Nurses Taking Patient Care to the Next Level at Allina Health
Founded in 2003 by the George Family Foundation Holistic training for Nurses and the Ted and Roberta Mann Foundation, the Penny George Institute for Health and Healing (PGIHH) is the largest hospital-based integrative healthcare program of its kind within the United States. It is part of Allina Health System and serves communities throughout Minnesota and western Wisconsin. PGIHH provides patient care in both inpatient and outpatient settings, educates health professionals, engages the community in healthy living through prevention and wellness, and researches best practices in integrative therapies.
Integrative Therapies in Patient Care
Studies show significant benefits from incorporating integrative therapies into patient care. Healthcare systems are looking for more efficient, cost-effective ways to improve patient outcomes. An Allina Health study published in the Journal of Patient Safety, reported that the use of integrative therapies led to an average reduction in pain scores of 1.9 points, resulting in an average reported pain reduction of approximately 55 percent, with 33 percent of patients reporting complete pain relief (Dusek Finch, Plotnikoff, & Knutson, 2010).
Setting national standards for enhancing health care through an integrative health approach, PGIHH’s integrative health professionals have made more than 65,000 inpatient visits since 2003 at Abbott Northwestern Hospital, providing access to complementary and integrative therapies such as acupuncture/acupressure, aromatherapy, energy healing, massage, and a variety of mind-body therapies. PGIHH continues to serve as an innovative model for holistic care.
Holistic Training for Nurses
The Transformative Nurse Training (TNT) program is one example of Allina Health’s commitment to excellence in nursing and is one of several integrative health training programs offered by PGIHH. An ongoing challenge for nurses in the acute care environment is the management of clinical issues of pain, anxiety, nausea, stress and sleep. The TNT program was established in 2005 in response to input from hospital nurses about the need for support to meet these challenges, and their interest in learning new ways to enhance their patient care. The program developed under the leadership of Lori Knutson RN, BSN, HNB-BC, then director of PGIHH and recipient of AHNA’s 2006 Holistic Nurse of the Year award. PGIHH’s integrative health nurse clinicians planned the content and designed the framework of TNT to educate nurses on the principles of holistic nursing and the use of basic integrative therapies in patient care, as well as offer them an opportunity for personal and professional transformation.
Since its inception in 2006, more than 1,000 nurses have completed the TNT training program. Beginning at Abbott Northwestern Hospital, the TNT program has spread across Allina Health System and outside its borders to include nurses from Children’s Hospitals and Clinics of Minnesota, the Mayo Clinic system, and a number of other Minnesota healthcare facilities. PGIHH was asked by the Samueli Foundation to run the training for the United States Department of Veterans Affairs in the VA Long Beach and the VA Greater Los Angeles (GLA) Healthcare Systems in California as part of a research study. As a result of the study, the training has continued with the VA GLA System, and the Birmingham, Alabama VA Medical Center is now running trainings as well.
Commitment to Self-Care
Nursing is a demanding profession. Patients in the hospital setting today are presenting with more acute and complicated healthcare challenges. To keep pace with increasingly complex technology, treatment options, and role responsibilities, it is essential for nurses to pay attention to their own self-care (McElligott, 2013). The American Holistic Nurses Association identifies self-care as one of the core values of holistic nursing, recognizing that if nurses are not able to care for themselves— body, mind and spirit—they will not be able to be fully present for their patients. The Holistic Nursing: Scope and Standards of Practice advocates that “the nurse’s self-reflection, self-assessment, self-care, healing and personal development are necessary for service to others, growth/change in the nurse’s own well-being, and understanding of the nurse’s own personal journey” (AHNA & ANA, 2013, p.8). The TNT program is based on the foundations and principles of holistic nursing, and focuses on self-care and personal development as a cornerstone of the training.
The program is grounded in holistic nursing philosophy, principles and theory, and brings nurses back to the essence of nursing practice. Initially a one-day class, the TNT program has evolved into a comprehensive four-day curriculum focused on professional practice, personal development and self-care. The TNT program emphasizes relationship-centered care and introduces participants to principles of stress management and resilience. Techniques for relaxation, guided imagery, basic massage and acupressure are taught and practiced. The training also provides an introduction to healing and beliefs systems so that nurses can increase their awareness of the healthcare practices their patients may be using.
Teaching methods include lecture, interactive discussions, and experiential practice sessions. Throughout the training, nurses learn to experience being centered and grounded when providing care for their patients. They learn the scientific basis underlying the different techniques as they practice these techniques to use when caring for their patients, coworkers, friends, families and themselves. Exposure to other whole medical systems and their underlying principles provides opportunity to discuss how healing and belief systems affect patients’ health. The training provides a safe environment for personal exploration and self-reflection.
As the TNT program evolved, the PGIHH nurse clinician team identified the need for a mentorship process to support the nurses in integrating their new skills and knowledge into their patient care. Multiple mentorship models have been developed to address the specific needs of the various environments in which the training has been implemented. Each TNT participant is paired with a mentor to support them as they explore how to apply their new knowledge in their personal life and professional practice.
Benefits and Improved Outcomes
Nurses who participated in the TNT program have reported that integrative therapies can improve patients’ quality of life. Preliminary results from a PGIHH study found that nurses felt they received adequate knowledge to use integrative therapies for others, and used integrative therapies in their own lives, personally and professionally, as a result of the training (L. Knutson, P. Weiss-Farnan, B. Hopperstad, & P.J. Johnson, personal communication, July 2010). TNT-trained nurses cited an improvement in their overall engagement and job satisfaction.
Financial sustainability and maintaining momentum were major concerns. While philanthropic support and research grants were effective tools in establishing the program and creating momentum, they were not viable solutions on a long- term basis. Healthcare systems will need to determine how to effectively provide financial support for implementation of the TNT program within their own organizations. For example, tuition reimbursement for nurses may be an option.
Another challenge in expanding the TNT program is maintaining adequate numbers of qualified trainers to provide more offerings of TNT. As the program expanded, there was an evident need to develop nurses not only as trainers, but also as leaders who could support the growth of integrative nursing and the transformation of health care. In response to this challenge, a unique trainer role was designed to accommodate the need for fluctuating demand in a cost-effective manner. A train-the- trainer program was designed to certify additional trainers to run the series, as well as prepare nurses in leadership skills to expand their roles as leaders within their institutions as they transform themselves, their practice, and begin to transform health care. These nurses and facilities have become members in PGIHH’s consortium of integrative nursing.
As health care faces the challenges ahead, many approaches are needed to transform our current system. The Transformative Nurse Training program is one of many initiatives that are advancing the art of healing and transforming health care. We must teach nurses new ways to care for their patients as well as support them in learning to truly care for themselves, and then maintaining a web of connection. Holistic nursing is the foundation upon which the health care of the future can be built.
American Holistic Nurses Association (AHNA), & American Nurses Association (ANA). (2013). Holistic nursing: Scope and standards of practice (2nd ed.). Silver Springs, MD: NurseBooks.org.
Dusek, J., Finch, M., Plotnikoff, G., & Knutson, L. (2010). The impact of integrative medicine on pain management in a tertiary care hospital. Journal of Patient Safety, 6(1), 48-51.
McElligott, D. (2013). The nurse as an instrument of healing. In B. Dossey, & L. Keegan (Eds.), Holistic nursing a handbook for practice (6th ed.) (pp. 827-840). Burlington, MA: Jones & Bartlett.
Penny George Institute for Health and Healing [PGIHH]. (2010). Overview and outcomes report 2010. Retrieved from http://www. allinahealth.org/ahs/anw.nsf/page/ANW_PGIHH_Outcomes_ FNL1.ForWeb.pdf/$FILE/ANW_PGIHH_Outcomes_FNL-1. ForWeb.pdf