Integrative Hospital Care: Medicine Embraces Holistic Modalities

Thirty years ago, hospital patients were treated for symptoms based on the Western medical model, and holistic modalities were excluded, largely due to a lack of reliable scientific studies. More recently, because of promising research, the traditional template is expanding. The Academic Consortium for Integrative Medicine & Health encompasses 75 university health centers and health systems that offer integrative approaches—a remarkable seven-fold increase in 21 years. America’s top hospitals, including the Memorial Sloan Kettering Cancer Center, the Mayo Clinic, the Duke University Medical Center and the Yale New Haven Hospital, now offer therapies such as acupuncture, reiki, homeopathy, touch therapy, yoga, clinical aromatherapy and chiropractic.

According to a report in Advances in Medical Education and Practice, nearly half of Americans receiving medical care use alternative medicine (although 80 percent don’t inform their doctors) and physicians agree on the importance of further research and training in such modalities.  A 2017 University of California survey published in the Journal of Alternative and Complementary Medicine found that hospital patients of all ages were willing to pay out of pocket for healthier food, therapeutic massage and energy work.

“Research has repeatedly shown that even with full medical access and optimal medical treatments, a population’s health improves by only about 15 to 20 percent. The rest comes from lifestyle, environment and the social and personal determinants of health. Even factors like emotional health, what you feel is your purpose in life and what motivates you to be healthy plays a role,” says physician Wayne Jonas, in Alexandria, Virginia, a clinical professor of family medicine at Georgetown University and former director of the World Health Organization Center for Traditional Medicine. As executive director of Samueli Integrative Health Programs, which aims to make integrative health regular and routine, Jonas emphasizes that patients become healthier and medical costs are reduced when they are engaged in the healing process.

For Jonas, the shift toward integrative health care has become most evident during the current opioid crisis and the search for non-pharmacological approaches like acupuncture and therapeutic massage therapy for pain management. “The evidence body for many of these approaches has grown tremendously over just the past five years, and has shown a spotlight on what works and what doesn’t. These approaches are now recommended in national guidelines as mainstream for chronic pain.”

Denise Millstine, integrative physician and internal medicine specialist at Mayo Clinic in Arizona, concurs: “The opiate crisis is an example of the need to broaden our clinical toolbox to incorporate care strategies that are less risky. I believe this change has been multifactorial, based on patient demand and more awareness of the importance of lifestyle management.”

Patient demand is also fueled by a desire to avoid medication side effects. In 1998, the Journal of the American Medical Association reported that 106,000 hospital deaths take place each year from adverse reactions to prescription drugs. With more than half of Americans already taking a pharmaceutical drug, and three being the average, adverse side effects can easily mount in a hospital setting.

 

For Millstine, integrative medicine offers many solutions. “We might recommend the best medication or provide cutting-edge therapies, but without considering stress management, resilience, movement and what people ingest, it’s hard to get optimal results. Integrative medicine expanded my approach to include nutrition, exercise, mind-body (connection), spirituality and other medical philosophies like Traditional Chinese Medicine (TCM) in the patient’s therapeutic plan.”

A 2016 meta-analysis by Taipei Medical University published in the journal PLOS ONE concluded that certain applications of acupuncture reduce pain and opioid use on the first day after surgery.

Acupuncture—an ancient modality based on the concept of energy meridians in the body—is also offered in many major hospitals to offset the side effects of chemotherapy and radiation.

Acupuncture treatments at the Mayo Clinic are given in a calming atmosphere of soft lighting and music, and performed by trained doctors, as well as licensed acupuncturists with a firm TCM foundation.

Integrative health care addresses the emotions that accompany a cancer diagnosis, and patients undergoing conventional treatment now have access to not only acupuncture but therapeutic massage, meditation, movement therapy, clinical aromatherapy, herbal applications, biofeedback and yoga. Millstine says of theMayo Clinic, “We have oncology-trained massage providers who are comfortable with what is and what isn’t safe after someone has had a cancer diagnosis and/or treatment.” 

Jonas highlights that when given under the supervision of a doctor and with conventional cancer care, complementary therapies may help people to manage cancer symptoms, boost overall well-being, better handle side effects of treatment and reduce the risk of cancer recurrence. “Integrative cancer care can help by activating one’s ability to heal and feel better physically and emotionally,” he says. “Lectures on nutrition, yoga classes and support groups for cancer patients are now common.”

The Urban Zen Integrative Therapy Program, launched by American fashion designer Donna Karan in 2009 after her husband died from cancer, partners with heavy hitters such as the American Cancer Society and the Beth Israel Medical Center, in New York City. In many hospital settings, Urban Zen is creating “Zen dens”, calming nooks where staff can discuss cases with colleagues, take a break for self-care or talk to their patients in a nurturing environment. Urban Zen’s dedication to healthcare integration is international and promotes therapeutic applications of reiki, essential oil therapy, nutrition and other contemplative care.

“Alternative therapies are no longer considered ‘alternative’ when conventional medicine adopts them—for example, using calcium and vitamin D supplements, which are a standard consideration,” says Millstine. “With high-deductible plans, many patients are accustomed to paying out of pocket for care, thus making payment for alternative providers possibly more palatable.”

Reiki, a Japanese form of energy medicine once considered alternative, is now offered at major hospitals like Yale New Haven, where it’s given free of charge to cancer patients. Many hospitals are also offering classes in energy work to families of patients, hospital staff and the community.

“A medical doctor introduced me to the practice when my grandmother was diagnosed with lung cancer,” says Denise Baron, a Philadelphia-based reiki practitioner who works with referrals from clients and wellness professionals. “A hospital does not hire me directly, but the staff know I am available. I’ve worked on patients post-surgery, during and after births, people with cancer and people in hospice. I would say 96 percent of clients walk away with a deep experience of peace, harmony and lower stress levels.” Most recently, she has seen an increase in nurses asking for support during stressful times, with many wanting to learn how to practice reiki themselves.

 

According to a 2017 study published in the Journal of Evidence-Based Complementary and Alternative Medicine, reiki is more effective than a placebo and activates the parasympathetic nervous system via the vagus nerve. Results include lower blood pressure and less anxiety and depression. Other research shows that the modality also reduces nausea, improves appetite and lessens fatigue.

Collaborating with physicians and holistic practitioners, nurses play a key role in integrative hospital care. “We all work together to facilitate the client towards a higher level of well-being. Each profession brings something to the table,” says Margaret Erickson, in Cedar Park, Texas, CEO of the American Holistic Nurses Credentialing Corporation.

The nurse’s role in a patient’s healing journey is an intimate one, and holistic nurses ensure that the whole patient is tended to. “The roots of holistic nursing, grounded in holism, were verbalized over 150 years ago by Florence Nightingale,” says Erickson. “She believed in the mind-body-spirit-emotion connections and that all aspects need to be nurtured in order for people to heal.”

Due to increased demand, more nursing schools are creating educational programs grounded in holistic philosophy, she says. “What makes a nurse holistic is not the skills or alternative therapies she/he/they do, but rather how they show up in their interactions with others. They value and recognize that they are gifted with sharing a person’s most vulnerable moments, and that this shared space is sacred.”

Some holistic nurses may use healing therapies such as guided imagery, aromatherapy, energy work, bodywork, deep breathing, mindfulness and meditation to help both their clients and other healthcare providers.

Those in the field of integrative medicine agree that the future of medicine is now. “People are becoming more self-aware and taking responsibility for their health and life. Consciousness is growing [by] leaps and bounds,” says Baron.

Jonas, drawing on 40 years of experience, agrees. “By working as partners with our patients to help find the care that works for them, we can help them achieve better health and quality of life.”