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Integrative Nursing

Self Care for Nurses at Core of Transformational Change


Mary Koithan is a patient visionary. She’s willing to start with incrementally small changes while thinking big – transformationally big.

With a grant from the David and Lura Lovell Foundation in 2007, the associate dean of professional and community engagement for the University of Arizona College of Nursing initiated a program to teach nurses about the need for self care in a profession that’s all about caring for others.

“Self care for nursing was at an all-time low in this city,” she said. Nurses were highly stressed, overworked and exhausted. They were burning out and leaving the profession. “The whole idea was to teach nurses about caring for self – what’s involved and why it’s important.”

One component of the program brought teams of nurses from five partner hospitals in Tucson to determine what they could do to improve their work environments. An estimated 200 staff nurses were directly impacted the first year and more than 750 the next. They received training not only in self care, but also organizational change.

“Collectively we changed the system,” Mary said.

One hospital created a restful garden haven exclusively for staff. Another changed glaring white ceiling tiles in the operating recovery area to soothing blue and dimmed harsh lights to reduce stress and promote healing. A third installed a bathroom near the nurses’ station and cleared the clutter from an unwelcoming break room.

“Nurses didn’t take breaks because they didn’t have coverage for their patients. So we made sure that supervisors would step in and say ‘I’ll cover for you. Take a break and eat something nutritious.’

“We introduced techniques for self care that can be used at a moment’s notice. People think they need huge amounts of time in the day to care for self. We wanted to impart the notion that a simple centering or calming can take moments, not hours,” Mary said.

Promoting holistic self-care behaviors

“Our long-term goal was to promote the health of Tucson’s nurses and increase their ability to engage in holistic self-care behaviors to prevent or reverse caregiver burnout, manage stress and improve nurse retention.”

Healing Touch

Healing Touch

This successful model became the focus of presentations at nursing conferences around the county and led to similar programs at other nursing schools and hospitals.

The Tucson program was thoroughly documented. “We created an archive of all the presentations and put the work on our website.”

The Tucson Holistic Healing Initiative for Nurses was the first project that the Lovell Foundation funded for the UA College of Nursing – but certainly not the last. Prior to 2015 the foundation provided a total of $101,147 over seven years, including ongoing support for a program to develop a healing environment within the College of Nursing that would build camaraderie and reduce stress for participating students, faculty, staff and community partners.

“We turned inward. We started to think how to impact the faculty who teach the students who become the nurses of the future. We sponsored self care,” Mary said.

Judith Brown, former director of development for the UA College of Nursing, said that Lovell Foundation support “allowed us to train faculty – to expose them to integrative modalities like tai chi, yoga and reiki – then make them available to the entire nursing community – staff, faculty and students.” A variety of movement classes were offered for free three days a week for the College of Nursing and the Arizona Health Sciences Center. People began caring for themselves – and each other. It was energizing. At one year-end event participants ranging in age from 18 to 92 did a Bollywood dance demo for the faculty.

Writing the book on integrative nursing

Judith first met Lu and Ann Lovell when all were involved with the Arizona Center for Integrative Medicine. Then Mary and Judith spent time with them exploring ways the foundation and the College of Nursing could partner to improve patient care.

“Lu had a fundamental impact on my life,” Mary said. After one brief but enlightening conversation, “I stopped doing projects I should be doing because it’s what was expected of someone in my position. Do what you love – not what you should. It changed the way I approached everything I did.

“One of the things I’d always wanted to do was write a book. So when the opportunity opened itself up I said yes.”

The result was “Integrative Nursing,” co-authored by Mary and her colleague Mary Jo Kreitzler, founder and director of the University of Minnesota’s Center for Spirituality and Healing and professor in the UM School of Nursing. Published in 2014 by Oxford University Press, the 648-page book is already in its third printing and quickly became the definitive text used in many nursing programs.

This is the first complete roadmap to integrative nursing. “The information was packaged in a way that was acceptable to hospitals and healthcare systems,” Mary said. “The book is very practical.” It is a step-by-step guide that focuses on symptom management – ranging from pain, nausea and insomnia to anxiety and behavioral dysfunction.

“We don’t want to reach for the easiest answer,” Mary said, which is often a prescription drug. Instead of pills for back spasms, nurses can recommend massage. “Massage works wonders on chronic back pain and muscle strain.” The nausea and vomiting associated with cancer treatments can be mitigated with acupuncture. Before reaching for the Tylenol, try treating a headache by turning out the lights, closing your eyes and taking five minutes to breathe.

This “Integrative Medicine” textbook brings it all together. It gives nurses more options for helping their patients. The goal is for patients to achieve the highest level of healing and wellbeing that they can.

“Nursing has always been an integrative discipline. The whole-system effort goes back to Florence Nightingale. This is what nursing is and always has been,” Mary said.

Changing the way we educate nurses

Founded in 1957, the UA College of Nursing is ranked among the top 10 percent of graduate nursing programs in the nation. “We’ve always been one of the best in the country,” Judith said. This was the first college west of the Mississippi to offer a PhD in nursing. “We’ve had extraordinary deans and they have pushed the envelope to be out there at the forefront.”

Now Judith, Mary and current dean Joan Shaver envision a more prominent and formalized role for integrated nursing – with dedicated faculty, a standardized curriculum and certification processes.

“We have to change the way we educate students,” Mary said. “We won’t change older people’s reliance on medication. We need to bring up the next generation to not expect pills every time they turn around.”

In the future each nurse graduate could be certified in at least two modalities that they understand in depth – whether that is reiki, homeopathy, acupuncture or other therapeutics. That would be part of the curriculum.

“This is awesome and exciting. This is a totally different way of approaching healthcare. I think it’s the right time to do this. This is a dream which is I believe is completely attainable,” Mary said.

“The Lovell Foundation has been really supportive. They’ve given me the space to think the opportunity to try things out and see what works.”

Training teams to champion system change

Integrative nursing has been taught and practiced for many years, yet programs and practitioners vary. There are no core competencies established, no uniform training across the industry. “The timing is right for curriculum-based integrative nursing education,” Judith said.

The UA College of Nursing is ready to play a leading role in this transformation. The faculty already includes practitioners trained in integrative therapeutics. The college offers a variety of continuing education sessions and recently developed online integrative nursing continuing education certification programs.

Their plan is to prepare faculty to teach integrative nursing – starting with the UA faculty – then training teams of peers from other schools. “At the Western Institute of Nursing meeting this spring I will tell our colleagues about this plan and ask them to start working now to identify 10 senior faculty in leadership roles,” Mary said.

Once trained, each of those 10 faculty leaders could go back and teach 100 or more students. That’s an impact of 1000 nurses right off the bat. It builds exponentially.

“We need champions in systems in order to reach a critical mass,” Mary said. “We cannot do this alone. If we try this alone – without a concerted effort – it will fizzle. We will partner with academic institutions and their affiliated hospitals. We will have a whole consortium of people involved.”

This embedded team approach to creating system change evolved from the self-care programs for nurses funded by the Lovell Foundation.

Judith said, “The Lovell Foundation is extraordinary in their understanding of healthcare and their understanding of the need for integrative therapies. They are visionaries. A lot of credit really goes to Lu for understanding this and bringing her passion toward this.

“This is where the confluence of thinking, passions and intentionality all come together. This is the time for transformational change.

“I believe that 10 to 15 years from now there will not be a college of nursing that will remember a time when there was no faculty in integrative nursing. It will be so imbedded they won’t remember it did not exist.”

In January 2015, the Lovell Foundation approved a three-year grant of $545,938 to develop an integrative nursing curriculum, train faculty, collaborate with peer institutions, and build inter-professional partnerships that will transform the UA College of Nursing and impact nursing throughout the country.