Research Question: Will nursing education, and readily available Complementary and Alternative Medicine (CAM) resources increase patient perception of a healing environment and caring behaviors consistent with Watson’s Theory of Caring Science?

1. Kaiser Permanente, Northern California
Caritas Consortium 2013
Comfort as Medicine: Integration of CAM into Bedside Care
Caritas in Action
How Caring Science informs and inspires KP caregivers and affirms our commitment to provide our
patients and their families exceptional care

2. Comfort as Medicine: Integration of CAM into Bedside Care
Intent to Contribute Statement:
Abstract: Numerous studies validate the use of Complementary and Alternative Medicine (CAM) for a variety of health issues
and symptoms. Complementary therapies offer nurses the opportunity to provide holistic care and empower patients to
actively participate in their care and recovery (Fountouki & Theofanidis, 2009). Holistic care seeks to treat the whole individual
as opposed to treating symptoms exclusively and recognizes the role of mind, body, and spirit in the healing process. The
White House Commission on Complementary and Alternative Medicine Policy (2002) recognized the need for increased
education and training of health practitioners in CAM. The California BRN identifies that nurses can help provide the missing
link between conventional Western medicine and CAM therapies (BRN, 2009). The integration of CAM into bedside care is
also consistent with Watson’s theory of Caring Science. Watson uses the term carative instead of curative to distinguish
between nursing and medicine. Watson’s theory focuses on 10 caritas factors that contribute to caring, healing relationships
and can be characterized by caring moments or caring occasions. A caring occasion occurs whenever the nurse and another
come together with their unique life histories and phenomenal fields in a human-to-human transaction. Our project seeks to
enhance nurse patient relationships, enable holistic, individualized by providing nurses resources and education to incorporate
simple CAM modalities and caring behaviors into their everyday practice.
Research Question: Will nursing education, and readily available resources increase patient perception of a healing
environment and caring behaviors consistent with Watson’s Theory of Caring Science?
Page 2

3. Comfort as Medicine: Integration of CAM into Bedside Care
… Continued
Methodology: Inservice education on elements with the ‘caring cart’ will be provided to staff
nurses in 2 nursing units, medical neurology Unit 430 and general surgery Unit 235 of Kaiser Santa
Clara Medical center. The carts will be provided for nursing use after the educational inservices.
Elements within the Caring Cart:
• TV channel guides: distraction, music therapy (care channel)
• Movie list: distraction, humor
• Aromatherapy: CAM (lavender, peppermint)
• Herbal Teas: CAM (mint, lemon, ginger, etc.)
• Guided Imagery Channel Guide & Brochure: CAM
• Lip Balm: comfort
• Playing Cards: distraction
• Insomnia Management: ear plugs, white noise machine, sleepy time tea
• Mind/Body Medicine KP patient resources handout: podcast, downloads info sheet for
depression, anxiety, pain, insomnia etc.
Page 3

4. Comfort as Medicine: Integration of CAM into Bedside Care
… Continued
Data Collection: The measures used to determine efficacy will be the Caring Factors Survey, this
reliable and validated tool measures caring behaviors based on Watson’s 10 Caritas Processes
(DiNaploi, Nelson, Turkel, & Watson, 2010). In addition specific HCAHPS and AVATAR data that also
measure patients’ perception of caring behaviors and comfort measures provided by nursing staff
will also be evaluated. All of these data points will be evaluated pre and post education and
implementation of the ‘caring cart’. We hope that these measures will support a healing
environment, further our integration of Caring Science into practice, and improve patient
satisfaction with caring behaviors and ultimately contribute to our organizational goals of providing
world-class care every patient, every time.
Page 4

5. Comfort as Medicine: Integration of CAM into Bedside Care
Inspired Contributor(s) 1 :
 Tracy Trail-Mahan
 Karen Finnie
-----Service Area: Santa Clara
Medical Center: SCL
Affiliation: PCS
-----Year Shared: 2013
Venue: Caritas Consortium
Format: PowerPoint, Poster
ID #: Q01
Page 5
Keyword TAGs:
Identifier
 Consortium2013-July, Santa
Clara, Podium, Poster, Patient
Care Services
 Healing Environments, Healing
Modalities, Patients/Families
Descriptor
 Aromatherapy, Complimentary &
Alt Medicine, Music, Self-Care,
Total Health, Research and
Metrics

6. Comfort as Medicine: Integration of CAM into Bedside Care
Page 6

7. Complementary and Alternative Medicine (CAM)
• Numerous studies validate the use of Complementary and
Alternative Medicine (CAM) for a variety of health issues and
symptoms. Complementary therapies offer nurses the opportunity to
provide holistic care and empower patients to actively participate in
their care and recovery (Fountouki & Theofanidis, 2009).
• Holistic care seeks to treat the whole individual as opposed to
treating symptoms exclusively and recognizes the role of mind, body,
and spirit in the healing process.
• The White House Commission on Complementary and Alternative
Medicine Policy (2002) recognized the need for increased education
and training of health practitioners in CAM.
• The California BRN identifies that nurses can help provide the missing
link between conventional Western medicine and CAM therapies
(BRN, 2009).
Page 7

8. Complementary and Alternative Medicine (CAM):
Bringing it to the Bedside
• The integration of CAM into bedside care is also consistent with
Watson’s theory of Caring Science.
• Watson uses the term carative instead of curative to distinguish
between nursing and medicine. Watson’s theory focuses on 10
caritas factors that contribute to caring, healing relationships and can
be characterized by caring moments or caring occasions.
• A caring occasion occurs whenever the nurse and another come
together with their unique life histories and phenomenal fields in a
human-to-human transaction.
• Our project seeks to enhance nurse patient relationships, enable
holistic, individualized by providing nurses resources and education
to incorporate simple CAM modalities and caring behaviors into their
everyday practice.
Page 8

9. Elements within the Caring Cart
• TV channel guides: distraction, music therapy (care channel)
• Movie list: distraction, humor
• Aromatherapy: CAM (lavender, peppermint)
• Herbal Teas: CAM (mint, lemon, ginger, etc)
• Guided Imagery Channel Guide & Brochure: CAM
• Lip Balm: comfort
• Playing Cards: distraction
• Insomnia Management: ear plugs, white noise machine, sleepy
time tea
• Mind/Body Medicine KP patient resources handout: podcast,
downloads info sheet for depression, anxiety, pain, insomnia etc
Page 9

10. CAM Patient Handout
•
Page 10

11. SMART Goal
• Specific - Promote caring science behaviors and provide comfort
measures consistent with caritas factor #8 create a healing
environment by use of a Caring Cart
• Measurable - Caring Factors pt survey pre and post Caring Cart
introduction, HCAHPS evaluate Caritas Factors data per & post
intervention
• Achievable - resources available to provide Caring Carts, statistical
support for evaluation of outcomes
• Realistic - will start in 2 units as a pilot and evaluate, using PDAS
methodology, effectiveness of cart, elements of cart, education of
nursing
• Time-bound - collect pre-intervention data, educate RNs,
implement Caring Carts, collect post-intervention data x 2 months
Page 11

12. Project Measurables
• Caring Factors Survey to pts pre and post
Caring Cart
• HCAHPS Caritas Factors
• HCAHPS potentially look at Pain Management
data
• Nursing survey component NrCAM K & A??
Page 12

13. Caring Cart
• TV channel guides: distraction, music therapy (care channel),
guided imagery channel
• Movie list: distraction, humor
• Aromatherapy: CAM
• Herbal Teas: CAM
• Guided Imagery Channel Guide & Brochure: CAM
• Lip Balm: comfort
• Playing Cards: distraction
• Insomnia Management: ear plugs, white noise machine, sleepy
time tea
• Mind/Body Medicine KP resources handout: podcast, downloads
info sheet for depression, anxiety, pain, insomnia etc
Page 13

14. Distraction
• TV Channel Guides
• Movie Listings
• Playing Cards
• Coloring pages and crayons
Page 14

15. C.A.R.E. Channel Guided Imagery
• Nursing education
• Pt brochure
• Nursing Policy
• Signage "therapy in progress: do not disturb
until____"
Page 15

16. C.A.R.E. Channel Guided Imagery
Page 16

17. Aromatherapy
• Nursing Education
• Pt Education/Brochure
• Nursing Policy, documentation
• Limited Scope
• Lavender indications anxiety, relaxation
• Peppermint indications nausea
• Ginger nausea
Page 17

18. Aromatherapy Diffuser Options
Page 18

19. Lavender
What Lavender Is Used For
What the Science Says
• Historically, lavender was used as
an antiseptic and for mental
health purposes.
• There is little scientific evidence
of lavender's effectiveness for
most health uses.
• Today, the herb is used for
conditions such as anxiety,
restlessness, insomnia, and
depression.
• Small studies on lavender for
anxiety show mixed results.
• Lavender is also used for
headache, upset stomach, and
hair loss.
Page 19
• Some preliminary results indicate
that lavender oil, combined with
oils from other herbs, may help
with hair loss from a condition
called alopecia areata.

20. Peppermint
What Peppermint Is Used For
What the Science Says
• Peppermint oil has been used for
a variety of health conditions,
including nausea, indigestion, and
cold symptoms.
• Results from several studies
suggest that peppermint oil may
improve symptoms of irritable
bowel syndrome.
• Peppermint oil is also used for
headaches, muscle and nerve
pain, and stomach and bowel
conditions such as irritable bowel
syndrome.
• A few studies have found that
peppermint oil, in combination
with caraway oil, may help relieve
indigestion, but this evidence is
preliminary.
Page 20

21. Ginger
What Ginger Is Used For
• Ginger is used in Asian medicine to
treat stomach aches, nausea,
and diarrhea.
• Many digestive, antinausea, and cold
and flu dietary supplements sold in
the United States contain ginger
extract as an ingredient.
• Ginger is used to alleviate
postsurgery nausea as well as nausea
caused by motion, chemotherapy,
and pregnancy.
• Ginger has been used for rheumatoid
arthritis, osteoarthritis, and joint and
muscle pain.
Page 21
What the Science Says
• Studies suggest that the short-term
use of ginger can safely relieve
pregnancy-related nausea
and vomiting.
• Studies are mixed on whether ginger
is effective for nausea caused by
motion, chemotherapy, or surgery.
• It is unclear whether ginger is
effective in treating rheumatoid
arthritis, osteoarthritis, or joint and
muscle pain.

22. Insomnia Resources
• Sound Spa
• Sleep Mask
• Ear Plugs
• Sleepy Time Herbal
Page 22

23. Music Resources
• Listening to music does wonders to
alleviate stress. Please note that
everyone has different tastes in music.
Listen to the music that you feel
comfortable.
• Music is a significant mood-changer
and reliever of stress, working on many
levels at once.
(http://www.holistic-online.com/Stress/stress_music-therapy.htm, 2009)
Page 23

24. Caring Factors Survey
Page 24

25. AVATAR Caritas Factors
Page 25

26. Possible other metrics to examine
Page 26

27. Cost of Components per Cart
• Cart
$63
• Essential oils (Lavender & Peppermint)
$20
• CD Player
$20
• Herbal teas
$xx
• Sound Spa
$xx
• Ear plugs
$xx
• Lip Balm (KP Brand Store)
$xx
• Playing Cards (KP Brand Store)
$xx
• Channel Guides (TV & Guided Imagery)
$xx
• Aromatherapy Diffuser
$10
• Aromatherapy cotton discs, plastic med cup $xx
• KP resources for podcasts
Page 27
$0

28. Page 28