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Abstracts

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.

Session 2: Nursing Systems and Operations

Location: Ballyvaughan Suite

  • 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.

Session 3: Care of Special Populations

Location: Lettermore Suite

  • 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.

Session 4: Integrative Primary Care

Location: Inishturk

  • 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.

Session 5: Research

Location: Inishmore

  • 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.

Session 6: Senior Care

Location: Inishmaan

  • 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.

ACCREDITATION

There will be 14.8 Continuing Nursing Education (CNE) contact hours available for the International Integrative Nursing Symposium. There will be 3.75 CNE contact hours for the Integrative Nursing Research Pre-Conference Workshop and 6.0 CNE contact hours for the Most Beautiful Way of the Healer Pre-Conference Workshop. University of Arizona Continuing Professional Education is an approved provider of continuing nursing education by the Continuing Nursing Education Group, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

SPONSORSHIPS

We are grateful to our Symposium sponsors:

Platinum Sponsor:

Gold Sponsor:

 

 

 

 

Silver Sponsor:

David and Mary Anderson Family Foundation

Bronze Sponsor:

Greater Boston Nursing Collective

PROMOTIONAL SPONSORS

Concurrent Session II

 

Thursday, May 23

11:15am-12:45pm

 

Session 7:  Workshop: Inclusive Spiritual Care in Integrative Nursing

Location: Lettermore Suite

  • Background:  The facilitator, a nurse educator & spiritual companion, has developed the ‘T.R.U.S.T. Model for Inclusive Spiritual Care’.  Inclusive Spiritual Care is relevant, non-intrusive care which tends to the spiritual dimension of health by addressing universal spiritual needs, honoring unique spiritual worldviews, & helping individuals mobilize factors that can help them gain/regain a sense of trust to promote optimal healing.  Elements of ‘T.R.U.S.T’ are: Traditions & Practice; Reconciliation; Understandings; Searching; & Teachers. 'T.R.U.S.T.' is rooted in the facilitator’s study, 'The Experience of Nursing Faculty, Students, & Clinicians in Use of the T.R.U.S.T. Model for Inclusive Spiritual Care'.   Purpose:  T.R.U.S.T. was created to help caregivers feel more prepared to address the spiritual dimension of health as an integral part of holistic care.   Findings:  T.R.U.S.T was found to enhance users’ comfort & confidence in spiritual assessment.  However, users needed further support in deepening their relational skills and their own spirituality before they felt prepared to engage in intervention.   Conclusion:  The facilitator has developed a Spirituality & Health nursing elective & related workshops which emphasizes the role of contemplative conversation in use of the T.R.U.S.T. framework. Contemplative conversation is a process of deep, spacious listening & intuitive, compassionate responding to self & others that helps co-create the contemplative space necessary to be fully present to all dimensions of the interaction & to each participant’s needs and strengths.  The facilitator’s workshop will offer participants the opportunity to deepen their inclusive spiritual care skills by gaining a working knowledge of both T.R.U.S.T. & contemplative conversation.

Session 8 has been cancelled

Session 9: Informatics

Location: Inisheer

  • Open source EHR using the Omaha System designed to support nurse coaching practice (M.E. Southard, D. Gotlib, K. Monsen)

    • ​Most Electronic Health Records are designed for administrators, insurance companies and funders, not the people who are actually providing and receiving services. EHRs are a major source of stress among clinicians, and often take up time that could be spent on serving patients. The design challenge is even more difficult for integrative nursing, which does not fit reductive, rigid approaches to patient management. On the other hand, nursing standards of practice do require structured notetaking, not only for clinical assessment, planning and implementation but also for continual evaluation and quality improvement. The Omaha System has demonstrated feasibility in nurse coaching practice. Embedded in an EHR, the OS will allow nurse coaches to adhere to standards of practice and evaluate outcomes.  This session will present an open source EHR that has been designed around the needs of clinicians and their clients. Further development using the Omaha System provides a comprehensive documentation system for nurse coaching.  The nursing customization was designed to support coaches through the 17 standards of practice and professional performance --  assessment, diagnosis, outcomes identification, health promotion and evaluation  -- in a way that reflects a holistic, patient-centered perspective. Administrative data entry was minimized through the use of 'hidden codes' that enter billable activities automatically when a nurse updates a patient's progress against their own self-identified goals.   The session will describe the design principles that guided the software and the customization process, as well as presenting the software itself. The customized software will be distributed free to attendees for their unlimited use.

  • Nursing care innovations according to integrative nursing and Omaha System in elderly women feeling lonely (A. Ilgaz & S. Gözüm)

    • ​Purpose: This study examined effects of nursing care interventions on the physical, psychological, social and spiritual health of the elderly women with high level of loneliness according to Integrative Nursing Principles (INP) and Omaha System (OS). Method: A randomized controlled trial with to parallel group design was conducted in community dwelling. Sixty nine elderly women with high levels of loneliness according to Loneliness Scale for the Elderly were randomized into intervention and control groups. The intervention group received nursing care interventions consisting of group-based (sightseeing, picnics, theater, cinema) and individual (special interventions for individuals’ health problem) according to INP and OS for 12 weeks. Loneliness and physical activity level, health perception, social inclusion and social support situations, perception of well-being and spirituality level were measured at the beginning and after 12 weeks.  Results: There was a significant decrease in loneliness level in intervention group. The level of physical activity, health status perception, social inclusion, perceived social support, well-being and spirituality level of elderly women in the intervention group increased significantly. The most common health problems of elderly women according to OS; decrease in social interaction, weakness in interpersonal relationships, physical inactivity, circulatory and bowel dysfunction. There were 5008 interventions consisting of health education, guidance and counseling (50%), surveillance (27.2%), case management (19.4%), treatments and procedures. Conclusion: INOSEL interventions based on INP and OS have a positive effect on decrease loneliness levels of elderly women. This interventions provided the development of physical, spiritual, social and spiritual health in community dwelling elders.

  • Standardization of integrative nursing therapy terms for clinical documentation: A data-driven approach (R. Austin)

    • ​Background There continues to be increase use of integrative therapies among individuals for a variety of conditions, specifically for pain management. Use of standardized terminologies can provide an organizing structure for data within the electronic health record (EHR) to enable representation of integrative therapies and allow for shareable and comparable data. Despite increased use, there is little knowledge how integrative therapies are documented and represented in the EHR.   Purpose  The purpose of this research is to understand the current state of integrative therapy terminology represented within an international standardized terminology. Integrative therapy data was extracted from multiple sources and mapped using the National Center for Complementary and Integrative Health and former National Center Complementary and Alternative Medicine classification structures. A team of integrative health experts validated the terminology. Validated terms were mapped to Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT).   Findings  A total of 789 integrative therapy terms were extracted. Preliminary analysis shows, of the 789 terms, 385 (48.9%) terms were mapped to SNOMED-CT, 26 were duplicate terms, six terms represented two or more interventions, and two terms (exercise and assistive devices) had multiple related concepts in SNOMED-CT.   Conclusion  Integrative therapy terms are partially represented in SNOMED CT. Use of standardized integrative therapy terminology may improve ability to document, track clinical use, and allow for data collection to support the use of integrative therapies in a variety of care setting and patient populations. Future research should validate the coding integrative therapies and develop recommendations for integrative therapies not represented by SNOMED CT.

  • High-tech, high-touch informatics: Integrative nursing and quality improvement (R. Austin, D. Ringdahl)

    • ​Background Informatics and Integrative Health represent two areas of health care influencing quality of healthcare at the point of care and system level through improving interface between technology and healthcare delivery and assuming leadership and expertise in an integrative model of health care. Integrative health/nursing increases the capacity of nurses to optimize health and wellbeing and reduce symptom burden and suffering. The fifth principle of integrative nursing outlines a tiered approach to symptom management that starts with the least invasive and is informed by evidence. Informatics enables data to be captured that links interventions to support patient outcomes and provides a critical foundation for evidence-informed care.   Purpose  To discuss the role of informatics and integrative health in graduate nursing education and healthcare system change and describe the need for developing expertise in these two areas to support nursing leadership and quality improvement.  Findings  The University of Minnesota School of Nursing DNP programs in Informatics and Integrative Health and Healing (IHH) were introduced in 2009. Combining scholarship and clinical application of informatics with integrative nursing increases quality improvement sustainability by creating deeper connections between information technology and nursing values.   Conclusion  The use of health information systems can support an integrative care model through use of clinical decision support, data collection and management, and facilitate use of evidence for symptom management. Informatics and integrative nursing demonstrate the value of both “high tech and high touch” and their contribution to patient safety and quality care.

Session 10: Nursing Education

Location: Inishturk

  • Baccalaureate nursing education and activities for senior nursing students to foster self-care (M. O’Connell)

    • ​Background:  Numerous studies indicate a high prevalence of compassion fatigue and burnout within the nursing profession.  Research suggests Novice nurses are at greatest risk for experiencing this within their first three years of practice.  To this end, all senior nursing students received an educational lecture, watched a video, and learned of evidence-based approaches to take for counteracting compassion fatigue and burnout.    Senior nursing students were assigned to keep a self-care journal over eight weeks and completed a survey about the value of this at the close of eight weeks.  As evidence supports the benefits of reflective journaling, students also choose one additional activity of gratitude journaling over a month’s time or selected a medium of their choice (e.g. art, poem, picture, video, affirmation, etc.) representing their personalized self-care approach, and created an individual written “commitment statement” of caring for themselves.  Qualitative data was collected upon completion of these activities.   Purpose:  To provide education and self-care activities/approaches to senior nursing students prior to the launch of their career, thereby fostering self-care and prevention of compassion fatigue and burnout in the nursing profession.    Findings:  Overwhelmingly students’ surveys and qualitative remarks indicates their understanding and appreciation of self-care assignment activities which provided engagement and personal wellness, ultimately decreasing the potential for compassion fatigue or burnout within their career.   Conclusion:  Education concerning compassion fatigue and nurse burnout are important topics to address with senior nursing students as these issues are highly prevalent among nurses, with likely potential for negative effects on nurses’ lives, their career, and patient’s outcomes.

  • Reframing symptom management for nurse educators (N. Pool, M. Koithan)

    • ​Background: One of the primary roles of nurses is to support patients and families in managing unpleasant symptoms. Integrative interventions improve patient outcomes, and may be more cost effective than the largely biomedical approaches currently taught in the majority of nursing programs. Despite this being an essential skill for nursing students to master, applying an integrative framework to symptom management can be challenging for nurse educators who lack resources and exemplars to facilitate effective learning in this area of instruction.       Purpose: To describe best practices and effective teaching-learning strategies for nurse educators seeking to reframe patient assessment and symptom management using an integrative framework.   Findings: Reframing this skill is an iterative process requiring that nurse educators: 1) understand the foundational concepts and philosophical underpinnings; 2) critically evaluate current assessment and symptom intervention and evaluation practices while identifying opportunities for modification that better align with integrative values; and 3) demonstrate proficiency in case-based learning scenarios using a variety of exemplar tools and extensive peer-faculty coaching. The case-based scenarios cover a total of 9 common symptoms and call for the full range of interventions to be implemented along a least-to-more invasive continuum. Challenges include accurately matching symptom intensity to an appropriate intervention; streamlining the intervention plan; and adjusting timelines and expectations in terms of assessing intervention response.  Conclusions: Nurse educators who undergo this process report being better equipped to embed the integrative model into assessment and symptom management instruction with nursing students. Allowing for multiplicity and nurse educator expertise in the process is essential.

  • Nursing education reform: Perspectives for integrative nursing (R. Ammende)

    • ​2020 a major reform in nursing education in Germany will be implemented, which will open up possibilities to introduce integrative nursing concepts. A brief outline of the reform will be presented, as well as the current work on the curricula for the theoretical and practical nursing education. The paper focuses on concepts and contents in the future curricula which are in line with key concepts of integrative nursing.

  • Teaching compassion in an end-of-life course for senior nursing students (M. Costello, A. Barron)

    • ​Background  The Institute of Medicine recommends that clinicians across disciplines and specialties who care for people with advanced serious illness should be competent in basic end of life care, including communication skills, interprofessional collaboration, and pain and symptom management. The American Association of Colleges of Nursing (AACN) acknowledges that much has been achieved in nursing education since 1997 in relation to serious illness and palliative care and acknowledges that more is needed if nursing students are to be well prepared to offer highly skilled and compassionate care to patients and families facing serious and life limiting illnesses.  Purpose The authors utilized the ELNEC Core Curriculum and Jean Watson’s theory of Transpersonal Care and the Caritas Processes™ in teaching students compassionate care in the course, Caring at the End of Life.  Findings The ELNEC curriculum and Watson’s Caritas Processes™ and concepts of caring moments, and multiple ways of knowing were integrated into each of the course modules.  Through readings, videos, lectures, guest speakers, discussion, reflective journaling, and other assignments, students were introduced to the foundation of end of life care and Caring Science as they addressed issues faced by patients, families, and health care providers at the end-of-life.  Conclusion: Students began the course describing a lack of confidence in relation to addressing the sensitive and important issues regarding advanced serious illness care. Following the course students were more aware and confident about providing compassionate care at the end of life and recommended that the course be required for all nursing students.

  • Integrating wisdom as contemplative pedagogy for 21st century nursing students (S. Williams, R. DeGennaro, D. Fontaine)

    • ​1. Background Based on evidence of  benefits of mindful and appreciative practices in improving patient care and reclaiming elements of humanism in healthcare, UVA School of Nursing initiated  Wisdom in Nursing  (WIN) in the baccalaureate program  2. Purpose WIN is designed to foster wisdom in nursing students within the context of a longitudinal patient partnership (LPP) and framed within a cognitive, practice-oriented matrix. WIN starts with a fall course laying the foundation for the curriculum, including didactic, experiential and interactive dialogue to teach concepts including wisdom, resilience, and compassion. Students experience the inner workings of mind and body, enabling them to integrate the practices. In the LPP students follow one patient for their final 2 ½ years. Acting as advocate, confidant, and caregiver, WIN students learn to apply cognitive, reflective, affective skills in working with patients, while maintaining the core of compassion that initially brought them to the profession. 3. Findings  The WIN program builds on the Phronesis Project started in 2014 at UVA Medical School. The project is now being integrated into the entire medical school curriculum.  WIN is adapted for nursing education and retains the essential components that made the Phronesis Project so successful.  4. Conclusion  The Qualtrics software system will measure outcomes using research instruments assessing student progress in wisdom, resilience, mindfulness and coping. This WIN experience is designed to foster improved clinical & relationship skills, self-care and compassion.  Graduates of this innovative program will  be empowered nurses that are critical change-agents in a health care system that deeply needs it.

Session 11: Clinical Care

Location: Ballyvaughan Suite

  • From sick care to health care: The Veterans Administration’s radical redesign of health care (J. Wagner)

    • ​In 2011, the United States' Veterans Health Administration (VHA) established the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) with the lofty goal of transforming the nation's largest healthcare system from one of "sick care" to one of "health" care. This "Whole Health" System is designed to move from episodic care to a more ongoing engagement with Veterans throughout their lifespan focusing on the Veteran's personal health and life goals through personalized, proactive, and patient-driven care. Comprised of three components, the Whole Health System includes; The Pathway-introduces Veterans to Whole Health concepts from the moment they seek care; Well-Being Programs-offer integrative health services and approaches to health and healing; and Clinic Care-embeds Whole Health principles within all clinical care. The Whole Health model is illustrated by the "Circle of Health" or the Components of Proactive Health and Well-Being. The Veteran is in the center of the Circle honoring their expertise in their own life, values, goals and priorities. In early 2018, 18 Whole Health Flagship sites were established around the United States and designed to deeply embed the Whole Health approach into everyday care of the Veteran. Evaluating the effectiveness of the Whole Health System includes collecting outcome measurements that will assess changes in the Veteran's perceived improvement in health and wellbeing, sense of life meaning and purpose, engagement in their health care and management, goal setting and attainment, experience of patient-centered care through healing relationships, as well as other important health factors. Data collection and analysis was initiated in late 2018.

  • From vision to reality: One integrative program’s journey to establishing a presence in an academic healthcare institution (J. Wagner)

    • ​In 2015, the Minneapolis VA Health Care System hired two nurse practitioners to establish and develop an Integrative Health Program within a large, long-standing academic/research medical facility. This presentation (or workshop) offers one team's journey from a fragmented presence of integrative-minded providers in various departments and specialties, to a broad dissemination of integrative health approaches including a nurse practitioner-run Integrative Health Clinic, and the opening the Center for Integrative Health and Healing offering acupuncture, yoga, tai chi, mindfulness meditation, iRest Yoga Nidra, integrative nutrition, and other integrative therapies and educational offerings. Lessons learned, challenges to expect, and key elements of success will be shared along with data analysis from outcome measures collected from patient and healthcare facility perspectives. The goal of this presentation/workshop is to support and encourage nurses to move forward with their passion and vision for bringing integrative approaches to their work environments despite any perceived barriers, and how to effectively collaborate with key stakeholders to optimize success.

  • Shifting paradigms at the bedside: How to create, implement and sustain a holistic model of care (T. Verner, A. Quarberg)

    • ​Integrative therapies are making their way into main stream hospitals across the country in a variety of formats--some of these formats are more sustainable than others.   Purpose: This presentation will allow participants to learn one method of cultivating a successful integrative care model in the acute care setting.   Background: Over the past 4 years The Integrative Services Team has led work in creating an Integrative Care model at 3 short term acute care hospitals.  This occurred primarily by providing education and resources that empower staff who provide direct patient care to offer integrative therapies at the bedside.       Findings: Nurse testimonials, chart audits, and nursing survey results will be presented as evidence of the success of this model. The innovative methodologies which resulted in improved sustainability of the holistic model of care will be discussed including; the systematic coordination of education, importance of role modeling, and the cornerstone of beginning with self-care for front line staff and leaders.   Conclusion: We are all aware that there are major areas for growth in the healthcare sector. The time is now for Integrative Care to come to the forefront in how systems operate. We want to share one way in which an Integrative Care model can be implemented and sustained, all with the goal of helping patients and staff feel more empowered and cared for.

  • Be careful what you wish for: Implementing an integrative medicine department in academic healthcare setting (H. Gujral, R. Sheinberg)

    • ​Background: There is growing evidence that current conventional medical care is often not sufficient. The landmark Eisenberg studies have demonstrated strong market trends of consumers actively seeking and utilizing complementary therapies in the U.S. for disease management and to optimize wellbeing.  Purpose: To meet the current consumer demand and to stay abreast of the recent trends in healthcare, this hospital’s leadership decided to open a full scale Integrative Medicine department.  Findings:  An Integrative Medicine department recently opened its doors to integrate conventional care with complementary modalities like acupuncture, massage, yoga, meditation and mindfulness. These innovative practices to cultivate wellbeing and resilience among patients and employees were implemented. Clinical symptoms were targeted using guided imagery, acupuncture, massage, essential oils, yoga and meditation classes. This organically created fertile ground for delivering compassionate care aimed to reduce opioids and other high risk medications traditionally used to manage our patients’ symptoms and address clinical burnout by enhancing staff self-care and resilience. In creating our brand new department where innovation is the foundation to target wellness for all, we also became the agents of organizational transformation. Little did we know expected and unanticipated challenges, roadblocks and barriers would need to be overcome one by one creatively.   Conclusion: Even though it was a deep desire of this Nurse Practitioner and Physician to be a part of Integrative Medicine department driving culture change, they did not fully realize what they were getting in to. Come hear the story filled with triumph and challenges!

Session 12: Mental Health

Location: Inishmaan

  • Complementary therapies and social psychiatry (A. Lunde, D. Dürr, H. Johannessen)

    • ​Background: Danish municipalities offer rehabilitative care and support for people with severe mental illness, and the rehabilitation involves a recovery-orientated focus. International studies show that the use of complementary therapies (CT) is higher among persons with mental disorders than in the population at large, and rumors say that several psychiatric residential homes in Denmark offer various CT like massage and ear-acupuncture.   Purpose: This project examines the prevalence of CT in psychiatric residential homes, explores residents and employees experience with these interventions, and investigates if and how residents and employees find CT relevant in recovery processes.  Methods: The study use mixed methods including participant observation, interviews, questionnaires and focus groups in four strategically selected psychiatric residential homes in two regions of Denmark. Data were collected from January to October 2017 and content analysis and descriptive and analytical statistics were made.  Findings: CT are used in various ways; as integral rehabilitative intervention, acute treatment, as alternative to PN medication, in therapeutic courses, and as body-mind interventions. Ear-acupuncture is most commonly used (38 %) followed by music therapy (37 %). 40 % of respondents “strongly agree” that CT strengthens their recovery process and physical symptoms are the main reason for using CT. In relation to recovery, employees emphasize CT as a learning possibility and a way to normalization.   Conclusion: CT are common in psychiatric residential homes and both employees and residents believes such interventions to strengthen a recovery process. In rehabilitation, CT offers a holistic approach working with both physical and mental symptoms.

  • Calming the storm: Treating anxiety disorders with mantra, breath, and mudra (K. Wilmering)

    • ​Anxiety is the plague of our times. According to the World Health Organization, 615 million people suffer from at least one form of an anxiety disorder, with the usual intervention of medication only partially effective. Even the highly-touted practice of Cognitive Behavior Therapy leaves many still suffering. Healthcare providers need a toolbox of self-regulating practices that they can teach their anxious patients. Other cultures with minimal access to conventional medical care have cultivated their own tools over the millennia. This 2-hour workshop will teach participants two or three (depending on flow of the group) of these simple energetic practices that use a combination of breath, mudras (which are hand or body positions that facilitate useful changes in the body-mind-spirit), and mantra to calm persistent anxiety. They will gain:   - an understanding of recent research findings on the polyvagal system's role in all aspects of anxiety,     findings that support the use of the practices they will learn.  - A basic understanding of the energy anatomy of the body.  - Knowledge of supporting research on nasal cycles and circadian rhythms.   - Tools that not only help their patients but also allow themselves to experience the deep calm that     supports joi de vivre and robust physical health.  These tools are applicable to many settings: primary care, psychiatry, public health, hospital.

  • Addiction recovery: An example of holistic healing (M. Manthey)

    • ​This is a presentation on the value of seeing addiction recovery as a model for holistic healing through whole-person transformation.  Substance use disorders (SUDS) in nurses are often considered a moral failure, rather than an acute and chronic condition that affects the mind, the body and the spirit.   Unless treat holistically, treatment results often end in relapse.   Addiction is a disease for which   conventional treatment 'per se' does not solve the problem.    At best, it opens the door to a real, transformational recovery of this chronic condition.    This kind of recovery results in individuals living a much healthier and more satisfyingly successful life.   Transformational recovery is achieved through a process of experiential learnings, often acquired through telling story sharing around the experiential of a structured development process.  Research has demonstrated nurses-in-recovery manage self-care and work-life balance that enhances their professional practice.

  • What our PMHNP DNP graduates tell us about using integrative therapies in clinical practice (M. Kaas, E. Geiger-Simpson, G. Kristófersson)

    • ​Background: In 2010 faculty teaching in the University of Minnesota School of Nursing, Psychiatric/Mental Health Nurse Practitioner Doctor of Nursing Practice (PMHNP DNP) program developed a new curriculum which emphasizes integrative mental health.  Fifty-five students, both BS-DNP and Post Graduate PMHNP DNP, have graduated.    Purpose: To assess the impact of our curriculum on clinical practice, an electronic  survey was emailed to the graduates asking them about their use of integrative approaches in clinical practice, therapies they refer out to other practitioners,  integrative therapies used for their own self-care, and benefits and challenges they have experienced using integrative therapies in their clinical practice.    Findings: Forty-two percent (N=23) of graduates responded to the survey.  Integrative therapies they used most often in clinical practice were deep breathing, nutraceuticals/supplements, aromatherapy, and meditation.  Integrative therapies referred to expert practitioners were acupuncture, mindfulness-based stress reduction, massage, and aerobic exercise.  Deep breathing, massage, aerobic exercise and nutraceuticals/supplements were the self-care practices used by the majority of graduates. Graduates identified improvements in their patients’ depression and anxiety, sense of health and well-being, and sleep by using integrative therapies. They also noted that their use of and/or recommending integrative therapies improved therapeutic relationships between them and the patients, and patients’ attitudes toward treatment. The main barriers included insurance, time, and organizational support.    Conclusion: This presentation will describe more detailed survey results and their implications for PMHNP education and clinical practice, including future curricular revisions to enhance our PMHNP DNP students’ capabilities to use integrative approaches.

Concurrent Session III

Thursday, May 23

2:45pm-4:15pm

Session 13: Workshop: Leadership/Systems​

Location: Lettermore Suite

  • The impact of the ‘Caring Behaviours Assurance System’ © on Leadership and Culture (S. Smith, A. Cavanagh)

    • ​Background Interim report - Francis (2010) of quality at the Mid Staffordshire NHS Trust in the UK, highlighted culture, staff attitude and behaviour, compromised service user needs.  Purpose  To address these issues, the Scottish Government’s Directorate for the Chief Nursing Officer, Patients, Public and Health Professions (CNOPPP), Persons Centred Delivery Group, commissioned a programme called ‘Caring Behaviours Assurance System’© (CBAS) from a company called Choice Dynamic International. By May 2015, 220 individual teams across nine NHS Boards in Scotland had implemented the system. Research conducted in the Golden Jubilee Hospital in Scotland reveal improvements e.g. two measures adopted – ‘Healthcare Environment Survey’ and care and compassion assessed using the ‘Caring Professional Scale’ plus qualitative survey.  Findings  Improved outcomes for three groups: Practitioners, patients and managers. Examples: Post CBAS results Practitioners– Leadership and Job satisfaction: All dimensions of job satisfaction, both socially and technically, were above the midpoint of 4.0, indicting more satisfaction.  Patients - Staff satisfied with their jobs were also the employees who were able to demonstrate behaviours of compassion to patients - Compassion predicted: Quality of patient care as perceived by employees  Managers – Action Plan submission to the Executive Board has improved overall assurance and accountability at every level for quality.  Conclusion  This system has since been adopted by the republic of Ireland due to its success. Francis, R (2010) Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust, January 2005 – March 2009. London. The Stationery Office Scottish Government, (2010).The Healthcare Quality Strategy for NHS Scotland.http://www.scotland.gov.uk/Publications/2010/05/10102307/1 [Accessed 10/05/12]

  • Enabling and Facilitating a Person-Centered Environment (M. Hardiman)

    • ​Background  There continues to be ongoing concerns related to the culture within hospitals and healthcare settings in Ireland. These concerns have emerged following repeated high profile failures by healthcare organisations to meet minimum standards of care and shortcomings in adequately addressing the care context and culture. The influence of Critical theory on the Practice Development literature and specifically on the development of a person-centred culture (McCormack, McCance 2017) provides a framework for significant cultural shift in hospitals and healthcare settings.  Purpose This presentation will introduce a programme of work involving the development of nurses as work-based facilitators of a person-centred culture in an acute hospital setting. The programme uses a specific facilitation method, Facilitation on the Run (Hardiman, 2017), designed to provide the supports and skills necessary for the development of a person-centred culture.  Findings  Enabling the development of work-based facilitators and providing them with a network and support to develop a culture of person-centredness has resulted in a cultural shift and improved experiences of care for both the patient and the nursing team. Outcomes include a radical reduction in complaints; the attraction of high quality candidates and the retention of staff within a highly competitive market. Conclusion  Cultural transformation is a slow process which will not happen without intentional and purposeful actions from within the organisation. Facilitation on the Run (Hardiman 2017) offers methods and tools to create the conditions where cultural transformation and the existence of a person-centred culture becomes a reality.

Session 14:  Workshop: Nurse Quest: Let Nature be Your Guide and Mirror to the Essence of Your Work in the World

Location: Inisheer

  • Background: Life in the fast-lane doesn’t always make accessing your inner wisdom easy. In the old days, people went on long journeys into the wilderness, or fasted for days or lived in monasteries to learn the methods of opening their gateways to inner guidance.  But in our modern world, we need methods that are accessible right from our own front doors and ones that can be applied right in the moment. One way to do this is to develop a deep relationship with Inquiry.  Purpose: NurseQuest uniquely blends indigenous nature-based wisdom traditions with integrative nursing and coaching methods to help us connect to the vast guidance streaming in from the natural world. This allows us to uncover the insights and action steps that are ripe to emerge and guide us in our work.   Findings:  The NurseQuest is a walk taken in nature while holding a Question of importance, relevant to our work or personal life. From this workshop participants will, frame their Inquiry related to an important question for their work, take a 20 minute solo walk on the Conference Grounds to tap into Nature as messenger and wisdom guide, have the journey of their solo time be mirrored by a partner receive and apply them to their work and life.  Conclusions:  This workshop prepares participants to use this method for future questions and as a guide to their leadership, entrepreneurial work, as educators and clinicians. The result will be to know where to place their energy and amplify their work in the world.

Session 15: Clinical Care

Location: Inishmaan

  • Healing through the seasons through Chinese Medicine and Five Element theory (T. Toledo)

    • ​Background  Worldwide, Eastern and Western medical theory and modalities combined can offer an integrative approach to facilitate healing the whole person.  Treatment based on acupuncture and the five-element theory of Chinese Medicine:  Wood (spring), Fire (summer), Earth (late summer), Metal (autumn) and Water (winter), teaches us to fully embrace the powers of the season. Each element has specific characteristics and runs through a generational cycle which transforms it into another element.   These seasons are designed to enhance one’s innate healing energy and realign imbalance in body, mind, emotions and spirit. Purpose Care based on acupuncture and the five-element framework will develop into a personalized master blueprint that diagrams nature’s interactions with the body and how the different dimensions of our being impact each other, contributing ultimately to the well-being of each individual. Findings Twenty-seven patients were treated in a private clinic over the course of one year, 2017.  Nine males, average age 74.3 and 18 females, average age 74.1.  They were referred by their primary care physician and the insurance company for pain control for a total of 6 visits for the year.  They were treated with acupuncture, nutritional counselling and tuina (Chinese massage) based on the season in which they were seen.   Conclusion As a direct result of positive patient outcomes, insurance coverage for acupuncture and Chinese Medicine doubled in 2018 and tripled for 2019.  Further research of this modality could lead to increased integration between Eastern philosophy and Western medicine.

  • Patient advocacy in an obstetric setting (L. Heelan-Fancher)

    • ​Background Patient advocacy is associated with improved patient outcomes. A theoretical definition of patient advocacy in nursing is safeguarding a patient’s autonomy, acting on their behalf when they are unable, and championing social justice. The routine practice of using continuous fetal monitoring (CEFM) is not based on evidence and doesn’t take into account a laboring woman’s beliefs or values.   Purpose Patient advocacy is a nursing value, but little is known about what factors either individually or collectively contribute toward nurses being patient advocates. Using Rogers’ Science of Unitary Human Beings, a correlation study design was used to examine the interrelatedness of power profiles, attitudes regarding intermittent fetal monitoring, and perceived barriers to research utilization with labor and delivery nurses’ (n = 248) attitudes toward patient advocacy.  Findings The linear combination of the 3 independent variables was significantly related to attitude toward patient advocacy F (3, 244) = 15.36, p ≤ .001.  The variable power as knowing participation in change had the greatest influence on patient advocacy as evidenced by the standardized beta (B = .356), and showed a small to medium effect size (.19).   Conclusion The willingness to change practice from CEFM to intermittent fetal monitoring is not based on the evidence or attitudes regarding intermittent fetal monitoring per se, but is based on the dynamic role of power as knowing participation in change and the nursing value of patient advocacy.

  • Aromatherapy deep dive: Safety of an essential oil program in an academic hospital setting (E. Anderson)

    • ​B  The impetus for this project was a seriously ill child within our facility experiencing adverse changes to lab values of a critical medication. An interdisciplinary effort determined exposure to aromatherapy products brought from outside to be the problem. The integrative team evaluated the situation, and identified questions relating to specific oils that could potentially increase risk for our most vulnerable patients; in particular the essential oil of peppermint. We assembled a nurse-led interdisciplinary group to assess the aromatherapy program regarding the level of acuity and vulnerability in our patients. P  The interdisciplinary group was asked to review our aromatherapy program to construct updated evidence-informed recommendations for appropriate changes to precautions or limitations. In the absence of national norms, we looked for community and peer standards in precautions related to peppermint, as well as standards for educational preparation for nurses initiating aromatherapy interventions. We took an informal poll of 9 hospitals/health systems, and conferred with chemists in the field of essential oils. F  Many institutions have endeavored to use the literature to create safe programs, and have emerged with different conclusions. The literature with the most concerning results comes from research using essential oils orally or in vastly greater doses than our patients receive. Hospitals we polled expect nurses to take aromatherapy education.  C  Recommendations regarding peppermint precautions, and nursing education, were taken to Leadership and Nursing Practice Council for endorsement and support. Clarifying additional detail in precautions for peppermint needed to be dependent on support for required aromatherapy education. Online education updated.

  • Infusing essential oils in the clinical setting: Engaging nurses with aromatherapy to expand their practice (J. Tomaino, M. Halm, M. Hoffmann)

    • ​Aromatherapy programs have been implemented in many clinical settings. Choices on which essential oils to use for symptom management or self-care are often difficult to make, and changes are often required after initial program roll-out.  This presentation provides insight into selecting essential oils for specific indications, as well as patient and staff populations.  The presenters will share their expertise and rationale for which essential oils and delivery methods work best with various populations.  Presenters from different organizations will share their unique experiences with aromatherapy programs in a variety of hospital /clinic units including pediatrics, obstetrics, mental health, oncology, med-surg, and perioperative, as well as with staff.   Strategies for keeping aromatherapy programs under a nursing framework, while extending to interprofessionals as a method to expand the delivery of essential oils to patients and families will be explored.   Creative ideas on how to keep your aromatherapy program robust and sustainable will also be discussed.  Discover how to adapt your program based on changing needs of patients and staff to keep staff engaged with using essential oils that have the most evidence for impactful use.  While research can be intimidating, it also engages nurses to review the literature and become champions of essential oil use.  Learn how to implement documentation that aligns with standard nursing workflows, and simple data collection methods that engage staff to monitor the effectiveness of the oils used in their practice.  The presenters will share preliminary results of a QI/research study investigating an essential oil to relieve acute urinary retention.

  • Therapeutic touch: A global healing modality (J. Cornman)

    • ​Therapeutic Touch (TT), as defined by the international organization for TT, as a holistic, evidence-based practice that incorporates the intentional and compassionate use of universal energy to promote balance and well-being.  Therapeutic Touch has been a recognized energy healing technique since the early 70’s in the United States. Soon after its conception, the modality began to spread around the world with the publication of TT books in other languages, and its acceptance in hospitals and nursing education in the US and Canada. TT has one of the most robust publication records including over 170 articles since the year 2000 describing research, the conceptual framework as well as applications to practice.  The purpose of this session is to speak about experiences in selected countries that represent the global expansion of TT, to discuss how the growth of TT practice has paralleled the conceptual growth of TT to inform a theory of healing and finally, how TT has supported practitioners in self-care by the essential step of centering in the TT process.  This overview provides the opportunity to discuss healing from a culturally holistic perspective.

Session 16: Spirituality

Location: Inishturk

  • Spiritual well-being as way towards increased overall health (L. Ronne-Petersen)

    • ​There is an urge to address the spiritual dimension of human nature in society, healthcare and science. Spirituality is considered important but there is a lack of research in the area.  Purpose: Adopting a salutogenic perspective, this study aimed to gain a deeper understanding of the spiritual dimension of human well-being, in a group of women with chronic pain, who had undergone integrative rehabilitation.   Method: A phenomenological hermeneutic method was used. Eight women with experience from integrative rehabilitation were purposively selected for interviews. Interview data was transcribed verbatim and analysed.  Results: The analysis resulted in seven themes, which were categorized according to the scientific questions. Themes one through four - meeting yourself and your history, reaching spirit through body, a healing environment, and to be lovingly cared for; all concern the experience of promoting and enabling factors for increased spiritual well-being, as described by the women. Themes five and six - sensing a divine presence and deep inner well-being; elucidated how an increased spiritual well-being is perceived and narrated. Theme seven - body and spirit as one, represent a feeling of wholeness, a mutual interaction between spirit and body, including pain. The significance of a synergistic whole were central to all themes.  Conclusion: A range of promoting factors for spiritual well-being were identified by the women, indicating the fact that an increased level of spiritual well-being may influence other dimensions of health, including pain.

  • EPICC project: Spiritual care education best practice for nurses and midwives (J. Whelan)

    • ​1.Background Contemporary evidence views spirituality as an integrative aspect of person-centred care. Professional regulation demands nurses and midwives address personal, religious and spiritual beliefs of patients as part of person-centred holistic care. How learners acquire spiritual care competences in undergraduate nursing education programmes is unclear, given the inconsistency that exists across Europe (Ross et al., 2014, 2016). Six international partners developed  ‘Enhancing Nurses’ Competence in Providing Spiritual Care through Innovative Education and Compassionate Care’ (EPICC) project over 33-months to July 2019 funded through an Erasmus+ KA2 Strategic Partnership Grant.  2.Purpose To develop a uniform spiritual care education standard directed towards the teaching of spirituality to undergraduate nursing and midwifery students across Europe.  To develop core spiritual care competences and a gold standard matrix for spiritual care education. To evaluate draft spiritual care education standard in Nursing and Midwifery Education in Higher Education Institutions.   3.Findings Minimum mandatory core spiritual care competences requirements refined from fifty three to ten competencies with distinct knowledge, skills and attitude sets. Spirituality is recognised as an aspect of person centred care and health promotion in Ireland. EPICC competency inclusions were demonstrated across national policy documents, nursing curriculi, and multiple care contexts. Overall there is a need to develop global spiritual literacy, increase students experiential learning and advance visibility in clinical practice around spiritual assessment,care planning, clinical decision making and patient documentation.   4.Conclusion  The development of spiritual care competence is essential to future proof nurses and midwives for practice requirements of 21st century healthcare.

  • Watson’s Caritas Processes® as a framework for spiritual end-of-life care for oncology patients (M. Costello)

    • ​Background: Spirituality is an important aspect of nursing care for the patient with advanced oncology illness, palliative care, and those at the end of life. Although nurses understand the importance of spiritual care, many feel ill prepared to provide spiritual care. The ability to connect with and embrace the spirit or soul of the other as they face life limiting illness is at the heart of providing spiritual care.   Purpose: A review of  the literature highlights the topic of spiritual care for the patient with advanced oncology illness, palliative care, and those at the end of life. The benefits and barriers to providing spiritual care is included in the review of the literature. .   Findings: The author, a Certified Hospice and Palliative Nurse (CHPN®) working at an inpatient palliative care unit in the United States, provides real life clinical examples of how nurses can utilize Jean Watson's theory of Caring Science and Caritas Processes® to provide spiritual care to patient's with advanced oncology illness, palliative care, and those at the end of life  Conclusion: Jean Watson’s theory of Caring Science and Caritas Processes® can provide a framework for the development of caring and healing practices that can facilitate spiritual care.   Costello, M. (2018). Watson’s Caritas Processes® as a Framework for Spiritual End of Life Care for Oncology Patients. International Journal Of Caring Sciences, 11(2), 639-644..

  • Inclusion of a spirituality course in nursing curriculum (M.E. Southard)

    • ​The nursing literature reflects spirituality in nursing from many countries including Saudi Arabia, Pakistan, Indonesia, South Africa and other European counties. While there have been studies regarding U.S. nursing students attitudes and perceptions of spirituality, there is not an emphasis on including spirituality within the clinical or educational discipline of nursing for RN’s or APRN’s globally. Statistics reveal that 75-90% of US medical schools have now incorporated teaching on spirituality and health, with the majority doing so as part of a required curriculum (Herschkopf, 2017). This  lag of educational coursework on inclusion of the spiritual domain does not support mind body spirit care.The focus on a bio-medical approach that excludes spirituality limits its importance for holistic patient -centered care.  Current literature suggests that by 2020, millennials will dominate the global workforce. Surveys of nurses demonstrate that nurse’s value spiritual care given to patients, yet  many RN and APRN’s may not feel comfortable or competent in this area. Honoring the patient’s story and being open and receptive to signs of spiritual distress, can impact both the caregiver and patient experience.  In this presentation, we will explore how a deeper understanding of spirituality can provide information  regarding the neuroscience of spirituality, its impact on resilience and ways to enhance one’s practice and presence with patients. Development of a spirituality course will help identify nursing’s role in mind-body-spirit health. It encourages a closer look at inclusion of a spirituality course, as more information is known about the influence of spirituality on health, wellness, and wellbeing .

  • Graceful presence: Using mindful movement for deepening divine connection (A. Quarberg)

    • ​Background: Providing a healing presence is the foundation of holistic nursing and a key factor in the first principle of integrative nursing. With ongoing pressure to do more with less time, and the burnout that is happening at an increasing rate among care givers, it is not surprising that being a healing presence is easier talked about then accomplished. ‘Graceful presence’ was the focus of my Master's work, in which I combined my passion for dance, mindfulness and presence all together. Purpose: This workshop will provide a unique and fun opportunity to make the mind/body/spirit connection for each participant, using a combination of didactic content and mindful movement for increased kinesthetic awareness. Moving mindfully naturally brings us back to center and the present moment and releases stress at the same time. As Jon Kabat Zinn reminds us, if we are not fully in the body we are not fully present. Findings: Having increased awareness of how we move, allows for a more embodied experience and access to our intuition and divine connection for ourselves and each other. Having taught nurses about presence and led groups of students and participants at conferences in movement, I have witnessed improved energy, focus and joy afterwards. Conclusion: Being a graceful presence is moving out of our head and into our body and soul; moving gracefully and grace-filled-ly. By being aware that we are grace-filled and connected to our divine essence reminds us that those we care for are also grace-filled and fosters a more therapeutic presence.

Session 17: Pain

Location: Ballyvaughan Suite

  • Facilitation of patient-centered approach in health of patients with chronic pain (K. Thorarinsdottir)

    • ​Background: A phenomenologically derived assessment tool, Hermes, was developed in a rehabilitation setting for adopting the central ideals of person-centered care and patient participation into health assessment practices in nursing.  Method: This focused ethnographic study aimed at exploring the feasibility of using Hermes for enabling the application of these ideals into assessment of patients with chronic pain upon admission to a rehabilitation centre. Participants were patients with 14 chronic pain, enrolled in rehabilitation, and 5 their nurses.  Data were collected by participant observation and interviews and analysed by thematic analysis.  Results: By the use of Hermes the impact of illness was explored from a holistic perspective through supportive connection and dialogue with open, reflective and interpretative features; understanding of the illness situation was enhanced; and possibilities provided in adjusting to health issues of concern.  Conclusion: Hermes facilitated person-centered participation of patients with chronic pain in their health assessment and made a phenomenological philosophy usable in nursing assessment practices.

  • Clinical meditation and imagery for self-management of pain postspinal cord injury (C. Gilchrist, C. Ortiz, J. Zanca)

    • ​Background: Pain is disruptive to the daily activities of people with spinal cord injuries (SCI). Clinical meditation and imagery (CMI) have been shown to have therapeutic value for pain control, however, their effectiveness in persons with pain post-SCI is not well established. The Kessler Foundation (New Jersey, USA) collaborated with integrative nurses to design and execute a pilot study of CMI interventions in individuals with chronic pain post-SCI.  Purpose:  To examine the feasibility and acceptability of CMI as a non-pharmacological approach for pain self-management in people with chronic pain post-SCI.  Findings: Perceived control over pain, depressive symptomology, and perceived stress improved to a greater extent in the CMI group relative to the control group with effect sizes ranging from large to small (d=0.97, 0.53, 0.21, respectively). Pain interference improved to a greater extent in the control group (d=1.23).  In interviews, CMI participants reported benefits including reduced pain while performing the practices, feelings of relaxation, and greater ability to “visit with pain” rather than “fight it”.  Members of both the CMI and control groups reported that they enjoyed social interactions with other class members, making them feel less alone.  Use of a web-based mode of instruction aided recruitment and retention of participants.  Conclusion: People with SCI were willing to learn CMI and reported mental health benefits and changes in their experience of pain. CMI warrants further study in larger-scale trials to determine its effectiveness as a non-pharmacological intervention to promote greater self-efficacy for pain management and enhanced quality of life.

  • Acupuncture for post-operative pain management (T. Rampley)

    • ​Background: Pain is often associated with increased healthcare utilization, poor overall health, and increased health-related disability (Nahin, Boineau, Khalsa, Stussman, & Weber, 2016).  Acute pain following surgery is one of the most common types of pain and typically managed with opioid medications that carry harmful side effects including respiratory depression, nausea, vomiting, itching, reduction in bowel motility leading to ileus and constipation and can ultimately lead to dependence and addiction (Seghal, Colson, & Smith, 2013; Garimella & Cellini, 2013; IASP, 2017).  The mainstay of postoperative pain therapy in most healthcare settings remains opioids (Garimella & Cellini, 2013). Acupuncture is a widely used treatment modality for pain and other conditions that has been utilized in China for more than 3,000 years (NCCIH, 2016).  Acupuncture has been shown to reduce postoperative pain, with little to no side effects, on the first day after surgery with reduced opioid use and a decrease in overall pain scores (Wu et al. 2016). Colorectal surgery is generally treated with large doses of opioid medications (Kirchhoff, Clavien, & Hahnloser, 2010).  Furthermore, colorectal surgery is often associated with prolonged hospital length of stay, high cost, and surgical site infection (SSI) rates over 20% (Carmichael et al., 2017).  Colorectal surgery readmission rates have climbed to nearly 36% due to SSI and difficulty managing pain.   Purpose:  A small pilot study to explore the use of acupuncture for acute pain management in the immediate postoperative period in adult patients recovering from colorectal surgery.  Findings: Pending.  Will be completed in February 2019

  • A program on integrative pain management: Helping nurses expand their toolbox (S. Hoffman, P. Koppel, C. Cuneo)

    • ​Background Integrative approaches to pain management (IAPM) are becoming valued and sought after in part due to the opioid crisis and current opioid shortages.  Many front-line practicing nurses lack skills and/or confidence in using IAPM.  Nurses are uniquely positioned to educate patients, healthcare colleagues, and organizations about IAPM. Incorporating IAPM into nursing practice will not only enhance patient comfort but also demonstrate the need for an integrative approach to patients’ health and well-being.   Purpose The goal of this experiential workshop is to educate clinical nurses about the use of IAPM with an emphasis on tools nurses can easily incorporate into daily practice.   Findings 20 nurses participated in this pilot training program. Program evaluations from the participants show that learning methods, including skills practice sessions, clinical simulation, at home case studies, and a webinar with expert nurse panelist, were effective strategies to teach IAPM.  19/20 participants would recommend that their nursing and interdisciplinary colleagues also participate in this type of training program.  IAPM taught that participants reported to be most beneficial:    -Engaging patients in assessment and ways to promote comfort   -Breathing techniques   -Guided imagery   Conclusion The workshop allowed participants to refresh and restock their toolbox with integrative strategies to augment and or replace pharmacological pain management.  Participants left with tangible and practical ideas and resources for implementing these skills into their own work and practice settings. Discussions are underway with suburban and city medical centers to host this training and increase access to IAPM skills to nurses.

Concurrent Session IV

Friday, May 24

10:30am-noon

Session 18:  Workshop: In the Footsteps of Nightingale: Becoming love, radiating light, healing ourselves and the world

Location: Lettermore Suite

  • Nightingale urged nurses to “strive to awaken the divine spirit of love in yourself, to awaken it in doing your present work, however you may have erred in the past.” Awakening the divine spirit of love (by whatever name) in ourselves and sharing it as light for the world is a core aspiration found across the world's wisdom traditions, placing nursing – in the lineage of Nightingale – squarely within the realm of spiritual practice/path. We are rightful heirs to a rich spiritual inheritance.  In this workshop, we will explore/unpack this and others of Nightingale's spiritual teachings as a source for radical (of the root) self/Self-care and healing and as a foundation for creating caring-healing relationships and tending the human spirit in our work as integrative nurses. Nightingale's wisdom will be augmented with other related teachings and practices from, for example, Jean Watson's Caring Science; the psychologies of Abraham Maslow and Karlfried Graf Durckeim; various spiritual traditions, including Buddhist, Christian, and Sufi; and the Perennial Wisdom which underlies all of the world's religions. Through a variety of teaching/learning strategies including presentation, dialogue, guided meditation/inquiry, sacred poetry, etc., we might begin to re-imagine our work in integrative nursing as deep spiritual practice; we might begin to reclaim our spiritual lineage and deepen our commitment to bringing love, light and healing into a world that couldn't need it more.

Session 19:  Workshop: Creating a Holistic Healthy Lifestyle through Healing and Wellness Coaching Practices

Location: Inishturk

  • Background:  Health Coaching empowers individuals to gain awareness, and successfully change beliefs and behaviors to gain greater wellbeing.  Current health care too often focuses on targeted disease management and minimization of morbidity, but leaves the empowerment and healing evolution of the patient out of the equation.  Supporting individuals to make intentional and sustainable life style changes is a critical responsibility not just for coaches, but for all health care providers.  Health Coaching returns the focus to a values-driven, strengths-based, activation of patients, creating the possibility for achieving their highest wellbeing.    Purpose: While Health Coaching is a new and evolving profession in its own right, its principles and practices may be used by any health care professional, including nursing, to transform their clinical experiences with patients, and also advance the provider’s own self-care and wellbeing.    Findings: Co-facilitators of this workshop share decades of coaching experience, and have successfully taught a range of health professionals to use these tools in a variety of clinical settings. Through the introduction of the 4 Pillars of Health Coaching model, we weave in experiential practices so that participants can leave able to immediately apply practical tools to their personal and professional lives, supporting healing and wellbeing for patients and selves alike.   Conclusion:  Using authentic communication practices in an intentional container of self-awareness and mindful presence, all health care providers can change the quality and effectiveness of their patient interactions.  Bringing such awareness into their own lives can build resilience and increase job satisfaction.

Session 20: Leadership

Location: Inishmaan

  • Embracing holistic leadership (S. Roe)

    • ​Embracing Holistic Leadership requires the full engagement of a leader's mind, body, heart, and spirit. When nurse leaders embrace these important holistic leadership dimensions they can positively manage the demands of change, promote and support innovation, can build and shape excellence, and be open to and available to inspire others.     This workshop presents "best practices in holistic leadership" focusing on holistic leadership dimensions of mind, body, heart, and spirit. Skills required are self-discovery, presence, resilience, and expressions of compassion and passion. Workshop participants have the opportunity to explore, discuss, and experience the following:    The Holistic Leadership Mind through Self-Discovery and Presence.  Activity: Presence Self-Reflection The Holistic Leadership Body through Resilience.  Activity: Resilience Checklist/Discussion The Holistic Leadership Heart through Compassion. Activity: Caring Expressions The Holistic Leadership Spirit through Passion.   Activity: Mindful Dreaming.   At the end of the Embracing Holistic Leadership workshop, participants put skills development/enhancement into practice by integrating these essential holistic leadership dimensions and then completing a Holistic Leadership Blueprint for Action.

  • Moving from complementary care to integrative care through collaboration (N. Strybol, M. Busch)

    • ​Background Complementary Care as a concept was introduced in The Netherlands in 1996, being defined as: nursing interventions embedded in the nursing process based on traditional therapies aimed to support, stimulate or activate the self healing process of the patient. Included interventions are biological, manipulative, mind-body and biofield interventions.The purpose is to enrich nursing towards whole person care. During the past 20 years the Dutch Nursing Complementary Care Association (DNCA) elaborated the concept resulting in education programs, a manual, a complementary nurse profile, a bachelor nursing program and guidelines for case reports.Thousands of nurses were trained to implement complementary care interventions. Although the aim of the DNCA was to integrate complementary interventions into nursing care "complementary" nursing interventions remain "complementary": they are "added" to standard care. Purpose Using all that is achieved to make the transition from complementary care to integrative care. Hereby following the steps of a collaborative (inquiry) process to facilitate learning from experience. Findings The first step in the collaborative inquiry process has been set, in which a group of complementary nurses, researchers and leaders explored the question at stake and decided to engage as peers in a learning process consisting of repeated steps of reflection and action. This road map has been formally endorsed by the DNCA. Conclusion Transforming the challenge of implementation of integrated care into a collaborative inquiry process in which the expertise of all participants is appreciated, has shown to be a promising method to help shift from complementary to integrative nursing.

  • The power of green care: How nurses can integrate green therapy into settings to address wellness outcomes (M. Williams, L. Radville)

    • ​Background In an integrative nursing practice, creating green spaces to improve nutrition and add green spaces can enhance wellness.  Most people do not the eat nine fruits and vegetables that WHO recommends for health. Obtaining the half hour of daily exercise, ideally in outdoor space, is also a challenge. Research shows that exposure to green spaces provides mental wellness and neuro-emotional benefits.  The Openlands program installs “green schoolyards” in Chicago, benefitted students dually: providing nature-based play settings and creating community vegetable gardens. An alternative green nutrition intervention is an aeroponic tower garden that requires lower maintenance than traditional gardens and has easily been integrated into community sites.   Purpose These Nurses will discuss the physical and socio-emotional outcomes of diverse types of green care. The settings included schools, centers for developmentally delayed persons, long term care facilities and community centers in diverse geographical areas.   Findings In all the settings, persons developed an increased interest in eating more fresh fruit and vegetables through their nurse led gardening activities. Persons demonstrated increased motivation to improve health via better nutrition.  Behaviors indicating more calmness were observed in autistic and persons with special needs with green therapy. In addition, the tower garden served as a mobile experiential learning unit resulting in improved academic learning in the science and social science school standards. Conclusions  A nurse can act as a change agent within a community health setting to design experiences to address wellness outcomes in all populations. Green Care is an effective way to do so.

Session 21: Provider Self-Care

Location: Inisheer

  • Multi-modal approach to self-care transformation in ICU clinicians (P. Robinson, A. Sawyer, K. McManus)

    • ​Background: A diverse group of healthcare professionals, including a nurse scientist, nursing leaders, and licensed mental health clinicians, have worked together to embed and study four self-care interventions to improve communication excellence and resilience and decrease moral distress and burnout among ICU clinicians.   Purpose: A mixed-methods study of PEACE Rounds, which are interdisciplinary rounds led by ethics, nursing, and medicine, will determine their impact on communication excellence and  conflict resolution. A qualitative study on Compassion Rounds, which is a practice for patient-centered whole-person self-care to reconnect with purpose in one's professions, will explain how they are conducted with patients, families, and healthcare providers and their impact on participants. A randomized controlled trial of a one-day Johnson & Johnson resilience course for RNs will determine whether it improves psychological and physical health, as well as unit-level outcomes. A mixed-methods study of a psycho-educational program with the themes of RISE (Resilience, Insight, Self-Compassion, Empowerment) will determine whether it has a positive impact on RNs with high burnout.   Findings: Final results will be available for these four studies by March 2019. Preliminary results show that these practices reduce burnout and increase intent to stay in the profession of nursing for intervention group participants.  Conclusion: We propose a workshop or podium presentation to give practical implementation guidelines to replicate some or all of these interventions at other facilities. Ultimately, strategies to optimize resilience and to keep discourse civil would be taught during nursing education and graduate nurse orientation for a more proactive approach.

  • Sit still like a frog and thump like a gorilla (J. Cornman)

    • ​The prevalence of emotional trauma due to abuse, neglect, poverty, and witnessed violence is finally being recognized as a major health challenge. Given the high rate of ACEs (Adverse Childhood Experiences) encountered in our children and the adults in the care taking role, nurses can teach and utilizing integrative methods to calm, soothe and hopefully ameliorate the damage to nervous system and epigenetic effects of these negative experiences. This presentation will discuss two methods - mindfulness meditation and tapping or EFT (Emotional Freedom Technique) that can help boost the resilience of this population effected by ACEs.  Evidence of the efficacy of both methods will be reviewed. Participants will have the opportunity to practice each method using familiar images and non-threatening exercises. These integrative, noninvasive, and healing methods are easy to do, apply to anyone experiencing stress, and provide individuals with self-care techniques that empower them to thrive.

  • Change Your Breath, Change Your Brain: 3 easy techniques nurses need to know! (L. Ellis-Young, N. Chakrin)

    • ​Background: “The sixth principal of integrative nursing focuses on the health and wellbeing of caregivers as well as those they serve with activities that nourish the body, mind and spirit.” The capacity for compassion and empathy is at the core of the nursing profession. For a nurse’s own health and wellbeing this capacity must include oneself and be the foundation from which outward caring flows.  Oftentimes nurses can feel they are running on empty.  Simply and powerfully our breath is our fuel with refueling capabilities always available. Workshop Overview: In this experiential workshop you will learn and practice six evidence-based techniques to cultivate breathing optimally for wellness, relaxation, focus and energy— including mindfulness breath awareness, diaphragmatic breathing, alternate nostril breathing and the Heart Breath. These techniques can effectively lower stress and anxiety within seconds to minutes. Results of a 21-Day Minnesota medical clinic staff Mindfulness Optimal Breathing pilot program will be reviewed.

  • Listen like a poet (F. Abralind, H. Gujral)

    • ​The Poets In Residence program brings poets to hospitals to help people. We listen, one on one, then write custom poems and present them to the recipients.   Started at Sibley Memorial Hospital, a community hospital in Washington, D.C., ​Poets In Residence recognizes the medical experience as more than just physical. It uses the power of deep empathetic listening to support an atmosphere in which the hospital address people as humans first. It underscores the humanity of the healthcare experience. We've found that the greatest impact of the PIR program comes from the simple act of empathetic listening: poem recipients often comment on how helpful it was to simply be heard.   Our poets make themselves available at designated locations and engage with any curious person who comes up to talk. Our primary focus is on hospital staff. Though we sometimes talk with and write for patients and visitors, we generally stick to employee-only areas like break rooms. We strive to support employee wellness, nursing resilience, and joy in medicine.   This interactive workshop, which recently received enthusiastic positive response at a design conference in Berlin, will focus on tips and best practices for empathetic listening. I'll also share some of our poems and their stories. You can see some examples of the poems and stories at http://poetsinresidence.org.

Session 22: Clinical Care

Location: Inishmore

  • Creating an acupressure-based program in a Boston cancer institution (E. Vallatini, S. Hoffman)

    • ​Background Nurse are chronically under high stress in their everyday practice.  Chronic stress reduces resiliency and creates imbalance in the body-mind-spirit.  The nurse’s role to create healing relationships with patients is negatively impacted. Teaching and supporting integrative strategies to mitigate the negative impact of stress and to support the body’s innate healing abilities is an effective way to improve nurse self-care and patient care.    Purpose The purpose of this innovative workshop is to teach the elemental knowledge and skills of acupressure being taught to nurses and staff at our Boston cancer center. Participants learn simple yet powerful techniques to reduce anxiety, relieve stress, and re-balance basic energies   Findings The outcomes of our ‘Acupressure for Self-care’ workshop (2016 – present) and the acupressure-based ‘Flu Shot Anxiety?’ instructional video project (2018) will be shared.   To date 34 nurses have attended the workshop and their reflections illustrate our program goals:  “Very useful quick techniques to help relieve stress and anxiety”  “Definitely a new tool in my nursing tool box”  “I was reminded if I’m at my best (self-care) my nursing practice will be at its best”  Symposium participants will have an opportunity to learn the techniques taught in the workshop, based on the principles of acupressure, mindful movement and the teachings of current energy medicine pioneers around creating a healing environment for self and others.   Conclusion Teaching the integration of Acupressure-based Self-care techniques to nurses and other healthcare providers is a powerful strategy to help manage stress, anxiety and promote healing.

  • Integrative therapies in pediatric blood and marrow transplant patients (M. Anderson, M. Voss)

    • ​Background  Pediatric Blood and Marrow Transplant (BMT) patients are among the most vulnerable health care patients.  These patients often experience extreme symptom burden including, but not limited to, gastrointestinal distress, insomnia, isolation, fatigue, anxiety, depression, deconditioning, mucositis, headaches, and musculoskeletal pain.  Due to vulnerability, complexity, varying developmental stages, and complicated data collection there is minimal research exploring the utilization and effectiveness of integrative therapies among this population.  The majority of research involving pediatric patients and integrative therapies has been completed within the oncology and behavioral/mental health populations.  While this research is relevant and guides the implementation of integrative therapies, it needs to be expanded.  Integrative therapies offered on the pediatric BMT unit include: essential oils, acupoint, biofeedback, breath work, clinical hypnosis, massage therapy, energy therapy, guided imagery, mindfulness meditation, and music therapy.    Purpose  The primary purpose of the investigators is to determine the utilization and effectiveness of integrative therapies among pediatric BMT patients.  A secondary aim is to determine if the Self-Assessment of Change tool captures the effectiveness of integrative therapies among the pediatric BMT population.   Findings  Study design and data collection are currently in process.  Preliminary findings will be discussed during presentation.   Conclusion  Integrative therapy is standard care offered to pediatric BMT patients at the University of Minnesota Masonic Children’s Hospital because of the feedback received from patients, family members, and interdisciplinary team members.  It is imperative to develop studies and contribute to available research demonstrating the profound effects integrative therapies have among pediatric patients.

  • Improving interprofessional whole person health care: Functional nutrition and mindful eating in patients with spinal cord injuries and neurologic disorders (K. Erickson, C. McGovern)

    • ​Background: Evidence-based complementary and integrative health education and services are increasing in demand among patients.  New care models and personalized assessment tools offering integrative wellbeing programs in conjunction with conventional biomedical interventions in healthcare are shifting to a whole-person, whole-systems approach.  Purpose: To introduce and evaluate components of the Whole Health (WH) model and Personal Health Inventory (PHI) tool to improve patient-centered/value-based care and food environment awareness while conducting whole-person educational interventions surrounding functional nutrition and mindful eating. An interprofessional, group-based, pre/post design using a convenience sample of inpatients and outpatients with spinal cord injuries and neurologic disorders (SCI/D) took place within a pre-established educational program over six weeks that was developed and facilitated by a Registered Nurse and a Registered Dietitian.  Findings: Participants’ self-awareness of internal and external food environments improved by >50%. The value-based improvement on the “Food and Drink” component of the PHI by participants was 35%, while 21% reported a value-based improvement in “Power of the Mind” on the PHI.  Conclusion: The implementation of both the WH model and PHI assessment tool not only supports patient-centeredness/value-based care, empowerment for self-care, and management of disease, but also models successful interprofessional collaboration. Based on the success of the interprofessional WH quality improvement program on the SCI/D unit, an introductory WH weekly education series is expanding with topics for patients, caregivers, and staff including functional nutrition, mindfulness, integrative pain management, mindful pressure ulcer prevention, and adaptive yoga. Group classes are also facilitated for outpatients across the organization.

  • Integrative nursing and sacred medicine: The emerging dialogue on entheogens in clinical practice (S. Hope)

    • ​Entheogens are substances that when consumed can catalyze a sacred experience. Sacred medicines, such as psilocybin mushrooms, peyote, ayahuasca, huachuma, and iboga, for millennia have facilitated physical and metaphysical healing and continue to be used today within rich socio-cultural and spiritual traditions. Synthetic entheogens such as psilocybin and LSD were studied extensively in the 1960s, and after a period of prohibition, have been the subject of renewed research initiatives yielding striking results in the areas of existential anxiety, addiction, and depression. Research on psilocybin for anxiety and MDMA for PTSD are now entering Phase III trials, suggesting that the rescheduling of these currently Schedule I substances may be imminent. Recent studies have also demonstrated the ability of entheogens to catalyze spiritual experiences in healthy participants. Bestselling books and popular news articles on the topic abound. The process of shaping the clinical practice of entheogen therapy has begun. It is essential that a diversity of practitioners participate in this process, especially indigenous wisdom keepers who have deep relationships with these sacred plants, and whose voices have been notably absent from the clinical dialogue. Integrative nurses are expert in many skills thought to be essential to psychedelic therapy (empathic presence, trust enhancement, ethical integrity, proficiency in complementary techniques), and are skilled in bridging conversations between people of different viewpoints and cultures (including from inside and outside conventional medicine). This presentation will explore the traditional use of sacred medicines, current research outcomes, and the critical role of integrative nursing in emerging clinical practice.

  • Innovative aqua care technique for constipation: Cool abdominal washing (M. Kerkhof)

    • ​The prevalence of constipation in the general population is approximately 20%, with higher prevalence in the elderly and in the palliative population, especially opioid-induced constipation. Although a common problem, constipation can become chronic and can have extensive consequences. Initial management should include minimising exposure to predisposing factors and general measures such as encouraging hydration, fibre intake and mobility. Yet those measures are not always adequate enough or easy to implement, and even the use of oral laxatives may fall short. To relieve patients of constipation the author has successfully introduced an innovative AquaCare technique in the Dutch health care system over the last 5 years, called the Cool Abdominal Washing. This washing consists of a short (2 minute) intervention, using a wash cloth and cool water, and performed on the lower abdomen in a certain rhythm and direction. It is safe for the majority of patients, easy to perform, and can be taught to relatively fit patients, increasing their self-reliance.  The wash technique has shown a 90% success rate and is perceived by patients as comfortable and many prefer it over oral laxatives, suppositories and especially enemas. The technique is now implemented in many hospices and nursing homes, as well as home care throughout The Netherlands. The Cool Abdominal Washing can provide nurses, informal carers and patients a non-pharmacological, comfortable, low key, yet highly effective way to relieve constipation.

Session 23: Research

Location: Ballyvaughan Suite

  • A conceptual-theoretical-empirical framework for integrative nursing principles: Implications for research (S. Gözüm &  A. Ilgaz)

    • ​Background: Integrative Nursing Principles (INP) has been explained in depth in 2014 by Koithan and Kreitzer proposed a conceptual process model. There have been important developments in the theoretical framework in about 5 years, but the reflection of the principles on researches has been less. Each of the INP allows for very comprehensive interventions and outcome measures. Interventions may be related to several principles. For this reason, the researcher should clearly define the principle that the initiative is based on.  Purpose: This article outlines a Conceptual-Theoretical-Empirical (C-T-E) framework to explain the six principles and measurements of INP in the INOSEL study example. INOSEL is an acronym of a study protocol that includes Integrative Nursing principles and interventions using the Omaha System for Elderly women with Loneliness.  Findings: In the conceptual part, each principle of the integrative nursing approach was handled one by one. There was theoretical explanations related to each principle in the theoretical section. The empirical section provides evidence of how these principles can be measured in practice. The C-T-E framework in the INOSEL study can provide a structure for guiding future nursing interventions and researches. When the principles of integrative nursing are measurable, this concept or theory symbolizes reality. The C-T-E structure, which provides a logical explanation and a systematic process in the process of making integrative nursing principles into measurable variables, can be used.  Conclusion: C-T-E structure; provides direction to thinking, understanding and nursing research. In this study, integrative nursing principles using C-T-E framework are presented in a research example.

  • An evidence-based use of music therapy for hospitalized children: How and what can we measure (M. van der Heijden)

    • ​Background Researchers studying the effects of non-pharmacological interventions such as music or massage come across the question of what outcome measurements to use. Music interventions are increasingly offered in hospitals with the purpose to enhance relaxation, cope with traumatic experiences, engage patients in treatments and to promote a general sense of well-being. However,  there are no standardized outcome measurements used in medicine to evaluate these results. Instead we are limited to use clinical outcomes measurements such as reduction in pain and distress.   Studies on music interventions in adults use self-reported outcome measurements alongside physiological outcome measurements. In children, especially young children, self-report and physiological outcome measurements are not always possible.  Therefore, the question arises how to best measure the effects of music therapy in children.   Purpose Our purpose was to develop a music therapy assessment tool suitable for clinical research on music therapy for hospitalized children: The Sophia Red Cross Music Therapy Assessment Tool (Sophia Red Cross Tool).   Finding We obtained video material of 72 children during music therapy sessions. With a panel of music therapists, nurses and child psychologists we identified four categories: level of patient engagement, patient relaxation, parent engagement and behavior of the music therapist. We hypothesized that the level of engagement of the patients and parents during the music therapy session could reflects the effect of the therapy.  Conclusion  The Sophia Red Cross Tool is a tool for clinical research on music therapy in children.

  • The effect of mindfulness on graduate student perceived stress (P. Cox, P. Potter, A. Vermeesch)

    • ​Background: Nurses and nurse practitioners are returning to school in growing numbers to acquire additional education and leadership skills. From 2015 to 2016, the number of students enrolled in graduate nursing education has increased from 21,995 to 25,289. During this same time frame, those graduating with a Doctor of Nursing Practice (DNP) degree have increased from 4,100 to 4,855. Returning to graduate school is not a decision to be taken lightly. Along with financial considerations, time management issues, work-related demands and family obligations, graduate nursing students express feelings of being overwhelmed with the experience of returning to school. Mind-body-stress-reduction (MBSR) has demonstrated a reduction in perceived stress in multiple studies. MBSR is an affordable, simple and effective method to ease perceived stress. Purpose: A nursing school in the Pacific Northwest developed an evidence-based mindfulness meditation focused intervention to reduce perceived stress and provide support to their graduate students.  Findings: Preliminary results of this year long effort demonstrate that between Time 1 and Time 2 there was a trend in reduction of PSS scores. There was a positive correlation between hours worked and increased stress. In addition, there was a positive correlation between daily practice and reduction in perceived stress.  Conclusion: Mindfulness meditation has been successful in reducing stress in other populations. Developing a self-care routine of mindfulness meditation may assist graduate students in reduction of perceived stress.

  • Promises and pitfalls in the doctoral preparation of integrative nursing researchers (L. Stauber)

    • ​Background: NCCIH has repeatedly called for increasing the quantity and rigor of research into various Integrative Health modalities. Doctoral-level education in Integrative Nursing (IN) provides the foundation for emergent nurse-scientists to expand the Integrative Health research base in such a way. Yet, little is known about best practices for training nurse-scholars in research approaches best oriented to IN research.  Purpose: This presentation will discuss and provide initial suggestions about best practice for developing doctoral curricula of Integrative Nursing that provide students the critical, conceptual, and methodological tools for developing rigorous and novel programs of integrative health research.  Findings: The first three years of a doctoral curriculum in Integrative Nursing at a large research university revealed several promises and challenges for building new cohorts of Integrative Nursing researchers. Salient among the challenges were, (1) A lack of concordance between IN modalities and the research methodologies employed to study them within existing literature, making assessing the evidence base difficult; and (2) A lack of concordance between doctoral students’ IN research agendas and the methodologies in which they had been trained.  Conclusion: Timely, quality research across the spectrum of Integrative Nursing practices is of signal importance for evidence-informed patient care. To achieve this, Integrative Nursing and Integrative Health researchers, broadly, need to further engage in critical consideration of how to train students in (1) Evaluating a complex and heterogeneous Integrative Health research base; and (2) Building research agendas in IN modalities that adequately capture the complexity of their respective interventions.

  • Show me the evidence: Validating the use of integrative modalities in nursing practice via multi-site studies (M. Rabinowitz, C. Eaches, N. Mishanie)

    • ​Background: Integrative therapies are not routinely woven into everyday nursing practice.  Studies exist to validate their efficacy, but are generally small Pilot and Case Studies.  Nursing studies with scientific rigor validating integration into practice are lacking and necessary.   Purpose: This presentation will illustrate how a large hospital system addressed incorporating integrative modalities into nursing practice by conducting Multi-site IRB approved studies. Exemplars of three studies follow: 1. Lavender for sleep:    The goal of this study is to examine the effect of lavender on overall sleep quality in adult’ patients on a medical surgical floor. A randomized control study design will be utilized to measure the effect of lavender on sleep quality.   2. Lavender for Pain: The goal of this study is to examine the effect of lavender on breakthrough pain in hospitalized post –surgical patients. A randomized control study design will be utilized to measure the effect of lavender on relieving breakthrough pain in post-surgical patients.  3. Efficacy of a Mindfulness Mobile Application for Stress Reduction in Nurses: Stress affects high-level cognitive functions, specifically attention and memory. Mindfulness based programs have proven successful in reducing stress experienced by nurses.  This study will measure the efficacy of a mindfulness mobile application for stress reduction in nurses. Findings:  All studies are in progress. Conclusion: A multi-site participatory model is effective in both educating nurses on conducting research and promoting the addition of integrative therapies into nursing practice. These studies satisfy Magnet requirements for all participating sites.

Concurrent Session V

Friday, May 24

1:00pm-2:30pm

Session 24:  Workshop: 21st Century Salons: Changing the World through Conversations

Location: Lettermore Suite

  • To paraphrase American author and business consultant, Margaret Wheatley, "Conversations change people, and people change the world."  This workshop provides participants with an experience of how to convene conversations that can 'change the world.'  Included in the presentation is a retrospective of historic changes that were influenced by the wide-spread use of salons, such as the French Revolution and Polish Solidarity revolt.   It will also include the history of salon development in nursing.   The salon movement that started in nursing is now occurring in a wide variety of settings, from student classrooms, to clinician practice sites   The Socrates Café conversation format is usually used and facilitates positive engagement of group members.   Following a 30-45 minute presentation, the audience is led in an interactive salon conversation.   In this workshop, multiple salons can occur simultaneously, depending ao on audience size.  After approximately 60 minutes of table conversations, the remaining time is used for feedback sharing of the experience.   The closing question, "What are you taking home from this conversation?" provides a meaningful and powerful commentary on the experience.

Session 25:  Change Your Breath, Change Your Brain: 7 easy techniques nurses need to know for themselves and their patients!

Location: Inishmore

  • Background: “The sixth principal of integrative nursing focuses on the health and wellbeing of caregivers as well as those they serve with activities that nourish the body, mind and spirit.” The capacity for compassion and empathy is at the core of the nursing profession. For a nurse’s own health and wellbeing this capacity must include oneself and be the foundation from which outward caring flows.  Oftentimes nurses can feel they are running on empty.  Simply and powerfully our breath is our fuel with refueling capabilities always available. Workshop Overview: In this experiential workshop you will learn and practice seven evidence-based techniques to cultivate breathing optimally for wellness, relaxation, focus and energy— including mindfulness breath awareness, diaphragmatic breathing, alternate nostril breathing and the Heart Breath. These techniques can effectively lower stress and anxiety within seconds to minutes.   

Session 26:  Workshop: An Introduction to Jin Shin Jyutsu® Self-Help for Nurses

Location: Inishmaan

  • The combination of the pressing need to retain qualified registered nurses in the workforce with the high cost of workplace stress make it imperative to introduce interventions to support stress management for this population.  There is increasing amount of evidence-based literature regarding the use of JSJ in healthcare.  JSJ Self-Help as a self-care measure has been shown to reduce anxiety in a nursing population.The purpose of this randomized comparative study done at Morristown Medical Center was to evaluate the effect of training nurses in JSJ self-help methods and caring efficacy for patients and impact on nurses’ personal and organizational stress.  A survey tool to measure self-efficacy and one to measure personal and organizational stress were used.  Nurses were randomized to an education group or a control group.  Education consisted of three, two-hour classes which included background, description and demonstration of flow patterns and practice at home.  Surveys were completed at baseline, at the completion of the last class and one month after the last class to determine sustainability.  The results provided insight to stress experienced by nurses and interventions to improve personal wellbeing and caring efficacy.  The interactive component of this presentation will provide participants a chance to learn several aspects of JSJ self-help that they can readily apply to both their daily self-care and throughout their day as needed.  JSJ self-help is simple and easy to learn, costs nothing to practice, can be done anywhere and can serve as a valuable tool in anyone’s healthy living toolbox.

Session 27: Staff Development

Location: Ballyvaughan Suite

  • Nurse residents’ healthy transition to practice (C. Weaver)

    • ​BACKGROUND:  Nurses are historically notorious for ignoring their own needs in favor of attending to patients and other demands.  These behaviors are often passed along to the next generation of nurses, becoming part of the caregiving landscape and negatively impacting care, interactions, and possibly retention.  To address stress management and self-care for new nurses, a large acute care facility implemented an  integrative nursing stress management series as part of their nationally accredited nurse residency program.  Over a 7-month period in their first year of practice, new nurse graduates participate in sessions facilitated by the integrative care nurse coordinator.  Five 15-minute sessions entail information on self-care, conversations with nurse residents about current stressors, coaching in one integrative health practice, and an activity assignment.  The final session is a 3-hour experiential of reflection on self-care, and introduction to other integrative modalities.  PURPOSE: To provide new nurses with tools for healthier transition into professional practice, facilitating development of self-care habits for stress management through awareness, reflection, and acknowledgement of own needs.   FINDINGS: Average rating of benefit gained from stress management session for May 2017 nurse residents was 3.4 on a 1 to 4 scale.  New nurses also report sharing practices knowledge and coaching co-workers, positively influencing unit stress levels.  CONCLUSION: Providing stress management education for new nurses through their first year of practice facilitates healthy transitions, promoting a more holistic, integrative approach to practice, and alters the mindset that meeting their own needs comes last.

  • How organizational culture impacts relational competencies (D. Wright)

    • ​Teaching people to engage and care for patients... is a wonderful goal.   But why is this objective of creating these caring environments often so difficult?   Why do we see initiative after initiative, as organizations try to make patient-centered care a reality?   Organizational culture has a huge impact on the success in developing relational and caring competencies.    This session will explore that impact and discuss wonderful models and tools to navigate our organizations to higher level of success in achieving true competencies that will impact our caring outcomes.   We will discuss the Wright Model of Competency Assessment which is grounded in three concepts -- Ownership, Empowerment, and Accountability.   We will also explore tools that measure and compare relational insights.  This relational insights will include all the three relationships in Relationship-Based Care -- Relationship with self, Relationship with coworkers and Relationship with the patient and family. We will explore all the organizational culture aspects that can enhance or hinder our expression of caring competencies.  And best of all, we will discuss what we can do to "set the sails" for building cultures that make caring sustainable... and a permanent part of our organizational culture, not just a flavor of the month.

  • WHOLE Care: A framework for integrative healthcare education and leadership (K. Scott-Barss)

    • ​Background:  The facilitator is a holistic nursing educator who has developed ‘The WHOLE Care Framework for Integrative Health Assessment, Education, & Leadership’.  Elements of WHOLE Care are: Wholism & Integrative Health Care; History of Healing; Options for Healing; Logistics for Caregivers & Clients; Environments for Healing; and Care of Self & Others in Daily Practice.    Purpose:  WHOLE Care is intended to help caregivers & healthcare educators deepen their ability to …  … address holistic health needs within themselves, their patients, & their workplaces. … assist patients to access safe & relevant integrative health care options of their choice. … offer leadership to help create a holistic healthcare culture for patients & caregivers alike.    Findings:  WHOLE Care has served as the framework in the facilitator’s undergraduate, interprofessional elective in Integrative Health Care, where it has been blended with Integrative Learning principles & received positive reviews over several course offerings. WHOLE Care has also been offered & favorably evaluated in an undergraduate nursing assessment course & at invited local & national presentations.  Conclusion:  WHOLE Care best support healthcare professionals in their integrative health care endeavors when blended with Integrative Learning principles.  Integrative Learning is a holistic, relational approach to learning that prepares learners to be self-aware, emotionally intelligent integrative practitioners and leaders who can effectively address the complex, contemporary challenges in their professional worlds & the broader society.  The facilitator’s workshop will employ Integrative Learning to help participants gain a working knowledge of WHOLE Care in support of their contributions to Integrative Nursing.

  • Developing self-care practices among nursing staff on in-patient acute care units (D. Corbett-Carbonneau)

    • ​Background The level of engagement of nurses plays an important role in the delivery of care and the attainment of optimal patient care outcomes. The prevention of burnout and compassion fatigue among nurses is pivotal in this regard. Self-care for nurses is an important contributor to this prevention and to levels of compassion satisfaction and engagement.  Kreitzer validates the importance of self-care for nurses through the inclusion of caregivers’ health and well-being as a major principle in the Integrative Nursing framework.  The role of nurse leaders in establishing healthy work environments which support the care of self is articulated in the American Nurses Association’s (ANA) Standards for Nursing Administration.  Purpose The purpose of this study was to add to the body of knowledge around self-care as it relates to nursing staff in an acute care hospital setting, the identification of meaningful self-care opportunities within the hospital setting, and the benefit of these practices to levels of engagement. This program development project utilized a mixed methods design including surveys and focus groups.  A month-long self-care program for nursing was implemented which included structured self-care activity sessions as well as a dedicated space for self-care activities.  Findings While there were no statistically significant results from the quantitative data, identified trends included an increase in engagement levels in the intervention group.  This trend was further supported by the themes which emerged from the qualitative data. Conclusion Given the importance of self-care to optimal engagement levels among nursing staff, further study is warranted.

  • The mindfulness activities project: Shifting the culture of care for providers, patients, and families (C. Hulme-Freudenberger, L. Speight, S. Hoffman)

    • ​Mindfulness has been shown to decrease the negative impact of stress in human beings and improve resilience. Using mindfulness as a standard part of nursing care is associated with improved patient outcomes and is linked to decreased stress in healthcare workers. Having standardized methods, tools and trained caregivers to teach mindfulness strategies to patients is a professional imperative for symptom management, patient engagement and to promote healing.  The purpose of the interdisciplinary project was to create a Mindfulness Activities Cart (MAC) and staff education program in an ambulatory  oncology clinic.  The goal of this project was to incorporate mindfulness activities into the care environment to reduce the negative impact of stress in both patients and staff.  The educational  program consisted of five training sessions offered multiple times per week over 12 weeks.    Sixty-seven percent of the clinic staff attended one or more voluntary mindfulness training sessions. Ninety-four percent of nurses attended one or more of the training's.  After participating, the percentage of staff reporting no comfort in teaching mindfulness decreased from 72 % to 23 %.  The percentage of staff reporting that they teach mindfulness practices 2 or more times per week increased from 4% to 14%.  Overwhelming staff feedback has resulted in a weekly staff mindfulness program.    Interdisciplinary teams can be engaged in cultural change to incorporate mindfulness for self-care and to improve patient care, as reflected by post project surveys.  Our project demonstrated that when mindfulness tools are standardized and accessible, staff comfort increased for individual practice and educating patients and families.

Session 28: Conceptual Musings

Location: Inishturk

  • “Integrative” healthcare for whom? Democratization through integrative nursing (L. Stauber, N. Pool)

    • ​Background: Many of the healing modalities practiced contemporarily in Integrative Healthcare derive from global populations of color, including the colonized. Within the United States today, meanwhile, European-descent whites dominate the customer base for most evidence-based integrative health modalities – though traditional healers provide first-line care to many under-resourced populations.  Purpose: The purpose of this presentation is to initiate a critical discussion of the accessibility of Integrative Health modalities to diverse–including marginalized–populations. A corollary purpose is to (re)consider how “traditional” healing, or complementary healthcare practices already practiced among non-hegemonic populations, might be best understood and integrated within the pantheon of Integrative Nursing principles and practices.  Findings: Current statistics on the racial and ethnic adoption of Integrative Healthcare/ CAM modalities are complex, but in sum: More affluent whites are more likely than other ethnic-racial groups to utilize most IH modalities, and the vast majority of these modalities incur out-of-pocket fees. American Indians/ Alaskan Natives and non-Mexican Latinos, meanwhile, are most likely to use traditional healing systems – many of which are poorly understood by healthcare providers. This presentation asks: How can Integrative Nursing practitioners and educators contribute to critical conversations about equity promotion through access to integrative health modalities, while simultaneously recognizing the benefits that even non-scientifically supported traditional healing practices might bring to individuals and communities?  Conclusion: As a healing profession with extensive patient contact, nursing offers unparalleled opportunity for expanding and democratizing the reach of IH modalities, while also providing the cultural safety required for effective recognition and incorporation of traditional healing practices.

  • Nightingale, integrative nursing and the “new” placebo research (J. Quinn)

    • The purpose of this session is to provide participants with an overview of the latest developments in the burgeoning field of placebo studies and to explore this data as a rich and growing evidence support for fundamental principles first put forth by Nightingale and those recently framed as the foundation for Integrative Nursing.   Placebo research and meta-analytic studies have revealed chinks in the "gold standard" myth of an evidence-based medicine/nursing which will also be examined, highlighting recent findings about the paucity of actual evidence (derived from rigorous, non-fraudulent, repeatable research that shows effects beyond placebo) for much/most of what constitutes the modern medical black bag of therapeutics, including drugs and many/most surgical interventions and medical devices. These findings, too, affirm both Nightingale's wisdom and the principles and practices of Integrative Nursing. Implications for advancing the art and science of Integrative Nursing will be explored in dialogue with each other.

  • The intersection of Planetree principles, Watson’s Caring Science, and integrative care (S. Yaguda)

    • ​Background: 60-90% of oncology patients utilize Complementary and Integrative Medicine (CIM), yet CIM use is underreported to healthcare providers. Nurses are a trusted source for information, expertise and support. Nurses’ knowledge of and attitudes toward CIM may influence interactions with patients about best CIM practices. RNs were surveyed at a multi-site, Planetree designated organization with a robust integrative department. Institution nursing practice is guided by Watson’s theory of Caring Science.  Purpose:  To describe and explore RNs’ perceived knowledge of and attitudes toward CIM and subsequent influence on clinical practice.  Findings: A survey was created in REDCap™ and sent via email to RNs throughout the cancer institute network (N=483), with a 55% response. Respondents were not identified by name. 66% reported asking patients about CIM use less than half the time or not at all. 57% estimated that only a quarter of patients use CIM, while 52% of nurses felt that patients did not think it is important for healthcare providers to know about CIM use. Respondent characteristics and work locations are explored in relation to responses.  Conclusions: Despite achieving Planetree designation, use of Watson’s Caring model and an institutional integrative department, RN respondents generally did not initiate conversations about CIM with patients and estimated few patients utilize CIM. Components of Planetree and Watson’s theory will serve as the foundation for future educational and experiential nursing activities.

  • What’s in a definition? “Integrative” of “holistic” nursing and/or healthcare (N. Frisch, D. Rabinowitsch)

    • ​Background:  Nursing practice is grounded in the enduring principles of caring, holism and healing when providing integrative care.  There have been various terms used to describe this approach to care, perhaps influencing our image as healing professionals and the image others have of us. Purpose: Questions emerged:  How are the terms 'integrative nursing', 'integrative healthcare' and 'holistic nursing' defined or described in the literature? Do we identify with these definitions/descriptions? To answer, we conducted an integrative literature review, following the process described by Whittemore and Knafl (2005) for a review that would be broad, and inclusive of theoretical and empirical approaches.  Focusing on our terms and using standard search methods, we reviewed 93 published papers. Findings: For over 30 years, the terms have evolved in their usage and definitions. One constant was observed – the term 'integrative' has been used to refer to practice that includes two or more disciplines or distinct approaches to care.  The term 'holistic' has been used to describe whole person care, often acknowledging body-mind-spirit.  'Holistic nursing' has been used to define a disciplinary practice specialty.  Both terms, 'integrative' and 'holistic', have been associated with alternative/complementary modalities and have been presented in relation to similar philosophical and/or theoretical underpinnings. Conclusions: There is considerable overlap between 'integrative' and 'holistic' care, such that the commonalities are stronger than the differences. Consideration of how one chooses the term(s) provide opportunities for reflection, collaboration and growth to be discussed in this presentation

  • Integrative nursing in a Danish context (A. Lunde, J. Jørgensen, B. Lissau)

    • ​Background: FS-KAB is a professional society within the Danish Nurses Organization DSR. FS-KAB has existed more than 10 years with a membership of around 100 nurses. The mission of FS-KAB is to improve and develop nurses’ knowledge on CAM in order to enhance the needed dialogue with patients, and to integrate CAM into nursing practice. Patients’ use of CAM and that they would like to discuss this with healthcare professionals is well documented but until now, CAM is mainly used outside the healthcare system in Denmark. In FS-KAB we find the vision, ideas and evidence from Integrative Nursing as the next step forward in relation to the purpose of our society, but the definition of Integrative Nursing mainly build on American nursing history, theories and understanding.     Purpose: To revise the six principles and definition of Integrative Nursing into a Danish/Nordic context for educational use. We have analyzed selected concepts, changed words and incorporated Nordic nursing theories and research with the intension to maintain the overall understanding and give respect to the existing definition.        Findings: We purpose this definition: Integrative Nursing is holistic, personcentered and based on relationships. Integrative Nurses focus on strengthening the selfhealing potential in human beings by integrating sustainable, documented and non-invasive treatments in nursing in order to strengthen health and promote wellbeing for patients as well as nurses.    Conclusion: The revision is work in progress and we would like to discuss, develop and validate this with feedback from nurses at the conference.

Session 29: Coaching

Location: Inisheer

  • Integrative nurse coaching: A leadership model for self-development, health promotion, and healing (S. Penque, D. McElligott, J. Turnier)

    • ​Background: Although there are differences in international health care models, similar concerns are shared within nursing leadership regarding the state of nursing and patient outcomes.  Nurses comprise the largest sector of the international health workforce, affording the opportunity to globally affect the well-being of nurses and work environment. Both the 2020 World Health Organization sustainable goals and nursing theories provide foundation for nursing action.   Purpose: This presentation will identify the Theory of Integrative Nurse Coaching (TINC) as a praxis nurse leaders  may weave into diverse healthcare environments to support the role of Holistic Nursing. The transformational power of Integrative Nurse Coaching on the individual nurse, the patient and the health care community will be emphasized, local to global.   Findings: The TINC component of self-development supports and expands prior research on self -care as it includes self-assessment, self-reflection, self-care and self-evaluation. Supporting the self-development of the nurse synergistically affects the healing and well-being of the nurse and promotes positive patient outcomes while contributing to the overall health of an organization. Integrative Nurse Coaching supports best practice standards such as the Magnet Recognition program.   Conclusions:  Supporting a specific group of twenty nurses in one institution to adopt the path and certification in Integrative Nurse Coaching resulted in positive outcomes from a leadership and clinical nurse perspective. An organization will demonstrate how they met Magnet standards using TINC for mentorship of leaders, improvement in nurse practice environment, and enhanced patient outcomes. Next steps include program expansion and research.

  • Integrative nurse health coaching with behavioral health and addiction populations (K. Welshman)

    • ​The behavioral health and addiction populations face many challenges.  Once diagnosed, many spend much of their adult lives on medication and in treatment at some level.  Their lives become filled with doctor appointments, therapists, pills and side effects, and often hospitalizations and rehabs.  Physical health tends to decline due to the primary focus on managing the psychiatric illness or staying sober. There is often poor nutritional accessibility and intake.  Side effects of medications can lead to increased fatigue, weight gain, decreased energy and activity.  Often patients isolate, have little or no family support, and have very minimal connection socially.      The purpose of bringing integrative health services to the behavioral health population is to bring awareness and education about how lifestyle changes can have a significant impact on health and chronic disease. At Hackensack Meridian Integrative Health & Medicine, we have developed a Personal Resilience Empowerment Program (PREP).  This program is based on the unique care model of our 5 Pillars of Health & Well-Being:  Sleep, Activity, Purpose, Nutrition, and Resilience. By partnering with an integrative nurse health coach, PREP will help develop awareness of current lifestyle and opportunities where patients can create healthy changes. Those with substance use disorders may have more significant challenges early in their recovery.  Attending PREP can help them to build a new foundation of self-care at a very fragile time, with the support of an integrative nurse health coach.  While setting small, manageable goals, patients learn new life skills to help achieve their personal best.

  • The Four Pillars of Integrative Health Coaching—a doorway to transforming clinical practice (K. Lawson)

    • ​Integrative Health Coaches serve as guides and facilitators for the process of lifestyle change, healing and growth.  Skills and tools from health coaching can be an expansive addition to the abilities of any health care provider, especially those who have an interest in and commitment to integrative practices.  While expertise in behavior change, goal setting, positive psychology, and other discrete disciplines are requisite for health coaches, their impact is greatest when applied through the lens of holism and with a belief that deep healing is possible. UMN trained health coaches practice within a structure defined by 4 core principles—Mindful Presence, Authentic Communication, Self-Awareness, and Safe Space.  Authentic communication practices alone--which include deep listening, curious inquiry, perceptive reflections, and silence--can transform both the practitioner and client experience.  This structure optimally contains the patient’s/client’s process of self-exploration and healing transformation. Through these principles, any health professional can transform the quality and healing potential of any type of practice—from medicine to therapy, from nursing to case management, from nutrition to biofeedback--optimizing the healing for your practice and yourself.

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