon: Haelan • Healing- restoring balance and harmony, moving toward wholeness, completion and the integration of the totality of the person. • “Healing” is when care is attentive to mind, body and the spirit: when patients feel they have a relationship with their healer; and when they are actively involved in decisions regarding their own care (RBC Information). • Instead of asking ‘what cures’, ask ‘what heals’. How is this different? • Healing as a journey, rather than a destination.

15. Benefits of Holistic Nursing Practice • Embodies Relationship Based Care Model • Public seeking more holistic, caring, compassionate approach & 38-64% utilizing CAM • Holistic nurses in prime position to meet the need/provide leadership • Enhances personal & professional life • Opportunity to truly know, partner, be present with our clients/patients • Holistic focus allows healing on many levels: emotional, spiritual, relational, physical and mental • Honors and integrates wisdom and knowledge from many sources and cultures • Holistic model promotes wellness and empowerment for giver and receiver • Source: www.ahna.org

16. Importance of Self-Care‘We Cannot Nurture Others from a Dry Well’ ~Jennifer Louden

18. What is One of the Best Things You Can Do For Your Patient?

19. Nurse as an Environment of Healing • ‘It is important to realize that the nurse is not only in the environment, able to make significant changes in ways of Being/Doing/Knowing in the physical environment, but the nurse is the environment’ • Quinn 1992; Watson 2005

20. Nurse as an Environment of Healing • If I am the environment, how can I be a more caring-healing environment? • How can I become a safe, healing space for this person? To draw out healing and wholeness? • How can I use my consciousness, my intentionality, my being, my presence, my voice, touch, face, heart, hands and so on, for healing? • Source: Quinn, 1992; Watson 2005:94-95). • How can I do all of this and be all of this for my patient and not burn myself out?

21. Why Self-Care? • “Burnout occurs from walling ourselves off, closing our hearts to human connection. When we connect with another person, even briefly, we have more purpose in our life and work. If this connection is not there, we feel a void and dispirited. The same thing happens to our patients.” ~Jean Watson • In order to be a present, healing environment for our patients and help prevent burnout, we must practice self-care. We must fill our own well. • What is something that nourishes and refreshes you? That feels good to your body, mind and spirit?

22. Why Self-Reflection/Self-Knowing? • Everything is connected • What affects one aspect of ourselves, influences all others. • Mind-Body-Spirit-Environment-Relationships • Leads to an appreciation to the interconnectedness of all things, healthier relationships and more self-awareness, insight and clarity. • To be of service to others: • You need to understand your own personal journey • You need to do periodic self-assessments • Pursue personal development • Self-care and self-healing

23. Holistic Self-Care Ideas • Hand washing ritual • Meditation through simple, daily activities that bring you joy and meaning • Connecting through the heart center • Journaling/self-reflection • Being in nature • Dancing and singing • Yoga and movement • Good nutrition • Gardening • Knitting/sewing

24. You always have your breath… • Simply focus on your breath moving in and out. Saying to yourself, “I am breathing in, I am breathing out”. • Or, choose a word that helps you feel relaxed (for example, peace, ocean, love). Close your eyes, breathe in and out through your nose. Become aware of your breathing. As you breathe out, say your word silently to yourself. When you notice your mind has wandered (and it will) gently and kindly bring your focus back to your word and your breath. (*The Relaxation Response, Benson. H. William Morrow and Co., NY 1975)

25. Resources and References • The National Center for Complementary and Alternative Medicine: www.nccam.nih.gov. Research, information on modalities, how to choose a practitioner, etc. • The American Holistic Nurses Association: www.ahna.org. Information on membership, holistic educational opportunities, self-care and links to Holistic Nurse Certification. • Inside St. Luke’s, Clinical Resources, Comfort Corner, Complementary and Integrative Therapies. • Inside St. Luke’s, Nursing at St. Luke’s, Relationship Based Care • Benson, H.W. (1975). The Relaxation Response. Morrow and Co: NY. • Watson, J. (2008). Nursing: The Philosophy and Science of Caring. University Press of Colorado: Colorado.

26. Thank you! Questions? Kamron Keep RN, BSN, MSTI Integrative Medicine Coordinator at 208-706-5410 or keepk@slhs.org.