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