INTEGRATIVE NURSING
Kreitzer and Koithan (2019) define integrative nursing as a “way of being-knowing-doing that advances the health and well- being of persons, families, and communities through caring/ healing relationships. Integrative nurses use evidence to inform traditional and emerging interventions that support whole person/whole system healing” (p. 4). Integrative medicine and integrative nursing are the same. In the past, these therapies were called complementary because they were adjuncts to the prescribed treatment regimen. Some called these therapies nonsense. The opioid epidemic has pressured providers with the option to prescribe more controlled substances or offer alternatives. Literature shows that integrative therapies positively affect patients’ perception of pain. DeBar et al. (2022) found that primary care–based cognitive behavioral therapy intervention (CBT), using frontline clinicians, produced modest but sustained reductions in measures of pain and pain-related disability compared with usual care. Yoga and low back pain demonstrated a similar positive finding. A systematic review published in 2022 found that yoga revealed robust short- and long-term effects on pain, disability, physical function, and mental health compared with nonexercise controls (Anheyer et al., 2022). In their book Integrative Nursing , Kreitzer and Koithan (2019) offer a tiered approach to pain management. Nurses have offered these therapies to their patients for years. The different tiers and integrative therapy approaches are shown in Table 6. Table 6: Tiered Integrative Approaches to Pain Management* Tiered Intervention Integrative Approaches Tier 1 Hot/cold therapy Relaxation response Guided imagery Tier 2 Aromatherapy Yoga Hydrotherapy Tier 3 Cognitive-behavioral (pain management therapy Mindfulness-based stress reduction meditation Massage Acupressure It is critical to gain as much information as possible about the specific complaint of pain to properly determine a course of treatment. The SOCRATES acronym is a useful tool that can be used to remember key points to be collected when assessing a complaint of pain: ● S ite: Where exactly is the pain? ● O nset: When did it start? Was it constant/intermittent? Was it gradual/sudden? ● C haracter: What is the pain like? Sharp? Burning? Tight? ● R adiation: Does the pain radiate/move anywhere? ● A ssociations: Is there anything else associated with the pain, such as sweating or vomiting? ● T ime course: Does it follow any time pattern? How long does it last? Instruments for evaluating pain Socrates
Table 6: Tiered Integrative Approaches to Pain Management* Tiered Intervention Integrative Approaches Tier 4
Homeopathy Chiropractic NSAIDs Transcutaneous electrical nerve stimulation
Tier 5
Pharmacological therapies Surgical procedures Nerve blocks *Adapted from Integrative Nursing (Kreitzer & Koithan, 2019). Clinical case example Ana is a 50-year-old female with chronic arthritis pain in her hands and knees. She states that the pain has worsened in the past two months, and she had previously tried therapies that do not alleviate the pain. She went for a morphine refill but was turned back to the pain specialist since the script was expired. So, Ana is asking the nurse practitioner for another prescription. Given the information provided, which tier aligns with Ana’s symptoms? Provide one short-term and one long-term intervention using the integrative approach examples: Suggest one i mmediate
Immediate interventions for Ana would include: • Therapeutic listening, presence, therapeutic use of self-touch. • Heat/cold therapy. Because of the recent change in pain and increase in the past two months, gather some diagnostics— check a rheumatoid factor, sed rate (ESR), and c- reactive protein (CRP). For long-term therapies, Ana could focus on some movement therapies, including: • Yoga. • Hydrotherapy. • Tai chi. These therapies might help with the circulation of joints. They might help with deep breathing exercises and a sense of appreciation for self.
intervention for your patient and provide a brief rationale.
Suggest one long-term
intervention for your patient and provide a brief rationale
● E xacerbating/relieving factors: Does anything make it better or worse? ● S everity: How severe is the pain? Consider using a 1–10 scale. (Swift, 2019) The physical examination conducted as part of the initial patient screening contains all the elements common to contemporary practice. A few areas should be emphasized because of the unique nature of opioid prescriptions (Clark & Galati, 2015). Here are topics to consider: ● A rigorous evaluation of the patient’s nervous system. ● An assessment of allodynia (pain from the stimulation that would not normally evoke pain, such as light touch). ● Hyperalgesia (amplified pain response to stimulation that would normally evoke only mild pain).
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Book Code: DFL3024
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