Hospital Incorporates CAM as Part of Daily Care

By Debra Wood, RN, NurseZone contributor

Nurses at Abbott Northwestern Hospital bring acupressure treatments, healing touch and other techniques to the bedside, with an innovative approach to holistic care giving that eases patients’ pain and anxiety.

“All healing is self-healing,” said Mary Ellen Kinney, RN, BA, an integrative medicine nurse clinician at the Minneapolis hospital’s Institute for Health and Healing. “We can do all kinds of things to support it.”

Abbott Northwestern, a 627-bed facility, consistently ranks as a top-tier allopathic hospital. HealthGrades rates it as five star, the highest level possible for overall quality. For the past three years, U.S. News & World Report has named it one of “America’s Best Hospitals” for heart and heart surgery, neurology and neurosurgery, urology and otolaryngology.

“We constantly try to stay out in front,” said Denny DeNarvaez, president of Abbott Northwestern. “During the last three years, we introduced complementary medicine to traditional medicine, to blend the best of both worlds.”

DeNarvaez hopes that eventually Abbott Northwestern’s model of care will start a national trend, ensuring complementary services become modalities in every nurse’s toolkit, a natural adjunct to traditional caregiving.

Patients at the hospital receive holistic services as part of their hospital care and are not billed for complementary therapies. Gifts from the George Family Foundation and the Ted and Roberta Mann Foundation support the program.

About 62 percent of the institute’s referrals come from staff nurses. Other employees, and patients and their family members also may request a visit.

After some initial skepticism, Abbott Northwestern’s physicians began ordering complementary therapies as well. In fact, the number of physicians participating has increased from five a year ago to 214.

“We’ve had significant growth in the last year, just because it works,” said Lori Knutson, RN, HNC, director of the Institute for Health and Healing. “It’s the patient outcomes that speak the loudest to both the nurses and physicians.”

Nurses report patients receiving the complementary therapies are calmer, experience less pain and are not on their call lights as often as they were before the treatments.

“People feel afterwards that it’s helpful, that they are able to relax,” said Susan Arnold, RN, BA, CHTP, the integrative medicine nurse clinician assigned to the cardiovascular community. “Some people are skeptical at first, which is OK, but feel differently afterward and marvel that such a simple thing helps them.”

The hospital tracks patients’ anxiety and pain scores using standard instruments, and is measuring whether recipients of the complementary medicine program use fewer pain and anxiety medications, and if it alters the length of stay.

The integrative medicine nurse clinicians are assigned to five units: cardiology, neurology and rehabilitation, orthopaedics and spine, women’s health, and medical and surgical oncology.

Once the integrative therapy team receives a referral, one of the nurses completes a holistic, mind-body-spirit assessment and discusses with the patient what alternative treatments might work best, including music therapy or massage, both performed by other members of the Institute for Health and Healing team.

“It’s a relief that someone is talking to them about all the things they worry about,” said Kinney, who is assigned to neurology and rehabilitation services.

At every visit, the integrative medicine nurse clinicians receive report from the staff nurse caring for the patient that day. They stay about 20 to 40 minutes in the room, depending on the patient’s condition and needs, and may visit as often as five days per week.

Arnold typically combines therapies, for instance giving the patient a foot massage while leading him or her through guided imagery. She also may use acupressure to help correct a cardiac arrhythmia or relieve nausea.

Kinney frequently includes healing touch, a modality that works with a person’s energy system. She, and other healing touch practitioners, use words to help the person relax, then assess the patient’s energy field by passing her hands about six inches away from the body. She may notice areas of greater heat or cold or pressure. Then she spends more time in that area to help balance it energetically.

“Healing touch attends to the human spirit,” Kinney said. “Most often people are not at peace, and that’s what this works with, bringing a person back into centering and harmony and grounding.”

As with other specialties, such as physical therapy, the nurses chart what modality the patient receives and his or her response. They also report to the staff nurse.

The Institute for Health and Healing receives 98 percent satisfaction scores on inpatient surveys. The inpatient program has grown from about 200 visits monthly, a year ago, to 900 visits a month, with the nurses typically seeing five to six patients per day.

“There’s a caring presence to every nursing intervention,” Kinney said. But “Nurses are so busy, with so much to attend to, [they] don’t have time to meet that person heart-to-heart, like we get to in this work.”

The integrative medicine nurses also teach patients techniques they can use in the hospital or at home, such as therapeutic breathing before an MRI scan or the relaxation response. Before discharge, they may suggest services from the institute’s outpatient center.

The integrative medicine nurse clinicians spend half of their time educating the hospital’s 2,000 nurses about ways they can incorporate basic holistic practices at the bedside. For instance, while inserting an intravenous needle, a nurse trained in guided imagery could talk the patient through a visit to the beach or some other happy place.

Abbott Northwestern nurses interested in complementary practices can receive additional training and become a nursing champion in their specialty area. The institute’s nurses mentor the champions and encourage them.

“There is no reason to believe nurses cannot provide healing touch if they are trained to do so or reflexology or music therapy,” DeNarvaez said. “We think what we are doing is having considerable impact on our patients.”

It also has affected the integrative medicine nurses, who experience the joy of spending extra time with patients and the satisfaction of providing a unique type of caregiving.

“This is a whole different thing,” Kinney said. “It’s the mind-body-spirit piece. I don’t think we do anything that doesn’t have something to do with the human spirit, and that is the part that is moving, awe inspiring. It’s humbling.”

Learn more about complementary techniques

More than one-third of Americans have tried complementary and alternative medicine. As these modalities become more accepted, nurses will need to learn more about the techniques, at least to understand what their patients may participate in on their own.

The American Holistic Nurses Association offers educational programs and publishes books and holistic practice. Visit it at: http://www.ahna.org.

The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, provides at its website, http://nccam.nih.gov, information about complementary techniques, statistics on their use, and alerts and warnings about certain products, such as ephedra. The center also funds scientific research to better understand the underlying mechanisms of CAM therapies.