This thesis examines an integrative health care (IHC) clinic set within a tertiary hospital located in large city in Canada. The enquiry began by exploring how biomedical and CAM practitioners, artists, hospital administrators, and the Artists’ Health Centre Foundation (AHCF) members interacted, communicated, and collaborated with one another for integrative patient/client care at the Artists’ Health Centre (AHC). Individual stakeholders’ knowledge and attitudes toward IHC are explored, to understand how these affected the everyday interactions among stakeholders. The thesis also examines the organizational structures of the hospital and the AHCF. The use of qualitative research provided useful in-depth accounts of respondents’ experiences of IHC. Semi-structured focus groups with artists, health-care practitioners, hospital administrators, and AHCF members, and ten in-depth interviews with the health-care practitioners were conducted between June, 2006, and February, 2007. Steps were taken to ensure the trustworthiness of the collected data. Qualitative research software, NVIVO, was used to manage the data. The findings suggest that despite a perceived lack of scientific evidence, attitudes towards IHC were positively influenced when biomedical practitioners had a personal experience with CAM therapies and when practitioners developed more confidence in their own work. There remained questions about the need for and presence of IHC at the AHC, as neither the hospital nor the AHCF worked in consultation with the practitioners and artists to develop a shared vision of IHC. The majority of respondents described the level of communication as “sporadic” and one-sided and thus not optimal for creating a communicative environment. Most respondents perceived communication among the stakeholders as one-sided and thus not optimal for creating a communicative environment. There was a lack of understanding regarding scope of practice and how to integrate the various practitioners, particularly CAM. This led to a lack of referrals and had a direct effect on practitioners’ level of confidence. Mechanisms of communication were informal and there were no formalized structures in place to facilitate communication or integration with one another. Additionally, there was no systematic way of charting patient information at the AHC. Respondents all agreed that IHC was an ideal to strive for and many noted how financial limitations impeded the evolution of integrative health care at AHC, truly forming a barrier to IHC. Strategies for sustainability and management of AHC funds included using a business model or an insurance model. Important implications of this research include enhancing the current knowledge of teamwork, collaboration, and integration among practitioners in general, and biomedical and CAM practitioners in particular. This research used existing IHC models, interdisciplinary teamwork models, and educational and organizational theories for building a theoretical and conceptual framework of IHC at the AHC. Combining these models with organizational theory shed light on relationship dynamics among CAM and biomedical practitioners while taking into consideration the several structural and process dimensions of integration.

This thesis examines an integrative health care (IHC) clinic set within a tertiary hospital located in large city in Canada. The enquiry began by exploring how biomedical and CAM practitioners, artists, hospital administrators, and the Artists’ Health Centre Foundation (AHCF) members interacted, communicated, and collaborated with one another for integrative patient/client care at the Artists’ Health Centre (AHC). Individual stakeholders’ knowledge and attitudes toward IHC are explored, to understand how these affected the everyday interactions among stakeholders. The thesis also examines the organizational structures of the hospital and the AHCF. The use of qualitative research provided useful in-depth accounts of respondents’ experiences of IHC. Semi-structured focus groups with artists, health-care practitioners, hospital administrators, and AHCF members, and ten in-depth interviews with the health-care practitioners were conducted between June, 2006, and February, 2007. Steps were taken to ensure the trustworthiness of the collected data. Qualitative research software, NVIVO, was used to manage the data. The findings suggest that despite a perceived lack of scientific evidence, attitudes towards IHC were positively influenced when biomedical practitioners had a personal experience with CAM therapies and when practitioners developed more confidence in their own work. There remained questions about the need for and presence of IHC at the AHC, as neither the hospital nor the AHCF worked in consultation with the practitioners and artists to develop a shared vision of IHC. The majority of respondents described the level of communication as “sporadic” and one-sided and thus not optimal for creating a communicative environment. Most respondents perceived communication among the stakeholders as one-sided and thus not optimal for creating a communicative environment. There was a lack of understanding regarding scope of practice and how to integrate the various practitioners, particularly CAM. This led to a lack of referrals and had a direct effect on practitioners’ level of confidence. Mechanisms of communication were informal and there were no formalized structures in place to facilitate communication or integration with one another. Additionally, there was no systematic way of charting patient information at the AHC. Respondents all agreed that IHC was an ideal to strive for and many noted how financial limitations impeded the evolution of integrative health care at AHC, truly forming a barrier to IHC. Strategies for sustainability and management of AHC funds included using a business model or an insurance model. Important implications of this research include enhancing the current knowledge of teamwork, collaboration, and integration among practitioners in general, and biomedical and CAM practitioners in particular. This research used existing IHC models, interdisciplinary teamwork models, and educational and organizational theories for building a theoretical and conceptual framework of IHC at the AHC. Combining these models with organizational theory shed light on relationship dynamics among CAM and biomedical practitioners while taking into consideration the several structural and process dimensions of integration.

The field of mindfulness research is rapidly growing as mindfulness is being utilized as a tool to improve mental and cognitive health. Mindfulness is paying attention in the present moment with non-judgmental awareness. As the research body increases, weaknesses in mindfulness research have surfaced. There is a need for improved measurement tools, an increased understanding of, meditation techniques used, the dose of meditation, and the population samples being studied. Meditation and movement are both tools that can improve an individual's mindfulness. The proposed dissertation will investigate mindfulness through three studies. Study 1 was completed in a population of individual members of the International Quit and Recovery Registry and met the Diagnostic and Statistical Manual, 5th edition criteria for substance use disorder. It was found that individuals with higher mindfulness and engagement with Integrative Health Practices demonstrate success in recovery, measured by the World-Health Organization Quality of Life Scale, craving, and Days in Recovery and are more likely to have reached remission. Engagement with meditation showed more and higher correlations with success in recovery than other Integrative Health Practices measured. Study 2 investigated how mindfulness is taught. Participants were divided into two groups, comparing traditional cueing to compassion cueing. Participants received neuroscience education paired with weekly meditation techniques. There were no group differences; however, all participants expressed improvements in mindfulness, self-compassion, decreased depression symptoms, and gains in neuroscience knowledge. The impact of mindfulness curriculum development can be seen through differences in daily outcomes assessing participants' thoughts, emotions, and body on a 10-point Likert scale from settled to active. Study 3 validated a new tool to measure the multidimensional impacts of movement based on a traditional yogic framework and validated with neuroscience tools. The Multidimensional Impacts of Movement Scale (MIMS) is a valid and reliable tool showing stability over time (r = 0.737, p<0.001) and strong Cronbach's Alpha for each scale ranging from α = 0.775 to α = 0.840. These three studies combine as a body of work supporting continued research in the field of mindfulness by adding new knowledge about teaching mindfulness, measuring mindfulness, and how mindfulness can be applied to improve quality of recovery for individuals with substance use disorder. / Doctor of Philosophy / The field of mindfulness research is rapidly growing as mindfulness is being utilized as a tool to improve mental and cognitive health. Mindfulness is paying attention in the present moment with non-judgmental awareness. As the research body increases, weaknesses in mindfulness research have surfaced. There is a need for improved measurement tools, an increased understanding of, meditation techniques used, the dose of meditation, and the population samples being studied. Meditation and movement are both tools that can improve an individual's mindfulness. The proposed dissertation will investigate mindfulness through three studies. Study 1 was completed in a population of individual members of the International Quit and Recovery Registry and met the Diagnostic and Statistical Manual, 5th edition criteria for substance use disorder. It was found that individuals with higher mindfulness and engagement with Integrative Health Practices demonstrate success in recovery, measured by the World-Health Organization Quality of Life Scale, craving, and Days in Recovery and are more likely to have reached remission. Engagement with meditation showed more and higher correlations with success in recovery than other Integrative Health Practices measured. Study 2 investigated how mindfulness is taught. Participants were divided into two groups, comparing traditional cueing to compassion cueing. Participants received neuroscience education paired with weekly meditation techniques. There were no group differences; however, all participants expressed improvements in mindfulness, self-compassion, decreased depression symptoms, and gains in neuroscience knowledge. The impact of mindfulness curriculum development can be seen through differences in daily outcomes assessing participants' thoughts, emotions, and body on a 10-point Likert scale from settled to active. Study 3 validated a new tool to measure the multidimensional impacts of movement based on a traditional yogic framework and validated with neuroscience tools. The Multidimensional Impacts of Movement Scale (MIMS) is a valid and reliable tool showing stability over time (r = 0.737, p<0.001) and strong Cronbach's Alpha for each scale ranging from α = 0.775 to α = 0.840. These three studies combine as a body of work supporting continued research in the field of mindfulness by adding new knowledge about teaching mindfulness, measuring mindfulness, and how mindfulness can be applied to improve quality of recovery for individuals with substance use disorder.

The opioid epidemic in the United States continues to be a national health crisis affecting all populations. From 1999 to 2016, more than half a million people died from drug overdose. Nonpharmacological therapies are underused in nursing practice due to the gap in nurses' baseline knowledge and confidence related to nonpharmacological techniques for pain management. The purpose of this scholarly project was to develop and implement an expert-reviewed, evidence-based education program focused on nonpharmacological techniques for pain management. Participants included 18 registered nurses (RNs) from an orthopedic unit in a large academic medical center. A 45-minute educational session was conducted for RNs. A pre/postquestionnaire, including a 5-point Likert scale on nurses' self-perceived knowledge and confidence in using selected nonpharmacological techniques, was the method of data collection. Descriptive statistics were used to analyze the data. The results indicated an increase in nurses' self-perceived knowledge in all nonpharmacological techniques. The most significant increase in knowledge posteducation intervention was guided imagery with an increase of 72% in terms of the response Good. The data analysis indicates that the nurses self-perceived confidence posteducation intervention increased in terms of the response Good by 50 % and response Excellent by 33% demonstrating the efficacy of an evidence- based education program on nonpharmacological techniques. The implications of this project for social change include the empowerment of nurses to provide holistic patient-centered care, opioid sparing in keeping in alignment with patient safety, and the development of an evidence-based program that can be replicated in other settings.

No description available.

No description available.

Bakgrund: Rytmisk insmörjning enligt Wegman/Hauschka (RI) är en beröringsterapi inom antroposofisk vård. RI utförs av sjuksköterskor inom landstingsfinansierad integrativ vård. Patienter får RI i primärvård, öppenvård och slutenvård. Det centrala i den antroposofiska synen på kropp, hälsa och lidande överrensstämmer i stor utsträckning med den vårdvetenskapliga livsvärldsteorin. Syfte: Att belysa hur patienter som fått eller får RI i öppenvård upplevt att behandlingen har påverkat dem. Metod: Kvalitativ innehållsanalys enligt Lundman och Hällgren Graneheim (2012) baserad på semistrukturerade intervjuer med fem patienter.   Resultat: Patienter som fått RI i öppenvård upplevde att deras hälsa förbättrades kroppsligt, själsligt och andligt. Kroppsligt lidande som smärta, nedsatt lungfunktion, tarmbesvär och sömnsvårigheter förbättrades. Själsligt och existentiellt lidande minskade i form av förbättrade kognitiva funktioner och ökad möjlighet att känna avslappning, avgränsning, mening, hopp, bekräftelse, trygghet samt livskraft. Slutsats: I denna studie på patienter i öppenvård liksom i tidigare studier på patienter i slutenvård upplevs RI kunna stärka hälsan kroppsligt, själsligt och existentiellt. RI är en vårdaktivitet där patienten bemöts utifrån ett helhetsperspektiv och vårdvetenskaplig teori omsätts i praktik. Större, jämförande studier med till exempel kontrollgrupp utan behandling eller med läkemedelsbehandling eller samtalsterapi liksom studier över tid är nödvändigt innan RI kan integreras i större utsträckning inom dagens hälso- och sjukvård. / Background: Rhythmical Einreibungen according to Wegman/Hauschka (RE) is a soft massage therapy for use in medicine and nursing extended through anthroposophy. RE is practiced by nurses working with integrative health care in the public financed health system, both with inpatients and outpatients (e.g. in primary care). The ontological definitions of caring science grounded in lifeworld theory of the human body, health and suffering is to a high extent corresponding with anthroposophic medicine. Aim: To explore how outpatients receiving RE have experienced that the therapy have affected them. Method: A quality content analysis, according to Lundman and Hällgren Graneheim (2012), based on semi structured interviews with five patients. Results: A decrease in physical suffering such as pain, reduced lung capacity, IBS and sleeping disorders was experienced. Psychological and spiritual improvement was experienced in cognitive functions, sense of relaxation, meaning, hope, confirmation, security and vitality. Improved health was experienced despite severe illness. Conclusion: RE is a therapy where caring science seems to be put in practice. This study on outpatients receiving RE indicates that it may improve health physically, psychologically and spiritually. The results match with earlier studies on inpatients receiving RE. Further studies, e.g. in comparison with psychotherapy or medical treatments, would be of great interest.