INTRODUCTION TO INTEGRATIVE HEALTH Pamela J. Potter, DNSc, RN, CNS-BC Patricia H. Cox, DNP, MPH, FNP-BC University of Portland School of Nursing Portland, Oregon, USA October 2015 DISCLOSURES There are no conflicts of interest or relevant financial interests that have been disclosed by these presenters or the rest of the planners or presenters of this activity that apply to this learning session. 1
OBJECTIVES At the end of this session the learner will be better able to: Define Integrative Health and implications for advanced practice nursing Identify sources to support evidence-informed decisions about integrative therapies Explore nurse self-care as a foundation for Integrative Health practice Describe one or more strategies the advanced practice nurse could utilize to incorporate an Integrative Health perspective into nursing practice WHAT IS INTEGRATIVE HEALTH? Holistic Conventional Alternative CAM Complementary 2
WHAT IS INTEGRATIVE HEALTH (IH)? Holistic? Refers to restoring balance and harmony among all aspects of the person (body/mind/spirit) within the environment Alternative? Approaches are chosen in lieu of what is conventionally practiced (as simple as herbs for a cold or as complex as an unproven cancer regimen) Complementary? Approaches chosen to complement the conventional (e.g. acupuncture to remediate chemotherapy associated side effects or Reiki to address associated anxiety and distress) CAM? Complementary/Alternative Medicine acknowledges the potential validity of both complementary and alternative approaches In Lieu of Conventional? Conventional western medicine is the predominant system of medicine, mainstream medicine; it uses medication, surgery, radiation and physical therapy to treat disease CONSORTIUM OF ACADEMIC HEALTH CENTERS IN COMPLEMENTARY INTEGRATIVE MEDICINE (CAHCCIM) Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing. Developed and Adopted by the Consortium May 2004 Edited May 2005, May 2009 and November 2009 3
INTEGRATIVE HEALTH Broadens the definition beyond medicine to include the person at the center of health care. INTEGRATIVE HEALTH AND CAM Alternative Medical Systems Mind-Body Interventions Manipulative Body-Based Methods Energy Therapies Biologically-Based Therapies 4
INTEGRATIVE HEALTH AND CAM While IH is not just conventional medicine with some CAM thrown in CAM can be a part of IH care Alternative Medical Systems: complete systems of theory and practice. Often evolved apart from and earlier than our conventional western medical approach. (Traditional Chinese Medicine, Ayurveda, Homeopathy, Naturopathy, Indigenous) Mind-Body Interventions: techniques designed to enhance the mind s capacity to affect bodily function and symptoms (Conventional: support groups and biofeedback) (CAM: meditation, yoga, tai chi, art/music/dance therapy, prayer) Manipulative Body-Based Methods: based on movement and/or manipulation of one or more parts of the body (chiropractic, osteopathy, massage) Energy Therapies: Biofield therapies affect energy that is thought to surround and penetrate the body (Reiki, Therapeutic Touch, Qigong) Bioelectromagnetic-based (pulsed fields, magnetic fields, alternating or direct current fields) Biologically Based Therapies: use substances found in nature such as herbs, foods and vitamins (Echinacea, vitamin C, garlic) INTEGRATIVE HEALTH APPROACHES TO MEDICINE Control Substitute Catalyze 5
IH APPROACHES Control Methods used by a health professional to take command of a medical condition that is dangerous, chaotic, and unlikely to correct itself (seizures, anaphylaxis, MI, CVA) Substitute Using substitutes for what the body might do for itself (e.g. insulin, hormones, decongestants, anti-inflammatories, & anti-hypertensives) Catalyze Type of clinical action that catalyzes inherent healing potential (modalities thought of as CAM like acupuncture, yoga, herbal remedies, as well as conventionally endorsed approaches like exercise & lifestyle changes PRINCIPLES OF INTEGRATIVE NURSING 1. Whole Systems 6. Focus Includes YOU! 2. Innate Healing Capacity Integrative Nursing 5. Evidence Informed Practice 3. Nature is Restorative 4. Person- Centered Relationship - Based 6
PRINCIPLES OF INTEGRATIVE NURSING 1. Human beings are whole systems, inseparable from their environments 2. Human beings have the innate capacity for health and wellbeing 3. Nature has healing and restorative properties that contribute to health and wellbeing 4. Integrative nursing is person-centered and relationship-based 5. Integrative nursing practice is informed by evidence and uses the full range of therapeutic modalities to support/augment the healing process, moving from least intensive/invasive to more, depending on need and context. 6. Integrative nursing focuses on the health and wellbeing of caregivers as well as those they serve (including the nurse!). SHOW ME THE EVIDENCE Jonas, W. (2001). The evidence house: How to build an inclusive base for complementary medicine. Western Journal of Medicine 175(2) 79-80. 7
WHERE TO FIND SOURCES National center for Complementary and Integrative Health https://nccih.nih.gov/ Academic Consortium for Complementary and Alternative Health Care (ACCAHC): http://accahc.org/ Academic Consortium for IM and Health (ACIMH): http://www.imconsortium.org/ Arizona Center for Integrative Medicine (ACIM): http://integrativemedicine.arizona.edu/about/definition.html Consortium of Academic Health Centers for IM (CAHCIM): https://www.imconsortium.org/ Institute for Integral Health, Mary Ann Osborne, DNP: http://instituteforintegralhealth.com/index.php/about-mary-ann.html Integrative Nursing Institute: http://www.integrativenursinginstitute.org/index.html International Integrative Nursing: http://integrativenursing2015.is/ University of Minnesota Center for Spirituality and Healing: http://www.csh.umn.edu/integrativenursing/ University of Portland s Philosophy Statement on IH: http://nursing.up.edu/default.aspx?cid=12189&pid=205 PUBMED: filter Complementary Medicine CINAHL: filter Alternative Therapies Google Scholar The Nurse! 8
CURRENT STATE OF HEALTH How do you feel at the end of the day? Frustrated that you patients still don t know how to take their medications? Frustrated that behavioral change therapy doesn t work in a 15 minute appointment? Angry that you got stuck in traffic on the I-5, had to stop and pick up groceries, the kids toys are all over the floor in the living room, the dog has eaten your favorite pillow and you still have to make dinner! Do you want wine or whine at the end of the day? SELF-REGULATION TECHNIQUES FOR EVERYDAY STRESSES One-Minute Mindfulness (Altman, 2011) Website: http://www.mindfulpractices.com/ 9
MORNING AWAKENS Slow down this morning. When you walk, know that you are walking. Fell the floor beneath your feet; sense each little movement. When you shower, know that you are showering. Listen intently to the running water. Note its temperature as it cascades over your skin. This morning, experience what it is like to let nothing go unfelt, unheard, or unnoticed. Altman (2011) GRATITUDE OF THE DAY Here is a gratitude practice that can have an immediate impact on your life. Every three or four days, look back over that time period and write down three to five things that happened at home for which you are grateful. This could be appreciation for a kind act someone did for you or for any of the little things in your life that comfortable chair, the flavor of a particular food, the book you are reading, the music you love, the hot water in your shower. (you are not limited to five items.) Do this for a four-week period to see how it affects your life. You might even track how gratitude impacts your mood, your sleep, how you eat, exercise, and interact with others. Altman (2011) 10
DE-STRESS YOUR INNER SPACE Practice controlled diaphragmatic breathing for one minute at a time at least three times a day. Notice how it helps you cope, and how it refreshes your mind. In particular, use this breathing technique when you feel as though your mind is spinning and losing focus. Also notice your posture and how it may be affecting your ability to take a deep, diaphragmatic breath. Eventually, you can retrain yourself to enjoy the benefits of breathing like this whenever you need to. Altman (2011) DEVELOPING A NURSE SELF-CARE PLAN The Wheel of Life 20 Things I Love to Do 11
STRATEGIES FOR APN PRACTICE Examine our own nursing practice Recognize strengths Identify areas for improvement Choose possible IH solutions Write a practice change to be implemented within the next three months REFERENCES Altman, D. (2011). One Minute Mindfulness, Novato, California: New World Library. Geisler, C., Cheung, C., Johnson Steinhagen, S., Neubeck, P., & Brueggeman, A. D. (2014). Nurse practitioner knowledge, use, and referral of complementary/alternative therapies. Journal Of The American Association Of Nurse Practitioners, doi:10.1002/2327-6924.12190 Kreitzer, M. J. and Koithan, M. (Eds). (2014). Integrative nursing. Oxford, New York: Oxford University Press. Mercier, D. (2012). A beautiful medicine: A radical look at the essence of health and healing. Easton, MD: Still Pond Press. Nottingham, E. N. (2006). Complementary and alternative medicine: nurse practitioner education and practice. Holistic Nursing Practice, 20(5), 242-246. Ott, M.J. (2004). Mindfulness meditation: A path of transformation & healing. Journal of Pyschosocial Nursing, 42 (7), 22-29. 12
REFERENCES OSBN (Oregon State Board of Nursing) Policy Statements: Complementary and Alternative Modalities and Nursing Practice http://www.oregon.gov/osbn/pdfs/policies/complementary-alternative_modalities.pdf Nurse Practitioners and Clinical Nurse Specialists with Prescriptive Authority and Non-Prescriptive Remedies http://www.oregon.gov/osbn/pdfs/policies/herbpoli.pdf Patterson, C., Kaczorowski, J., Arthur, H., Smith, K., & Mills, D. A. (2003). Complementary therapy practice: defining the role of advanced nurse practitioners. Journal of Clinical Nursing, 12(6), 816-823. Ponte, P. R., & Koppel, P. (2015). Cultivating mindfulness to enhance nursing practice. The American Journal Of Nursing, 115(6), 48-55. doi:10.1097/01.naj.0000466321.46439.17 Robins, J. L. W., Kiken, L., Holt, M., & McCain, N. L. (2014). Mindfulness: An effective coaching tool for improving physical and mental health. Journal of the American Association of Nurse Practitioners, 26(9), 511-518. doi:10.1002/2327-6924.12086 Sohn, P. M., & Loveland Cook, C. A. (2002). Nurse practitioner knowledge of complementary alternative health care: foundation for practice. Journal of Advanced Nursing, 39(1), 9-16. CONTACT INFORMATION Pamela J. Potter, DNSc, RN, CNS-BC Associate Professor potter@up.edu Patricia H. Cox, DNP, MPH, FNP-BC Assistant Professor coxp@up.edu University of Portland School of Nursing 13
PEACE & BLESSINGS 14