CAM in Nursing Education Rev12

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CAM in Nursing Education 1

Running head: CAM IN NURSING EDUCATION

Status of CAM Education in Nursing Curriculum at College of St. Catherine

Julie Brown-Price and Elizabeth Nelson

College of St. Catherine

May 11, 2009


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Table of Contents

Abstract...........................................................................................................................................3Abstract............................................................................................................................................3

Introduction......................................................................................................................................4

Literature Review.............................................................................................................................9

Research Lenses.............................................................................................................................33

Method...........................................................................................................................................39

Results............................................................................................................................................45Weekly meetings, meditation & oracle cards. The foundation of this research

teams preparation was their weekly meetings. The opposite schedules of thetwo researchers at first seemed to indicate that weekly meetings would beunlikely. Brown-Price is a stay-at-home mom, with a child in school fulltime. She preferred to meeting during her daughters school hours. Nelsonsfull-time corporate position in downtown Minneapolis made evenings andweekends her most convenient meeting times. Nelson arranged her work schedule to allow for a standing Wednesday lunch meeting for the research

pair to meet. Brown-Price took the bus downtown and together the team

worked on each step of this project together, at a variety of downtownrestaurants, and most often at the corporate cafeteria of Nelsons employer.These 1-hour lunch meetings began with check-ins about family and work,and continued with work on the project at hand for that week. This lunch-together ritual continued during the consulting meetings, when theresearchers would have a meal or tea together to debrief the meetings. Inaddition, emails and phone calls were made throughout the week as work

progressed on the project................................................................................46

Discussion......................................................................................................................................57

References......................................................................................................................................63

Appendix A

and type appendix title]............................................................................................................71


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Abstract

Literature confirms the explosive growth of complementary medicine (CM) by American

medical consumers. Despite this rapid growth, research also indicates that medical education has

been slow to accommodate this knowledge into the curriculum, resulting in knowledge deficits

which may lead to patient care that is fragmented, incomplete, and at times unsafe. The purpose

of this project was to explore the current state of CM inclusion in the nursing school philosophy

and curriculum at the College of St. Catherine (CSC). Using an action research model,

researchers served as consultants and met with stakeholders in the colleges School of Health to

educate and raise awareness about this issue. As a result, stakeholders indicated an interest in

further integrating CM into the current curriculum in nursing and across the School of Health.

The initial step in this process would involve the integration of CM into the Doctorate of Nursing

Practice (DNP) curriculum. Implications of incorporating CM education into other healthcare

disciples affords CSC the opportunity to become a leader in the holistic education of health care

professionals. As the second largest educator of healthcare professionals in the state of

Minnesota, CSC could use this curricular innovation to leverage and support the complementary

/integrative medical model that so many patients are seeking, resulting in a fully comprehensive

approach to patient care.


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Introduction

Sometimes a major change in society requires workers to learn and adopt new approaches

to their jobs. Horse-drawn carriage drivers needed to learn to drive a car. Tailors who sewed byhand, learned to use sewing machines. Wood carvers moved from hand tools to electric ones.

Typists moved from using copy paper to operating a duplicating machine. A similar societal

change is occurring inside todays medical clinics and hospitals, where health professionals

encounter patients who are using a new approach to health care an approach based on

wholeness, balance, and respect for the bodys ability to nurture itself an approach known as

Complimentary Medicine (CM).

During these allopathic/complementary medical interactions, physicians and nurses come

face-to-face with patients who have gathered vast amounts of complementary health information

from a variety of sources. Over the past ten years, these patients have come to embody the

explosive use of complimentary and alternative therapies by medical consumers in the United

States. During the 1990s, computer ownership and Internet usage grew exponentially

(Computer Ownership, 2008), with people searching the World Wide Web for conventional

and CM health information. In 1998, WebMD.com becomes a central clearinghouse and

resource for reliable health information, and eventually a publicly traded company on NASDQ in

2005 (WebMD Investor, 2009). During this same time period, the popular press begins reporting

on CM. Dr. Andrew Weil is the cover story in Time magazine in 1997, giving CM the national

endorsement of a Harvard-trained medical doctor (Kluger & Parker, 1997). From his cover story,

Dr. Weils complimentary health information spreads through his business empire of books, CDs,

vitamins, DVDs and his prototype integrated healing center in Arizona. Even Oprah Winfrey

spreads CM information on her daily television show, when she regularly hosts holistic doctor


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and best-selling author, Mehmet Oz, M.D. (Dr. Mehmet Oz, 2009). By 2001 the rising use of

CM suggests continued demand that will affect health care delivery for the foreseeable future

(Kessler, 2001, p. 262).What the media describes as complementary medicine (CM) is a more than a new way of

medicine. CM is a very different way of thinking about health and illness an ancient practice

rooted in balance and wholeness and the bodys ability to self-heal. Whereas allopathic medicine

treats one body part or system at a time, the holistic belief sees an illness through the lens of a

persons entire self (body, mind, spirit, emotion, environment). Allopathic medicine seeks cures,

meaning absence of disease. Holistic and complementary medicine seeks holism, meaning

balance in all parts of the person, even through death. In allopathic medicine, diagnoses are made

with numbers and technology. In holistic medicine, diagnoses are made with patient input, touch,

observation and assessment. The philosophic center of allopathic medicine is physician

knowledge and power, whereas, the center of holistic medicine emphasizes the patient, honoring

the bodys innate wisdom for self-healing (Micozzi, 1996/2001).

Over the past 15 years, the verbiage used to identify the holistic techniques and

modalities has evolved. At first called quackery and voodoo, these holistic therapies were

commonly called alternative. This name implied that patients have made a choice between

holistic and allopathic medicine. Complementary medicine on the other hand, describes

treatments that are used in conjunction with conventional medicine. The ultimate fusion of the

two approaches results in integrated medicine, where both complementary and conventional

medicine are practiced in a conventional medical center (Use of Complementary, 2008).

Eisenberg (1998) says the term Complementary Medicine (CM) best describes the current use of

these healing therapies by consumers, as complements to their western medicine. For this


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reason, complementary medicine (CM) will be used in this report to describe the holistic-based

healing treatments that are outside of traditional allopathic medicine.

With the general media demystifying CM and shedding light on holism, medicalresearchers make their first attempt to quantify on a national scope, the true scale of the CM

usage phenomenon. Richard Eisenbergs landmark study (1998), published in the Journal of the

American Medical Association, reveals CM use rose from 33.8% of households in 1990 to

42.1% in 1997. He also finds that when CM users see their primary care physicians, fewer than

40% of them report discussing their CM use with their doctor. In 1997, the number of visits to

CM practitioners in the United States exceeded the number of visits to primary care physicians

by more than 243 million visits (Burnman, 2003, p. 28). Together, these studies create a picture

of growing CM usage by patients who are self-educated about complementary techniques and

personally empowered health consumers.

The U.S. government validates CM therapies in 1996, by opening a National Center for

Complimentary and Alternative Medicine (NCCAM) as part of the National Institutes of Health.

The work of this center serves several important purposes: to fund scientific research on the

effectiveness of CM therapies, to share CM news and information, and to support integration of

proven CM therapies into the medical system. In the process, NCCAM codified a wide array of

diverse therapies into five domains: whole medical systems, mind-body medicine, biologically

based practices, manipulative and body-based practices and energy medicine. Medical systems

include all therapies that are part of whole system of thought about health, such as Traditional

Chinese Medicine, Ayruvedic medicine, homeopathic and naturopathic medicines. Mind-body

medicine encompasses more traditional means of healing support: prayer, support groups,

meditation, and art/music/dance therapies. Biologically based practices are based in nature, such


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school philosophy and curriculum, particularly at the College of St. Catherines School of

Health.


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Literature Review

The landscape of medical practice in the United States is shifting. News announces a

medical system in crisis. Health care costs escalate out of control. The rolls of uninsuredcitizens explode. Health Savings Accounts replace Health Maintenance Organizations. Policy

makers discuss personal health responsibility and personal risk. Medical debt forces people into

bankruptcy. Care is compromised by a shortage of health care workers (Buerhaus, Donelan,

Ulrich, Norman, & Dittus, 2006). Chronic conditions account for 75% of medical expenditures,

yet allopathic medicine offers few treatments and no cure (Shepherd, 2008). At the same time,

this same medical system cures cancer, keeps two-pound infants alive, transplants body parts and

repairs a body ravaged by bullets no matter what the cost.

In this medical environment, people increasingly turn to complementary medical

treatments, which they pay for out of their own pockets, and from which they receive balancing

and healing of their minds-bodies-spirits. These same individuals also visit their doctors, discuss

their health with nurses, take prescription drugs and generally participate in the allopathic

system, though not exclusively. They are on their own trying to figure out how to integrate their

care, using what is best of both approaches for the welfare of their health and wellbeing (Boon,

Verhoef, O'Hara, Findlay, & Majid, 2004). Some even claim that these health care integrators

have lower overall health care costs than their non-integrating peers (Sarnat, Winterstein, &

Cambron, 2007).

This paper reviews current research at the confluence of CM usage and the health care

system, in general and with particular focus on nurses who function on the front line of patient

care delivery. The research reveals the roots of CM appeal, healthcare system responses,

nursings responses, impact on nursing education, how some medical systems have integrated


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and the current state of integration in nursing schools in the Minneapolis/St. Paul metropolitan

area.

Roots of Complementary Medicine Appeal

The reasons people turn to CM are both logical and highly personal. For some, a chronic

health condition fails to respond to conventional medical treatments (Richardson, 2003). Others

are college-educated women with disposable income who consider spirituality important to their

health. Klingler et al. (2004) find that deficiencies in medical care and commitment to personal

health activism prompt interest in CM. Astin (1998) reports that CM users look for healing

practices that align with their own values, beliefs and philosophies. Greater access to information

also brings exposure to non-Western philosophies and healing practices (Engelbretson, 1999).

Others are drawn by natural therapies that may be perceived as safer than conventional medicine

and have fewer side effects (Burnman, 2003). More generally, CM use is driven by changes in

society. In his research, CM researcher, Engelbretson (1999) describes health care in the United

States as a societal contract, with four simultaneous societal changes driving increased interest in

CM: technology, communication, economics and values.

Technology. As early as 1982, researchers identified the shift in medical practice toward

reliance on data gathered, analyzed and interpreted by machines or laboratory tests, rather than

through observations and relationships made during a more time-intense doctor-patient

interaction. Increased machine-based, care-and-diagnosis technology translates to higher

medical costs too. Fuchs and Patrick, as well as Erickson, in their respective books on health

policy, mention technology as one aspect of increasing health care costs (1994 &1993). In 2008,

the Robert Wood Johnson Foundations report High and Rising Health Care Costs states that

technology is the key driver of rising health care costs, accounting for one-half to two-thirds of


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health care spending growth. Technology also fuels the trend of increased specialization in

medical practice which narrows the approach to patient care.

Medical technology also imparts a higher cost to those using the health care system.Focus on technology results in patient reports of depersonalized, dehumanizing care and loss of a

personal doctor-patient relationship (Cicatiello, 2000). Ciatiello also feels patients have less

confidence and trust in their physician and hospital, than they did during times of less-

technology-driven medicine. Locsin (1995) reports that nurses are keenly aware of technologys

impact as well. They perceive that over-emphasis on technology is at the expense of the human

element in medical care. Complementary therapies, on the other hand, use low-tech, low-cost

techniques and focus on the spiritual and interpersonal aspects of healing (Engelbretson, 1999).

Communication. The Information Age impacts the medical care delivery system and at

the same time explodes the amount of information (medical and otherwise) available to

consumers. Through Internet, TV, online and print magazines and newspapers, consumers learn

about other approaches to health and healing. Bookstores now have entire sections dedicated to

self-help and alternative medicine information (Barnes & Noble.com). These new avenues for

health information allow consumers to learn more about their own health and research

complementary methods of dealing with their particular health concerns (Engelbretson, 1999).

Advertising of health products and prescription drugs directly to consumers is another

change in communicating health information. Drug manufacturers now use Internet, TV and

magazine advertising to sell their products directly to the end user, bypassing the doctor as the

arbiter of drug information (Gellad & Lyles, 2007). In the process, consumers become more

empowered about their health. They bring information to their doctor visits and actively discuss

treatment options. Without a health care professional acting as a broker/interpreter of health


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information, the consumer becomes an independent agent who seeks, finds, decides and often

uses various healing products and techniques (Engebretson, 1999, p. 216).

Economics. Current conventional wisdom links health care insurance costs with globalcompetition. Politicians and business leaders believe that employer-supplied heath care is partly

responsible for Americas competition problem in world trade (Brailer & Van Horn, 1993). In a

world economy, the U.S. system of employer-provided health care insurance included in the cost

of American products makes those products uncompetitive in a global market. At the same time,

the cost of that insurance has outpaced individuals ability to pay for it on their own. If U.S.

citizens cant afford medical care in this country, some have resorted to medical tourism

receiving their medical care in another country at a fraction of the cost (Forgione & Maith,

2007). While the high cost of technology is highly responsible for driving the ever-increasing

cost of health insurance, uninsured and insured Americans alike, find that CM therapies offer

more cost-effective health care alternatives. By using CM therapies, some patients find they can

manage the side-effects of drugs more cost effectively. For instance, they can use acupuncture

instead of costly drugs, IVs and hospital stays to combat the effects of chemotherapy.

Another advantage of CM is in disease prevention and health promotion dealing with a

health issue before it develops or at its earliest stage. With a mind-body-spirit focus, many CM

therapies reduce the bodys stress response and enhance immune function, both contributing

factors in most chronic health conditions. Incorporating CM early in a treatment process may

prevent a chronic condition from developing at all (Orrh-Gromer & Schneiderman, 1996;

Schneiderman, McCabe & Baum, 1992).

Values. Societal values of personal responsibility and ecology also drive the use of CM

therapies. Insurance companies and government policies make the link between personal


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behavior and healthiness, accentuating the personal responsibility at the root of personal health

care. CM methods also put the person at the center of their healing, teaching self-care techniques

and empowering the bodys self-healing knowledge and ability.Likewise, societal emphasis on ecology and recycling aligns better with natural remedies

than radioactive medical treatments that produce toxic wastes. Complimentary healers often

promote harmony in ones physical and social environment (Engelbretson, 1999). Leiser (2003)

finds common beliefs among users of CM therapies. They espouse ecological responsibility,

belief in the paranormal, personal empowerment, health living and importance of stress

management.

For all of these reasons, and numerous others, CM therapies are here to stay. While

personal reasons for choosing CM may change, the societal shifts in technology, communication,

economics and values that support and encourage CM usage are permanent developments in the

ever-changing fabric of American society. As the saying goes, you cant put the genie back in

the bottle. Then, what happens to the healthcare system as a result of these societal changes?

Healthcare response to Complementary Medicine

Nearly all players in the healthcare system have responded in some way to CM use and

the call for greater integration between CM and allopathic medicine. Government gave CM

credibility. The medical profession studied job satisfaction. Hospitals found a marketing edge.

Schools added courses. Researchers validated the mind-body connection.

Government. As mentioned in the Introduction, CM moved out from under its medical

rock in 1992 when the government-funded National Institutes of Health launched the Office of

Alternative Medicine, later renamed the Center for Complementary and Alternative Medicine

(NCCAM) in 1999. Alternative medicine researcher, Jacqueline Wooton calls this NIH decision,


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a watershed event, conferring legitimacy to the area of CM and heralding a new wave of

surveys (2003, p. 11). In 2000, President Clintons administration established the White House

Commission on Complementary and Alternative Medicine Policy to set standards for thescientific study of CM therapies, establish an agenda for the education of health professionals in

CM therapies and to make recommendations for third-party payment of CM therapies

(Richardson, 2003, p. 23). Between 2000 and 2002, the NCCAM awarded 15 grants to

academic institutions to develop curricular initiatives in integrative medicine (Kliger, 2004, p.

522).

Medical profession. Recognition of the need to change the practice of medicine has

gained steam as well. In 2001, the Institute of Medicine published Crossing the Quality Chasm ,

which asserted,

Health care today harms too frequently, and fails to deliver its potential

benefits routinely. As medical science and technology have advanced at a

rapid pace, the health care delivery system has floundered. Between the

care we have and the care we could have lies not just a gap, but a wide

chasm (Kligler et al., p. 521).

Physician dissatisfaction is another call for systemic change, with doctors primary

frustration being the time and productivity limitations imposed by insurance companies (Kligler

et al., 2004). The medical press acknowledges this shift too, with an array of peer-reviewed

publications that offer scientific support for CM therapies and evidence for holistic thinking.

These publications include: Journal of Alternative & Complementary Medicine, Alternative

Therapies in Health & Medicine, American Journal of Chinese Medicine, Complementary

Therapies in Medicine, Complementary Health Practice Review and Journal of Holistic Nursing.


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CM information also is published in peer-reviewed specialty journals, such as Annals of Internal

Medicine, Clinical Journal of Pain, Journal of Pediatric Oncology Nursing, Journal of Clinical

Rheumatology and Journal of Palliative Medicine.

Hospitals. In 1999, 7.7% of hospitals reported offering complementary and alternative

therapy programs. In 2004, the number of hospitals reporting the same more than doubled, to

18.3%, with most recent counts surpassing 37% ("Complementary and Alternative," 2008;

Horrigan, 2006). For hospitals, offering CM therapies is a business decision. The 2006 report

Complementary and Alternative Medicine Survey of Hospitals shows that patient demand was

the primary reason for offering CM services (Horrigan). From a marketing viewpoint, offeringCM services helps a hospital differentiate itself by responding to patient demand and provide

additional billing opportunities for existing patients (Clement, Chen, Burke, Clement, & Zazzali,

2006). The 2006 survey also noted regional differences in the number of hospitals offering CM

services, with the East North Central region (Illinois, Indiana, Michigan, Ohio and Wisconsin)

continuing to lead the nation in the number of hospitals offering CM programs (Horrigan, 2006).

Outside this CM-leading region, prestigious academic medical centers, such as Duke Integrative

Medicine at Duke University, the Osher Center for Integrative Medicine at University of

California, San Francisco and The Continuum Center for Health and Healing at Beth Israel

Hospital not only offer CM therapies, but have blended CM with allopathic techniques to create

and model a new way of Integrative Medicine in a hospital setting (Best Practices, 2009). But

for hospitals to offer integrative medicine and CM services, they need physicians and nurses who

understand the holistic view of medicine and recommend CM services.

Medical schools. While government and medical associations talk about the need for

integrated medical care, such change requires a new kind of physician, trained in a new kind of


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medical school. Charitable foundations, White House commissions and the NCCAM publicize

the need for educational change. Dr. Andrew Weil partners with the University of Arizona and

develops a physician education program focusing on an integrated medical approach, and

innovative medical schools started integrating CM into their curriculum.

Voices for medical school change sprouted from esteemed charitable institutions. The

Robert Wood Johnson Foundation and the Pew Charitable Trust recognize the importance of

education in meeting the changing needs of the healthcare system. In the early 1990s, they

called for medical school focus on interdisciplinary studies, community and preventive health

and transitioning the patient from passive object to active partner (Marston, 1992). The WhiteHouse Commission on Complementary and Alternative Medicine Policy promoted the inclusion

of evidence-based CM practices in the education of healthcare workers, with greater emphasis on

self-care principles (Kreitzer, 1997). The National Conference on Medical and Nursing

Education Blue Ribbon Panel cited the need for medical education to include information about

complementary heath care practices through didactic and experiential learning, continuing

education, faculty development and greater resources for self-learning (Richardson, 2003, p.

23). In the mid 1990s, Dr. Andrew Weil was the first U.S. physician to partner with a university

(the University of Arizona) to launch a program to train physicians as integrative medicine

practitioners (Andrew Weil, 2009). Within 10 years, 64% of 117 medical schools responding to

a survey reported that they offer integrative therapy training in their curriculum, though most

often as an elective, rather than a core value of the educational training experience (Wetzel,

1998).

Between 2000 and 2002, NCCM offered further incentives, awarding 15 grants to

medical and nursing schools for the purpose of developing and sharing curricular initiatives in


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Breckinridge as similar to CM therapies. Nursing theorists, such as Roger, Watson, Newman,

Parse and others laid a holistic foundation for nursing to view health and illness from a broader

perspective than a biomedical one (Engebretson, 1999, p. 220). Their view responds to patient

demand for humanized care and holistic approaches to stress reduction that addresses the

spiritual, emotional, and social components, as well as the physical aspects of a person, all at a

lower cost and with fewer side effects (Engebretson, 1999). Frisch (2001) explored CM use

within nursings worldview in her article Nursing as a context for alternative/complementary

modalities. Through the lenses of Nursing Theory and Nursings Taxonomies of Care, she

says, these therapies can easily be brought into a nursing context (Frisch, p. 1).Contrary to these beliefs, other members of the nursing profession hold fast to the

biomedical model. They are skeptical of CM therapies that they see as lacking hard scientific

research and do not have physician endorsement. Lack of personal knowledge about CM also

creates professional resistance to CM integration and lack of faculty to teach such courses

(Engebretson, 1999).

Meeting Societys Needs. A holistic approach to health care supports nursings long

history of meeting societys needs. In their article, Teaching holistic nursing: The legacy of

Nightingale, OBrian-King and Gates (2007) find that nursing has been in the forefront of

providing care and comfort to those who are ill and education to preserve the health of the

public. While recognizing the need for those services, nursing has been respectful of cultural

diversity as well as individual needs and concerns. They conclude, If nursing is to continue to

meet societys needs, nurses must be attentive to the requests of society (2007, p.337).

Engebretson (1999) looked into the future of nursing when he wrote:


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Why are simple, nontechnical modalities gaining in popularity when

technology and communication have become so advanced? The

complementary healing community is responding to the public interest in

healing and to these shifts in the social context. Many of these modalities

are similar to autonomous nursing interventions, such as touch massage,

stress management, counseling, comfort measures, and activities to

facilitate coping. The purpose and viability of any profession is to meet a

public need. For the profession of nursing, it is therefore important to

consider the implications of the popularity of complementary therapies.(p.215)

Halcon, Chlan, Kreitizer and Leonard (2001) also see the link between nursing practice

and an integrative medical approach that is based in nursings historical response to community

need. In their article, Incorporating alternative and complementary health practices within

university-based nursing education they write:

The public, today as in the past, looks to the health professions for

competent advice about health practices and therapies. Nurses, as the

most accessible and numerous of health professionals, are in an ideal

position to provide such guidance to individuals and communities.

Since many complementary therapies have long been part of nursing

practice and nursing has an established body of research in this area,

the nursing profession is well situated to take a leadership role in

integrative health care. Nurses involved in acute, chronic, and long-

term care must be prepared to provide guidance to individuals and


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families: furthermore, public health nurse must be prepared to respond

at a community or population level and to guide the field of public

health in integrating mind-body-spirit unity into its philosophy and

practice. Nursing, as a field with deep roots in holism and population

health, has an ethical responsibility to advocate for the public on issues

of regulation and reimbursement for CM. (p.133)

The non-profit group Bravewell Collaborative is a politically active organization on the

forefront of integrative education of medical workers. On their website, they attest to their view

of nurses as the health care workers with the greatest potential impact on the diffusion of integrative medicine, is nursing. In their 2005 study, nurses were identified as key to

implementing integrative approaches in both hospice and community hospitals. Their study

concludes that as chronic disease management requires more and more effective forms of

ambulatory nursing, nurses could be at the forefront of the adoption of integrative medicine

approaches (Examples of the Emergence, 2005). As early as 1999, CM researcher,

Engebretson, warned that when biomedicine and others in the health care industry are beginning

to incorporate these approaches, nursing should not move backwards by restricting its paradigm

to that which is derivative of traditional biomedicine (p. 221). Rather, he proposes that nursing

can take the lead in investigating and incorporating those elements into an integrated practice

that meets the publics need and promotes the profession.

Hospice. Possibly the most fertile ground for nurses to provide integrative care is in a

hospice setting. Care is personal, intimate and embraces all aspects of the patient. The setting

allows time for longer therapies. Care is patient and family directed. When the Bravewell

Collaborative surveyed hospice nurses, they reported that use of integrative therapies is old hat


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an ethical responsibility for nurses. She says, nursings deep roots in holism and public health

create an ethical responsibility to advocate for the public on issues of regulation and

reimbursement for CM (2001, p. 133). She also attests that there is increasing recognition that

nursing as a profession and nurses as individuals must be prepared to credibly advise patients

and the public about the vast array of therapeutic options available and in widespread use (2003,

p. 387).

Holistic nursing specialty. Indeed, nursing publicly and formally embraced CM

integration when the American Nursing Association (ANA) officially recognized Holistic

Nursing as a nursing specialty with defined scope and standards of practice (Sharoff, 2008). Theguidebook for this specialty, Holistic Nursing , describes what makes this specialty unique;

Holistic nursing focuses on protecting, promoting and optimizing health

and wellness, assisting healing, preventing illness and injury, alleviating

suffering and supporting people to find peace, comfort, harmony and

balance through the diagnosis and treatment of human response. . . . .

Holistic care is person-relationship centered and healing oriented vs.

disease/cure oriented. Holistic nurses emphasize self-care, intentionality,

presence, mindfulness and therapeutic use of self as pivotal for facilitation

of healing and patterning of wellness for others (Dossey & Keegan,

2008/2009, p. 1).

This approach complements and broadens conventional medical treatments by enriching the

nursing practice and helping individuals access the full potential to heal (American Nurses'

Association, 2007). Holistic nurses are supported by the American Holistic Nursing Association

(AHNA), which was founded in 1980, publishes two professional journals and holds an annual


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professional conference. Since its inception, the AHNA has granted 6,692 nurses, Holistic

Nursing certificates (Member Demographics, 2006/2009).

Nursing Education

For all nurses to fill their roles at the nexus of allopathic/holistic medical care, education

is the key that opens the door to integration. Hospice care, consulting, and a nursing specialty all

involve nurses and nursing students learning and incorporating CM techniques and philosophy in

their work. But just as some medical schools are teaching CM and integration to all students, the

same trend is occurring in nursing schools around the country. Some schools are moving ahead,

embracing nursing roots in holism. Other schools conduct and explore research that supportsincorporation of CM into nursing curricula. Some educators see holistic education as

instrumental for improved self-care and as a possible answer to nursing burnout. And other

institutions evaluate solutions to address common barriers to change.

Rooted in holism. Philosophically, nursing began as a calling rooted in holism. Florence

Nightingale, founder of modern nursing, promoted the nurses role as one of making the patient

as comfortable as possible, to put the patient in the best possible condition, so nature could act

and healing occur (Kreitzer & Sierpina, 2005, p. 308). She understood that physical healing

does not happen in isolation. It includes the spiritual and emotional aspects of the patient. In

fact, the writings and teachings of Florence Nightingale mention numerous complementary

therapies (Halcon, Leonard, Snyder, Garwick, & Dreitzer, 2001). Some of these practices are

included in the widely used nursing intervention classification (NIC) systems (McClosky &

Bulechek). As Florence Nightingale taught and practiced nursing so many years ago, so do the

holistic nurses of today bring a sense of calmness and understanding of the patients needs,


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2002; Melland & Larson, 2000; Reed, Pettigrew, & King, 2000; Watson, 1995). Reed, Pettigrew

& King conclude that including complementary and alternative therapies (CAT) in undergraduate

curriculum provides students with necessary knowledge to give congruent as well as competent

care. Because consumers are using complementary and alternative therapies at a high rate, they

also suggest that students learn to interview their patients regarding the use of CAT and evaluate

the impact of these therapies on the patients health, (OBrian-King, 2006, p. 336). Similar ideas

were the focus at the 2003 Gillette Nursing Summit on Integrative Health and Healing. This

meeting highlights the opportunity to refocus on CM, or integrative healing, to revitalize both

care of patients and the profession of nursing and to recapture (nursings) historical traditions andidentity (Halcon, 2003, p. 387). In this environment of change in nursing education, Dutta et al.

(2003) report that in their survey of nursing schools in the United States, 50% of those schools

responding reported including some CM education in their curricula. No doubt, the fact that CM

questions are now included on the Nursing Board exams has advanced the addition of CM

education in the curricula of nursing schools across the country. But OBrian-King advises

caution. She says more research is needed to identify what content should be taught, to whom,

when and how. For now, it seems that an awareness of different healing systems complementing

allopathic medicine, and an introduction to certain therapies which can be readily included in

nursing practice is a good beginning (p. 336).

Holistic self-care and burnout. Another important reason for including holistic

therapies and philosophy in nursing curricula is the impact on nursing students themselves.

Armed with the concept of wholeness and established techniques for holistic self care, nurses

will have methods to counter the stressors of the nursing profession that often lead to burnout.

Several studies support this logic. A peer-reviewed study of hospice care professionals (HCPs)


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found a link between self-care, compassion fatigue, burn out and compassion satisfaction among

the HCPs. The more a HCP used self-care strategies, the lower the level of burnout and

compassion fatigue, and higher the level of compassion satisfaction (Alkema, Linton, & Davies,

2008). Another researcher at a large, urban hospital found a high correlation between a nurses

need for control and perfection, irrational thinking and burnout. He cites the need for nurses to

receive regular stress management education (Balevre, 2001), the kind of training nurses would

receive when integrative techniques are included in nursing education. Similarly, a multi-

university study found burn out correlation with level of perceived control, with emergency

nurses having the lowest perceived level of control and the highest rate of burnout (Browning,Ryan, Thomas, Greenberg, & Rolniak, 2007). Other researchers found highest burnout among

psychiatric nurses (Sahraian, Fazelzadeh, Mehdizadeh, & Toobaee, 2008). Given the evidence of

nursing burnout, Sharoff (2008) learned that nurses are eager to learn new means of providing

self-care for their own healing processes.

Barriers to change. As with any change, there are barriers to be addressed. So it is with

efforts to implement CM into undergraduate and graduate nursing programs. Burman sees three

primary challenges: already dense curricula, lack of clear guidelines and views of healing that

directly oppose mainstream medicine (2003). The current curriculum needs to keep pace with

the explosion of biomedical information, he says. Current focus on pharmacology, physiology,

biology, disease, prevention and clinical practice fills available teaching time. (Burman, 2003).

Lack of clear guidelines reflects the need for clear educational structure from the American

Nursing Associations education body. But Burman calls the philosophical difference the most

challenging. Nursing programs rooted in biology have difficulty expanding to a view of human

health as a complex interaction among mind, body and spirit (2003, p. 29). OBrian-King and


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Gates (2006) see barriers in the structure of the nursing educational system. They include the

lack of faculty to develop and teach CM classes, lack of resources to hire such faculty and lack

of leadership by deans and directors to embrace holistic concepts, and therefore influence

change. To balance this resistance, they suggest the following measures: promote a positive

image of nursing, provide research data, respect differences, support research for quality

healthcare, offer your services to others and partner with others. Sharoff (2008) says the shift to

holistic nursing education is also constrained by lack of awareness of therapies and their

benefits, uncertainty of effectiveness, concern about payment for therapies and the limited

number of qualified providers (p. 208).Centers for Holistic Nursing Education

Despite these barriers to change, some nursing programs have found ways to integrate

CM into curriculum. Four nursing programs serve as examples of how holism can be integrated

into nursing school curricula. They include: New York University; The University of California

at San Francisco; Rush University and the University of Washington.

New York University . Since 2001, this 48-credit masters degree melds allopathic

(pathophysiology, pharmacotherapeutics, psyconeuroimmunology and health assessment) with

concepts of holism, healing practices of other cultures and the role of self as healing facilitator.

Students learn holistic assessment and acquire expertise in breath work, meditation, relaxation,

nutrition, reflexology, therapeutic touch, homeopathy and self-healing techniques. Graduates

work in settings such as acute care, outpatient, healing centers, holistic health centers and home

health care. The nursing schools motto is holistic nursing takes place wherever healing occurs,

(Kreitzer & Sierpina, 2005).


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University of California at San Francisco. This program grew out of a 1999 federal grant

from the Health Resources and Services Administration (HRSA). It integrates complementary

therapies into its adult nurse practitioner program by offering a specialty in integrated

complementary healing. Students in the program gain basic skills in complementary therapies

such aromatherapy, herbal therapies, and energy healing. The also observe chiropractors,

practitioners of Traditional Chinese Medicine and homeopaths. Most graduates of this program

bring their integrative expertise to clinical settings (Kreitzer & Sierpina, 2005).

Rush University. This program takes a web approach to teaching CM integrated care.

When the universitys nursing school received a grant from NCCAM to incorporatecomplementary content into undergraduate and graduate curricula, they launched a series of web-

based teaching modules for Masters students. In each of the two required modules, students

work through a medical case that has a complementary therapy solution. The web module guides

students to web sites for more information. Though this program does not provide didactic

training in complementary techniques, it does offer a method for expanding student knowledge

that allows graduates to apply complementary principles in the patient setting (Kreitzer &

Sierpina, 2005).

University of Washington. Before and during the course of integrating complementary

principles into its nursing school curricula, the university found a way to solve the problem of

faculty development in CM. Again, a grant from NCCAM provided the funding. Its solution:

offer CM summer camp for its nursing school faculty. Each year five to seven faculty members

attend a four-week course at Bastyr University, an accredited school of natural healing. The

course exposes faculty to a wide variety of CM practices, including use of herbs, whole foods


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and naturopathy. Following camp, the camper-faculty discusses and plans ways to use their

newly learned information in courses and curricula (Kreitzer & Sierpina, 2005).

Minnesota Nursing Programs and Complementary Medicine

Complementary therapies are finding their way into nursing programs around the Twin

Cities too. Most notable are at the University of Minnesotas School of Nursing and

Metropolitan State University. The College of St. Catherine and the College of St. Benedict also

are beginning to include CM information in their curricula.

Under the guidance of Dean Connie Delaney, the University of Minnesotas School of

Nursing has worked in collaboration with the universitys Center for Spirituality and Healing for a decade. She says, we understand that integrative health practices are essential to the full

experience of health and treatment of illness for patients, families and communities (King,

2008, p. 16). In 1999, the nursing school offered a minor in complementary therapies and healing

practices, which enticed master and doctoral students as well as undergraduates. A year later,

with a $1.6 million NCCAM grant, a University initiative integrated complementary therapies

into the curricula of nursing, medical and pharmacy schools. With the grant, the University also

now offers online learning for health professionals and a website for consumers. In addition, the

University provides integrative and holistic health education for health systems in the

Minneapolis-St. Paul area, and an integrated health clinic that serves underprivileged clients.

Most recently, the university announced that, in fall 2009, it will be one of the few programs in

the world to offer a doctorate of nursing practice (DNP) with a focus in integrated therapies,

while also committing to advanced practice preparation that includes integrative therapy care in

all specialties. Every program will have significant content in integrative health and healing,


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says Linda Halcon. Its so consistent with nursings history and theoretical base, (King Hoff,

2008, p. 17).

Metropolitan State University s nursing program is the only one in the state of Minnesota

to be accredited by the American Holistic Nursing Association. Rather than offering courses on

complementary theory and technique, Metropolitan States nursing program infuses all classes

with holistic and integrative philosophy. Its Fundamental Concepts of Professional Nursing

course introduces the concept of physical, emotional, cognitive, social/relational and spiritual

factors affecting health and self care. All medical education is presented from a holistic

framework. The online course catalogue describes Theoretical Foundations of Nursing II as thecourse focuses on the application of theory based clinical decision making for providing

holistic nursing care. The centrality of the clients model of mind-body-spirit within the context

of health is emphasized. The specific therapeutic interventions of relaxation, imagery, therapeutic

touch and pattern explication are taught (MetroState.edu.). The schools holistic nursing

education is available for bachelor, master and doctoral students.

At The College of St. Catherine and St. Benedict College , complementary and holistic

medicine education is beginning in their baccalaureate nursing programs. The College of St.

Catherine includes a two-hour overview of holistic philosophy in the first semester of the junior

year of its program, an optional J-term elective that teaches complimentary technique and a two-

week look at complementary therapy in the clinical setting, during the senior year. The J-term

class is open to all students in the college. The course is so popular that nursing students

generally fill the class within the first 24 hours of open registration. College of St. Benedict

nursing instructor Mary Nelson teaches a course titled Integrating Complementary Therapies into

Nursing Practice, which includes practical experience in aromatherapy, healing/therapeutic touch


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and music therapy. She wrote in an email, we teach holistic care of the client/family throughout

all of our courses, (personal communication, April 23, 2008).

Community colleges in the Twin Cities are other sources for integrative health care

education. Normandale Community College offers an Associate of Arts degree with emphasis in

Health that focuses on integrative wellness. Courses include Stress Management, Tai Chi,

Qigong, Yoga and Exercise. Continuing Education offerings include Experimental Foods,

Healing Touch, Medical Qigong, and Tai Chi for arthritis and diabetes (Health: Associates,

2009). The school also offers continuing education classes on a wide range of holistic therapies

and is the solo provider of Master Chunyi Lins Spring Forest Qigong training (Normandalecontinuing health education, 2009). Anoka-Ramsey Community College offers integrative heath

training too. Its Associate in Science degree has a specialty in Integrative Health and Healing

which emphasizes the emerging field of holistic health. According to the schools website,

some classes in this program will transfer to various baccalaureate programs such as the College

of St. Catherine, (Career Programs, 2009).

Summary

As the literature indicates, consumer use of CM is here to stay and all players in medical

marketplace are responding. Consumers find empowerment from health and CM information on

the web. Hospitals begin to offer CM therapies to inpatient and outpatient populations. Students

in medical schools acknowledge the need for additional CM and holistic training and the schools

are finding ways to respond. The same is true for nursing students. In the Minneapolis-St. Paul

area, two nursing programs stand out for their innovations and integration in CM nursing

education. As the states second largest educator of health professionals, with a new School of

Health, the College of St. Catherine, stands at the brink of opportunity to become a health care


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education innovator and answer the publics call for nurses educated in complementary and

integrated therapies. Our research question is: What is needed for the College of St. Catherine to

more fully incorporate complementary care education into the nursing program?


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Research Lenses

While both are trained as energy practitioners, researchers Brown-Price and Nelson bring

different backgrounds and biases to their Creative Application Project. They also share a global

view of health and healing that has brought them together for this project. In this section, those

backgrounds, viewpoints and biases are examined.

Theoretical Lenses

During their time together in the Holistic Health Studies masters program, in the College

of St. Catherines School of Health, Brown-Price and Nelson explored and came to agree on aview of health care that reflects the words of several health care innovators. Fundamental to this

view is the belief that the body is a more than a bio-medical machine. True care for the person

involves care for all parts of the person (body/mind/emotion/spirit). Ancient ways of healing

have value and relevance. The body knows how to heal itself. Marc Micozzi embraces these

ideas in his book Fundamentals of Complementary and Alternative Medicine (1996/2001).

Brown-Price and Nelson believe in the power of energy healing, rooted in the works of Barbara

Brennan, Dolores Kieger, Dora Kunz, Janer Mentgen, Dr. Mikao Usui and the scientific findings

of quantum physics. The work of Frances Vaughan also influences these researchers belief in

multiple ways of knowing. As a participant in the medical system and a medical professional,

Brown-Price and Nelson, respectfully, have experienced and envision a heath care model that

integrates these mind-body principles and therapies with allopathic biomedical services. Larry

Dossey, M.D. writes about such an integrated system in his 1998 book, Reinventing Medicine:

beyond mind-body into a new era of healing. These researchers also agree on a Buddhist

worldview of interconnectedness, interdependence and spiritual practice rooted in meditation.


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Rooted in these theoretical viewpoints, Brown-Price and Nelson see that their Holistic

Studies Masters degree program is part of a School of Health that teaches a body-only way of

medical care in its other degree programs. They are curious about these divergent philosophies

and wonder why one School of Health teaches two different views of health care. This curiosity

sparked their decision to conduct a consulting project within the School of Health for their

masters research work.

Beyond their common theoretical views, Brown-Price and Nelson bring unique

professional and personal biases to their Creative Application Project. Their individual life

stories follow, as well as the beliefs that grew out of those stories.Professional Lenses

Since both researchers have decades of educational and work experience, it is important

to examine the attitudes and views that have formed as results of those experiences. The beliefs

of each researcher are presented separately, in order to honor the unique biases of each.

Brown-Price. Writing and marketing skills are at the center of Brown-Prices

educational training and work experience. Her undergraduate education in journalism gives her

curiosity and respect for the importance of every persons story. She sees the written word as a

critical mode of healing, communication and persuasion. She values a literate citizenry.

Positions in marketing, incentives and public relations give her eyes for strategy and envisioning

what is possible. She believes that every person has a valuable life story to tell, while stories of

businesses and industries can be distorted and manufactured for financial gain. She feels the

freedom of creativity and is motivated by possibility. Through volunteer work and graduate

school, Brown-Price has grown to value the creative problem-solving potential in teamwork and

the fulfillment that comes from working on causes bigger than herself.


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Her involvement in a consulting research project flows organically from her professional

beliefs in story, possibility and big-picture problems. As a consultant, Brown-Price she can stay

open to hear the stories of why things are the way they are within the School of Health and be

creative in ways to change, if change is the desired outcome of School of Health stakeholders.

The consulting project is also of a scale that fits easily in Brown-Prices professional experience.

Nelson. Researcher Nelson has a bachelors degree in nursing, which she received in the

traditional medical model of the positivist paradigm. Grounded in the reductionist-research

methodologies, and education/treatment protocols of western medicine, she practiced Emergency

Room nursing with a specialty in trauma. In the traditional western medical approach, only thosestudies utilizing highly controlled methodologies were seriously considered as credible and

reliable. Although trauma protocols are consistent across ERs in the U.S., Nelson soon realized

that many patients defy the odds and do not fit within the constructs of predictable medicine.

Some patients related stories of alternative treatment modalities they were using without the

advice of their physician, and outside the practice of conventional medicine. These practices

were not approved by the western approach. Credible research did not support it, yet many

patients used alternative methods as an adjunct to standard medical treatment. Their stories of

recovery and improved quality of life supported their decisions and beliefs.

Nelson began exploring some of these alternative treatments that were that were not

proven by the western medical standards. Even through her professional positions as a

healthcare consultant and in the medical device industry, Nelson maintained her ongoing interest

in complementary medicine, eventually enrolling in a masters program for holistic health

studies. This immersion in complementary medicine caused her research paradigm to shift from

concrete positivism to a postpositivist/constructivism position. She believes that a medical


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approach that integrates complementary and western approaches is the best way to optimize

health.

Nelsons professional lenses extend organically into a consulting project within the

College of St. Catherines nursing program. She embodies the same shift in nursing philosophy

that she is interested in influencing. Her nursing experience provides a nurse-to-nurse credibility

that is unique to the profession. Furthermore, she realizes the importance of research to justify

changes within the science-based medical community.

Personal Lenses

Brown-Price and Nelson share a childhood foundation in the Catholic Christian spiritualtradition, complete with elementary education in Catholic schools, where they were immersed in

a dogmatic worldview with clear categories of right and wrong. Their life stories share the

trauma and transformative experiences of divorce and remarriage, which put them at theological

odds with the Catholic Church. Though their lives share common touchpoints, Brown-Price and

Nelson honor the individual values they each gained by walking through life experiences, each in

her own way.

Brown-Price. Though growing up and currently living in suburbia, Brown-Price is

comfortable creating her own unique path. As the oldest of five siblings, she learned to quietly

and safely rebel from the set a good example mantra of her parents. In journalism school, she

found creativity within the grammatical structure of a story, staying curious for an interesting

story or captivating lead to an article. Though she initially married the Catholic boy next door,

she broke with Catholic dogma, divorced and remarried a Jewish man. When her daughter had

academic troubles, Brown-Price found a smaller school, where her daughter blossomed. When

her son became immune to antibiotics from over-treatment for ear infections, Brown-Price took


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her first step into alternative medicine. From early in her life, Brown-Price turned away from the

rigid positivist worldview, embracing the postpositivist viewpoint. Her experiences in energy

healing have opened her beliefs to allow a more constructivist understanding.

Another significant aspect of Brown-Prices personal lenses is her experience with breast

cancer. On the day she was diagnosed, her therapist asked What is cancer going to teach you?.

She experienced her breast cancer journey with empowerment and personal command, sourcing

doctors and integrative therapists that met her needs. She discovered that her allopathic

treatments could be experienced through her own unique lens. In true constructivist form, she

journaled with cancer, drew cancer and eventually had a personal farewell ritual when the timecame for cancer to move on. Brown-Prices lens sees the uniqueness every person brings to a

given situation.

Nelson. Nelsons personal lenses have evolved over time and been influenced by a

variety of factors. Raised in a family with very defined ideas of right and wrong did not leave a

great deal of room for flexibility of truths. Everything fit neatly into place and was consistent

with the positivist viewpoint. Maternal relatives exposed the researcher to a variety of alternative

modalities in her formative years. Personal experiences of family members and the Nelson

familys own health issues presented an opportunity to seek out complementary medical

practices, when conventional medical treatments did not resolve their health issues. These

positivist experiences, coupled with further education in complementary medical practices lead

the researcher to a postpositivist/constructionist approach.

Brown-Price and Nelson understand and appreciate their respective views. In working

together on this Creative Application, they comfortably dance between the beliefs they share and


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those that make them unique. Their common postpositivist belief in individual healing

treatments and CM fuel their professional partnership and growing friendship. Both believe

strongly in the value of integrative medicine. They are curious about the barriers to the adoption

of this model. They share the experience of integrating CM and allopathic care in their personal

health histories.

Their partnership on this Creative Application project also reveals how differences

between Brown-Price and Nelson can serve to balance and support each other and the process.

Where Nelson brings structure and discipline to the project, Brown-Price offers creativity. Where

Brown-Price brings writing and just right word choice to the teams documents, Nelson adds professional polish to the text. Where Nelson brings a nursess heart, Brown-Price speaks a

patients experience. They refer to themselves as Yin and Yan in their partnership.

Brown-Price and Nelson now understand more deeply their theoretical, professional and

personal lenses and the impact they have on their Creative Application project. By making their

public, in this document, they claim the potential biases they bring to their work. Their choice of

a consulting model for their research project is made intentionally, in an effort to minimize the

impact of these biases on their work.


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Method

Researchers Brown-Price and Nelson are interested in the barriers to full integration of

complementary therapies with allopathic medical care. Operating from the

postpositivist/constructivist paradigm, they believed in more than one answer to their curiosity.

With Nelsons nursing background, this team focused on exploring the integration of CM into

nursing curriculum, as it might be taught in the College of St. Catherines nursing program. This

chapter describes the teams Creative Application project modeled on action research. It also

includes rationale for the project, description of the process, along with ethical considerations

and strengths/limitations of this approach.

Description

Using an action research model, Brown-Price and Nelson scheduled and participated in

consulting sessions with the leadership of the Colleges graduate nursing program and School of

Health. Nelson and Brown-Price worked with the Colleges Holistic Health graduate program

faculty and key undergraduate nursing faculty who have an interest in CM. These individuals

facilitated introductions to both nursing and School of Health leadership. Acting as consultants,

Nelson and Brown-Price presented information from the Literature Review to the graduate

nursing leadership and faculty, as well as School of Health leadership. As subject matter experts

and at the request of their leadership clients, Brown-Price and Nelson also developed

recommendations for integrating CM information into the graduate nursing program.

In the course of developing their action research, Nelson and Brown-Price considered

several other methods of evaluating and infusing complementary medicine information in the

College of St. Catherine nursing program. They initially planned to implement a nursing student


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CM workshop or a nursing faculty CM survey. But after receiving input from their HHS student

peers and research faculty, Brown-Price and Nelson acknowledged that workshops and surveys

could alienate key stakeholders in the nursing program. Rather, a consulting approach offered

CM information to these stakeholders without imposing Brown-Price and Nelsons pro-CM bias

and allowed the client freedom to decide what action, if any, this new information might prompt

within the clients organization. As the consulting meetings progressed over the course of

months, Nelson and Brown-Price cam to understand that their consulting was a form of action

research.

The action research model applied in this situation, where graduate students were at thecenter of the research. In action research, the researchers describe, interpret, and explain a given

circumstance, while seeking to affect change within an institution. Action researchers gather

information from public sources (as Brown-Price and Nelson did in their Literature Review) and

use that information to drive change. Their work is motivated by the researchers values about

what is good and possible (McNiff, Lomax, & Whitehead, 2002).

Rationale for a Applied Project

As graduate students in holistic health studies specializing in energy healing, Brown-

Price and Nelson were subject matter experts on CM research, usage, modalities and energy

healing technique. Through their review of the literature, they also came to understand the

common barriers to CM integration into nursing curricula. Their holistic graduate program is

part of a School of Health that did not appear to espouse holistic healing philosophy. Yet the

integration of CM services with allopathic medicine, requires medical professionals who are

schooled in holistic health philosophy and therapies. By consulting with like-minded leaders in

the College of St. Catherine nursing program, the design of this consulting approach was


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intended to be instrumental in developing an action research plan that moves holism forward in a

way that is meaningful and important to the nursing program.

Information gained in Brown-Price and Nelsons review of the literature also provided

rationale for this consulting project in a nursing education program. Research indicated that

nursing traditionally works in areas needing social change (OBrian-King & Gates, 2007). The

nursing profession has a responsibility to respond to the needs of the public, who are using CM

more and more each year (Reed, Pettigrew, & King, 2000). The current health crisis also called

for educating nurses about CM, since the majority of health costs involve patients with chronic

conditions and CM can offer some relief for such conditions (Sheperd, 2008). Perhaps moreimportantly, nurses need to be knowledgeable about CM, for the overall safety and efficacy of

the patient care they provide (Halcom, 2003).

The Center for Complementary and Alternative Medicine and the Holistic Nurses

Association both emphasize the importance of nursing education to produce health care

professionals ready to work in an integrated health system. In fact, two nursing programs in the

Twin Cities already incorporate holism, one of which is accredited by the Holistic Nurses

Association. How the College of St. Catherines School of Health would respond to this

changing environment was unclear.

Description of the process

This consulting process took place over several phases. First, this team of researchers

prepared themselves as consultants. They studied and gathered information prior to the

consulting meetings. They took part in meetings with graduate nursing and School of Health

leadership. Later, those leaders were asked to evaluate the function of Nelson and Brown-Price

as student consultants.


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Preparation. In order to fulfill their role as consultants, Brown-Price and Nelson needed

to learn the basics of consulting. Nelson has professional consulting experience, though not in

an educational setting. Brown-Price has no previous consulting experience. To acquire and

practice their consulting skills, this team followed this plan:

Feb 1 20 Read Flawless Consulting byPeter Block

Brown-Price Nelson

Feb. 12 19 Interview business consultant,Janet Sokol-Seidman

Brown-Price

Feb. 12 19 Interview consultant, KevinColton

Nelson

Feb. 10 14 Make consulting appt. NelsonFeb. 9 Consulting review with CarolGeisler

Brown-Price Nelson

Feb. 16 Finalize Lit Review & printfor distribution to Jacobson &other nursing faculty, andSchool of Health leader

Brown-Price Nelson

Feb. 25 Have consulting appt. withJeanne Jacobson

Brown-Price Nelson

Brown-Price and Nelson chose to further enhance their consulting knowledge by reading the

book, Flawless Consulting, which is considered a classic consulting text that explains the

tangible steps of building a consulting relationship (Block, 2000). Brown-Price and Nelson also

were guided by angel cards at their weekly team meetings. As individuals, they meditated and

kept dream journals in order to stay focused and open to subconscious insights.

Brown-Price and Nelson also gathered background information prior to the consulting

meetings. Over the course of two months, they met with nursing faculty members Corjena

Cheung and Sue Hageness, to learn about existing holistic education in the nursing program.

Meetings with Holistic Health faculty members, Karen Hilgers and Janet Marinelli, provided

historical context for the Holistic Health program and its place in the School of Health.


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Evaluation. Brown-Price and Nelson received feedback on their roles as consultants

through a short written survey that their nursing leadership/clients completed. The survey

requested feedback about the process as well as the individual consulting skills of Brown-Price

and Nelson. This qualitative survey consisted of open-ended questions and took place in April

2009.

Ethical Considerations

An action research project such as this must took into consideration several ethical

possibilities. One was the privacy of the vision of both the individual members of nursing

leadership, as well as the nursing department as a whole and the School of Health leadership.Another ethical consideration involved the current and longstanding political undercurrents that

pulse through any educational institution.

During the consulting process, Nelson and Brown-Price were careful with information

acquired during their consulting meetings. Notes taken during the meetings were kept secure

and only shared with appropriate individuals involved.

Design Strengths and Limitations

The design of this creative application brought with it inherent strengths and limitations.

The strength of the consulting model was its particular usefulness in a situation where the

consultant can offer services to improve or change a situation, but does not have direct control

over implementation. A consultant has leverage and impact, but not direct control (Block, 2000).

Consulting was also a respectful way for these graduate students to serve a decision makers in

the nursing program and the School of Health, share with information gained during the

literature review process, and aid in planning/implementing the course their clients chose to take.

By serving as consultants, these holistic graduate students assumed the role of subject matter


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experts. The goal of action research was to impact change in the College of St. Catherines

nursing program to incorporate CM in the nursing curriculum and positively affect the lives and

careers of students in the program, as well as the patients they care for.

The use of the action research model was also a strength for this project, which took

place within the School of Health, where the researchers were graduate students. As its name

implies, action research is dynamic and interactive, requiring cooperation between the

researchers and the client personnel. Researchers act as both management consultants and

academic researchers simultaneously. The understandings that result from an action research

project are holistic and recognize the complexity of the situation. Action research occurs in realtime and is a method to understand, plan and implement change for a given organization (Coglan

& Brannick, 2003). These aspects of action research provided form and meaning for Brown-

Price and Nelsons project.

This consulting project also was limited by a number of constraints. Development of

collegiate curriculum is often a lengthy, complex and political process. The academic school

calendar constrained the time available for this project, which limited its potential for

effectiveness. Nelson and Brown-Prices roles as graduate students, also limited their

involvement as stakeholders in any curriculum change. Public and unspoken ideologies within

the nursing program and the School of Health were other potential limitations. Finally, the pro-

CM biases of Brown-Price and Nelson limited their objectivity in the consulting process.


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ResultsThe purpose of this chapter is to describe in sufficient detail the results of an applied

research project. In this case, the result is a consulting project, rooted in an action research

model. Since the applied research involved a creative process, this chapter begins with a

description of the process used to develop this consulting method. This process includes how

researchers Nelson and Brown-Price prepared themselves for the consulting process and the

various steps taken to actually implement consulting meetings. This chapter also describes the

consulting meetings, the outcomes of those meetings and a description of the unique features of

this intra-School of Health consulting project. Samples of the meeting agendas, executivesummary document and PowerPoint presentation are included in the Appendices of this

document.

Description of the Process

The actual consulting portion of Brown-Price and Nelsons consulting project took place

in several phases over the course of three months. The researchers began by preparing

themselves intellectually (through books and interviews), internally (through meditation and

oracle cards), and professionally (through background interviews). Next, they participated in a

series of consulting meetings and follow-up presentations. In its entirety, this process had some

unique and identifiable characteristics and distinguishing features.

Preparation. In order to prepare for this project, researchers Nelson and Brown-Price

incorporated a variety of approaches which included: weekly meetings, personal preparation,

individual meetings with consulting professionals and joint reading of Peter Blocks book,

Flawless Consulting: A Guide to Getting Your Expertise Used (2002). Meetings with CM


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stakeholders within the School of Health also provided background and further prepared these

researchers for later consulting meetings.

Weekly meetings, meditation & oracle cards . The foundation of this research teams

preparation was their weekly meetings. The opposite schedules of the two researchers at first

seemed to indicate that weekly meetings would be unlikely. Brown-Price is a stay-at-home

mom, with a child in school full time. She preferred to meeting during her daughters school

hours. Nelsons full-time corporate position in downtown Minneapolis made evenings and

weekends her most convenient meeting times. Nelson arranged her work schedule to allow for a

standing Wednesday lunch meeting for the research pair to meet. Brown-Price took the bus

downtown and together the team worked on each step of this project together, at a variety of

downtown restaurants, and most often at the corporate cafeteria of Nelsons employer. These

1-hour lunch meetings began with check-ins about family and work, and continued with work

on the project at hand for that week. This lunch-together ritual continued during the consulting

meetings, when the researchers would have a meal or tea together to debrief the meetings. In

addition, emails and phone calls were made throughout the week as work progressed on the

project .For personal preparation, Nelson and Brown-Price each used meditation and Angel &

Oracle cards to guide their intentions and dream journals to raise subconscious insights into

consciousness. During personal meditation times, Nelson and Brown-Price became more open

to the process they were undertaking and comfortable with letting go of the results of their

efforts. Angel and Oracle cards also provided valuable learning. Most notably, the researchers

pulled Business and Competition cards while they were planning the consulting meetings, the

Risk card on the days of their consulting meetings and preparation phase of the consulting


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process, and the Balance card, during busy final months of the project and school semester. They

also kept daily dream journals, which repeatedly confirmed the need to focus on education and

teaching. One particular dream involved Nelson and Brown-Price doing a TV newscast. In

another dream, the researchers were working in an election to win votes for a holistic health

candidate. Building and moving were other dream themes. Looking back, the meditation,

Angel/Oracle cards and dreams reassured Brown-Price and Nelson that their project was

grounded in truthful purpose and meaning, and guided by the source of universal energy.

Reading & interviewing. Acquiring consulting knowledge was another aspect of

preparation. Brown-Price met with a family friend, Janet Sokol, who uses her psychology background to consult about change in local businesses. From Sokol, researcher Brown-Price

learned the importance of asking questions and listening for information as well as intention and

motivations of your client. Nelson sought how-to consulting knowledge from a professional

consultant, from whom she learned the importance of defining who the key stakeholders and

decision makers are within an organization, and also the importance of learning how information

is shared within that organization. Peter Blocks book, Flawless Consulting (2002) also provided

valuable and holistic how-to consulting information. Blocks book catalogues necessary

consulting skills, describes the importance of being authentic, suggests building collaborative

relationships, and maintaining an even balance of tasks between the consultant and the client.

With information gained from this book, Brown-Price and Nelson were able to deflect a client

request for them to write a holistic curriculum.

About two-thirds of the way through their consulting process, Brown-Price and Nelson

learned that their project had many similarities to action research. To understand and apply

action research principles to their work, the researchers read several action research texts,


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including Croghlan & Brannicks Doing Action Research in Your Own Organization (2001), You

and Your Action Research Project (McNiff, Lomax, & Whitehead, 2002), Practical Action

Research for Change (Schmuck, 1977) and All You Need to Know About Action Reseach (McNiff

& Whithead, 2006). Through these books, Nelson and Brown-Price learned the action research

principles of holism, researcher as change-agent and change that comes from inside an

organization. They realized that these principles were organically at work in their existing

consulting project. They also recognized that the action research model includes a cyclical

process of planned interventions followed by a time of evaluating the affects of that intervention.

The time constraints of Nelson and Brown-Prices research class did not allow them to completea full action research project. They did however, learn about action research and realized the

similarities between the action research model and their consulting project within the School-of-

Health.

Background interviews. Brown-Price and Nelsons final phase of preparation involved

meeting with faculty from the nursing and Holistic Health Studies programs, in order to more

fully understand the history and current situation regarding CM in the College of St. Catherines

School of Health. Two faculty members from the undergraduate-nursing program who currently

include CM information in their curriculum were contacted and interviewed over the phone and

also met personally with the researches. The instructors outlined the CM information they

included in junior and senior-level classes. Undergraduate nursing students exposure to CM is

limited, and they expressed their desire to integrate more opportunities into the curriculum in the

future. They also identified that the cornerstone of their CM education efforts was a two-week,

four-hours/day Complementary Therapy January-term class which they have co-taught for the

past two January-terms. During this class, students learned about different therapies and


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experienced Healing Touch energy therapy. The faculty reported that although this class is open

to all undergraduate students in the college, nursing students are the first to sign up and fill the

class, resulting in a

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