Step-by-step approach slowly brings integration
August 1, 2000 5 minutes read
Step-by-step approach slowly brings integration
Committee learns from patients to teach staff
While consumer demand is the driving force behind integrating complementary therapies into health care systems, it is staff interest that usually initiates the process. "We started a committee in the outpatient center where there were a few of us that were interested in complementary and alternative practices," says Nancy Jonap, ACSW, CISW, chairperson for the pediatric integrative medicine committee at Phoenix (AZ) Children’s Hospital. Because a lot of Latino and Native American families use the hospital’s services, the team thought it would be helpful to look at the traditions of healing in those cultures so health care workers could be more supportive, she explains.
The goal of the committee is not to incorporate complementary therapies into the medical system, but to learn what patients are interested in and provide educational programs for the staff. "We are in the very early stages and are just beginning to identify what educational programs might be useful to get people to dialogue around alternative complementary healing," says Jonap. The hope is that patients will not only feel comfortable discussing therapies with their physician but also that the physician will feel comfortable enough to include some of the complementary therapies in the treatment plan, such as biofeedback or guided imagery.
To determine what types of complementary therapies patients were using, the committee conducted a computer-based touch screen survey in the lobby of the outpatient center. Patients were asked what treatments they used for their child, and a long list of choices was provided. They were also asked if there were treatments for their child they would want to know more about.
A secondary goal is to develop relationships with reputable providers in the community so that if a family was determined to use a particular modality, the various providers involved could collaborate as a team. "They could have a conference at some point, and there wouldn’t be a wall between the providers," says Jonap.
The integrative medicine steering committee at Mercy Healthcare Sacramento (CA) has representatives from a variety of service lines, both inpatient and outpatient, and includes physicians, nurses, and even a chaplain. It, too, is in the beginning stages, but has established goals to work toward, says Marcia Taylor-Carlile, RN, CDE, team leader for healing environment at Mercy.
One project is intended to create a list of available complementary or integrative services within the Mercy system. A second project will establish a competency or credentialing process for the practitioners of the various therapies. Another goal is to determine what kind of education staff must have to counsel patients on the use of complementary therapies. "As a whole, our health care providers may not be any more knowledgeable about massage or herbal medicine than the lay public," says Taylor-Carlile.
Integrating complementary therapies
At many health care facilities, a department is created to meet public demand, and complementary therapies are integrated into the system. In these cases, decisions must be based on what types of therapies should be offered. When the Department of Complementary Care was established at Longmont (CO) United Hospital in 1994, massage therapy and Tai Chi were the first two modalities chosen.
"Six years ago, the acceptance wasn’t the same as it is today, and I had to look at what is most acceptable to the medical community," says Michelle Bowman, BSN, RN, C, manager of complementary care/senior wellness at Longmont. Another catalyst was the fact that the Boulder College of Massage Therapy, located nearby, was asking for placements for student interns.
Today, the department has a staff of 14 massage therapists, seven acupuncturists, one medical herbalist, three Tai Chi instructors, a music therapist, and an art therapist. To become part of the staff, practitioners must meet high standards to ensure they are well-trained.
Practitioners must meet patient’s needs
For example, acupuncturists must have passed the national certification exam administered by the National Certification Commission for Acupuncture and Oriental Medicine in Alexandria, VA, and have 4,000 hours of training. Massage therapists must have 1,000 hours of training to be hired. The practitioners work in both inpatient and outpatient areas and must be willing to meet the patient’s needs.
"I have refused to hire people because of their inability to adapt to the patient’s demands," says Bowman. (To learn more about creating a freestanding facility for complementary therapies, see article on p. 91.)
When the Department of Complementary Medicine was established at Banner Health Arizona in Gilbert, three criteria were used to select the therapies. They had to be accepted by the medical community, backed by scientific research, and nonpolitical, says Renee Pierce, ND, health guide coordinator/complementary medicine champion at the facility.
As a result, acupuncture, behavioral health, health guiding or lifestyle counseling, and massage therapy were selected. Practitioners must belong to the national professional organization of a discipline that is recognized by the NIH. They also must be willing to work as a team. "I want someone who knows their limitations and their scope of practice and doesn’t think their particular modality is going to heal all things," says Pierce.
The cost of bringing up a new service can be prohibitive when incorporating complementary therapies into your health care system, warns Taylor-Carlile. "Our fiscal environment is very tight," she says.
Yet, in 1998, the complementary medicine program at Longmont United Hospital was separated from the senior program where it originated because it generated too much revenue. The senior program is the hospital’s community benefits program, explains Bowman. The complementary therapy clinic, located in a freestanding building on hospital grounds, has about 45 acupuncture clients a week and provides more than 400 massages a month.
For more information about integrating complementary therapy into the health care system, contact:
• Michelle Bowman, BSN, RN, C, Manager, Complementary Care/Senior Wellness, Longmont United Hospital, 1840 Mountain View, Suite 3, Longmont, CO 80501. Telephone: (303) 651-5188. Fax: (303) 485-8218.
• Nancy Jonap, ACSW, CISW, Chairperson for the Pediatric Integrative Medicine Committee, Phoenix Children’s Hospital, 909 East Brill St., Phoenix, AZ 85022. Telephone: (602) 239-4203. E-mail: njonap@ phxchildrens.com.
• Renee Pierce, ND, Health Guide Coordinator/ Complementary Medicine Champion, Banner Health Arizona, 1325 North Fiesta Blvd., Gilbert, AZ 85233. Telephone: (480) 503-9640. Fax: (480) 503-9633. E-mail: [email protected].
• Marcia Taylor-Carlile, RN, CDE, Team Leader for Healing Environment, Strategic Learning Development, Mercy Healthcare Sacramento, Mercy American River Hospital, 4949 Engle Road, Carmichael, CA 95608. Telephone: (916) 484-2117. Fax: (916) 484-2227. E-mail: [email protected].
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