Cam In Nursing Education Rev12

CAM in Nursing Education

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...........................................................................................................................................3 Abstract............................................................................................................................................3 Introduction......................................................................................................................................4 Literature Review.............................................................................................................................9 Research Lenses.............................................................................................................................33 Method...........................................................................................................................................39 Results............................................................................................................................................45 Weekly meetings, meditation & oracle cards. The foundation of this research team’s 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 daughter’s school hours. Nelson’s 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 Nelson’s employer. These 1½-hour lunch meetings began with check-ins about family and work, and continued with work on the project at hand for that week. This lunchtogether 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................................................................................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 college’s 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 by hand, 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 today’s 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 body’s 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 1990’s, 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. Weil’s 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 body’s 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 person’s 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 body’s 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, medical researchers make their first attempt to quantify on a national scope, the true scale of the CM usage phenomenon. Richard Eisenberg’s 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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as use of plants, herbs, foods and animal products like shark cartilage. Manipulative and bodybased practices include chiropractic, massage and osteopathic manipulation. Energy medicine works with the energy field that surrounds and infuses the body. Such therapies are Qigong, Reiki, Therapeutic Touch, Healing Touch and bioelectric use of magnets, currents and pulsed fields (“What Is CAM?,” 2008). With these clear, common definitions and scientific-research data, the NCCM gives CM therapies a level of credibility acceptable to the positivist-rooted medical community and system. Together, this shifting constellation of influencers – consumers, medical researchers and a government research center – elevated CM from voodoo and quackery to valid and important. In fact, one of the NCCAM’s published purposes is to foster the integration of CM therapy and philosophy into allopathic medical practice. Unfortunately the shift to greater complementary medicine acceptance and integration, for the most part, has taken place without and in spite of, the health care workers, physicians and nurses of the medical delivery system. In fact, some physicians and nurses ignore, belittle and chastise patients who discuss their CM usage. This lack of knowledge about complementary techniques can create apprehension and distrust in the medical provider, which blocks the opportunity for honest dialogue with a complementarymedicine-using patient/consumer. Since doctors and nurses spend years being educated in the ways of biological medicine, they have greater knowledge of allopathic medicine than their patients. But when a patient discusses his/her CM usage, most physicians and nurses experience a CM-knowledge deficit, and this creates a shift in the traditional doctor/patient relationship. The traditional professional/patient balance is upset. Knowledge is the key to restoring this balance – CM knowledge of doctors and nurses. The purpose of this research project is to explore the current state of CM inclusion in nursing

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school philosophy and curriculum, particularly at the College of St. Catherine’s 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 uninsured citizens 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, nursing’s 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 Foundation’s 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 lesstechnology-driven medicine. Locsin (1995) reports that nurses are keenly aware of technology’s 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 global competition. Politicians and business leaders believe that employer-supplied heath care is partly responsible for America’s 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 can’t 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 body’s 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 body’s 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 one’s 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 can’t 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 Clinton’s administration established the White House Commission on Complementary and Alternative Medicine Policy to “set standards for the scientific 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, offering CM 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 1990’s, 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 White House 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 1990’s, 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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integrative medicine (Kligler, 2004). Even medical school students see the need for change. At the University of Minnesota, 81% of medical students and 88% of medical school faculty believe CM practices belong in the school’s educational offerings (Kreitzer et al., 2002). In 2006, Torkelson, Harris, & Kreitzer, published their study of pre-med students’ CM attitudes, before and after CM treatment. They found that medical students changed their views of CM after they had personal experiences of a CM therapy over the course of one clinical rotation. Compared to their pre-CM-treatment views, these students were more accepting of CM, saw CM as more credible and were more willing to refer their patients to a CM provider. A study of medical students at Georgetown University concurs that an experiential approach produces a change in the attitudes of medical students. At Georgetown, first year students took an 11-week mind-body skills course, which resulted in greater self-awareness and self-reflection and an understanding of the importance of self-care while they were in medical school (Saunders et al., 2007). Medical students want CM information and these studies demonstrate the change such education can bring. Nursing response to CM As partners in health care delivery, patient usage of CM has had an impact on the nursing profession as well. The professions’ response is multifaceted and divided. While some nursing leaders ignore CM usage, others have embraced CM therapies in hospice care, CM consultancy and the creation of a nursing specialty in holistic nursing. Two Viewpoints of CM. Leaders in the nursing profession hold two diverging beliefs. One side views CM as in alignment with nursing’s historical roots of “providing care and comfort to those who are ill and education to preserve the health of the public,” (O'Brian-King, & Gates, 2007, p. 337). These CM supporters cite the work of Nightingale, Walk, Sanger and

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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 nursing’s worldview in her article “Nursing as a context for alternative/complementary modalities.” Through the lenses of “Nursing Theory and Nursing’s 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 Society’s Needs. A holistic approach to health care supports nursing’s long history of meeting society’s needs. In their article, “Teaching holistic nursing: The legacy of Nightingale,” O’Brian-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 society’s 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 nursing’s 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 longterm 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 public’s 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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in a hospice setting. They also expressed dismay that these same therapies, such as energy healing, guided imagery, massage and acupuncture, might be seen as radical in other health care settings (Bravewell Collaborative, 2005, p. 15). The Center for Palliative Studies in San Diego California partnering with outside Chinese medicine, massage and harp therapy providers to support already-present hospice nursing care, but concluded that the ideal situation would be for hospice nurses to deliver CM therapies themselves (Lewis, deVedia, Reuer, Schwar, & Tourin, 2003). Hospice of the Valley, in Phoenix, AZ, reports using CM therapies since 1977 (Medlyn, 2007). Another study found that a combination of personal relationships, traditional therapies and complementary therapies served to maximize comfort during the dying process (Brenner & Krenzer, 2003). Integrative therapies also help with pain and symptom management, in hospice and home care settings (Johnson, 2005) Nurses as CM consultants. Some nurses embrace CM and actively integrate it into their professional lives. They learn CM modalities and open their own, integrated practices. They refer to CM providers at clinic visits. They invite CM conversations during a provider visit. They look for dangerous interactions between herbs/supplements and prescription drugs and may proactively evaluate the potential CM modalities and synergistic effects of an integrated treatment regimen. They take seriously their role to “credibly advise patients and the public about the vast array of therapeutic options available” (Halcon, 2003, p. 387). According to Engebretson, nurses must have knowledge of CM therapies in order to assess a patient’s use of these techniques (1999). Eisenberg et al. see the nursing role as a health protector, guarding against dangerous interactions between prescription drugs and herbs (1998). Burman cautions that “an estimated 15 million adults are at risk for adverse interactions because of concurrent drug, herb and/or megavitamin use” (2003, p. 29). Halcon goes as far as making CM integration

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an ethical responsibility for nurses. She says, “nursing’s 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). The guidebook 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 supports incorporation 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 nurse’s 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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leading to an improved and enhanced healing process for the patient and the nurse practitioner” (Sharoff, 2008, p. 206). Complementary Medicine curricula. Researchers also are finding nursing student and faculty interest in CM education. International and domestic research demonstrates consistently high interest in and desire for knowledge about CM therapies. In interviews with 48 Canadian oncology nurses, researchers report a dominant belief that information on unconventional therapies are important for both patients and health care workers (Fitch et al., 1998). Danish oncology and hematology share positive attitudes toward CM. Domestically, a survey of Nurse Practitioners (NPs) in Connecticut reports that they are somewhat knowledgeable about CM and more than half of those surveyed ask their clients about CM use. One third of these NPs have some training in alternative therapies, with the remaining two-thirds express interest in such training (Hayes & Alexander, 2001; Melland & Larson, 2000). A cross-section survey of undergraduate and graduate students and faculty at a nursing school reveals that 80% of respondents thought CM had benefits, 85% desire more CM education and 70% want clinical care integrated with CM. Yet more than 50% of students and faculty report little or no personal or professional experience with CM (Kim, Erien, Kim, & Sok, 2006). At the University of North Dakota, faculty report that 80% of graduate students think it is important for health care professionals to understand CM therapies (Melland & Larson, 2000). Other researchers investigate the broader issues involved in incorporating CM information in nursing curricula. Four studies concur that nursing leaders and educators throughout the country are trying to determine what CM information already exists in current curricula, what needs to be implicitly and explicitly in education and practice, and what are the implications of these decisions in terms of faculty development (Hageness, Kreitzer, & Kenney,

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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 patient’s health,” (O’Brian-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 (nursing’s) historical traditions and identity” (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 O’Brian-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 nurse’s 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 multiuniversity 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 Association’s 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). O’Brian-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 master’s 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 school’s 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 university’s nursing school received a grant from NCCAM to incorporate complementary content into undergraduate and graduate curricula, they launched a series of webbased teaching modules for Master’s 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 Minnesota’s 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 Minnesota’s School of Nursing has worked in collaboration with the university’s 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. “It’s so consistent with nursing’s 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 State’s 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 “the course focuses on the application of theory – based clinical decision making for providing holistic nursing care. The centrality of the client’s 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 school’s 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 twoweek 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, T’ai Chi, Qigong, Yoga and Exercise. Continuing Education offerings include Experimental Foods, Healing Touch, Medical Qigong, and T’ai 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 Lin’s Spring Forest Qigong training (Normandale continuing 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 school’s 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 state’s 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 public’s 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 master’s program, in the College of St. Catherine’s School of Health, Brown-Price and Nelson explored and came to agree on a view 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 Master’s 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 master’s 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-Price’s educational training and work experience. Her undergraduate education in journalism gives her curiosity and respect for the importance of every person’s 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-Price’s professional experience. Nelson. Researcher Nelson has a bachelor’s 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 those studies utilizing highly controlled methodologies were seriously considered as credible and reliable. Although trauma protocols are consistent across ER’s 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 master’s 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. Nelson’s professional lenses extend organically into a consulting project within the College of St. Catherine’s 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 spiritual tradition, 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-Price’s 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 time came for cancer to move on. Brown-Price’s lens sees the uniqueness every person brings to a given situation. Nelson. Nelson’s 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 family’s 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 team’s documents, Nelson adds professional polish to the text. Where Nelson brings a nurses’s heart, Brown-Price speaks a patient’s 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 Nelson’s nursing background, this team focused on exploring the integration of CM into nursing curriculum, as it might be taught in the College of St. Catherine’s nursing program. This chapter describes the team’s 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 College’s graduate nursing program and School of Health. Nelson and Brown-Price worked with the College’s 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 Nelson’s pro-CM bias and allowed the client freedom to decide what action, if any, this new information might prompt within the client’s 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 the center 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, BrownPrice 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 Nelson’s 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 (O’Brian-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 more importantly, 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. Catherine’s 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 Feb. 12 – 19 Feb. 12 – 19 Feb. 10 – 14 Feb. 9 Feb. 16

Feb. 25

Read Flawless Consulting by Peter Block Interview business consultant, Janet Sokol-Seidman Interview consultant, Kevin Colton Make consulting appt. Consulting review with Carol Geisler Finalize Lit Review & print for distribution to Jacobson & other nursing faculty, and School of Health leader Have consulting appt. with Jeanne Jacobson

Brown-Price Nelson Brown-Price Nelson Nelson Brown-Price Nelson Brown-Price Nelson 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. Catherine’s 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 real time 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 BrownPrice and Nelson’s 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-Price’s 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 proCM biases of Brown-Price and Nelson limited their objectivity in the consulting process.

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Results The 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, executive summary document and PowerPoint presentation are included in the Appendices of this document. Description of the Process The actual consulting portion of Brown-Price and Nelson’s 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 Block’s 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 team’s 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 daughter’s school hours. Nelson’s 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 Nelson’s employer. These 1½-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 Block’s book, Flawless Consulting (2002) also provided valuable and holistic how-to consulting information. Block’s 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 & Brannick’s 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-Price’s research class did not allow them to complete a 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-ofHealth. Background interviews. Brown-Price and Nelson’s 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. Catherine’s 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 student’s 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 greater demand than they can accommodate. They feel this enrollment trend is evidence of nursing students’ desire to learn more about CM. The faculty suggested that we investigate the opportunity to engage the leadership/faculty of the graduate nursing program in CM curriculum discussions, as the program is not currently including CM education in the program. Both individuals are strong supporters of advancing the integration of CM education into all levels of nursing at the College of St. Catherine, and throughout the entire School of Health. Two faculty members of the Holistic Health Studies program also provided background information for Nelson and Brown-Prices consulting project. The first, explained the transition of the College’s Holistic Health education offerings from a certificate program, begun in 1987, to a master’s program launched in 2001. The researchers asked probing questions regarding knowledge of any potential known barriers (past and present) of incorporating CM education into the nursing program, including previous attempts or conversations. They learned that some resistance for the Holistic Health Master’s program came from departments rooted in the hard sciences: Chemistry, Physics etc. It was also confirmed that to her knowledge, there were currently no known barriers to holistic integration into the School of Health. A second faculty member reflected even more deeply into the initial formation of the Holistic Health program. She related that she and two others were sent to investigate CM both at a national conference and in the Twin Cities community. The results of these early investigations, was organized into the first Holistic Health certificate program in 1987, the first of its kind in the Twin Cities. From this information, Nelson and Brown-Price realized that the cutting-edge lead in holistic health

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education, once held by the College of St. Catherine, had eroded as other nursing programs have added CM specialties or obtained certification by the Holistic Nursing Association. In their consulting role, Brown-Price and Nelson could use this important internal history to position the need for a return to a commitment to become the leading educator of healthcare professionals in the area of holistic health once again. Contacting clients. Following the team’s initial preparation, Nelson and Brown-Price were ready to contact and engage with their clients. Faculty from the Holistic Health program provided guidance and made introductions to the two key School of Health leaders who agreed to be Nelson and Brown-Price’s consulting clients: A leader in the Graduate Nursing program, and a key member of new program development for the School of Health. With this support, the consulting project began in earnest. Nelson made calls and sent emails to set up the first appointment with the leader in the nursing graduate program. BrownPrice and Nelson made a conscious choice to have Nelson lead the team’s consulting effort within the nursing program. They agreed that Nelson’s nursing background would position the team’s work more favorably with nursing faculty. They predicted that Nelson’s interpersonal skills, professional dress, calm demeanor and use of language would make nurses feel more comfortable and maximize the potential for a positive response to the team’s consulting information. While attempting to schedule the first consulting appointment, Brown-Price and Nelson also became sensitive to the inter-organization risks of working inside an organization, especially as graduate students making appointments with School of Health faculty. The team’s intention was to work within the organization, as supportive and encouraging consultants. At the same time, they were aware that their work could be seen as disruptive, unnecessary and naive.

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Nelson and Brown-Price decided that communication and transparency were the keys to keeping their intentions and actions clear and open within the School of Health leadership and faculty community. To enhance the communication process, the researchers supplied copies of their Literature Review to the team’s preparation coaches inside the nursing program. A hard copy of the Literature was sent to the Program Director for the Master of Arts in Holistic Health Studies, along with a note explaining the team’s intention to have a consulting meeting with her peer in the graduate nursing program. The team’s research faculty also gained initial approval and gave needed updates to the entire faculty of the Holistic Health program. This system of information sharing continued as the consulting meetings progressed and results evolved. Description of the Consulting This CM-integration-into-nursing-curriculum consulting project took the form of meetings. Nelson and Brown-Price met with two instrumental leaders within the School of Health to review the findings of their Literature Review and discuss possible implications for the leaders’ circles of influence. Both meetings resulted in invitations to share holistic health integration findings to other audiences, which moved holistic health integration several steps forward in the School of Health. Nursing meetings. The first consulting meeting was with a leader in the graduate nursing program. Prior to the meeting, the researchers provided her with a copy of their literature review and explained the purpose of their meeting – to obtain her feedback regarding incorporating CM education into the graduate nursing program. Upon initial discussions the researchers learned that this nursing leader found the Literature Review very informative and expressed interest in incorporating CM education into the graduate program. She also requested more information on how this could be accomplished. Options and next steps were discussed, and resulted in an

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invitation to Nelson and Brown-Price to present their findings at an upcoming meeting of the graduate nursing faculty. She expressed the need for the researchers to understand the work of the graduate faculty, and brainstorm how they could integrate CM into their coursework. It was also recommended that Nelson and Brown-Price share their findings with the Dean of the School of Health. Although the client offered to set up the appointment, it was agreed that strategically the project may be best served by the researchers first discussing the concept of CM education with others on the Dean’s leadership team and gain their insight, and then request that they discuss the topic of CM education with the Dean. This strategy promoted leadership buy-in and leveraged an organic process to impact change. The client agreed with the approach, and supported the plan to meet with new program development leader at the School of Health who reports directly to the dean. Serendipitously, this individual was also recommended as a client to the research team, by their research faculty member. Following the success of their first consulting meeting, Brown-Price and Nelson’s proceeded to create a PowerPoint presentation for the upcoming meeting of the graduate nursing faculty and schedule an initial meeting with the new program development director at the school of health. Following their communication strategy, they also shared results of their first faculty consulting session with their research faculty who communicated updated information to the Holistic Health leadership and faculty. New Program Development meetings. The meeting with leadership for new program development in the School of Health followed a similar structure. Again the client received the team’s Literature Review findings prior to the meeting, and, again the meeting opened with the client indicating that she found the literature review informative, timely and expressed an interest in moving the concept of CM education forward within the school of health. She shared her

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vision for a breaking down the silos to create a school of health that is integrative, across the disciplines, and for holism to be integrated into the college’s ethics leadership. From the client’s perspective, the timing for integrating holistic health was fortuitous. The recent creation of a new curriculum committee, and the possibility of leveraging the college’s experts from the Master of Arts in Holistic Health Studies program to assist in creating an integrative health education model across the School of Health could support implementation of this concept. The client suggested we create an executive summary of the Literature Review which she could present to the executive leadership of the School of Health at their meeting the following week. The researchers agreed and created and forwarded an initial draft of the executive summary for the client’s review. After obtaining input and incorporating edits, a final copy was submitted for the meeting. A tight agenda did not allow time for discussion of the document at that particular meeting, but the client did have the opportunity to present the summary in an individual meeting with the Director the following week. She reported that her meeting was positive and timely, and she would keep the research team informed as the integration effort evolved. It was also of interest, that the client explained to the researchers, that their consulting project fit an action research model. In research class, later that same day, Brown-Price and Nelson’s research faculty had reached the same conclusion. Nursing faculty presentation. The next consulting engagement took the form of a presentation to the graduate nursing faculty. Nelson and Brown-Price created a PowerPoint presentation that summarized the findings of their Literature Review and suggested integration options for consideration. Though there are eight graduate nursing faculty members, attendance at the meeting swelled to 14, including representatives from Admissions, Business Office, and the Associate Dean of Nursing. The presentation was originally allotted one hour, but was

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condensed to 15 minutes by leadership just prior to the start of the meeting due to last minute agenda additions. As a result of the time constraint, there was no time for group discussion following the presentation. Both of these factors were unplanned and caused Brown-Price and Nelson to improvise in their information delivery. During the time of presentation preparation, Brown-Price and Nelson decided to have Brown-Price present the broader and societal trend information. Nelson again represented the medical voice, presenting the integrative changes occurring in medical and nursing schools, as well as in local nursing education. There were no questions during the presentation and Jacobson allowed the presentation to extend beyond its 15minute initial time allowance. Brown-Price suggested to the attendees that integration should be organic to the St. Catherine community, explaining that some schools integrate, while others cover CM in separate course work. She suggested that the program would need to find it’s own St. Kate way to proceed along this path. Nursing leadership responded by indicating that St. Kate’s would lean towards integrating holism throughout the program. Immediately following Nelson and Brown-Price’s presentation, they were approached by two graduate faculty members and asked if they were available to provide a two-hour CM education session to graduate nursing students in an upcoming class. As consultants, Nelson and Brown-Price were excited by the immediate interest and application of the information they had just presented. They also were aware that two undergraduate faculty inside the nursing department already had existing curriculum and experience teaching the holistic integration approach. This presented an ideal opportunity to involve existing CM educators within CSC and build bridges inside the nursing department itself. The consulting team gave the names of the undergraduate faculty to the two graduate faculty members who requested holistic education help, advising both sets of faculty to work together and build this bridge.

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Identifiable Characteristics This consulting process had a number of important characteristics. It used the researcher’s Literature Review as a type of sales document, to create interest and urgency with potential clients, and subject matter expert status for the consultant/researchers. In most academic research, the Literature Review becomes background information, but in this project it was the most frequently re-printed part of this research team’s written documentation. The Literature Review also presented a consolidated view of the changes occurring in society today, and how those changes are being met in the medical care and medical education settings. Without this broad-based research summary of the current situation, leaders in the nursing and School of Health areas could potentially make decisions about the future based on their personal experience, professional knowledge, professional reading and knowledge of the community. Sharing of the Literature Review to School of Health leadership also promoted the Holistic Health Studies program and positioned its research projects as academically meaningful and important at this time of shift in medical education. Distinguishing Features This consulting project indicates that graduate students can become change agents within their own educational institution. These student/consultants gained access to key decision makers and stakeholders within the School of Health. Not bound by turf or presumed bias, they received a clear hearing of their work and consideration of how it might move beyond the scope of graduate research work, to take on a momentum of its on in the School of Health. For the Holistic Health Studies leadership and faculty, this consulting project opened doors to cooperation and collaboration possibilities with other departments in the School of Health and beyond.

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This consulting project also is unique in the openness of the graduate researchers/consultants. Unlike most researchers who search for new facts or approaches, this consulting project embraced the unknown. Student/consultants presented their research-based view of a changing medical education system, with no preconceived goals or desired outcomes. Whereas college faculty-student information sharing is usually a one-way model, in this project, the graduate student/consultants were able to bring compelling new information to faculty and educational leadership. Evaluative Feedback STILL COMING

In summary, Brown-Price and Nelson found that the doors of change opened after they preparing themselves adequately and professionally shared information about the changing medical delivery system with stakeholders in the College of St. Catherine’s School of Health. Starting in Fall 2009, CM information will be part of the DNP program and the School of Health’s leader of New Program Development will add to her responsibilities the Master of Arts in Holistic Health Studies program.

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Discussion During their years of graduate study in holism and complementary medicine, Nelson and Brown-Price developed a passion for their field of study, that of complementary and integrative medicine. They became interested in reasons why complementary/integrated medicine was not more prevalent in Western medical settings given the overwhelming and ever-increasing numbers of Americans using these modalities. According to the literature, one such reason is the exclusion of complementary/integrated medicine education in the curriculum of healthcare professionals. The researchers elected to further investigate this topic using a research-based approach. After reviewing an extensive amount of research and acting as consultants, they shared their accumulated research with stakeholders in the College of St. Catherine’s School of Health. In review, these researchers learned that the consulting process and results mirrored trends found in published literature, as well as revealing some unexpected findings. Looking forward, Brown-Price and Nelson see future implications stemming from their work: implications for practice, for the community, for the College of St. Catherine’s School of Health and for future research. Findings Supported by the Literature In preparing for their consulting project, Nelson and Brown-Price reviewed more than fifty published articles concerning the increased use of complementary therapies in the United States, the response of the healthcare community to this trend, the need to incorporate CM into healthcare education and reports from those schools that have begun this integration process. The results from this consulting project aligned with the information in several ways.

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Complementary Medicine (CM) education. This consulting project confirmed that the College of St. Catherine’s School of Health has taken initial steps toward adding CM education in its undergraduate nursing program. After reading the literature review and meeting with the researchers, the School of Health and nursing stakeholders revealed the desire to integrate holistic CM education across all nursing programs and, indeed, even the entire School of Health and respond to the changing medical marketplace. Meeting the patient need. The literature also traced the history of nursing to its Florence Nightingale roots in caring touch, belief in the body’s self-healing ability, and the unique position of nurses to respond to changes in society that impact patient needs. Again, these researchers found similar beliefs in their client/educators. The clients acknowledged a desire for their programs to adapt to meet the needs of the evolving and informed patients who seek health care from a variety of care providers outside of the western model. These patients are independently incorporating complementary and holistic modalities into their health and illness treatment plans and often find that traditional medical providers are not able to manage/understand their entire plan of care. Faculty development. This consulting project confirmed what research has demonstrated -- that changes in healthcare education needs to begin with faculty. Several studies demonstrated that when individuals actually experience a CM therapy, their opinion of such therapy changes. St. Kate’s School of Health stakeholders are aware of these factors and are interested in moving forward to educate faculty about complementary/integrated medicine and incorporate this education into the schools healthcare curriculum.

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Unexpected Findings Because a consulting process does not predispose an outcome, Nelson and Brown-Price became aware of many surprises both during, and reflecting back upon the process. Their initial surprise was the unexpected fact that their Literature Review became the focus of their consulting project – an educational tool providing research-based information, that addressed changes in healthcare education, specifically the integration of allopathic and complementary medical training. Used in this way, the Literature Review expanded the awareness of stakeholders about CM usage trends, promotion of CM education by private organizations and government agencies, and changes occurring in local nursing education programs. What was originally prepared as background for the research, in fact became the focal point of this consulting effort. Brown-Price and Nelson also didn’t expect their consulting to spread to the broader School of Health (SOH). They didn’t realize initially the fortuitous timing of their work within the School of Health, the existence of a position created to evaluate new program development options, and a curriculum committee that was currently evaluating program curriculum. Nor were they expecting such immediate invitations to assist in incorporating CM into current programs, such as a request to teach a class of graduate nursing students about CM/integrated medicine, and an invitation to provide direction on how to incorporate CM into the graduate nursing program. They were surprised by the access they gained with leadership within the School of Health, and leadership’s openness to the idea of CM integration to the college’s health care education. Equally surprising was the lack of communication and absence of bridges between departments and programs within the School of Health. Researchers found a lack of awareness

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by faculty and management in the School of Health of the Holistic Health Studies program, what it means, what is taught and its underlying philosophy. Given this silo structure, it wasn’t surprising that HHS’s holistic philosophy remained isolated from the rest of the School of Health. The researchers discovered inner epiphanies as well. They didn’t realize until near the end of their consulting process how holistic their research project had become; holistic students doing holistic research – researchers looking inside themselves for direction, working on a project that looks inside their college. Likewise, they learned a major life lesson in letting go. After several false starts on other approaches related to the topic, they settled on the consulting approach, intentionally opening themselves to an unknown outcome. They presented information from their literature review, with no anticipation or desired outcome. They witnessed surprising and satisfying results that occurred only because they let go of trying to control the results. Letting go is a key part of living a holistic life, and these researchers received a first-hand experience of that important lesson. Implications for Practice and the Community Nelson and Brown-Price believe that their consulting project is not an end, but the beginning of an evolutionary time for the College of St. Catherine’s School of Health. They see the need for the School of Health to publicly embrace CM integration and for the doctorate nursing program to become the pilot for this integration. They recommended that existing CMexpert faculty (in nursing and HHS) assist in driving this integration and leverage their expertise in the field. For the College of St. Catherine, it is important to leverage its mission, dedicated to “innovation and market responsiveness” and return to its rich history as a cutting edge education center for healthcare professionals. The resident experts for this integration effort is the valuable

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in-house expertise of the HHS program, which can help expedite this process by interacting with all SOH faculty and offering complementary and integrated medicine expertise. Beyond this nursing program pilot, the overarching goal is for St. Kate’s to teach a holistic-infused curriculum across all classes in the School of Health. To achieve this goal, silos within the School of Health will need to be dissolved. Initially, leadership of HHS faculty and nursing faculty would meet, with HHS faculty sharing information about their program. A brainstorming session would follow, with HHS and nursing undergraduate CM faculty facilitating discussion of how holistic medicine information could be integrated into all levels of the nursing program. Some easy-to-implement steps might include the following: 1. Utilizing HHS faculty as guest lecturers in classes 2. Educating nursing faculty about HHS, using online modules, books, research articles and possibly the Holistic Nursing Association Simultaneously, this same process could apply across the School of Health, identifying areas for possible integration that may follow the nursing integration model. Additionally, graduates of a holistic School of Health will improve their communities by providing the holistic care their patients are requesting, These healthcare professionals will be prepared to evaluate, treat and refer patient’s in a safe and effective manner supported with knowledge of a complementary and integrated medicine approach. Future Research In the action research model, taking action and evaluating that action are the final two steps. Unfortunately, the timing of this research project did not allow for the completion of those final two steps. Completing this action research project is one future action that grows out of this project.

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Other future research possibilities include assessment of faculty and student attitudes toward CM, further exploration of any barriers to integration inside the School of Health, investigation of successful methods for educating faculty, and development of a curriculum to move towards an integrative and holistic approach to patient care. Outside of the School of Health, research could continue to investigate CM/integrated healthcare education efforts and the success of those efforts, nationwide and within the Twin Cities.

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References Alkema, K., Linton, J. M., & Davies, R. (2008). A study of the relationship between self-care, compassion satisfaction, compassion fatigue and burnout among hospice professionals. Journal of Social Work in End-Of-life & Palliative Care, 4(2), 101-109. American Nurses' Association. (Ed.). (2007). Holistic Nursing - Scope & Standards of Practice. Silver Springs, MD: American Nurses' Association. Andrew Weil. (n. d.). Retrieved from Andrew Weil Web site: http://www.webmd.com/andrewweil Astin, J. (1998). Why patients are alternative medicine: results of a national study. Journal of American Medical Association, 279(19), 1533-1548. Balevre, P. (2001). Professional nursing burnout and irrational thinking. Journal for Nurses in Staff Development, 17(5), 264-271. Best Practices in Integrative Medicine. (2009). Retrieved from The Bravewell Collaborative Web site: http://www.bravewell.org/transforming%5healthcare/models Block, P. (2000). Flawless Consulting: a guide to getting your expertise used (2nd ed.). San Francisco: Pffeiffer. (Original work published 1981) Block, P. (2000). Flawless consulting: a guide to getting your expertise used (2nd ed.). San Francisco: Pfeiffer. (Original work published 1981) Boon, H., Verhoef, M., O'Hara, D., Findlay, B., & Majid, N. (2004). Integrative healthcare: arriving at a working definition. Alternative Therapies, 10(5), 48-56. Brailer, D. J., & Van Horn, R. L. (1993). Health and the welfare of U.S. business. Harvard Business Review, 71(2), 125-132.

CAM in Nursing Education

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Brenner, Z. R., & Krenzer, M. E. (2003). Using complementary and alternative therapies to promote comfort at end of life. Critical Care Nursing Clinics of North America, 15(3), 355-362. Browning, L., Ryan, C. S., Thomas, S., Greenberg, M., & Rolniak. (2007). Nursing specialty and burnout. Psychology, Health and Medicine, 12(2), 248-254. doi: 10.1080/13548500600568290 Buerhaus, P. I., Donelan, K., Ulrich, B. T., Norman, L., & Dittus, R. (2006). State of the registered nurse workforce in the United States. Nursing Economics, 24(1), 6-12. Burman, M. (2003). Complementary and alternative medicine: core competencies for family nurse practitioners. Journal of Nursing Education, 42(1), 28-34. Career Programs: Integrative Health & Healing (1st ed.). (2009). Author. Retrieved from Career Programs: Integrative Health & Healing Web site: http://www.anokaramsey.edu/ career_programs/ihh.cfm Cicatiello, J. S. (2000). A perspective of health care in the past - insights and challenges for a new health care system in the new millennium. Nursing Administration Quarterly, 25(1), 18-29. Clement (Halcon, Chlan, Kreitizer, & Leonard, 2003), J. P., Chen, H., Burke, D., Clement, D. G., & Zazzali, J. L. (2006). Are consumers reshaping hospitals? Complementary and alternative medicine in U.S. hospitals, 1999-2003. Health Care Management Review, 31(2), 109-118. Coghlan, D., & Brannick, T. (2003). Doing Action Research in Your Own Organization. Thousand Oaks, CA: SAGE Publications Inc. (Original work published 2001)

CAM in Nursing Education

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Cohen, M. H., Hrbek, A., Davis, R. B., Schachter, S. C., Kempter, K. J., Boyer, E. W., et al. (2005). Emerging credentialing practices, malpractice liability policies, and guidelines governing complementary and alternative medical practices and dietary supplement recommendations: a descriptive study of 19 integrative health centers in the United States. Archives of Internal Medicine, 165(3), 289-295. Complementary and alternative services added by hospitals. (2008, October). Hospitals & Health Networks, 82(10), 68. Computer ownership & Internet usage. (n. d.). Retrieved from Computer ownership and Internet use Web site: http://informplease.com/ipa/A0931441.html doi: 10.1177/0888010102250273 Dossey, B. M., & Keegan, L. (Eds.). (2009). Holistic Nursing A Handbook for Practice (5th ed.). Sudbury, MA: Jones and Bartlett Publishers. (Original work published 2008) Dr. Mehmet Oz. (2009). Retrieved from Oprah.com Web site: http://www.oprah.com/contributor/ health.droz Eisenberg, D. M. (1998). Trends in alternative medicine use in the United States, 1990-1997. Journal of the American Medical Association, 280(18), 1956-1975. Examples of the emergence of integrative medicine in communities. Phase 2 of continuing study to map the field of integrative medicine. (2005). Retrieved from Bravewell Collaborative Web site: http://www.bravewell.org/transforming_healthcare/mapping_the_field Forgione, D. A., & Maith, P. C. (2007). Medical tourism and its impact on the US health care system. Journal of Health Care Finance, 34(1), 27-35. Frisch, N. C. (2001). Nursing as a context for alternative/complementary modalities. The Online Journal of Issues in Nursing, 6(2). Retrieved from The Online Journal of Issues in

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Nursing Web site: http://www.nursingworld.org//MainMenuCategories/ ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/ AlternativeComplementaryModalities.aspx Fuch, V. R. (1994). The future of health policy (1st ed.). Cambridge, MA, US: Harvard University Press. Gellad, Z. F., & Lyles, K. W. (2007). Direct-to-Consumer Advertising of Pharmaceutical. The American Journal of Medicine, 120(6), 475-481. doi: 10.1016/j.amjmed.2006.09030 Hageness, S., Kreitzer, M. J., & Kenney, M. E. (2002). Complementary, integrative and holisitic care in emergency nursing. Nursing Clinics of North America, 37(1), 123-133. Halcon, L., Chlah, L., Kreitizer, M., & Leonard, B. (2001). Incorporating alternative and complementary health practices within university-based education. Complementary Health Practice Review, 6(2), 127-135. Halcon, L., Chlan, L., Kreitizer, M., & Leonard, B. (2003). Complementary therapies and healing practices: Faculty/student beliefs and attitudes and the implications for nursing education. Journal of Professional Nursing, 19(6), 387-397. doi: 10.1016/S87557223(03)0133-9 Halcon, L., Leonard, B., Snyder, M., Garwick, A., & Dreitzer, M. J. (2001). Incorporating alternative and complementary health practices within university-based nursing education. Complementary Health Practice Review, 6(2), 127-135. Hayes, K., & Alexander, I. (2001). Alternative therapies and nurse practitioners: Knowledge, professional experience and personal use. Holistic Nurse Practitioner, 14(3), 49-58.

CAM in Nursing Education

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Health: Associates in Arts Degree with Emphasis in Health. (2009). Retrieved Feb 11, 2009, from Health: Associate in Arts Degree with Emphasis in Health Web site: http:// www.normandale.edu/academics/depts/health/health.cfm Horrigan, B. (2006). Growing number of hospitals offer complementary and alternative medicine. Explore: the Journal of Science and Healing, 2(6), 482-485. doi:10.1016/j.explore2006.08.005. Johnson, E. (2005). Integrative therapies: a valuable role in patient care. Caring, 24(11), 58-60. Kim, S., Erien, J., Kim, K., & Sok, S. (2006). Nursing students' and faculty members' knowledge of, experience with, and attitudes toward complementary and alternative therapies. Journal of Nursing Education, 45(9), 375-378. Klinger, B. (2004). Core competencies in integrative medicine for medical school cirricula: a proposal. Academic Medicine, 79(6), 521-531. Kluger, J., & Parker, A. (1997). Mr. Natural (149th ed., Vol. 19). Retrieved from Time magazine Web site: http:// www.time.come/time/magazine/article/ 0,9171,1115682,000.html?idd=chix-sphere Kreitzer, M. J., & Sierpina, V. (2005). Innovation in integrative health care education. Explore, 1(4), 308-309. Kreitzer, M.J. (1977). Trends in healing. Creative Nursing, 3(3). Retrieved 1/21/09. http://web.ebscohost.com.pearl.stkate.edu/ehost/detail?vid=3&hid=102&sid=a0baceeadea1-427896eca8a9adf3ba38%40sessionmgr104&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#d b=rzh&AN=1998027111

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Kreitzer, M.J., Mitten, D., Harris, I., & Shanedling, J. (2002). Attitudes toward CAM among medical, nursing, and pharmacy faculty and students: A comparative analysis. Alternative Therapies in Health and Medicine, 8(6), 44-53. Leiser, D. (2003). Support for non-conventional medicine in Israel: cognitive and sociological coherence. Sociology of Health & Illness, 25(5), 457-480. Lewis, C. R., deVedia, A., Reuer, B., Schwar, R., & Tourin, C. (2003). Integrating complementary and alternative medicine (CM) into standard hospice and palliative care. The American Journal of Hospice & Palliative Care, 20(3), 221-228. Marston, R. Q. (1992). The Robert Wood Johnson Foundation Commission on medical education: the sciences of medical practice. Journal of the American Medical Association, 268(9), 1144-1146. McClosky, J. C., & Bulechek, G. M.. Iowa Intervention Project: Nursing Interventions Classification (NIC) (3rd ed.). St. Louis, MO: Mosby Medical Publishers. McNiff, J., Lomax, P., & Whitehead, J. (2002). You and your action research project. London: Routledge/Falmer. (Original work published 1996) Medlyn, B. (2007). Integrative therapies go mainstream in hospice care. Caring, 26(11), 24-27. Melland, H., & Larson, T. (2000). Complementary therapies: Introduction into a nursing curriculum. Nurse Educator, 25(5), 247-250. Member demographics and statistics. (2009). (Original work published 2006) Retrieved from American Holistic Nurses Association Web site: http://www.ahna.org/AboutUs/ WhoAreOourMembers/MemberDemographics/tabid/Def Micozzi, M. S. (Ed.). (2001). Fundamentals of complementary and alternative medicine (2nd ed.). Philadelphia: Churchill Livingstone. (Original work published 1996)

CAM in Nursing Education

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Normandale continuing health education/integrative health and healing. 2009. [Brochure]. Bloomington, MN: No Author. O'Brian-King, M., & Gates, M. (2007). Teaching holistic nursing: The legacy of Nightengale. Nursing Clinics of North America, 42(X), 309-333. Patrick, D. L., & Erickson, P. (1993). Health status and health policy: quality of life in health care evaluation and resource allocation (1st ed.). New York, NY, US: Oxford University Press. Reed, F., Pettigrew, A. O., & King, M. (2000). Alternative and complementary therapies in nursing curricula. Alternative and Complementary Therapies, 39(3), 133-139. Richardson, S. (2003). Journal of Holisitic Nursing, 21(1), 20-35. Robert Wood Johnson Foundation. (2008, October). High and Rising Health Care Costs (The Syththesis Project, Issue 16). Washington, DC: Author. Sahraian, A., Fazelzadeh, A., Mehdizadeh, A. R., & Toobaee, S. H. (2008). Burnout in hospital nurses: a comparison of internal, surgery, psychiatry and burn wards. International Nursing Review, 55(1), 62-67. Sarnat, R. L., Winterstein, J., & Cambron, J. A. (2007). Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update. Journal of Manipulative and Physiological Therapeutics, 30(4), 263-269. Saunders, P. A., Tractenberg, R. E., Chaterji, R., Amri, H., Harazduk, N., Gordon, J. S., et al. (2007). Promoting self-awareness and reflection through an experiential mind-body course for first year medical students. Medical Teacher, 29, 778-784. doi: 10.1080/01421590701509647

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Sharoff, L. (2008). Exploring nurses' perceived benefits of utilizing holistic modalities for self and clients. Holistic Nursing Practice, 22(1), 15-24. Sharoff, L. (2008). Holistic nursing and medical-surgical nursing: a natural integration. Medsurg Nursing, 17(3), 206-208. Shephers, L. C. (2008, Sept). Lowering the cost of chronic health conditions. Employee Benefit News, 22(12), 1-2. Torkelson, C., Harris, I., & Kreitzer, M. J. (2006). Evaluation of a complementary and alternative medicine rotation in medical school. Alternative Therapies in Health & Medicine, 12(4), 30-34. Use of complementary and alternative medicine is rapidly increasing. (2008). Retrieved 2008, from Nursing Times Web site: http://www.nursingtimes.net/ntclinicial/ complementary_therapies/2008/11/ use_of_complementary_and_alternative_medicine_is_rapidly_increasing.html Watson, J. (1995). Nursing's caring - healing paradigm as exemplar for alternative medicine. Alternative Therapies & Health, 1(3), 64-69. WebMD Investor Relations. (2009). Retrieved Feb 16, 2009, from WebMD Investor Relations Web site: http://investor.shareholder.com/wbmd/stocklookup.cfm What is CM? (2009). Retrieved from What is CAM? Web site: http://NCCAM/nih/gov/health/ whatisCM/#1 Wootton, J. C., & Sparber, A. (2003). Surveys of complementary and alternative medicine usage: a review of general population trends and specific patient populations. Seminars in Integrative Medicine, 1(1), 10-24.

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