Myra, a 67-year-old female has severe neck pain and imaging shows a herniated disc. A surgeon tells her that she will need cervical spinal fusion. Let's keep her in mind as we learn about two key principles of integrative nursing. The first is encourage her innate ability to heal. The second is to start with the least invasive intensive therapy and move to more intensive therapy only as needed. Although these are nursing principals, they apply to anyone working with a patient as you will see. Let's start with some context about integrative nursing and how the principals of this practice are relevant to any provider interested in patient-centered care. According to the textbook on integrative nursing, the goal of nursing practice is to support the innate healing capacity and growth of the individual, family, or community. Care focuses on supporting the healing process. Integrative nurses personalize interventions based on their patient's needs, wants and preferences. They use an evidence-informed approach to practice when selecting or recommending appropriate interventions or therapeutics, which include the use of integrative therapies and healing practices to manage symptoms and improve clinical outcomes and quality of life. Integrative care uses the body's innate ability to heal. For example, when you cut your skin, your body automatically goes into a process of cellular repair. When nerves are damaged, the surviving nerve cells reorganize and establish new neural connections. Our mind can also help us heal. Neuroscientific research demonstrates that the brain is capable of changes in structure and function, a property known as neural plasticity, and that these changes can result from experiences or internal mental activity. Positive emotions flood our brains with dopamine and serotonin, enhance immune system functioning, diminish the inflammatory process and response to stress, and facilitate changes in the brain. Some people have the capacity to heal from deep physical, psychological, emotional, and spiritual traumas. One of the roles of the integrative care is to support that natural healing. If one goal of integrative care is to support our innate capacity to heal, it is important to begin with the least invasive therapies and move to more invasive modalities as needed so as to not interfere with the natural healing process. This has the additional advantage of reducing additional trauma, potential side effects, or complications from mourn basic therapies. Many of the less-invasive approaches involve integrative therapies. For example, opioid addiction is a huge issue in the United States. Less invasive pain management approaches include mind-body interventions such as the relaxation response, guided imagery, hypnosis and mindfulness-based stress reduction, as well as acupressure, acupuncture, yoga and movement therapy, massage, and access to nature. A major focus is using integrative therapies to more effectively manage symptoms as informed by research evidence. In contrast, biomedical management of symptoms frequently begins with a pharmacologic intervention intended to suppress symptoms and fix the problem. Integrative care shifts the focus from curing to healing, thus changing the nature of the problem solving and prioritizing. This does not mean that biomedical interventions are discarded. Rather, they're introduced when that level of intervention is warranted. Nurses and other clinicians practicing from an integrated perspective, are not merely adding on integrative therapies. These therapies are core to their practice. Jessica, aged 12 was diagnosed with leukemia four years ago and was preparing to receive a bone marrow transplant. Pain was a major problem for Jessica, and while she received traditional pain medications, she felt anxious constantly and wasn't able to sleep or eat. The team of nurses, doctors, pharmacists, we're all concerned with the amount of opioid pain medication she was requiring while her pain was still poorly controlled. Neither Jessica or her mother knew much about integrative therapies, but they were open to trying anything that might ease her pain. Jessica thought that Reiki sounded appealing and it turned out to be particularly effective in helping Jessica manage pain and fatigue. After the very first session, Jessica's pain decreased by half. Her mother noted that it was only after Jessica received Reiki treatments that she could sleep. The dramatic results continue, the more Jessica and the nurse work together to build a relationship. Eventually, the nurse helped Jessica make the connection between feelings of peace, calm and relaxation, and decrease pain. They started practicing other methods such as progressive muscle relaxation and guided meditation that Jessica could use on her own for relaxation. The integrative therapies helped Jessica manage her pain and anxiety. She was able to reduce her opioid medications. In addition, they taught her skills for self-regulation and built her self-confidence at a time in her life when she most needed that confidence to heal and develop a new equilibrium. Bone marrow transplant is a powerful example of the innate human capacity for health and well-being. Prior to the transplant, the patient's immune system has been destroyed in order to eradicate the cancer. Without the body's innate capacity for healing, this life-giving intervention would become life-threatening. In the first 100 days of a bone marrow transplant, one of the care teams most important jobs is to hold space for the body to heal and flourish again. The speed and efficacy of recovery is very related to our body's ability to create an environment that both protects the patient from infection and supports that natural healing capacity of the body. How can you practice integrative care? To start, when making treatment recommendations, begin by acknowledging the broad range of therapies available and begin with the intent to heal. Look at the evidence for integrative healing practices as well as allopathic options, choosing the treatment that is the most natural and the least disruptive. These treatments that are non-invasive and have the fewer side effects as well as the greatest potential to alter the mind, body, and spirit of the recipient. Of course, it is always important to consider the risk in relation to the benefit for any therapy or practice. Think about using all five senses and deep listening to look for the root causes of problems. Embrace uncertainty. See beyond your comfort level. Get a broader and potentially more accurate view of what's going on. Lastly, seek diverse perspectives and consider each situation from a different view, asking others opinions on treatment options. Different types of knowing help us choose the appropriate intervention, practices informed by multiple sources of evidence. Our knowledge is not limited to evidence created empirical sciences. We value equally all types of information gained through personal experience and the clinical knowledge gained from patient care experience. Without using any private health information, consider a past or current patient. Is there a less invasive option you could have suggested? Post to this week's discussion. Outline the case without using any identifying information and what treatment recommendations you would make for this patient in an allopathic perspective, and then from an integrated perspective. What are the similarities and differences between these two perspectives?
