Integrative and Holistic Health

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Integrative and Holistic Health

• Kamron Keep RN, BSN

April 20th, 2011
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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.

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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

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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.

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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.

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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/osteopath
  ic 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

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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.

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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

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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.

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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.
• Patients dont often tell their health care
  providers about the CAM practices they may be
  using. And, health care providers arent asking
  about what the patient may be using.
• Source www.nccam.nih.gov

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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

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CAM at St. Lukes

• MSTI Integrative Medicine Program
• Kamron Keep RN, BSN at 706-5410 or
  keepk_at_slhs.org.
• Wood River Integrative Therapies Program
• Mary Kay Foley at 727-8417 or foleym_at_slhs.org.
• McCall Integrative Medicine Program
• Comfort Corner Website
• C.A.R.E. Channel (74 and 76)
• And others

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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

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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.

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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

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Importance of Self-CareWe Cannot Nurture
Others from a Dry Well Jennifer Louden
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What is One of the Best Things You Can Do For
Your Patient?
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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

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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 200594-95).
• How can I do all of this and be all of this for
  my patient and not burn myself out?

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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?

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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

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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

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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)

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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. Lukes, Clinical Resources, Comfort
  Corner, Complementary and Integrative Therapies.
• Inside St. Lukes, Nursing at St. Lukes,
  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.

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Thank you! Questions?

• Kamron Keep RN, BSN, MSTI Integrative Medicine
  Coordinator at 208-706-5410 or keepk_at_slhs.org.