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.

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.