Psych and Holistic care

[IamRN08]

I would love to hear some experience from anyone who has used a holistic approach in a psych setting. There seems to be such a benefit to that approach yet it is such a rare thing to see in psych settings unless it's a upscale private facility.

[indigo girl]

I'm not sure about what you consider to be holistic as there seem to be

differing ideas about what exactly that might mean. My facility has an

Integrative Medicine Dept. They were consulted after two deaths

occurred by suicide on my psych unit in July within a period of 3 days.

I.M. recommended changing the lighting, and the color of the walls which

is still being done. The colors are quite beautiful and soothing, very toned

down. Some murals will also be painted in rooms such as the Seclusion/Quiet/

Time Out Room, and Restraint Room to give patients something calming

to focus on.

Integrative was also used to support the staff, especially those who were

present when the deaths occurred. Holistic techniques were offered both

in their space and on our unit for staff that were too busy to get off the

unit, to help relieve stress.

We have been experimenting with using music at various times to relax

patients as a group when it is needed. Our Activities Director uses

music, stretching, and yoga with wonderful results, and our patients really

respond well to this. Many of them are so bored that they are willing

to do anything even meditation if we are willing to teach them how to

do it. Now of course, this does not work always work well with the more

psychotic patients because of their inability to focus...

Our unit was in such crisis after those deaths that management was

willing to use many holistic suggestions that I won't even bring up here

but PM me if you want to know what they were.

[IamRN08]

This is just amazing stuff to hear! I hear the hospital where I work is very resistant to change and right now they are going through a flurry of change and there is a lot of staff who are fighting tooth and nail. I would love to hear how your IM department (which is what I meant by holisitic) made the first steps to get the psych department on board with changes. How did you introduce it? Also, I would love to PM you but I don't have that option. I think I have to upgrade or have a certain amount of postings to get that option.

[indigo girl]

IM offered to help at a time when we were in a crisis situation. They have

always been available for the staff of our hospital. A physician runs the

department. I do not know much about her except that she is perhaps

from India, and trained in complementary therapies. There is a nurse

practitioner of Healing Touch, who works for another hospital also,

and at least one volunteer staff.

Our Nurse Manager as well as her boss, a hospital vice president are

supporters of these therapies or they might not have been open to the

changes that were made. Then again, they had to do something,

(a great many things as it turns out, and not just holistic). Many

of our staff were in shock. Our hospital was the center of great

controversy, and attention, and probably still is. I don't listen to the

news or read newspapers but have heard about some of what the

media was saying, most of it greatly exaggerated and just plain untrue.

The holistic techniques that were in use for our patients are not new.

These were present prior to the deaths on the unit. What is new, is the

open acknowledgment that IM is welcome on the unit for staff (not patients),

and that their suggestions for changing light, color and sound have been

acted upon, and that work is still under way.

Our Mental Health Counselor teaches breathing techniques to relieve

anxiety to patients that would benefit from this. This is done on a one to

one basis where it is most helpful.

I should also say that the doctor that runs the unit is not on board

about holistic therapy or so he tries to say, but, I have heard him

say some very intuitive things about why patients were exhibiting

certain behaviors, and the med students and residents just nod as

if he was quoting to them from a text book, but he isn't. He is looking

at that patient holistically, just doesn't realize it. He's "from Missouri",

he said to the the head of IM as he called her "the Witch Doctor" when

they were introduced on the unit. He is actually a very gifted and

caring doc, and a pleasure to work with for me though he jokingly

accuses me of putting crystals in my patients' pockets (I don't, of

course).

There is certainly more that we could do. One of the things that

would be interesting to try would be to teach our patients some

Qigong as a group activity. Our nurse manager would probably be

open to this, and I have mentioned it to her, but we have all been

extremely busy with the actual physical changes taking place to the

structure of the unit, and the implementation of many, many other

safety precautions, and the ongoing education of staff. As we are

always trying to find ways to keep our patients busily engaged and

not just vegging out, or fighting each other or us, Qigong could really

work out well. Our doubting doc would probably just consider it as

another relaxation technique which it is, but so much more than that

also. Patients would benefit from having something to do that would

actually help them with focusing on relief of symptoms such as anxiety

or pain before their meds kick in. I am looking into Spring Forest

Qigong as it was developed for lay people to use, and sounds like it

would be a good fit for our unit.

[ruralnurs]

This is a very interesting thread for me. I was a psych nurse in an in-patient psych facility, then got my FNP and am now in my post master's program for psych NP.

As a psych nurse I always felt that psychology and the therapy it brought to the mental health table was a big part of the puzzle, and I personally, see therapy as Integrative Medicine. One of the reason I have chosen to get my PM in psych is that I am tired of primary care providers (that have little to no experience in psych) give people diagnosis that may not be valid and then throw what ever free sample they have in the medicine cabinet at them and send them on their way.

I truly see therapy (group and individual) as part of psychiatric care, regardless of diagnosis. I was educated in the DBT model and some of its teachings are very valuable. We used the Distress Tolerance classes for those that experiences auditory hallucinations and for many it was very successful. And the Mindfulness classes were very effective for those with Borderline PD in helping them be less impulsive. I used to hold Yoga classes in the evenings that were not mandatory and mostly those with schizophrenia came, and did very well, were able to focus and relax.

I have actually been looking for some type of actual education specifically that I can utilize as an NP for those that are interested in Integrative Medicine. Maybe like a certificate program. There is an ND that lives about 60 miles away that I have toyed with the idea of asking her if I could spend some time with her (kind of in a student or mentoring manner). Nursing does that but not sure if MD/NDs do the mentoring model.

[darrell]

I am a DBT skills trainer and used mindfulness and emotion regulation quite a bit in an inpatient locked ward, both individually and in groups. It was very well-received and we got letters from patients after they'd left indicating they were still successfully using the skills. Axis II and depressive mood disorders seems to benefit the best, but we also treated addiction and applied the skills to that problem as well.

There's nothing like a patient with a psych diagnosis, the accompanying physical complaints and a chemical dependency issue to exemplify the perfect beneficiary for some holistic health teaching!

D