Comfort as Medicine: Integration of CAM into Bedside Care

Kaiser Permanente, Northern California

Caritas in ActionHow Caring Science informs and inspires KP caregivers and affirms our commitment to provide our

patients and their families exceptional care

Caritas Consortium 2013

Comfort as Medicine: Integration of CAM into Bedside Care

Intent to Contribute Statement:Abstract: Numerous studies validate the use of Complementary and Alternative Medicine (CAM) for a variety of health issues

and symptoms. Complementary therapies offer nurses the opportunity to provide holistic care and empower patients to

actively participate in their care and recovery (Fountouki & Theofanidis, 2009). Holistic care seeks to treat the whole

individual as opposed to treating symptoms exclusively and recognizes the role of mind, body, and spirit in the healing

process. The White House Commission on Complementary and Alternative Medicine Policy (2002) recognized the need for

increased education and training of health practitioners in CAM. The California BRN identifies that nurses can help provide

the missing link between conventional Western medicine and CAM therapies (BRN, 2009). The integration of CAM into

bedside care is also consistent with Watson’s theory of Caring Science. Watson uses the term carative instead of curative to

distinguish between nursing and medicine. Watson’s theory focuses on 10 caritas factors that contribute to caring, healing

relationships and can be characterized by caring moments or caring occasions. A caring occasion occurs whenever the nurse

and another come together with their unique life histories and phenomenal fields in a human-to-human transaction. Our

project seeks to enhance nurse patient relationships, enable holistic, individualized by providing nurses resources and

education to incorporate simple CAM modalities and caring behaviors into their everyday practice.

Research Question: Will nursing education, and readily available resources increase patient perception of a healing

environment and caring behaviors consistent with Watson’s Theory of Caring Science?


Methodology: Inservice education on elements with the ‘caring cart’ will be provided to staff

nurses in 2 nursing units, medical neurology Unit 430 and general surgery Unit 235 of Kaiser Santa

Clara Medical center. The carts will be provided for nursing use after the educational inservices.

Elements within the Caring Cart:

• TV channel guides: distraction, music therapy (care channel)

• Movie list: distraction, humor

• Aromatherapy: CAM (lavender, peppermint)

• Herbal Teas: CAM (mint, lemon, ginger, etc.)

• Guided Imagery Channel Guide & Brochure: CAM

• Lip Balm: comfort

• Playing Cards: distraction

• Insomnia Management: ear plugs, white noise machine, sleepy time tea

• Mind/Body Medicine KP patient resources handout: podcast, downloads info sheet for depression, anxiety, pain, insomnia etc.

… Continued


Data Collection: The measures used to determine efficacy will be the Caring Factors Survey, this

reliable and validated tool measures caring behaviors based on Watson’s 10 Caritas Processes

(DiNaploi, Nelson, Turkel, & Watson, 2010). In addition specific HCAHPS and AVATAR data that also

measure patients’ perception of caring behaviors and comfort measures provided by nursing staff

will also be evaluated. All of these data points will be evaluated pre and post education and

implementation of the ‘caring cart’. We hope that these measures will support a healing

environment, further our integration of Caring Science into practice, and improve patient

satisfaction with caring behaviors and ultimately contribute to our organizational goals of providing

world-class care every patient, every time.

… Continued



Inspired Contributor(s) 1 : Tracy Trail-Mahan Karen Finnie

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Service Area: Santa Clara

Medical Center: SCL

Affiliation: PCS

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Year Shared: 2013

Venue: Caritas Consortium

Format: PowerPoint, Poster

ID #: Q01

Keyword TAGs: Identifier

Consortium2013-July, Santa Clara, Podium, Poster, Patient Care Services

Healing Environments, Healing Modalities, Patients/Families

Descriptor Aromatherapy, Complimentary &

Alt Medicine, Music, Self-Care, Total Health, Research and Metrics

Complementary and Alternative Medicine (CAM)

• Numerous studies validate the use of Complementary and Alternative Medicine (CAM) for a variety of health issues and symptoms. Complementary therapies offer nurses the opportunity to provide holistic care and empower patients to actively participate in their care and recovery (Fountouki & Theofanidis, 2009).

• Holistic care seeks to treat the whole individual as opposed to treating symptoms exclusively and recognizes the role of mind, body, and spirit in the healing process.

• The White House Commission on Complementary and Alternative Medicine Policy (2002) recognized the need for increased education and training of health practitioners in CAM.

• The California BRN identifies that nurses can help provide the missing link between conventional Western medicine and CAM therapies (BRN, 2009).

Complementary and Alternative Medicine (CAM):Bringing it to the Bedside

• The integration of CAM into bedside care is also consistent with Watson’s theory of Caring Science.

• Watson uses the term carative instead of curative to distinguish between nursing and medicine. Watson’s theory focuses on 10 caritas factors that contribute to caring, healing relationships and can be characterized by caring moments or caring occasions.

• A caring occasion occurs whenever the nurse and another come together with their unique life histories and phenomenal fields in a human-to-human transaction.

• Our project seeks to enhance nurse patient relationships, enable holistic, individualized by providing nurses resources and education to incorporate simple CAM modalities and caring behaviors into their everyday practice.

Elements within the Caring Cart

• TV channel guides: distraction, music therapy (care channel)


• Aromatherapy: CAM (lavender, peppermint)

• Herbal Teas: CAM (mint, lemon, ginger, etc)





• Mind/Body Medicine KP patient resources handout: podcast, downloads info sheet for depression, anxiety, pain, insomnia etc

CAM Patient Handout

•

SMART Goal

PENDING

• Specific - Promote caring science behaviors and provide comfort measures consistent with caritas factor #8 create a healing environment by use of a Caring Cart

• Measurable - Caring Factors pt survey pre and post Caring Cart introduction, HCAHPS evaluate Caritas Factors data per & post intervention

• Achievable - resources available to provide Caring Carts, statistical support for evaluation of outcomes

• Realistic - will start in 2 units as a pilot and evaluate, using PDAS methodology, effectiveness of cart, elements of cart, education of nursing

• Time-bound - collect pre-intervention data, educate RNs, implement Caring Carts, collect post-intervention data x 2 months

Project Measurables

• Caring Factors Survey to pts pre and post Caring Cart

• HCAHPS Caritas Factors

• HCAHPS potentially look at Pain Management data

• Nursing survey component NrCAM K & A??

Caring Cart

• TV channel guides: distraction, music therapy (care channel), guided imagery channel


• Aromatherapy: CAM

• Herbal Teas: CAM





• Mind/Body Medicine KP resources handout: podcast, downloads info sheet for depression, anxiety, pain, insomnia etc

Distraction

• TV Channel Guides

• Movie Listings

• Playing Cards

• Coloring pages and crayons

C.A.R.E. Channel Guided Imagery

• Nursing education

• Pt brochure

• Nursing Policy

• Signage "therapy in progress: do not disturb until____"

C.A.R.E. Channel Guided Imagery

Aromatherapy

• Nursing Education

• Pt Education/Brochure

• Nursing Policy, documentation

• Limited Scope

• Lavender indications anxiety, relaxation

• Peppermint indications nausea

• Ginger nausea

Aromatherapy Diffuser Options

Lavender

What Lavender Is Used For• Historically, lavender was used as an antiseptic and for mental health

purposes.

• Today, the herb is used for conditions such as anxiety, restlessness, insomnia, and depression.

• Lavender is also used for headache, upset stomach, and hair loss.

What the Science Says• There is little scientific evidence of lavender's effectiveness for most

health uses.

• Small studies on lavender for anxiety show mixed results.

• Some preliminary results indicate that lavender oil, combined with oils from other herbs, may help with hair loss from a condition called alopecia areata.

Peppermint

What Peppermint Is Used For• Peppermint oil has been used for a variety of health conditions, including

nausea, indigestion, and cold symptoms.

• Peppermint oil is also used for headaches, muscle and nerve pain, and stomach and bowel conditions such as irritable bowel syndrome.

What the Science Says• Results from several studies suggest that peppermint oil may improve

symptoms of irritable bowel syndrome.

• A few studies have found that peppermint oil, in combination with caraway oil, may help relieve indigestion, but this evidence is preliminary.

Ginger

What Ginger Is Used For• Ginger is used in Asian medicine to treat stomach aches, nausea, and diarrhea.

• Many digestive, antinausea, and cold and flu dietary supplements sold in the United States contain ginger extract as an ingredient.

• Ginger is used to alleviate postsurgery nausea as well as nausea caused by motion, chemotherapy, and pregnancy.

• Ginger has been used for rheumatoid arthritis, osteoarthritis, and joint and muscle pain.

What the Science Says• Studies suggest that the short-term use of ginger can safely relieve pregnancy-

related nausea and vomiting.

• Studies are mixed on whether ginger is effective for nausea caused by motion, chemotherapy, or surgery.

• It is unclear whether ginger is effective in treating rheumatoid arthritis, osteoarthritis, or joint and muscle pain.

Insomnia Resources

• Sound Spa

• Sleep Mask

• Ear Plugs

• Sleepy Time Herbal

Music Resources

• Listening to music does wonders to alleviate stress. Please note that everyone has different tastes in music. Listen to the music that you feel comfortable.

• Music is a significant mood-changer and reliever of stress, working on many levels at once.

(http://www.holistic-online.com/Stress/stress_music-therapy.htm, 2009)

http://www.holistic-online.com/Stress/stress_music-therapy.htm

Caring Factors Survey

AVATAR Caritas Factors

Possible other metrics to examine

Cost of Components per Cart

• Cart $63

• Essential oils (Lavender & Peppermint) $20

• CD Player $20

• Herbal teas $xx

• Sound Spa $xx

• Ear plugs $xx

• Lip Balm (KP Brand Store) $xx

• Playing Cards (KP Brand Store) $xx

• Channel Guides (TV & Guided Imagery) $xx

• Aromatherapy Diffuser $10

• Aromatherapy cotton discs, plastic med cup $xx

• KP resources for podcasts $0

Comfort as Medicine: Integration of CAM into Bedside Care

Health & Medicine

Transcript of Comfort as Medicine: Integration of CAM into Bedside Care