Innovative Approaches to Implementing Integrative Modalities

Transcription

1 Innovative Approaches to Implementing Integrative Modalities Presented by: Karen Maier, RN Clinical Coordinator Integrative Medicine Program Northern Westchester Hospital

2 Our Community Northern Westchester: approximately minutes north of NYC Serve primarily 9 commuter towns Ave household income significantly above national mean Price of an average single family house ranges from $407K to $707K. Percentage of adult population older than 25 years with education beyond high school ranged from 63% to 88%. Ethnicity 85%+ white. Poverty rate =1-3%. (Based on 2000 census)

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4 Our hospital 233 bed community hospital Ob/Gyn service Cancer & Wellness Center Orthopedics General Medical/ Surgery Behavioral Health

5 I am constantly amazed and blessed by the tools integrative medicine has given me. I have the intention of bringing healing to my patients and their families and instead find myself becoming part of a healing relationship. As I let these healing modalities unfold and guide my nursing practice, I become more conscious of the healing resilience that my patients intrinsically have available to them and also the power of healing energy that I can transfer to them. Lisa Beckman, LPN, MCH

6 The Integrative Medicine Program Patient Care Services Implemented in April 2004 Program Support: Funded by philanthropy Staff: Karen Maier RN Clinical Coordinator Certified Aromatherapist/ m Technique Instructor Reiki Master/Teacher Level III Certification in Hypnotherapy for Stress/Pain Management Facilitator for HealthRHYTHMS group empowerment drumming Ann E. West M.S.,RN, La.C. Licensed Acupuncturist Reiki Master/Teacher Level III Certified Aromatherapist/ Certified m technique practitioner

7 Modalities Therapeutic Suggestion/Guided Imagery Aromatherapy m Technique - gentle touch therapy composed of structured stroking movement, suitable for even the most fragile patient (R.J. Buckle,2003) Energy Healing - Reiki/Therapeutic Touch.

8 Point of Care Reiki: Setting an Intention Any patient I hold for an epidural, any patient I draw blood from or start an IV, I Reiki before starting. I find it difficult to remember to write it down, because it's like asking us to write down every time we take a BP. It has become a very integral part of my care Peggy Ohnmacht, RN, L&D

9 Percentage of Integrative Modalities by Type April through December % Aromatherapy 77% "M" Technique 78% 61% Reiki Therapeutic Suggestion

10 As you can see, I've got quite a following among employees, even m'd one of the pharmacists! She's always running, around very busy. I really didn't think she was going to sit long enough for me to do both hands, but she did and enjoyed the break Alicia D/Arcy, RN, ICU/CCU

11 Bringing about changes in the culture of the hospital The Holistic Nursing Council Created as part of the Shared Governance Leadership Council in 2005 Consists of representatives from each nursing division Identifies strategies to promote the adoption of integrative medicine modalities by direct care nurses.

12 Holistic Nursing Council Goals Direct care providers will be educated on the benefits of integrative therapies and their role in health care. Direct care providers will receive training in selective integrative therapy modalities. The use of integrative therapies in conjunction with traditional medical modalities will become the standard of care at NWH. Patient satisfaction will be increased through the use of integrative modalities.

13 The Champions The Holistic Nursing Council Members have become the champions for the program on each of their units. Holistic Council members recruit more council members LET YOUR CHAMPIONS DO THE TALKING!!!!

14 Integrative Medicine and New Staff Orientation In 2006, the Holistic Nursing Council requested an introduction to Integrative Therapies be included for all new nurses during their orientation program: Ten minute experiential relaxation exercise Therapeutic Suggestion workshop: Healing Conversations m - Techinque of the hand workshop

15 Mentoring and Nurturing other Staff Mentoring programs were established: To support staff To demonstrate how these approaches are just a part of everyday care. Complementary sessions are provided to staff members: The Holistic Nursing Council continues to provide over 400 session at nurse and staff appreciation wellness fairs.

16 Percentage of Encounters provided by PCS Staff vs Coordinators 80% 75% 70% 63% 64% 65% 60% 50% 40% 30% 49% 51% 53% 56% 52% 51% 47% 48% 49% 52% 48% 44% 37% 25% 55% 45% 36% 35% Coordinator PCS 20% 10% 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2007

17 In 2008 a Unit by Unit Approach to Accommodate patient requests began Ambulatory Surgery: 14 nurses including the care manager Maternal Child Health: Post Partum: 7 nurses L&D: 6 nurses Nursery: 1 nurse

18 Ongoing Computerized Documentation. Average monthly sessions are 190 Point of Care Reiki sessions average 140 sessions per month Caregiver sessions average 5 per month Staff sessions average 32 per month

19 Direct Care Providers st Qtr 2nd Qtr 3rd Qtr 4th Qtr MCH ASC REHAB 2008

20 Patient Satisfaction: Did your nurse offer the option of integrative therapies? 100% 80% 60% 40% 20% 0% 90% yes 10% no n=294

21 Was the integrative therapy effective in enhancing your comfort? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 92% 8% 0% very effective somewhat effective not effective n=301

22 Was the integrative therapy you received beneficial in the healing process? 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 80% 18% 2% very beneficial somewhat beneficial not beneficial n=294

23 Measurable Outcomes Visual Analogue Pain Scale (0-10) (n=147) Min Max Mean Std Dev Score prior to treatment Score after treatment CHANGE in SCORE

24 Visual Analogue Tension Scale (0-10) (n=74) Min Max Mean Std Dev Score prior to treatment Score after treatment CHANGE in SCORE

25 I performed the m - technique of the hand, foot and back on one of my patients. She was having a pacemaker inserted the next morning and was very worried about the procedure. In addition to having the usual cardiac monitoring equipment, she had an external pacer on standby - more wires to get tangled up in! Her stress level went from an 8 down to a 3. This lady didn't think she would be able to sleep, but after m -ing her she actually did have a good night's rest even without the sleeping pill prescribed by her physician Alicia Darcy, RN, ICU/CCU

26 Due to Popular Demand Policies and Procedures have been created for volunteers and non-nursing staff Oncology, ED, and Radiology are now expressing interest in a customized unit workshop

27 Climbing the Clinical Ladder Nurses are seeking CEU s Salary increases with level on clinical ladder m technique offers certification and 14 CEU s. Nurses must make a commitment to using the modality as direct care providers to get conference time and fees paid by the Nurse Education Fund

28 Workshops offered Aromatherapy and the hand m Reiki Level I Reiki Level II Therapeutic Suggestion and Guided Imagery m -Technique full body certification

29 I start my patient care by offering aromatherapy to enhance the relaxation process. Most choose lavender or geranium, but the other day the whole unit was fragrant with mandarin orange. I give out cotton pads with essential oils all the time to staff at their request: for headaches, nasal congestion, stress, etc. Even the doctors are asking for some! Peggy Ohnmacht, RN, L&D

30 Education/Mentoring of Staff The Holistic Nursing Council continues to promote the use of integrative therapies within the nursing scope of care A realistic and cost-effective approach compared to the traditional model of hiring additional practitioners to provide services.

31 Dr. Angelo Cumella, Obstetrics & Gynecology I just love the program and the positive impact it has on my patients. It is tremendously beneficial in enhancing their comfort level, and I recommend it to all of them.

32 Other Innovative Integrative Medicine Programs for Patients, Caregivers, Staff and Community Members

33 PACU PONV Evidence based NWH joined a study initiated at Good Samaritan hospital to study the effects of Peppermint on Post-op nausea and vomiting in the female population Research Study Peppermint

34 More Evidence Based Research The effectiveness of the essential oil Lavandula Angustifolia as a sleep aid in comparison to traditional sleep aid medications. Will the use of Lavender as a sleep aid help to decrease falls?

35 Peggy Huddleston s Prepare for Surgery, Heal Faster Learn Mind-Body Techniques to: Feel calmer before surgery Use 23-50% less pain medication after surgery Strengthen the immune system Recover faster

36 A method of encouraging the body to promote natural healing and to improve function Acupuncture

37 Remo HealthRhythms Group Empowerment Drumming a comprehensive, evidence-based, therapeutic technique known to reverse the biological markers of stress. Nurturing/Support Camaraderie Self Expression Exercise Visualization Spirituality Music Making

38 Meditation Sessions Focused Intention Breath Work Inspiration Reflection Comfort Personal and spiritual growth

39 Relaxation CDs General relaxation CDs were created and distributed to staff for their personal use. They were also distributed to patients in the Cancer Treatment and Wellness Center, as well as to members of the Meditation Group.

40 Acubands Gentle pressure to the Nei-Kuan acupressure point on the wrist To relieve nausea and vomiting Popular on ASC and MCH

41 Smoking Cessation Program Introduction of aromatherapy for relief of tension and help with the physical cravings associated with smoking cessation

42 Barnes,P., Powell-Griner,E., McFann,K., Nahin,R. (May27, 2044). Complementary and alternative medicine use in adults: United Sates CDC Advanced Data Report #343. Buckle, J. (2003). Clinical aromatherapy. Essential oils in practice. Churchill- Livingstone. Geary,H. (2003). Facilitating an organizational culture of healing in an urban medical center. Nursing Administration Quarterly, 27, Hagenow, N.R. (2003). Why not person-centered care? Challenges of implementation. Nursing Administration Quarterly, 27,