Concurrent Session I

Thursday, May 23

9:15am-10:45am

Session 1:  Workshop: Implementing Integrative Nursing in Pediatric Setting

Location: Inisheer

• There is growing prevalence of integrative health use among pediatric patients in both in- and outpatient settings. It is difficult to balance patient/family preference, patient need, and evidence based practices to determine how to incorporate integrative approaches into pediatric care.  In this workshop, case studies will be used to highlight integrative nursing principle five. A brief introduction will give context, then case studies will be presented and discussed in small group format. Determining an integrative approach congruent with the patients’ plan of care, common challenges including family dynamics, interdisciplinary collaboration, and patient motivation will be discussed.   Following small group exercises, large group discussion from the audience including conversation around challenges of taking an integrative approach in the pediatric acute and post-acute care setting will occur.  Taking an integrative approach to caring for pediatric patients is challenging and can feel overwhelming and time consuming. This workshop will help nurses and advanced practice nurses overcome challenges in practice.   At the end of this session:  1. The learner will begin to assimilate integrative nursing principle #5 into practice on a daily basis. 2. The learner will develop a list of at least three new assessment questions that can be integrated into practice. 3. The learner will analyze two key characteristics of a healthcare provider who successfully introduces integrative therapies to an adolescent, teenager, or young adult. 4. The learner will distinguish the various goals of integrative therapy in the acute care setting and how to discuss goals of integrative care with patients and families, including expectation setting.

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Session 2: Nursing Systems and Operations

Location: Ballyvaughan Suite

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• Implementation and outcomes of a daily management system (J. Foley, C. Phelan, K. Sulmonte)

  • Background: As part of our Lean Quality Improvement work, we built a method for continuous improvement that could be owned by front line staff and would enable us to respond to quality issues in an immediate and continuous fashion.   Purpose:  We sought to eliminate the initiative fatigue that can occur when top down, large scale initiatives dominate the quality structure. Driven by the needs of front line staff, the system builds quality by using rapid cycle improvement on a small scale. Our Daily Management System has built in features that enable front line workers and leadership staff at all levels to be involved in continuous improvement.   Findings:  By using a lean process we identified meeting time that could be eliminated or shortened. This eliminated 50% of leadership time which enabled staff education and engagement on local identification of barriers and problem solving.  Unit leadership were trained on our "Daily Management improvement structure which included a 5 minute daily huddle of front line staff during which staff track and address improvements. This approach had an emerging effect on team dynamics and created a new way for staff to identify , track,  and solve problems related to teamliness, collaboration and workflow.   Conclusions: We believe this type of dynamic improvement structure creates a way for every staff member, every day, to be involved in continuous improvement.  Moreover, multiple small success at the unit level builds our organizational quality in a way that naturally aligns with broader improvement goals set at the organizational and industry level.

• Joy in our practice (C. Hayes)

  • ​Background: The Greater Boston Nursing Collective (GBNC) exists to promote health and well-being locally and to influence the same nationally.  The initiatives of the GBNC are guided by integrative nursing principles prioritizing caring and healing relationships and environments. The GBNC includes a Board of Directors and Program Committee comprised of nurses from academic and clinical settings.  Purpose The Board charged the Program Committee with the creation of a Joy Campaign in alignment with the American Association of Critical-Care Nurses (AACN) Healthy Work Environment and the Institute of Healthcare Improvement (IHI) quadruple aim.  There are three campaign goals: To strengthen our community by creating a community milieu that establishes an intention to bring joy to nursing practice. To reinforce high-touch everyday moments as significant by sharing caring moments - a witnessing of each other’s practice.  To energize ourselves and elevate our practice through celebration of the practice we want to predominate and prevail.  Findings The campaign’s kick-off will be November 2018. National and local speakers on integrative nursing principles and healing practices will be facilitating the day-long symposium. Technology will be used to capture moments of joy in practice. Future initiatives include conducting research, compiling evidence and best practices, and leveraging the use of technology in the art of healing. Feedback from our symposium and examples of expressive imagery of joy in practice created from our technology platforms will be shared.  Conclusion The Board supports the planned Joy Campaign given the increasing evidence of the impact of an engaged workforce and healthy work environments.

• Expanding Mindfulness into a movement for health care organization (J. Levin)

  • Background: Many nurses arrive at their practice of mindfulness to relieve personal stressors and then recognize the  multiple opportunities to expand the benefits they found personally to their workplaces, students and communities. However, they often struggle with how to develop programs that gain traction within their organizations. With provider burnout, compassion fatigue, bullying on the rise and new nurses leaving the profession within their first two years of work, patient safety and healthy professional communication will deteriorate to a crisis proportion. Mindfulness strategies can be an essential strategy to shift toward a solidly compassionate and listening healthcare environment.   Purpose: The purpose of this podium presentation is to demonstrate how to move from a personal practice to mindfulness as an organizational culture of health, wellbeing and mutual respect. From my work at large urban hospital systems to small critical access hospitals, I will share how to start small, gain administrators’ trust, and grow mindfulness throughout an organization.   Findings: Mindfulness practice improve health, communication and patient safety across all areas of healthcare and provider well-being a cornerstone for this. Now it is both part of the Institute of Health mission (Bodenheimer T, Sinsky C, 2014, Berwick DM, Nolan TW, Whittington J., 2008) as well as Joint Commissions to ensure the health and well being of health professionals and support staff.  Conclusion: A mindfulness movement of nurses can transform healthcare, support health inter-professional communication, increases staff engagement and retention, makes our work as nurse change agents profound across all where patients and nurses are found.

• Compatibility of integrative clinical behaviors with ANA Scope of Practice and Standards (N. Pool, M. Koithan)

  • Background: In order to support our assertion that integrative nursing is not a specialty practice, it is essential that any integrative clinical behaviors measured during evaluation remain within the boundaries of the American Nurses Association (ANA) Scope & Standards of Practice. However, alignment of the existing Scope & Standards and the six principles of integrative nursing to create observable integrative clinical behaviors has not yet been explored. Purpose: This presentation will demonstrate the fit and compatibility of the ANA Scope & Standards and the six integrative nursing principles by proposing measureable integrative clinical behaviors for each standard and level of student.  Findings: Three collaborative cohorts of nurse-educators participated in an activity to evaluate proposed revisions to the existing standards and competencies and to co-create integrative clinical behaviors. One additional standard addressing creation of a healing environment was developed after noting a deficiency in the existing ANA Standards. Utilizing the slightly modified standards and competencies, nurse-educators were able to successfully generate practical and appropriately-scaled behaviors across practice levels that reflect the values and tenets of integrative nursing.           Conclusion: We found that clinical behaviors emanating from the six integrative nursing principles are designed for a mainstream nursing audience, including all levels of students. Although minimal revisions to the ANA standards and competencies are suggested, their overall alignment with the six integrative nursing principles is promising and confirms our assertion that integrative nursing is not a specialty practice or beyond the scope of even entry-level students.

• Patient flow improvement project: a patient-centered initiative (H. Horsnell, E. Kelly)

  • Background Galway University Hospitals was selected for the National Pilot Programme for improved quality, safety and efficiency of healthcare using a whole system approach, in partnership with General Electric Healthcare Finnamore. The Patient Flow Improvement Project (PFIP) team has implemented more than 200 projects. Outcomes include significant improvements in patient flow and patient experience and improved staff engagement and commitment. Purpose The purpose of Patient Flow Improvement is to ultimately ensure that the patient experience throughout their hospital journey flows seamlessly adopting the SAFER patient flow bundle. Supported by clinical and executive leadership, the project team engages with leaders at all levels of the organisation who are passionate about patient care and continuous improvement.    Findings Kaizen and workout methodologies and tools are used by the PFIP team support teams to ensure that any improvements realised are sustained. Examples of Improvements include introduction of a second emergency theatre resulting in reduced delays for patients and a reduction in the number of complaints and introduction of model wards with a focus on improved interprofessional communication and integrated team-working that has resulted in a dramatic whole-system cultural change through the entire organisation. Conclusion It is evident that when teams have a shared purpose in an integrative, patient-centred approach of being-doing-knowing, results in improved outcomes in the health and well-being of patients. Staff engagement and staff well-being also improves as they are more connected with the values of the organisation, empowered and energised to spark innovation and implement change.

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Session 3: Care of Special Populations

Location: Lettermore Suite

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• The effects of an adaptive mindfulness intervention on male prisoner in Iceland (G. Kristófersson, T. Gunnarsdottir, S. Kjærnested, K. Guðmundsdóttir)

  • Background: Mindfulness is an intervention that has been gaining popularity and international respect in the mental health system for the last few years. Multiple studies have demonstrated its efficacy for various mental health problems in various settings. Although mindfulness based interventions have only been used as an intervention in western medicine for about 40 years their background is ancient. There are indications in the research literature that the practice of mindfulness may be an appropriate intervention for prison populations due to its safety, accessibility and efficacy.  Purpose: To assess the effects of an adapted mindfulness based intervention on Icelandic male prisoners on anger, anxiety, stress, mindfulness and depressive symptoms. As well as assessing effects of the intervention through qualitative interviews.   Findings: This mixed methods study compared the effects of mindfulness based intervention with a wait list control group receiving treatment as usual. All in all the study included over 20 male prisoners in Iceland. Special care was taken to adapt the intervention to fit the need of the prisoners, when it came to length of homework, nature of exercises and other didactic content. Conclusion: The findings are still being analysed, work that will be completed by the end of January 2019 and presented in detail in Ireland, but initial review of both qualitative and quantitative data indicates that a mindfulness based intervention might be a good fit for male prisoners in Iceland.

• Nurse-led behavioral and nutritional intervention to improve health in women living with HIV in India (A. Nyamathi)

  • Women Living with HIV/AIDS (WLH/A) in rural India face extreme health disparities, challenging adherence to Antiretroviral (ART) Treatment. Nutritional deficits including anemia exacerbate disease progression. We present the 18-month follow-up of a nurse-led behavioral and nutrition intervention, supported by Asha (lay village women), and focused on improving the health of WLH/A in India. Health parameters include Depressive Symptoms, CD4 levels, Body Mass Index [BMI]) and Hemoglobin.   After extensive formative research, we conducted a four-arm quasi-experimental trial with 600 women recruited from primary-health centers. The 4 programs each included group-education sessions and Asha support and differed on the nutritional component: 1) Asha-supported standard education (SE) alone; 2) SE + nutrition education (+NE); 3) SE + nutrition supplements (+NS); or 4) SE + nutrition education and supplements (+NENS). The intervention was delivered over 6 months. Assessments occurred at baseline, and month 6 (post-intervention), 12, and 18, with 100% retention. Multilevel modeling examined effects of program over time.   At baseline, mean age was 34 years and CD4 level was 447.4. 100% of the women were anemic. At 18-month follow-up, Program 4 experienced greatest improvements in CD4 counts compared to the Program 1. For BMI, Programs 3 and 4 exhibited greater gains compared to Program 1. All programs improved depressive symptom scores and ART adherence from baseline to 18-month follow-up; no severe anemia at 18-months.  Implications: A low-cost Nurse-led and Asha-supported behavioral and nutritional intervention improved health parameters sustained at 18-month follow-up. Future research should explore this model in other communities and infectious diseases.   Funding: R01MH098728

• Capacitar International: A Model for Healing Ourselves and Our world. (M. Duennes)

  • Background Capacitar means "to empower, to encourage, to bring each other to life." Capacitar is an international network of empowerment and solidarity working in over 45 countries in the Americas, Africa, Asia, the Middle East and Europe. Capacitar is dedicated to places of poverty, trauma, war and disaster giving people skills so they can work effectively for peace and healing in the midst of the violence. It is most relevant in these times of unprecedented forced global migration.   Purpose Nurses around the world are dealing with clients impacted by trauma, war and violence and experiencing its effects on their own health and well-being. The need for self-care in our own lives has never been more imperative, if we are to continue the necessary work we have been called to do.  Findings The workshop will include practices, methods, theory and applications of Capacitar's simple healing skills and energy-based methods. The practices empower people to deal with traumatic stress, to stabilize and balance strong emotions and memories and to awaken their own healing process. They include simple, effective tools for self-care that are also easily shared with others across the lifespan.  Conclusion  The simplicity of the work invites participants to easily share what they learn and is especially valuable to those working in emergency settings, detention facilities, crisis response centers, community health and mental health centers. " To accompany is to bear witness, to offer presence in mind, body and spirit, and to recognize the inherent worth and dignity of the person." (Capacitar Refugee Accompaniment Manual)

• Plain Complexity: Integrative Nursing Care in the Old Order Amish and Mennonite Communities (J. Zimmerman)

  • ​The Old Order Amish and Mennonites comprise a unique religious minority, primarily in the United States, Canada, and Mexico, with similar groups worldwide. This paper explores the role of religious beliefs and community environment on healthcare decision making. Through informal interviews with approximately thirty community members, lay leaders, and ordained officials, I developed a framework for understanding beliefs around healthcare and alternative medicine. Additional interviews with healthcare practitioners provided a lens into common frustrations and concerns from the healthcare perspective.  Analysis revealed a surprisingly non-unified understanding and approach to healthcare. Practice runs the gamut from strict adherence to American Medical Association guidelines to serious mistrust of all medical practitioners, from mistrust of herbal medicine to total reliance on herbals, from careful avoidance of all potential occult practice to embracing almost any practice without regard for occult connection. Beliefs around healthcare are just as varied, with explanations ranging from standard biology text style, to esoteric explanations derived from a blend of eastern mysticism and rural legend, to shrewd observations of cause and effect. Even more intriguingly, individuals do not adhere to a single explanation or practice but pick and choose based on circumstances. Thus, one woman may always seek antibiotic therapy for a bladder infection but treat her child’s earache with a natural remedy, while preferring “pain pulling” (also known as “brauche”) for colic. Cost and availability also influence decisions. Effective nursing care requires understanding the multiplicity of truths they hold and addressing the whole person, including the community.

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Session 4: Integrative Primary Care

Location: Inishturk

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• Holistic Nursing Values in NP Care (E. Kinchen)

  • ​In the current U.S. political healthcare climate, Nurse Practitioners are in a position to promote primary healthcare delivery models that facilitate healing in partnership with patients, and consider the wholeness of persons in providing care. In view of this opportunity to transform healthcare delivery, there is an emerging need to quantify holistic nursing values in NP practice, as the inclusion of these values is essential to the delivery of comprehensive and patient-centered care.  The Purpose of this study was to measure the degree to which NPs incorporate holistic nursing values in their care, using the Nurse Practitioner Holistic Caring Instrument (NPHCI), a new, investigator-developed scale, and to further explore the psychometric properties of the NPHCI.  This quantitative, descriptive study surveyed a convenience sample of NPs.   The sample (n=573) was predominantly female, white, aged 46-65 years, master’s-prepared and in practice more than 10 years.  Results suggest that NPs most often incorporate holistic nursing values such as listening and taking time to talk to patients, knowledge of physical condition, showing concern for what matters most to the patient, and working with the patient to create a plan of care.  The NPHCI exhibited quite high reliability in the sample, further strengthening the reported psychometric properties of the instrument, which has been distributed in patient, faculty and NP populations.  In addition to contributing to knowledge of holistic care in NP practice, results from this study may also provide guidance in the ongoing evaluation and revision of NP educational programs, policy, and scope of practice.

• The meaning of the caring encounter within Swedish primary care (M. Jong, K. Lundberg, L. Kristiansen)

  • ​1. Background: Efforts to prevent cardiovascular disease should be targeted on people with risk factors and their need of lifestyle changes must be prioritized. Since changes in lifestyle are difficult to achieve and difficult to sustain, we assumed that in order to reach and support people in need of lifestyle changes, the primary health care had to use a more holistic approach involving surrounding factors like family and other to the patient important support. The current study explored aspects of the phenomenon of the caring encounter and its impact on health behavior among people at risk of developing CVD, describing the deeper levels of interaction between patient and nurse after an intervention containing the "The Attending Nurse Caring Model”, described by Jean Watson had been implemented at the health center. 2. Purpose: The specific aim was to more deeply explore study the patients´ lived experiences of participation in health conversations with the district nurse at the health center where the intervention (ANCM) had been performed. 3. Findings: From the phenomenological analysis of 12 Individual interviews, three masterthemes emerged; (1) Feeling the deepest essence of being cared for (2) Perceiving senses of acceptance and (3) Being in a supportive atmosphere that cultivates hope.  4. Conclusion: When having the feeling of being seen and paid attention to in a genuine manner and being treated with receptivity and permissive attitudes the encounter with the nurse can be understood as an understanding beyond the verbal conversation where the participant and the nurse could unite in conscience and peace.

• The re-greening of health: restoring the role of food and healing (K. Niemeyer)

  • ​Background:  In integrative health, food is information and diet is prerequisite for other treatment prescriptions. While food today is more industrialized and less nutrient dense, food-related chronic diseases have accelerated. Many chronic diseases are preventable and  the trajectory of chronicity can be impacted by food intake choices. As humans have coevolved with plants, eating  organic plant-based diets has reciprocity. Humans heal and the planet heals.   Purpose:  This session will evaluate three diets recommended in integrative health (Mediterranean, Ancestral, and Anti-inflammatory). While comparing the diets, benefits will be considered in the context of supporting research. Even though these diets are considered healthful diets, the food source or origin may amplify or negate healthful effects. A discussion of organic real food plant-based diets and supporting research will challenge common notions of eating for health. Finally, eating for health and wellness will be contrasted to applications of short term trending or fad diets (ketogenic, high protein, low carbohydrate, blood type) and risks for nutrient depletion.  A stepwise approach for food or diet prescribing will be presented and explored.   Findings:  A substantive body of research  supports the application of the Mediterranean, Ancestral, and Anti-inflammatory diets in the health and wellness of diverse patient populations. Likewise, evidence is emerging to support the health benefits of an organic real food diet.   Conclusion:  The health of the people may reflects the health of the planet. Considering this, there is a primacy for restoring the role of organic real food nutrition for health and wellness.

• The re-greening of health: evolving the practice of herbal medicine (K. Niemeyer)

  • ​Background:  The World Health Organization reports approximately 80% of the world’s population uses herbal medicines. Sustainable wellness and regreening of health includes appropriate and safe use of herbal medicines. A strong working knowledge of foundational and safe applications of herbal medicine for personalized wellness is requisite for integrative nurses.         Purpose:   The intent of this session is to focus on safe uses of herbal medicine in practice and self-care as supported by science and blended with ethical, experiential, and traditional knowing. While health challenges are manifesting as system-wide dysregulations, herbal medicines for support, restoration, and eutrophy offer viable options for the integrative practitioner. Green health, using herbal medicines, is constructed by moving from the reductionistic or single symptom-treatment perspective into plurality of the complex or whole systems perspective. A history of herbal synergy and complementation paired with human receptivity has resulted in deep cellular knowing dependent on plant intactness. Herbs close to their natural state have innate complexity that provide information to the human organism for qualitative changes in health and well-being.   Findings:  Research on commonly-used herbs and potential safety risks will be reviewed along with findings that dispel common myths of herbal medicine. Challenges have emerged for research generalizations and herb delivery. Herbal use focused on whole person health and vitality  along with expected outcomes will be addressed.     Conclusions:  This educational session will advocate for the regreening of health with integration of herbal medicines in personal health and healthcare of our patients in order to promote the best conditions for self-healing.

• The use of an integrative nursing wellness care plan in primary care (K. Moore)

  • ​Background: The United States health care system has a segmented approach to patient care when it comes to primary care delivery. Many individuals demand new models of healthcare and choose to integrate non-traditional methods into their health regimen beyond what is typically offered in many primary care settings (1, 15 & 23). This doctoral of nursing practice (DNP) project surveyed a group of patients receiving care at an integrative clinic, and explored satisfaction with services based on an Integrative Wellness Care Plan used by that clinic to deliver primary care.  Purpose, Materials, and Methods: The purpose of this DNP project was to explore and evaluate the lived experience of primary care patients that were combining both traditional primary care and integrative care modalities as part of an Integrative Wellness Care Plan (IWCP) from their family nurse practitioner - primary care provider (Appendix A). A survey was developed and sent to 52 patients that were participating in this care plan to evaluate the patient experience (Appendix B). Content analysis method of data analysis was utilized, and findings were categorized into major themes. Findings: Themes identified through analysis of qualitative data suggest that patients are highly satisfied with their integrative primary care experience and believe this model of care supports wellness and achievement of individual health goals.   Conclusions:  Survey responses suggest patients value the integrative care approach as opposed to typical primary care services they had received in the past. Respondents mention preferring this model of care over traditional primary care.

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Session 5: Research

Location: Inishmore

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• Randomized Study Using Jin Shin Jyutsu® Self-Help for Nurses (C. Errico)

  • ​Jin Shin Jyutsu® (JSJ) is an ancient art of harmonizing the energy of the body. JSJ uses a light touch on 26 locations along the body’s major energy channels to elicit the relaxation response and promote the body’s self-healing mechanism.  It can be applied by a person themselves (JSJ self-help) or by a practitioner.  The essence of JSJ  is that when we are in balance we are self-aware and in touch with our center. Self-awareness and self-reflection are necessary components of self-care required to create a therapeutic presence with our clients.  There is increasing amount of evidence-based literature regarding the use of JSJ in healthcare.  In 2014, Lamke, Catlin, and Mason-Chadd published a study on the relationship between JSJ self-help education for nurses and stress, physical, personal and professional health and caring efficacy.  Their results showed decreases in aches and pains, muscle aches, stress symptoms as well as sleeplessness, anger, morale issues, and increases in nurses’ caring efficacy   In 2017, nurses from the Integrative Medicine department at Morristown Medical Center in New Jersey replicated the study using 1:1 randomization, a larger sample size and a control group to add further validity of these research results.   This presentation will describe this research study, its findings, how its results have influenced hospital wide practice, and the Research to Practice grant award received from the American Holistic Nurses Association.      This podium talk (if workshop time not available) falls into the categories of Research, Self-Care and leadership.

• Bioenergy for stress relief in a university community (A. Running, N. John-Henderson, L. Hildreth)

  • ​University students  are increasingly described as a stressed group.  Stress can manifest itself in a variety of ways including depression, anxiety, sleep disorders, exhaustion, relationship difficulties and failing grades.  To manage these stress responses students report consuming junk food, drinking soda and/or alcohol and losing sleep.  While these responses could serve to mitigate immediate stress, consistent or long term dependence is not a healthy approach.  While pharmacotherapeutics are appropriate in some instances for stress reduction, integrative therapies have the potential to provide a lasting impact on students as they graduate and move into their respective disciplines.  One such integrative therapy is Bioenergy.  Nursing evidence related to bioenergy identifies psychological and physiological relaxation, reduced pain, decreased agitation and anxiety, decreased anxiety in hospitalized patients and decreased stress in University students.  One form of bioenergy is Healing Touch, a nursing intervention that is noninvasive and nontoxic.  This presentation will discuss 3 separate studies conducted on convenience samples during the week before final exams, and on a 4th study conducted over the course of a semester. After consent, a chakra connection was provided for intervention participants.  Self reported measures of stress were obtained in the first 3 studies, and cortisol and interleukin 6 were added as objective measures, along with blood pressure and pulse for the 4th study. In every instance, students reported a significant decrease in stress after the healing touch intervention, and cortisol and interleukin 6 were significantly decreased in the 4th study.  Plans for a 5th study will be discussed.

• Shinrin-Yoki (Forest Bathing) and Nature Therapy: A state of the art Review (M. Hansen, R. Jones, K. Tocchini)

  • ​Background: Current literature supports the comprehensive health benefits of exposure to nature and green environments on human systems. The aim of this state-of-the-art review is to elucidate empirical research conducted on the physiological and psychological effects of Shinrin-Yoku (or Forest Bathing) in transcontinental Japan and China. Furthermore, we aim to encourage healthcare professionals to conduct longitudinal research in Western cultures regarding the clinically therapeutic effects of Shinrin-Yoku and, for healthcare providers/students to consider practicing Shinrin-Yoku to decrease undue stress and potential burnout. Methods: A thorough review was conducted to identify research published with an initial open date range and then narrowing the collection to include papers published from 2007 to 2017. Electronic databases (PubMed, PubMed Central, CINAHL, PsycINFO and Scopus) and snowball references were used to cull papers that evaluated the use of Shinrin-Yoku for various populations in diverse settings. Results: From the 127 papers initially culled using the Boolean phrases: “Shinrin-yoku” AND/OR “forest bathing” AND/OR “nature therapy”, 64 studies met the inclusion criteria and were included in this summary review and then divided into “physiological,” “psychological,” “sensory metrics” and “frameworks” sub-groups. Conclusions: Human health benefits associated with the immersion in nature continue to be currently researched. Longitudinal research, conducted worldwide, is needed to produce new evidence of the relationships associated with Shinrin-Yoku and clinical therapeutic effects. Nature therapy as a health-promotion method and potential universal health model is implicated for the reduction of reported modern-day “stress-state” and “technostress.”

• The effect of acupuncture on mobility sensory motor function and QOL in persons with MS (B. Siminovich-Blok, H. Karpatkin, S. Winsor)

  • ​Background Recent evidence suggests that up to 70% of persons with Multiple Sclerosis (pwMS) have tried acupuncture as a means of managing their MS symptoms. There is little evidence however that supports its use in this population.   Purpose The purpose of this  study is to investigate the use of a 4-week acupuncture intervention on mobility, sensorimotor function, and quality of life measures in pwMS. We hypothesize that pwMS will experience an improvement in these measures following the acupuncture intervention when compared to a no treatment control group To date, 5 subjects have completed the training program.   Methods A crossover design is being used.Subjects are randomized into acupuncture or control groups. A licensed acupuncturist does the assessment and provides acupuncture  The control condition consists of the subject lying . Mobility measures include the 6-Minute Walk Test (6MWT) and the MiniBESTest (MBT). Sensorimotor testing will include upper and lower extremity hand held dynamometry (HHD), biothesiometry, and the Modified Ashworth Scale (MAS). Quality of Life (QOL) measures  include the MSQOL-29, the Fatigue Severity Scale (FSS), and the Medical Outcomes Study Pain Effects Scale.    Findings To date, 5 subjects (EDSS=3.0,sd=.57) have completed the study. and 4 are currently in data collection. Descriptive statistics include improvements following the acupuncture intervention in the MSIS-29 (86.25 to 61.0), FSS (5.4-4.6). Mean MAS scores decreased from 1.8 to 1.0. Left sides strength improved from 25.9lbs to36.9lbs.  Conclusions     Due to the small subject size thus far judgments about the efficacy of acupuncture in improving mobility, sensorimotor function, or QOL cannot be made.yet.

• Using yoga and prayer to reduce diabetes and hypertension stress (S. Benavides-Vaello, K. Flagg, A. Spring)

  • ​Background: Hispanics are one of the fastest growing minority populations in the US, and the fastest growing minority group in Montana. The state has experienced an 86% increase in this demographic between 2000 to 2015. Hispanics in Montana are at increased risk for adverse health events due to nearly 30% living below the federal poverty level, lower education levels, and often encountering language barriers as they try to navigate the US healthcare system. Further, 30% and 51% of Hispanic women and men (respectively) have no personal health care provider; and 36% and 35% of Hispanic women and men report poor mental health. Purpose: The purpose of this exploratory descriptive study was to determine the receptivity of using yoga and prayer to reduce stress among lo-income Hispanics/Latinos with DM and HTN. A single-item instrument was developed by the PI (stress staircase) to capture changes in stress level pre and post a single yoga session. Findings: The baseline (pre) staircase scores ranged from 0 to 10 with a median of 6; the post staircase scores ranged from 0 to 5 with a median of 1. The participants’ pre to post score decreases ranged from 2 to 6 with a median decrease of 4 (for 17/19 participants). Conclusion: Participants were open to using yoga and prayer as a way to reduce DM and HTN disease stress.  The reported favorite elements of the yoga practice were: prayers used to open and close the session, guided meditation/relaxation at the end of the session, and music used during the practice.

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Session 6: Senior Care

Location: Inishmaan

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• Integrative nursing and leadership in the senior care setting (R. Trelstad-Porter)

  • ​Background Integrative nursing has many tools to offer in the senior care setting. The challenges experienced by the residents, with the changes of aging bodies and transition to a new environment, lead to rich opportunities to utilize the six principles of integrative nursing. This setting creates an ideal space for integrative nurses to contribute their unique voices.   Purpose This presentation will highlight the application of integrative nursing principles within the context of senior care. Discussion will include examples of relationship-based care; evidence to support integrative modalities used for symptom management; examples of arts and healing in practice; conversation about opportunities to enhance dementia care; and a discussion on integrative nursing leadership, including the impact of intercultural development and reflective practice.   Findings Since implementing an integrative nursing model of care, we have seen shifts in wellbeing that reflect increased comfort and relaxation for our residents. We have witnessed decreased isolation, loneliness, agitation and anxiety; and have seen the positive benefits of relationship-based care. Integrative staff, volunteers, nursing graduate students, and caregiving staff regularly observe these advances toward health and healing. In addition, staff rejuvenation opportunities have become an important pillar of our program.  Conclusion The senior care setting is ripe for the principles and practice of integrative nursing. In this context, integrative nursing leadership provides an essential voice to strengthen the care, healing, and resilience of the residents, advancing wellbeing to its highest level.

• The perspectives of staff in Icelandic nursing homes on the use of integrative nursing (T. Gunnarsdóttir, I. Bjartmarz, I. Hjaltadottir)

  • ​Aim: Research suggests that Icelandic nursing homes provide recreational activities and complementary therapies as part of their integrative nursing. No information about the specifics of the activities and therapies is available from the perspectives of the staff providing them but it is important to hear their perspective to gain information on how they are used for the residents.  Method: Focus group interviews were conducted in four different nursing homes in Iceland. Each focus group consisted of 6-8 staff members with different background. The focus groups met once at the nursing homes and the duration of the interviews was 1 1/2 hours. The researchers also observed activities for a few hours at all the four settings. The interviews were transcribed and the findings analysed using content analysis.  Results: The three main themes that emerged were: Knowing who the person was and is now; Engaging the individual; and The real world and the individual. The work in the nursing homes aims at taking care of the residents and therefore knowing them as persons is essential. In the busy nursing home environment, being organized and plan ahead for activities is important. Positive changes were observed when working with the residents. The environment has boundaries, time and resources are not always available and it is important the staff is well informed.  Conclusion: Recreational activities and complementary therapies may have positive effects on residents.  Nursing home managers need to provide courses and continuing education opportunities in recreational and complimentary therapies for staff in nursing homes.

• How the Eden Alternative Philosophy and person-centered care affects residents’ quality of life (A. Magnúsdóttir, H. Erlingsdóttir)

  • ​Background: The Eden Alternative is a cohesive philosophy that is about changing the culture of care in nursing homes, it impacts the organizational structure, physical environment and relational interactions in residential care. Öldrunarheimili Akureyrar (ÖA) is a nursing home in the north of Iceland that has been an acknowledged Eden Alternative nursing home since 2013.  Purpose: To practice person centered care in a holistic understanding of human needs and capacities; body, mind and spirit. The goal is to erase loneliness, helplessness and boredom, be content and to help our elders live a life worth living.  Findings: Making a big change in an organization is hard work and a constant journey. With education and empowering of residents and staff, or “care partners” as we like to describe them, we have evolved and will keep evolving together. Eden Alternative offers us many tools to accomplish that goal. In 2004 a task force of culture change experts were brought together where they identified the Eden Alternatives seven Domains of Well-being: identity, growth, autonomy, security, connectedness, meaning and joy. Conclusion: ÖA has been incorporating these domains in more than one way. We are now using them for example when we collect information about a residents life story to get a deeper understanding of who the person is. It helps us to identify if or which need is not being met and what we can do to enhance the person’s well-being.

• Health and wellbeing of older people in northern Iceland (A. Sigurdardóttir, G. Kristófersson, T. Gunnarsdóttir)

  • ​Background: The world population is getting older. One of the major health care policy challenges we are facing is how older people can be enabled to live in their own homes as long as they can and want, especially in sparsely inhabited areas like in rural Iceland.   Purpose: To find factors affecting health and well-being of older community-dwelling inhabitants. Face-to-face interviews were conducted with participants along with a variety of physiological measures. These included the CD-RISC (resilience scale), Mini-Mental State Examination (MMSE), SF-36 and the Geriatric depression scale (GDS).  Findings: Participants were 175, with a response rate of 57.8%. Mean age was 74.2 (6.3), range of 65-92 years. Males were 100 (57.1%), 40 (17.5%) lived alone. Average number of medications used was 3.0 (2.7) and diagnosed diseases 2.9 (1.8), BMI was on average 28.1 kg/m2 (5.2), range 19.2 to 56.3 kg/m2. Factors that increased self-rated health were more resilient, less BMI, better cognitive functioning (MMSE), fewer diagnosed diseases and more physical activity (p≤ 0.001, r2 =0.26). Scoring of GDS was affected by more resilience, better cognitive performance (MMSE) and better self-rated health (p≤0.001, r2 =0.25). Conclusion: As resilience is affecting both physical and mental well-being in older people living at home, nurses should emphasize factors such as adaptability when coping with change and taking on responsibility for dealing with stress. Use of a holistic approach when caring for older people is recommended to ensure well-being for elderly people, and further ensure their ability to live independently as long as they can and want.