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Advancing Integrative
Therapies at the
Bedside
P. Ann Blaney, BSN, RN-BC
Clinical Coordinator Integrative Therapies,
Bryn Mawr Hospital
Main Line Health
The presenter for this presentation has
disclosed no conflict of interest related to
this topic.
2
Objectives
• Overview of Integrative Therapies, Holistic Care in the acute care
setting
• Describe the details of the Integrative Therapy Program within
Main Line Health system.
• Review of MLH program research, outcomes and goals
3
Established in 1893, located in the heart of the Philadelphia
Main Line
• Non-Profit, Full-service, Acute Care Teaching Hospital
• 287 Licensed Beds
• 700 Clinical RNs:
Over 76% with specialty certification /BSN or greater
4Greetings from Bryn Mawr Hospital
AWARD-WINNING NURSING AND
PATIENT CARE
Main Line Health 5
6
What is Integrative
Therapy?
7
Growing Trend
More than 30% or American adults use some form of
integrative therapy.
• Relieve symptoms associated with chronic disease
• Relieve symptoms associated with side effects of medication
• Improve health and well being
8
Americans spent $30.2 billion dollars out-of-pocket
on complementary health approaches2012 National Health Interview Survey
11 million U.S. Adults suffer from High Impact
Chronic Pain (HICP) HCIP is defined as Pain lasting 3 months or longer with one major activity restriction
It is estimated more than 10 million people misuse
opioids, including heroin
9
10Integrative Therapy Program
Mission:
Create a sustainable healing space where staff focus on wellness, healing, and treating
patients using the principles of integrative medicine (1)
Vision:
MLHS will be the health care provider of choice in leading and optimizing the
health of all in our communities (2)
Values:
Our Values are our core beliefs that guide our daily behaviors in fulfilling
our Mission and achieving our Vision—what we believe.
•Safety
•Communication
•Compassion
•Diversity, Respect and Inclusion
•Excellence
•Innovation
•Integrity
•Teamwork and Systemness
Purpose of Integrative Therapy Program 11
Current Therapies at MLH 12
MLH Integrative Therapy Journey
2015
2016
2019
2018
2017Aromatherapy: total
58 trained nurses
Reiki: total 175trained nurses
Reiki: 5 trained nurses
Aromatherapy: total
639 trained nurses
14
465
1,110
1,834 1,776
3,919
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
2015 2016 2017 2018 2019
Reiki Treatments
Budget – Organization Commitment
FY19
• Aromatherapy oils: $ 16,000
• Reiki treatment time: $100,000
(annualized for FY20 is
$194,000)
• Trained RN’s provide 4 hours of
Reiki per month – straight time
• Program Coordinator: potential
to increase time by 8 hours
15
FY18
• Supplies:
– Aromatherapy oil per year
• Personnel:
– Program coordinator
• Other costs:
– Marketing brochures (prints)
• Budget:
– Aromatherapy oils :
~$12,000/year for System
– Reiki: treatment ~ $64,000/year
for BMH
• Training sessions
– Aromatherapy
– Reiki
Nursing commitmentsReiki
• Developed curriculum for 8 hour class
specific to Reiki in the hospital setting
with approved credit hours
• Each nurse committed to 4 hours per
month outside their worked hours on
their home unit
Aromatherapy
• Nurse Training session was developed
with credit hours approved.
• MSDS/GCMS sheet obtained for
essential oils and on file.
• A kit of approved standard supplies is
distributed to each nurse after training
of safe practice.
16
Documentation built into EPIC
Nurse is responsible for assessment of allergies/sensitivities, determines
essential oil for use, obtains verbal consent, initiates therapy and evaluates
response to the therapy.
Aromatherapy• Lavender
• Calming reduce anxiety
• Promote sleep / relaxation
• Peppermint
• Nausea
• Headache relief
• Sweet Orange (inhalation only)
– Uplifting
– Energizing
“I was feeling moderate
pain and high anxiety
prior to the session, I
was able to relax and my
pain was reduced after the
treatment.”
- Patient
Over 600 MLH nurses are trained in Aromatherapy
Aromatherapy is embedded into Nursing Practice
Current Practice at MLH 17
A Japanese touch therapy
Believed to promote deep states of
relaxation and reduce the perception
of pain with no known side effects or
contradictions
Reiki has become a popular therapy
in the U.S. and worldwide.
Reiki
18
Sessions usually last 30 – 90 minutes
Various hand placements are utilized
Calming environment
What happens during a Reiki
Session?
19
• Stress reduction & relaxation
• Balances mind & emotions for a calmer state of being
• Relieves pain & physical symptoms
• Promotes inner peace & harmony
• Speeds up recovery process from surgery or illness
• Helps prevent sickness & disease
• Increases natural healing abilities
Potential Benefits of Reiki
20
Therapeutic Music “Uplifting, peaceful
music. Adds class
to the hospital
image.”-BMH Patient
“Very special
experience from a
talented musician in a
“blah” environment. A
great surprise,
unexpected and most
appreciated.”-BMH Patient
21
WXPN 88.5 Radio Station
National program
Brings live music
to the bedside
22
Pet Visitation
•Provided through
volunteer office
•Our therapy dogs
see 40-50
patients per week
23
24
Notte, B.B., Fazzini, C., Mooney, R.A.
Nursing. 2016 Feb;46(2):17-23
Reiki's effect on patients with total
knee arthroplasty: A pilot study
Research Highlights
• Randomized controlled pilot study
• Theoretical framework: Martha Rodgers’s Theory of Unitary
Human Beings
• Reiki (N=23) non-Reiki (N=20)
• Controlled group received standard of care
• Reiki group received four Reiki treatments: 20 minute Pre-op, 30
minute PACU and 20 minute treatments PODs 1-3.
• The Numeric Rating Scale (NRS) 1-10 was used to measure pain
• Mean pain intensity rating scores were significantly lower post-
Reiki than pre-Reiki.
25
DefineHCAHPS survey questions include, “During this hospital stay, how often was your pain well controlled? and, During this hospital stay, how often did the hospital staff do everything they could to help with your pain?”
AnalyzeRoot causes of why pain was reported as not always well controlled and that staff were not always doing everything to help with pain were identified:
• Integrative therapy nurses spend most of their time with hospice patients; minimal weekend coverage
• Inconsistent or underutilization of the following alternative/integrative therapies:
Reiki Aromatherapy Guided Imagery Pet therapy Therapeutic Music
A3 Project Update - 6c: Pain, Integrative Methods and Patient Experience Date: 1.10.2018
MeasureQuarter 4, 2016 pain scores decreased significantly on Unit-6c. The team reviewed data and investigated causes. Post-implementation of improvements (March, 2017) resulted in a 12% increase in roll-up pain score:
Improve
May, 2017• Education related to effective communication, realistic pain goals
and robust use of integrative therapies• Separate education for Reiki Nurses• Pain Score Chart for patients
July, 2017• Dedicated Integrative Therapy Nurse Rounding
Control
Audit pain score charts; standardize integrative therapy nurse rounds; pull team together regularly for communication and action planning; continuous education and process improvement oversight
Team Members: P. Blaney, RN, D. Rugh, RN, L. Bruce, RNB. Ryan, RN, Integrative Therapy Nurses
Oct-Dec2016
Jan-Mar2017
Apr-Jun2017
July-Sep,2017
Pain Domain (Roll-up)*
66% 60% 66% 72%
Pain Well Controlled 64% 54% 52% 58%
Staff Do Everythingto Help w/Pain
67% 67% 80% 86%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%Non-Analgesic Pain Project 6C
26
27
28
Outcomes
Reiki 29
Total: 3,919 Reiki
treatments
Reiki Treatments30 minute sessions
• Surgical & oncology patients
• Hospice patients
• Pain & Palliative Care
• OB/ GYN
• Emergency Room
• Psychiatric / Post Traumatic Stress
• Outpt. Cancer Treatment Centers
• Physical Rehabilitation
• Self Care –* popular to reduce
nurse burnout
311
461
679
702
1,766
- 200 400 600 800 1,000 1,200 1,400 1,600 1,800 2,000
PH
BMR
RH
LMC
BMH
Reiki treatments
Reiki Treatments by Entity in 2019
Reiki 30
4.4 4.4
5.05
4.64
3.56
4.54
5.21
4.24 4.22 4.233.99
4.53
3.8
4.324.44
2.29
21.88
2.32
1.31
1.62
2.25
1.561.71
1.57
1.08
1.85 1.75 1.76
1.44
0
1
2
3
4
5
6
Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20
Ave
rage
Pai
n S
core
(0
-10
)
BMH - REIKI PAIN SCOREJAN 2019 - MAR 2020
Average Pre Reiki treatment Average Post Reiki treatment
31
32
Patient Feedback
33Patient Feedback
34
“I feel like I took a relaxation pill.”
“My Reiki session was emotionally, physically and spiritually uplifting! I
had 3 months to worry before having a partial nephrectomy and this
session eased my anxiety and built up stress. There’s a world of healing
beyond chemicals! This is a wonderful service to offer patients. Thank
you!!”
“The session alleviated the worry and anxiety that I always seem to feel.
Especially being in a hospital setting where our worries increase. This
session can be as helpful to many as it was to me.”
“Very relaxing and calming. I did experience the energy through heat
sensation. Very positive to the hospital setting.”
Patient Testimonials
35
• Overall Program Growth
• ANCC Magnet RecognitionThe Main Line Health Integrative Therapy Program was
recognized as an exemplar practice by ANCC Magnet
Recognition Commission (December, 2019)
• Community Education / Seminars
• Community Service
Reiki Team volunteers 2x/ year at
VA Hospital and Children’s Home
• Culture of Caring Initiative for Staff
Achievements
36
97% Staff reported the caring cart initiative
made them feel valued
94% of staff reported they really enjoyed
aromatherapy and hand massage
“(A nurse extern confided that she was suffering from
anxiety. She expressed how calming the lavender essential
oil and hand massage made her feel. An ICU nurse was
running around and too busy to stop even for a moment. A
hot cup of tea and a healthy snack was placed at her work
station. When she had the moment, she could be nourished
too.)It’s these amazing moments that make me so proud to
be a nurse at Main Line Health. The core values of
compassion, respect, excellence, and team work was clearly
demonstrated with the care we provided with the caring
cart.”
-MLH Staff Nurse who provided Caring Cart
Caring Carts
P. Ann Blaney, BSN, RN-BC, Donna Rugh MSN, RN-BC, CHPN, Barbara Wadsworth, DNP, RN, NEA-BC, FAAN
References
• The cart itself is the physical vessel and the treats and personal touches can be tailored to match the culture of an individual institution
• The idea of a Caring Cart is easily adaptable as costs can be contained to accommodate any budget
• The message of intentionally offering gratitude to staff and personally acknowledging the important work they do each day by making an effort to be present with employees is universal to any setting
Findings
• Caring for staff by intentional rounding, therapeutic listening and overall holistic care had positive outcomes.
• Staff reported an overwhelming sense of feeling valued and appreciated the investment in the caring cart by administration
• Development and implementation of the Culture of Caring and Caring Cart initiative reflects the American Organization of Nurse Leaders (AONL) (2015) competency of Communication and Relationship Building
• The nurse leaders acknowledged the issue of turnover and burnout within the organization and worked to provide creative solutions
• By focusing on a culture of caring for caregivers, the leadership team strengthened relationships and communication with staff while providing an environment that promoted self-care, minimizing stress and promoting wellness
Literature Review
Problem
• Main Line Health (MLH) is a non-profit, Magnet-designated health system serving areas of Philadelphia with four acute-care facilities, one rehabilitative medicine hospital, one addiction medicine center, and a homecare/hospice program.
• MLH recently experienced staffing challenges and lower employee engagement
Caring for Our Caregivers: A Hands on Culture of Caring Initiative The Main Line Health System Caring Cart
Methods
Adaptability
Acknowledgments
American Nurses Association (2017) Executive summary: American nurses health risk appraisal. Retrieved from
https://www.nursingworld.org/~4aeeeb/globalassets/practiceandpolicy/work-environment/health--safety/ana-healthriskappraisalsummary_2013-2016.pdf
American Organization of Nurse Leaders. (2015). AONE Nurse Executive Competencies. Chicago, IL: Author.
Accessed at: www.aone.org
Accessible at: http://www.aone.org/resources/nurse-leader-competencies.shtml
Allard, M., Katseres, J. (2018) Using essential oils to enhance nursing practice and for self-care. The Nurse Practitioner, 43 (5) p 39–46.
doi: 10.1097/01.NPR.0000531915.69268.8f
Blum, C. (2014) Practicing self-care for nurses: a nursing program Initiative" OJIN: The Online Journal of Issues in Nursing 19, (No. 3, Manuscript 3) doi: 10.3912/OJIN.Vol19No03Man03
Wu S., Singh-Carlson, S., Odell, A., Reynolds, G., & Su, Y. (2016). Compassion fatigue, burnout, and compassion satisfaction among oncology nurses in the United States and Canada. Oncology Nursing Forum, 43(10.1188/16.ONF.E161-E169),
E161-E169. https://doi.org/10.1016/j.gerinurse.2016.08.003
MLH Caring Cart Staff & Reiki Teams
Members of MLH Healthy Work Environment Council
Melissa Slusser, MLH Palliative Care Practice Manager
MLH Marketing Team
Barbara Wadsworth DNP, RN, MBA, MLH CNO
Jack Lynch, FACHE, President & CEO MLH,
Linda Carrick, PhD, RN, MLH Regional VP Patient Care Services
Evaluation
• A 2014 study concluded that it is necessary to build intentional
support for nurses into the workplace that focuses on relieving
caregiver burnout and compassion fatigue
• The American Nurses Association (2017) calls for a continued focus
on the health of nurses by educating nurses and employers on the
importance of emotional and physical workplace health
• Administrative commitment to sustainable employee driven
programs focusing on improving the emotional distress of staff are
shown to have long term impact on morale
• The use of integrative therapies has been shown to improve well
being and reduce stress
• Two staff nurses met with the Chief Nursing Officer to discuss
staffing and engagement challenges across the system.
• A Caring Cart was proposed to support employees
• The Caring Cart was stocked with snacks and staffed by MLH
trained Reiki and aromatherapy clinical nurses who offered
aromatherapy hand massages, stickers, and inhalation sticks
• A two week schedule was arranged for the Caring Cart to visit staff
across the health system
• Caring Cart staff also utilized active listening techniques and
delivered emotional support to colleagues.
• Deliverers of the Caring Cart debriefed about the experiences
What’s next for Integrative Therapies at MLH?
• Pilot: Massage for Oncology inpatients
• Expand and offer Integrative Therapies to outpatient Pain
Management patients.
• Develop 3-5 custom Mindfulness sessions for inpatients
• Research Study: The Effects of Reiki during Spontaneous
Breathing Trials (SBT) on mechanically ventilated patients in the
ICU
• Research: Reiki Practice and the reduction of nurse burnout.
• Continue community outreach/ programming
• Explore Virtual Reality options for pain management
38
Arnstein, P. (2020, February). Evidence-Based Approaches to Pain
Control.
Lin, Y., Wan, L. and Jamison, R., 2017. Using Integrative Medicine in Pain
Management. Anesthesia & Analgesia, 125(6), pp.2081-2093.
Nematollahi, M., et al., Effects of aromatherapy on anxiety in patients with
acute coronary syndrome hospitalized in cardiac care unit. Bali Med J
(2017), Vol 6, Number 2:331-336.
Notte, B.B., Fazzini, C., Mooney, R.A. Nursing. 2016 Feb;46(2):17-23
Reiki’s effect on patients with total knee arthroplasty: A Pilot study.
New Joint Commission advisory on non-pharmacologic and non opioid
solutions for pain management. (n.d.). Retrieved from
https://www.jointcommission.org/en/resources/news-and-
multimedia/news/2018/08/new-joint-commission-advisory-on-non-
phamacoligic-and-non-opioid-solutions-for-pain-management/
40References
Questions?
P. Ann Blaney, BSN, RN-BC
Clinical Coordinator Integrative Therapies
Suite # 575
130 South Bryn Mawr Ave Bryn Mawr, Pa 19010
484-337-8963
41
