Online RN to MSN
Clinical Systems Leadership

Integrative Nursing

Date: March 6, 2017
In this webinar, Cheryl Lacasse and Natalie Pool will discuss the principles of Integrative Nursing and examples of how the principles can be implemented by practicing nurses. In addition, they will talk about self-care strategies for health-care providers.


[Start of recorded material 00:00:00]
Melissa: Okay, so welcome everyone to the University of Arizona’s online Master of Science in Nursing in clinical assistance leadership webinar. Thank you for taking the time to join us for the hour. My name is Melissa, I’ll be your moderator for today.
I would like to introduce you to Cheri Lacasse and Natalie Poole, they’re going to be our panellists from the University of Arizona college of Nursing. As a bio Cheri is a clinical professor, core faculty and director for the online RN to MSN program at the University of Arizona College of Nursing. She has clinical expertise as an advanced practice nurse in geriatric and oncology care management. Her experience in nursing practice, education and research has led her to focus on mentoring students, faculty and other professionals in the application of integrative health principles across healthcare populations and delivery settings.
And Natalie is a clinical assistant professor at the University of Arizona. She teaches the healing environments course which focuses on the application of integrative nursing approaches in the clinical setting. She has more than a decade of clinical nursing experience primarily working with underserved populations in sub-Saharan Africa and with two southwestern Native American communities. She also coordinates the integrative nursing faculty fellowship at the University of Arizona College of Nursing.
So hi Cheri and Natalie, I want to thank you guys for being here today. I will pass it over to you for your presentation.
Cheri: Great, thank you Melissa and welcome everyone. We have a roving mouse so I may have to have you advance the slides Melissa because our mouse is running all over the screen, I’m sorry.
Melissa: That’s fine, I can do that.
Cheri: Okay, thank you. So the next slide is just sort of our roadmap for the next 40 minutes or so, what Natalie and I are going to cover you and that’s really looking at describing the principles of integrative nursing, looking at why this is important right now as a model to look at clinical care and infuse into our clinical care that we have. And then look at some of the competencies that integrative nursing demands in our clinical and our education of clients and peers. And looking at ways to promote health and wellness in families, caregivers and of nursing staff and members of the healthcare team.
So we can move to the next slide to talk about foundations in integrative nursing and the context is very, very important especially in today’s climate where we have shifting healthcare perspectives on a daily basis. But the healthcare costs are continuing to rise in our country. And sometimes individuals are really asking for a different approach and sometimes different approaches may cost less but be as effective or diminish the cost of other expensive treatments. So we’re really seeing individuals asking for integrative therapies, we have a lot of consumer interest in integrative therapies right now. There is a body of evidence that tells us that integrative therapies do benefit individuals in different ways than our traditional approaches might, traditional meaning pharmacological, surgical and other types that you might see in the medical community.
We also have a focus on professional self-care and this has come up significantly over the last few years and will become more and more of a focal point as we look at healthcare reform and how that impacts our healthcare providers.
Another focus that we’ve had for several years now in healthcare is looking at the different aims for safe quality care. Right now in the literature they’re talking about a quadruple aim and we’ve been working with for the last probably five years or so the triple aim which talks about enhancing the patient care experience, looking at a population health focus and the costs of care. The fourth aim is looking at quality of life of healthcare providers and making sure that all of those pieces come together so that we have a strong healthcare system that is meeting the needs of individuals but also making sure that providers are being cared for in meeting the needs of individuals.
The next slide will help us take a look at the definition of integrative nursing. And I think at this point I’m going to turn it over to Natalie to start talking about integrative nursing and the principles.
Natalie: Great, thanks Cheri. So I think it’s important that we do sort of have a working definition of integrative nursing, really clarify that this is not a theory but it’s much more a perspective and an approach to care. So here at the University of Arizona in particular we are lucky enough to have Dr. Mary Koithan on faculty who together with Mary Jo [unintelligible 00:07:07] from the University of Minnesota have literally written the book on integrative nursing. So we use their definition which is a way of being, knowing, doing, so all three verbs that advances the health and well-being of persons, families and communities through caring healing relationships. Integrative nurses use evidence to inform traditional and emerging interventions that support the whole person, whole system healing. And as we get into the principles here over the next few minutes it’ll really illustrate this definition.
And I think as we move to the next slide here we’ll see that this definition is not really outside the boundaries of what we’ve been doing as nurses all along. In a way it returns us to our roots, our Florence Nightingale roots. Florence said our goal as a nurse and our role as a nurse is to put the patient in the best possible condition so that nature can act and healing can occur. Notice that she’s saying there the nurse does not facilitate or direct healing but the patient innately is capable of it in addition to being influenced by their environment.
So that’s where the roots of nursing lie and that’s where the roots of integrative nursing lie. And it’s a very foundational belief from integrative nursing as we’ll see here in the next few slides for the principles. Before we get into the actual principles I think it’s important that we distinguish these principles from a nursing theory. Ours is a practice framework that ultimately is action-oriented so it’s important to note that integrative nursing is not a theory but rather a practice-oriented framework.
So for principle one – and again this comes from the [unintelligible 00:08:54] and Koithan [work] – human beings are whole systems inseparable from their environment. So nursing embraces the principle that human beings are complex adaptive systems and we recognize that human beings are part of a much larger whole which is manifested across all different levels within a scale. If we do go back to some of our nursing theorists such as Martha Rogers, she taught us that experience is a manifestation of the human environment transaction so we’re constantly being influenced by our environment as well as influencing our environment.
And it’s important to notice that a person is nested within a relationship-based system as this graphic here explains in a very rudimentary way. So we are part of this much larger system and environment at all times. So organ functions are understood as intact wholes based on the information provided by the tissue level organization, for example. On a larger level families cannot be known by investigating individual members but you have to examine all of the relationships and the whole of the family within the context of their environment. That’s principle one in a nutshell and I think that will make sense to a lot of practicing nurses on a really fundamental level.
Principle two posits that human beings have an innate capacity for health and well-being. So again think about that Florence Nightingale quote that we just re-visited. Florence gave us a very important legacy message, health arises from the person themselves and from the nature that heals and cures. So this sort of in a way changes our role as nurses or healthcare providers and I think in some ways we’ve lost sight of this message with modern science.
So in a complex system it’s emergent through properties, health is, so by continuing to take in information we make choices and decisions as a living system and we’re continually being co-creating our health through a process of emergence. We as nurses and care providers can provide just the right amount of support for flourishing and thriving to occur. I think a perfect example of this principle for me from a clinical perspective is if you look back at patient experiences we’ve all had we can all think of a patient who managed to thrive or flourish despite a terminal prognosis, for example. And so what that shows is that there is an innate capacity for health and well-being regardless of the physical constraints or adversities.
So let’s look into this principle a little bit more in the next slide because it’s very focused on well-being which in some ways is a much more comprehensive concept than merely health. We seem to have lost our way since the time of Florence in some ways because so much of nursing has become overly focused on just the physical aspects of health. But from an integrative nursing perspective we look at everything, the environment, physical health – which is certainly important, we don’t throw that away or disregard that – relationships, as we mentioned in the first principle. Security, purpose and community, all these aspects make up the whole system in which human beings exist.
Principle number three says that nature has healing and restorative properties that contribute to our health and well-being. So nursing since the dawn of nursing has claimed that human beings are inseparable from their environments, we are hardwired to interact with our natural environment. In the 1860s Florence, again, wrote about the relationship between nature and health and more recently Jean Watson has claimed that human beings cannot be without nature and the loss of a nature human relationship reduces the person to a machine which creates suffering and a diminishing of our actual human nature.
So I think this is important and this is something that is unique about integrative nursing because we recognize our place, again within a larger nested system which includes nature and in the environment. And we use nature and the environment as part of the healing and well-being process.
We’ll move onto principle four. Integrative nursing is person-centred and relationship-based. So the American Nursing Association social policy statement claims that “true partnership” is a core value of the profession. So again, while this might seem familiar to us as nurses I think we need to critically ask ourselves is this really being enacted in the clinical or even academic setting. Are we really person-centred and relationship-based on a day to day basis despite what the ANA says, despite our roots as a profession.
This extends to people and communities that we serve as well as other health professions not merely individuals and I think that’s also an important distinction. There is a way to be person or community-centred and have relationships on a broader scale. Nurses have, are often the glue that holds the health team together – I think that’s a familiar for many of us – and we tend to be very focused on the person, patient, community, family that we serve.
But what does a partnership actually mean like the ANA says. I think it’s important that we consider a shared power, mutual valuing and respect, a recognition of all parties’ strengths and limitations. And I think it’s important there that we’ve said strengths in integrative nursing because much of bio-medicine today tends to be very problem or disease-focused or looking at limitations and potential solutions there are always existing strengths both at the individual and community level. And we also need to look at a willingness to support or assist rather than take over so again reframing our role as nurses as Florence Nightingale suggested.
So this principle really heralds nursing’s focus on social justice, choice and self-determination and the unique contributions that everyone brings into the caring healing relationship.
Principle five. So this is a principle that I have to say our Master’s students enrolled really like because this is a very exciting familiar yet interesting principle for practicing nurses. Integrative nursing practice is informed by evidence and uses the full range of therapeutic modalities to support and augment the healing process moving from least intensive invasive to more, depending on [unintelligible 00:16:01]. So why do practicing nurses love this principle so much. I think it’s because sometimes the term integrative nursing gets associated with being anti-research, anti-evidence, anti-intervention sometimes. And that’s not the case at all. One of the most easiest phrases that I use to explain integrative nursing to people is that we don’t throw the baby out with the bathwater. We use the evidence and the science there to inform our practice as nurses but we also complement it with additional evidence and other therapies as well as our experience, what we know to be true as nurses. All of that gets included into our decision-making process. I think that’s something really important to consider.
So, for example, if we have a patient that’s septic they probably need antibiotics. Integrative nursing would say yes let’s treat this patient with antibiotics, there’s nothing wrong with that kind of evidence-based intervention. But can we not also offer them some additional therapies or interventions that might also support their healing in addition to the antibiotics. Might they benefit from, you know, traditional Chinese medicine, massage, guided imagery, all these other other options that are out there.
I think it’s important too to look at what this principle says regarding evidence, it’s [informed-ness]. I think that nursing has adhered to the biomedical model of using evidence-based material for making many of our decisions over the last few decades but what that does is often negate nursing’s experience, what we anecdotally know to be true. Think about the things that have been passed down to you from older practicing nurses, for example, or just traditional healing models of care. My own experience of working with Native American populations, a lot of those approaches don’t have evidence supporting them but we know them to be effective. So evidence-informed is very different from evidence-based and I think that’s important to consider with this principle in particular.
So integrative nursing uses the full complement of therapies informed by multiple sources of evidence and that includes empirical, aesthetic, ethical, personal, political and personal knowing.
This is an example of an integrative nursing symptom management approach. So this is in alignment with principle five, for example. Here we are looking at the symptom of nausea and this is a symptom management tier that we might use in our integrative nursing course. Notice on there that there’s a full range of therapeutics and interventions that as a nurse you can apply to your patient and that includes pharmacological intervention which you’ll see down there in tier five. We’re not opposed to anti-emetics for the treatment of nausea with this patient population but look at all of the other options we have as well. These can be used as first line perhaps to avoid the use of medication, it can be used in conjunction with the medication, it can be used to support the medication. It’s going to depend on the individual context, where the patient’s severity of their symptom is falling into this tier and really this is a very, like I said, an exciting principle for a lot of our Masters students because what it does is expand their toolbox and it expands the clinical training that we’ve already received as nurses and really opens our eyes to all these other possibilities for meeting our patients’ needs. So this is just one example of how to manage and look at a symptom from an integrative nursing approach.
The number six. As Cheri alluded to there’s increasing focus on the, with the quadruple aim for the health and well-being of the caregiver. So integrative nursing is definitely addressing this issue through this principle in that we focus on the health and well-being of caregivers as well as those they serve. So we’re concerned for the well-being of self, of ourselves because we can only support others to the capacity that we ourselves are supported. So when our reserves are depleted then we’re unable to provide the level and quality of care that our patients demand and that in turn affects quality, patient satisfaction and ultimately cost. If you look at the turnover and compassion fatigue and burnout rates among our profession there’s serious economic implications for that.
And so I think this principle touches on all of that. And again we’re not just paying lip service to self care with integrative nursing, it’s a huge focus of this perspective and is actually threaded throughout everything that we do.
So if we look at these principles as a whole we can definitively say that integrative nursing builds on and extends our historical nursing beliefs and values. Again we can see everybody from Florence Nightingale to Martha Rogers to Jean Watson threaded throughout this framework. It clarifies and structures our nursing interventions. So if you think about that nausea management tier it provides all these opportunities and tools and choices for you to better meet your patients’ needs. It provides greater transparency to the critical clinical analysis that we use when we’re caring for individual families and communities.
And integrative nursing really suggests a roadmap for building a science of patient-centred complex care again recognizing that a nested system that we all exist in as individuals and recognizing the whole person, whole systems perspective.
I’m going to hand it over to Cheri now to talk a little bit about the implications for nursing practice in regards to actual integrative competencies for care.
Cheri: So I’m going to talk about 10 proposed competencies for integrative nursing care and they really speak to all the different dimensions of a nurse and how you can be an integrative nurse. So the first competency that I’ll be discussing talks about this notion of patient-centred care and relationship-based care. This is very inherent in nursing, it is what we do all of the time but really being mindful of is the patient in the centre, is the person in the centre and those could be two very different things. Looking at the patient as a person and not as a patient.
So just one brief example is thinking about not the diabetic patient but the patient with diabetes or the person with diabetes. It’s a slightly different perspective but very important. Also talking about the relationship that you have with a patient and their family and their friends and whoever their support team is and really making sure that you’re able to have open dialogue and open relationships. So you can really engage the patient in their support group so that the patient can be placed in the best possible space for healing. And that comes through engaging in a teaching and learning process, about self care and how people can look at themselves and do a complete body scan and say “How do I feel today and then what do I need to do about how do I feel today?” if they happen to not be feeling well. And when would they then need to reach out to a healthcare provider. So really having a good relationship. And also looking at that whole person well-being from assessment through collaborative interventions.
The final piece of this competency is to, for the nurse to engage in reflective practice and that means taking a step back and saying in this relationship what’s working well, what’s not working well and how can I as a nurse impact that relationship.
The second competency that we look at is being able to truly provide an integrative assessment and history on each individual that you work with. So really delving into all of those different components that Natalie talked about when we talked about well-being. This particular model doesn’t have every single component but really looking at not only the physical – because we always assess the physical as nurses – but really making sure are they socially where they need to be, are they emotionally where they need to be, mentally, spiritually. Are they safe, do they have financial security, do they have nutrition security. There’s lots of different components of the history. And sometimes in our zeal to get the things done that nurses need to get done we might miss some of these really critical pieces that may have a huge impact on physical health and well-being and healing.
So really taking a look at how you might be doing, your assessment and learning about your patient. And that really goes back to building those critical relationships with your patient.
When we look at competency three that talks about collaborating with individuals and their families for personalized care plans. And really thinking about what’s important to that a person, what’s important to their family, what will bring them the best possible well-being and assist them to heal. As Natalie talked about this is also evidence-informed so really thinking about what is evidence-informed. It’s what the evidence shows us – and we’ve all been taught that you can go out on the internet and find evidence just about for anything – but the evidence-informed, what that means is you review the evidence that’s appropriate for your patient but then think about your practice and your experience and your knowing of the patient. Is that the best intervention for that patient at that time to support a healing process that’s very personal. And also thinking about that notion of moving from the least intensive interventions to the most.
We use integrative approaches a fair amount in the healing process and health restoration process and really thinking about coaching your patient of the different things that they can do. So, for example, if you’ve got an individual who’s been in an acute care setting for two weeks because of an emergency situation and now healing has happened with a lot of intensive support in an acute care environment but now they’re going home and healthcare providers will not be at their bedside day in and day out to watch them minute by minute and they might get a little anxious. So you might be able to teach them some very brief anti-anxiety measures.
So things like slow rhythmic deep breathing might be really helpful for that individual. For others maybe they’re very tactile people and maybe petting their dog at home is going to calm them down and help them get a sense of self-calming and that they can certainly handle being at home after being in hospital for such a long period of time. So that’s the essence of competency three.
As we move to competency four that really looks at taking a look at what is the skill set and demonstrating skills for understanding the evidence and then putting it into practice. And I’ve already described what that means as far as evidence-based care but in action what that might mean for you is you take your population-specific knowledge and wisdom and you look at the evidence but you’re also talking to your colleagues who also know the patient and thinking about again is this the best group decision for those interventions at that time for that particular individual based on what you know right now and all the evidence that you can pull together. And that means experience and wisdom is part of the evidence base and we don’t often think of that.
So in competency five we’re really encouraging individuals to look at basic knowledge and really use your professional knowledge to be able to work with individuals not only on the health care team, affect the patient but the patient and family and that really comes down to good communication skills and being able to be a strong team member whether you’re a leader in that team or a follower in that team and really being able to defer those decisions to the person on the team who has the greatest expertise to make the decision. And that may mean that you bring your nursing expertise to the table and you might be the coordinator of that care but what that patients really needs is really strong nutritional coaching. So you bring in your dietician colleague who can do that and use their body of knowledge to be able to affect that particular individual’s best chance for healing.
In competency six, what we’re looking at is trying to facilitate a behaviour change and that could be in individuals or families or communities but that’s, nursing does this all the time in our assessment of where is someone in their willingness to assess themselves, learn about something to be able to effect a change for their health and well-being. Very often we take a coaching role in this and we try to move people from where they are to just one step closer to where they will have the best possible well-being and very often that takes the form of motivational interviewing as you sit down and you get to know your individual that you’re working with and where they would like to be as a goal. And then how far are they willing to take a step towards that goal and how quickly they want to move towards that goal. So it’s really getting to know the individual and then using the educational strategies that we know to engage that individual in active self care and self management of health and well-being.
In competency seven we look at that effective team member approach and we don’t do any care alone these days, we always work with members of the healthcare team. And it’s really the nurses in today’s world are truly a care coordinator whether you’re in acute care or you’re in the clinic or you’re in homecare or another place where your nursing role is a little bit different. But you’re always coordinating a team of individuals who will have a major impact, positive impact on a person who needs the care. And that’s really coordinating your inter-professional colleagues around that notion of patient-centred care and relationship-based care. So you have to have good relationships with each other as team members but also with the patient and their family to be able to move that patient forward and to do that in a safe, high quality manner.
As we look at competency eight this is the competency that quadruple aim talks about and it really talks about practicing self-care. And it’s really important that not only that you demonstrate self-care but you back up just one step before that and say “Do I care for myself? If I don’t what are the barriers to self-care and how can I fit self-care into my daily practice?” And if you’re working a 12 hour shift think about how can you fit self-care in. Think about how you can fit self-care into your days off that are beyond sleeping which is just a piece of self-care. But really thinking about how do you restore yourself in body, mind and spirit when you’re outside the workplace so that when you go into the workplace you have something that you can give and you can be fully present.
So taking time to restore the body, mind and spirit and how do you do that during your work day. Well, some of the things you might try is taking a time out and that might be just taking a slightly longer bathroom break if that’s what it takes on a busy unit. Because you’re by yourself and for the most part people are not knocking on the bathroom door looking for you. Other things is engage in a healing environment and some of you may be in workplaces where they actually have a courtyard that’s got trees and benches or it might be a healing garden that’s adjacent to the building that you can go to. Or you can do meditative walking and just walk around the building or any place where you can be mindful. And that means you can break away from the chaos of a unit or a chaos of what’s going on on your computer or your desk or in the clinic and you can just refresh your mind. And it doesn’t take but five minutes just to break away and give your brain a break from all the chaos that goes on.
Also making sure that you nourish your body. Very often people get very busy during the day and they might eat snacks out of their pocket which may not have good nutritional value or they might forget to hydrate. Those of us who lived in the deep southwest we know that hydration is extraordinarily important and it is during your nursing day as well wherever you live. Making sure that that hydration is, that you’re well hydrated, it’s very, very important.
Also you can engage in relaxation breathing. If you can find a quiet space, take five minutes to do some deep relaxation breathing, put your body in a position that’s comfortable for you. You might close your eyes, you might plug into soothing music for five minutes, put it on a timer. Many people might have different apps that they can use for calmness and you put your phone on if you have a smart phone you put that on a timer and you take your five minutes and you do rhythmic breathing or you listen to music that goes along with that or you might do a quick mediation to break away. And for people who, maybe you’re at work but you’d like to be at the beach take five minutes and go there and try to relax and you will come back rejuvenated.
You might do some self reflection as well as, you know, “Why am I feeling so frazzled today, what’s going on that’s causing this feeling in me?” And you might be able to get some brief insight so that you can take the corrective action in the middle of a long shift and that makes your shift better.
Another thing that you might do and think about on your unit and it’s great if you make this more of a group endeavour is to perhaps do a code lavender in your unit. And that would be, the essence of the code lavender would be that maybe each unit or the unit that you’re on has some very special things in a box that’s only for the nurses or you extend it to the healthcare team. And one of the things that you can do if someone’s having a bad day you can enact a code lavender. So one of the colleagues gives that person a break, maybe that person can go to a quiet space and another person can just give them a gentle neck massage, for example. And they can close their eyes and they can just sort of relax, just for a moment. Or perhaps a hand massage with some aromatherapy. Some people find the essence of lavender very, very soothing so sometimes using essential oil or a cream with lavender in it to massage someone’s hand might be very, very helpful in relaxing people.
And taking care of one another on the unit when that person is having a bad day or perhaps that person just lost a patient. Or just their, one of their longstanding relationships with a patient, they just got some bad news about that. So trying to take care of, being mindful of each other but taking care of each other in the midst of a very busy day.
Competency nine talks about developing skills in the healthcare system in community settings so really engage with the community and all of our individuals that we work with are part of a community and part of a population. And thinking about what are the population’s needs, what are the resources for that population, what are the best practices for coordinating care across the care continuum as we have people transitioning from perhaps an acute care setting to rehab to homecare, what are the supports that are needed. And what are the technologies at our disposal that we might be able to use to make sure that our patients are safe and have good quality care and are able to have good communication with their healthcare team as their health improves or perhaps deteriorates. So really making sure that we have that community perspective and healthcare systems perspective for our patients.
And then our final competency, competency number 10 talks about the ability to practice within our ethical standards and deliver care according to the ANA code of ethics which many of us had to all but memorize when we went through nursing school and we live by that as our moral and ethical code. But also to be able to really think about how can you advocate for your patients, making sure that standing up for social justice and equity in the healthcare system for individuals and for populations.
And also importantly as we do that making sure that we can recognize within ourselves emotional and moral distress because of some of the inequities that we may be observing and take some action to advocate for change to improve the circumstances. And I know I’ve read several accounts of nurses across the country who’ve noticed this on their unit [unintelligible 00:41:56] to their supervisors and said can we have ethics rounds so we can talk about these things, can we have someone come in and help us process these really distressing situations on our unit which seem to be happening daily.
So really, you know, noticing what’s happening on your unit but also be bold to lead the unit to take action or you yourself take a bold action as a leader to effect change and that in turn will help your colleagues be better caregivers because they will be whole people as well. Because we can’t be whole people as caregivers if we need healing. And I think that’s a really, really important perspective to take.
So with that we can open it up for questions.
Melissa: Okay, I guess I can start it off. One question we have in Cheri, in your and Natalie’s opinion what do you think the future of integrative nursing will look like in the next five to 10 years?
Natalie: That’s a great question, this is Natalie. So I think that healthcare as a whole, and I mean all of healthcare is heading in this direction already. And we as nursing are poised to be at the forefront of it because like part of this presentation relayed many of the, much of the perspective is fundamental to who we are as nurses already. We can find evidence in an integrative nursing approach in our nursing roots so we need to be on board with this. As Cheri alluded to at the start of this presentation our patients are asking for this, there’s a huge consumer demand for alternative and complementary therapies in addition to the more traditional biomedical approach. People are using this approach outside of the acute setting or our contact with them so we need to meet our patients where they’re at.
I think that nursing is inherently open to this or we can be very open to this and we, the science is evolving. We’re seeing more and more research and literature devoted to supporting this approach, researching this approach. And I think when you look at the quadruple aim integrative nursing is a huge or integrative healthcare in general is a huge component of the quadruple aim. This is going to have an impact on our healthcare costs which are rising with our aging population, this is going to have an impact on patient satisfaction scores which are directly linked again to the financial structures of Medicare, Medicaid and those kinds of services. And this is going to have a huge impact on the overall health and well-being of our caregivers, ourselves. Turnover, burn-out, huge financial implications for that. I think that this integrative approach, the more we research it, the more we put it into practice, the more we tailor it, target it and track its effectiveness I think that’s where we’re heading in the next five to 10 years.
Cheri: And I would definitely agree with Natalie and I think the other thing that I would add is integrative therapies overall are far more acceptable in the population than they used to be. So not only are people are asking for it but people will come to expect that as part of the menu of interventions that they are given. So when we have people who say “I don’t want to take drugs, is there anything else I can do?” nurses at least have to be knowledgeable enough to say there are several other options. You may not know how to do acupuncture but you need to know enough about it to know what conditions it may be very helpful in for individuals who perhaps do not want to go down the pharmacological path.
So what we’re probably going to see, if I were going to look into the crystal ball, is a lot more information being imparted not only to current nurses but also to nurses to be, to our pre-licensure folks in nursing school so that people are truly knowledgeable about the different therapies and the different options that our patient populations are asking for.
Melissa: Great. One other question I’ve got here is how does this particular RN to MSN program at the University of Arizona prepare students with an integrative nursing approach?
Cheri: That’s a great question. We have a somewhat traditional trajectory as far as the topics that we teach in the Master’s program. What sets our program apart is that we have one full course that is dedicated to healing environments where individuals learn from the very beginning all the way through to the end of the course, they learn about the principles, they learn how to apply the principles. They look at evidence of integrative therapies and share that with one another and they do this parallel track of self-discovery through the entire, or through, they do it through the program certainly but through this particular course they really drill down to who am I, what am I all about, what are the issues that I might have that I really need to look at.
So, for example, we have individuals look at the ANA self-assessment and I know in the past people have had some incredible revelations about their workplace and the fact that it perhaps was not a healing environment and have some real interesting thoughts about what they can bring into the workplace to make it a better place to work. And when we talk about a healing environment we talk about a work environment that everyone can peacefully co-exist and move the patient to a higher level of healing. So, you know, we’re talking about very simple things like temperature, wall colour, floor colour, curtain colour all the way through to civility and how people treat each other, how people work together, what the expectations are, that people aren’t overworked and underpaid perpetually. And, because those are huge stressors in a work environment.
So we really talk about a lot of those things and students get to explore that in that course and then they bring that knowledge forward. So we do have a component of integrative nursing and integrative health that we have them pull through to their capstone project and we want them to infuse that in there. But we also as faculty encourage students to practice self-care techniques all the way through the program. And that’s really important to us that individuals have that balance and do as much as they possibly can for personal health and well-being. So that’s how we bring that through the program.
Melissa: Alright, that’s great. And Kathleen actually wanted to know if you can give an actual example of how nursing self-care is integrated into the curriculum. I think you kind of touched on it there but maybe just if there’s any specific examples of things that you know are actually touched on in the curriculum.
Cheri: So in the healing environments course one of the assignments is to have individuals explore an integrative therapy and then engage in it. So people will go out and perhaps engage in yoga or take a yoga class or they might go get a massage or acupuncture, acupressure. And then we have folks journal about that and then we also have people connect with a provider of an integrative therapy and interview them so that they can get a perspective of what it’s like to provide a therapy from someone who provides a very specific therapy.
So that is done in the healing environments course. And then really throughout the program what we do as faculty is very often we remind people to do the simple things like take a deep breath, to reconnect with what’s valuable to you and sometimes those reminders are extremely important when you’re a busy student, busy professional. And to have someone remind you to do self-care sometimes is huge because sometimes we don’t remind ourselves. So I don’t know if Natalie has anything to add.
Natalie: Yeah, I would say my experiencing teaching in the healing environments course is how often are you literally assigned self-care. And sometimes that’s what it takes because I think as nurses we are often acculturated to put ourselves last, we tend to do that. And so when you, it’s part of an assignment worth points to actually engage in self-care, all of a sudden it pushes it up to the forefront. And I know for many of my students who are just wrapping up this course right now that was a huge turning point for them, a huge realization for them that a) they’d been neglecting that piece for themselves for far too long and b) they could actually feel the positive repercussions of engaging in that assignment. It made them better nurses, it made them better students, it made them better spouses and parents and family members.
And many of them have continued to carry that assignment through the end of the course voluntarily. I literally just have had several students email me in the past couple of days saying I’ve kept up my yoga practice that I did for my assignment, I’ve kept up my 15 minutes of deep breathing a day, it’s helping me sleep so much better. Literally assigning and “forcing” people to engage in that self-care has really had a transformation on the rest of their journey I think in the RN to MSN program.
Cheri: And outside of school.
Natalie: Absolutely.
Melissa: Okay. I think that’s all the questions we’ve got for today. Just want to remind everyone that Cheri and Natalie are both a part of the RN to MSN program at the University of Arizona and as you can see from the slide we are accepting applications for summer 2017. You can contact an advisor through the phone number or the email address. There’s also the link to the appointment booking site on the far right on the bottom of the screen. Other than that, Cheri and Natalie, do you guys have any final notes, wrap-up?
Natalie: I just want to thank everyone for attending today. I hope that this was an interesting and useful topic for you and I hope it was clear to you how applicable integrative nursing really is to our practice and science of nursing.
Cheri: And we hope that you’ll really consider who you are as a nurse and who you might want to be as a nurse. And perhaps for you that means more education either in integrative health or in leadership. If you’re the kind of person who says “Wow, I’m really interested in this and I would like to implement this in my institution” one of the paths to do that is through leadership. So you can not only impact your colleagues but you can impact a much bigger group of people and influence individuals in your institution.
And we have had our graduates go on and do exactly that in leadership positions where there was one person in particular I can think of who is a director of nursing and she went around to every unit at least once a week and had integrative nursing rounds in her, on her units that she was responsible for. And she brought the lavender and she had lavender huddles and really sort of totally embraced it. And she said it made a huge difference in the way individuals treated each other and the way the teams worked together and people noticed.
So think about what impact you might like to make and the path to get there. So, thank you very much for attending today.
Melissa: Okay, thanks everyone, have a great day.
[End of recorded material 00:56:21]

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