While people in the United States still use Western medicine, many are also doing so in conjunction with Eastern treatments used for centuries. Jennifer Bjork, MSN, RN, Clinical Educator and Interdisciplinary Partnership Council Site Coordinator at Sutter Maternity and Surgery Center, implements aromatherapy and healing arts with patients. The center began using aromatherapy with patients in October 2016, and added additional techniques in December 2016.
Bjork, who has earned certifications in Clinical Aromatherapy in Obstetrics and Level 1 Integrated Healing Arts, took time to answer some questions about these for us.
Regarding Aromatherapy and Healing Arts: Please explain what these are to those who may not be familiar with them.
Integrated Healing Arts, which includes gentle touch techniques, simple breathing techniques, presence, imagery, and use of essential oils—or aromatherapy—are used to help hospital patients undergoing some sort of stress. We know that hospitals can be stressful places, and we integrate these techniques with traditional medical treatments to help our patients heal by decreasing their stress. We also teach these techniques to our staff, because we know that we are best at helping others when we first help ourselves. Here is a breakdown of our Aromatherapy and Healing Arts program components:
- Aromatherapy is the use of essential oils—liquids taken from plants, flowers, and trees that have been used for centuries to reduce symptoms, such as pain and emotional distress. They are also disinfectants and used to promote a sense of peace and well-being.
- Gentle touch techniques—such as a gentle massage—are simple techniques from many healing traditions used to help a person relax.
- Simple breathing techniques help the body release tension and slows the brain activity.
- Imagery is using your mind to imagine an image that brings a patient relaxation, decreases anxiety, and promotes overall healing. Our bodies do not know the difference between “imagining” an experience and actually experiencing it. We get the same benefit from both.
When do you use these procedures?
We use these therapies any time a hospital patient is feeling pain, fear, anxiety, depression, nausea, or any other form of stress. Any patient, actually, any person—including staff—can benefit from the Integrated Healing Arts.
Why do you use them for the patients?
Being sick, having a baby, and having a surgery or procedure can be very stressful. This stress can cause fear, pain, anxiety, depression, poor sleep, etc. Stress activates hormones and chemical reactions in our bodies that can decrease immunity and not allow us to heal.
How does it help?
We use them to reduce the human stress response by promoting relaxation and stimulating the release of chemicals in our brain that improves immunity, allowing hospital patients to heal. The work with our bodies’ neuro-hormonal-endocrine system helps promote consciousness and relationships.
What are these processes bringing to patients that other methods don’t?
These techniques, or treatments, are used together with traditional medical interventions to treat the human response to illness (i.e., reduce stress, reduce pain, increase well-being, enhance immune function, diminish emotional distress, promote rest, or sleep, etc.). For instance, if a pain medication is not working for our patient, we use one of our techniques to help our patient relax, and thus, allow the medication to work fully and, hopefully, with the least amount necessary to alleviate her pain.
Is there research that it benefits patients or are you going based on anecdotal evidence?
There is a multitude of evidence-based literature to support our use of the Integrated Healing Arts. In our electronic medical record at Sutter Maternity and Surgery Center, our care plans have these methods as interventions for the human response to illness based upon evidence-based practice. These plans are reviewed every year with updated evidence. There is strong evidence that the use of the Integrated Healing Arts can improve traditional medical care by assisting the mind, body, and spirit.
What would other facilities or nurses need to do to implement this into their own situations?
You need support from the leadership team, experiential training in these techniques, a policy that supports the use of these Integrated Healing Arts, rounding to support the staff in using these techniques, and sharing of successful stories to assist the culture in believing that these techniques actually work.
What else haven’t I asked you about regarding your use of Aromatherapy and Healing Arts that you think is important to know?
We know the biological impact of stress or negative emotions can decrease immunity and increase our chances of becoming ill, and once we are ill, not allow us to heal. These Integrated Healing Arts all help ourselves as caregivers, allowing us to be present and get our nurses back to the bedside, where they can do what they do best: provide compassionate care for our patients and assist them in their healing process. We also know these techniques can improve our hospital patients’ overall satisfaction with their care.
In October 2015, Diane Hosmer, RN, MSN, IBCLC, Sutter Medical Foundation, Women’s Services at Sutter Amador Hospital, held the first Grandmother Tea, which is an educational program and celebrations for new grandmothers. Hosmer says that they have hosted four Grandmother Teas (the event is held twice a year) with more than 125 participants.
What exactly is a Grandmother Tea? It’s an event held on a Saturday afternoon for three hours, and it teaches the latest information in newborn care to Grandmothers-to-be as well as expectant moms.
Hosmer took time to answer some questions about this program.
Why did you and/or the hospital believe it was important to offer this program?
I saw firsthand the difference in newborn information that is provided now compared with what I received as a mother. As a grandmother, I wanted to help bridge the gap by creating a Grandmother Tea and received wonderful support from the hospital to create the program.
Grandmothers spend a lot of time caring for the infant or providing advice to the new mom. In my position, I see how much things have changed in the past 10 to 15 years in information that we were providing new moms as opposed to what their own mothers were taught. Grandmother Tea allows us to educate generations of women and each topic touches the participants in a different way.
What do moms-to-be and grandmothers learn at this program? Where is it held?
Each tea is held at the hospital and is taught by board certified lactation consultants and labor and delivery pediatric nurses. We teach topics ranging from safe sleeping and breastfeeding to cue-based feeding and baby-wearing.
The program is broken down into three activities. Between activities we pose a related question then have a discussion over tea. Presenters sit with participants to discuss the topic, often answering additional questions and guiding the discussion to a positive outcome.
We honor the experience Grandmothers have, while acknowledging ways newborn care has changed over the years and how we continue to learn new ways of doing things. Many women tell us this is one of their favorite parts of our program.
Do the attendees get any items to bring away with them? If so, what are they and why do you give them out?
Similar to a baby shower, each grandmother and mother is left with armfuls of gifts, including local resources and information to take home thanks to Sutter Amador Hospital and community sponsors: Amador-Calaveras Breastfeeding Coalition, First 5 Amador, WIC, Calaveras Public Health, and Amador Public Health.
How successful has the program been? What do you enjoy about it?
We have received great feedback about the program and hope to continue to see it grow. The next Grandmother Tea is October 14, 2017. We plan to continue offering the program twice a year.
Is there anything about the Grandmother Tea that is important for readers to know?
It all starts with a vision. I encourage other nurses to think creatively and enlist others in the quest to find unique ways to engage patients and their families in educational opportunities.
In March 2016, Sutter Health and WellSpace Health started The Street Nurse Program. Funded by Sutter Health, the program is geared to meet the needs of an underserved population—those affected by homelessness—in Sacramento, California. To date, it has helped more than 200 people who have received access to on-site care, medical advice, disease management education, and wound care.
Amanda Buccina, RN, BSN, is the program’s sole nurse. While they are looking to expand the program, Buccina is making a huge difference in the meantime on her own. “I’m happy to be selected as the first nurse in this role. I was previously in a position managing Medicaid case management programs for a large managed care corporation,” explains Buccina. “When I saw the street nurse job description, it sounded like a great opportunity and one that aligned with my experiences. For the first time in a long time, I felt excited and inspired by a nursing role, so I knew that it was the right opportunity to pursue.”
According to Sutter Health, The Street Nurse Program provides a vital piece in the continuum of care, with programs and partners seamlessly working together to provide a whole health stability model for the most vulnerable among us.
“The Street Nurse Program is an effort to provide an access point into a traditionally very guarded population, enabling us to start linking the homeless to the services they desperately need,” says Buccina.
Oftentimes, those affected by homelessness won’t come to clinics. As Buccina says, “Working with this population, you have to be willing to meet people where they are.”
A great deal of her job involves building relationships. “I work to build trust and rapport with my clients so even if they don’t need me in that exact moment, we have a relationship and familiarity with one another. This comes in [handy] when clients do want and need support, like medical advice, an advocate at a doctor’s appointment, help getting into an alcohol or drug rehab program, or just general wound care,” explains Buccina. “Sometimes, honestly, they just want someone to listen to them–that there is somebody who is consistent and that they trust. If they know someone is invested in them, it makes it slightly more likely they will be invested in themselves.”
Buccina finds it touching when her clients let her into their lives. “They don’t have to let me into their world at all—and they do. It’s kind of like a window into their world. And if they trust me enough to help them,” she says, “it’s kind of a big deal.”
Every nurse has them—the difficult patients that, no matter what good is happening in their lives, are just really negative with their attitudes all the time. So what can you do to help them and to help yourself, as it’s not easy to deal with so much negativity?
Dr. Jodi De Luca is a licensed clinical psychologist who has been working in hospitals for years and currently works in an Emergency Department at Boulder Community Hospital in Colorado. She’s the “go-to” person, especially when patients are negative or challenging to work with.
“In-patient hospitalization or a visit to the ER can be a threatening and stressful experience,” De Luca explains. “From an emotional and psychological perspective, the visit can be overwhelming.” She says that everything from the loss of control, fear of procedures, fear of death, and the like can terrify patients. “Nurses in particular bear the brunt of the negative behavior.”
It’s important to know how to deal with these patients because they can cause nurse burnout, increase anger and resentment toward the patient, and other patients suffer or can be neglected because all the nurse’s time is spent on this particular patient.
De Luca has some tips for nurses on dealing with these kinds of patients:
1. Setting structure and limits are key.
Be direct when clarifying limitations, particularly in explaining to the patient what is unacceptable and disrespectful behavior.
2. Eliminate the unknown whenever possible.
Knowledge gives the patients power and control.
3. Whenever possible, offer the patient realistic options of care.
By doing so, the patient feels empowered in his/her decision making and may feel validated and more in control. As a result, the behavioral manifestations may be reduced.
4. Ask questions that elicit a sense of control for the patient.
Ask questions such as: What would make things better? What options do you propose? If this option is not possible because of (the reason), but these options are available, which do you think would be best for you?
5. If possible, have nursing and medical staff alternate work load with a negative patient.
This gives everyone a chance to mentally recharge and prevents the negative patient from monopolizing all of your time.
6. Find out what the patient’s expectations are.
Are they realistic? Can they be accommodated? Are there options?
7. Explain to them how their behavior negatively affects their overall well-being and treatment.
When patients are under duress, particularly in a hospital setting, they are often unaware of their own behavior.
8. If possible, have a third party present when you are dealing with difficult patients.
Document not only behavior, but also what the patient states verbatim. Documentation and third-party witness is our best defense particularly with regards to future potential repercussions, complaints, and litigation.
9. Consider engaging the assistance of the Behavioral Health Team at the hospital.
Psychologists, psychiatrists, case management, and social workers can help provide treatment recommendations for the staff as well as the patient and to rule out any other potential contributors to the behavioral disruption and negativity (such as medication reaction, delirium 2nd to metabolic insufficiency, infections, etc.).
After Pamela D. Toler’s book Heroines of Mercy Street: The Real Nurses in the Civil War was published, she began giving talks about nurses during the Civil War as a spin-off. Toler, a freelance writer with a PhD in history and, as she says, “a large bump of curiosity,” is currently working on a global history of women warriors. She took some time to talk with us about Civil War Nurses.
You give talks about nurses in the Civil War. How did you get into doing this?
In some ways, I just fell into the project. PBS was looking for a writer to produce a work of historical non-fiction as a companion for their historical drama, Mercy Street. I had the right skills and was in the right place at the right time.
At the same time, the subject was made for me. I was that nerdy kid who hung out at the local Civil War battlefield on the weekends, learned to shoot a muzzle-loading rifle, participated in living history programs, and read and re-read the biographies of women like Clara Barton, Julia Ward Howe, and Harriet Beecher Stowe. Writing Heroines of Mercy Street allowed me to return to my first historical love: the Civil War in general and the involvement of women in the war effort in particular.
Today, nursing is female dominated. But back then, women had to try and crack into nursing because men were doing it. How did they go about it? How did they break through the male-dominated war and get accepted? Who were the key players?
In the mid-nineteenth century, nursing as a skilled profession barely existed and most people didn’t consider it a job for a respectable woman. Before the Civil War, the Army’s Medical Bureau depended on convalescent enlisted men who were not yet well enough to return to their duties to work as nurses.
Even after Congress approved the formation of the army nursing corps, women experienced a great deal of resistance from Army doctors. They argued that women didn’t have the upper body strength to do the job. They complained women didn’t have the training to do the job—not that convalescent soldiers had any training. They were worried that women would suffer indignities in the rough atmosphere of the military hospitals. And some of them thought that the only women who would volunteer would be husband-hunters.
Civil War nurses won acceptance the only way women have ever won acceptance in male dominated fields: by changing the opinions of one man at a time. The longer a nurse was on the job, the more likely she was to conquer the prejudices of the doctors she worked with. By the end of the war, most army doctors had come to believe that the nurses they worked with were indispensable.
What are some of the most surprising things that everyday people don’t know about these nurses?
At some level, the question is what isn’t surprising about these nurses?
The most important thing is that there were no nursing schools in the United States before the Civil War. With a few exceptions, these women had no formal training as nurses. Most women of the period had some experience nursing a relative or neighbor, but taking care of someone with measles or a broken leg was no preparation for working in military hospital. When you read the letters and memoirs written by women who served as nurses, their first experiences of hospital work often made them ill and sometimes caused them to faint. They learned how to take care of patients on the job.