Tylenol For Heartache?

Here is a very interesting bit of research. Last year there was a study conducted at the University of Kentucky, College of Arts and Sciences. It was examining the connection and possible overlap between physical pain and emotional pain. This particular study had 62 participants who were filling out the “Hurt Feeling Scale,” a self-assessment tool that measures an individual’s reaction to distressing experiences. In addition, the study was using doses of the active ingredient in Tylenol, acetaminophen, as art of its protocol.

The researchers separated the study volunteers into two groups. The first group, after filling out their self-assessment tools, were given 1,000 mg of the acetaminophen. This is a dose that is equal to one Extra Strength Tylenol. The control group, however, received a placebo instead of the acetaminophen.

The finding from this study showed that the control group without the acetaminphen, after three weeks, did not experience any change in the intensity of "hurt" feeling during the three week period. However, the group that did receive the active ingredient reported a noticeable reduction of "hurt" feelings on a regular, day-to-day basis.

The outcomes were so interesting that the researchers started a second study cohort group of 25 different volunteers, but this time upped the amount of acetaminophen to 2,000 mg daily and added computer games that were designed to create social rejection and a feeling of isolation in the participants. Also new to the study was MRI scans, which were able to identify when the participants had feelings of social rejection.

Now here is the "gold" of this research–the outcomes demonstrated that the area of the brain where emotional discomfort is felt is the same location where the physical pain is experienced. This would explain why the group that was taking the acetaminophen, while having not physical pain reported less feelings of hurt and rejection than the group that was not taking the acetaminophen but rather a placebo substance.

Geoff MacDonald, PhD, an associate professor of psychology at the University of Toronto, who is an expert in romantic relationships, co-authored this study. MacDonald states that our brain pain centers cannot tell the difference between physical pain and emotional pain.

So, while Tylenol is not recommended to be used routinely as it can lead to liver and digestive system disturbances, knowing that it can take away the pain of a broken heart, it may soon be that our therapists as well as our physicians will recommend that we “take two Tylenol and call me in the morning” for heartache as well as for headache!

 

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References

Medical News Today: http://www.medicalnewstoday.com/releases/227298.php http://web.psych.utoronto.ca/gmacdonald/Research%20Interests.html

A Tipping Point For Holistic Nurses

I was recently featured in the American Holistic Nurses Association’s ‘Beginnings’ publication. Below is a reprint of the article, shared with permission.

In the cover story of the October 2016 edition of the Healthcare Financial Management Association’s magazine, hrm, Clive Fields, MD and Tim Barry address the health insurance industry’s move to value-based care and value-based billing reimbursement. The U.S. insurance industry is a multi-trillion dollar compilation of private insurers and payers that functions independently of the ever-changing political scene in Washington. These private insurers and payers control the cost of health care, as well as the manner in which health care reimburses providers for services rendered.

The hfm article begins with the following statement: “The tipping point. The point of no return. A critical juncture” (Fields & Barry, 2016, p. 1). This refers to the healthcare industry’s embrace of a value-based purchasing standard. Pay-for-performance programs place professional and financial pressure on medical providers by paying out reimbursements based on the providers’ past performance. Programs include:

  •  Inpatient Value-Based Purchasing
  •  Hospital Readmission Reduction
  •  Physician Value-Based Payment Modifier

What these three programs have in common is they all involve patient centered care. This means healthcare providers need to revamp their current patient care model to include prevention through incorporating patient health education, a cornerstone of patient centered care. The authors explain: By 2018, 50 percent of all Medicare payment will be tied to value-based alternative payment models, recognizing not only the volume of care delivered but also the clinical outcomes that care generates. Commercial carriers all have followed suit. (Fields & Barry, 2016, p. 1)

The impact of this tipping point on nurses, and holistic nurses specifically, is significant. For the first time, the U.S. insurance industry has endorsed a holistic approach to healthcare and disease prevention as a preferred model of medical delivery. This is forcing health care to move beyond the acutecare, symptom-based approach to include both disease prevention and patient empowerment through patient education for self-care. Nursing education is rooted in the holistic, whole-person care model developed by Florence Nightingale in the mid-nineteenth century. The nursing scope of practice, which includes patient health education, aligns standards and competencies with current healthcare philosophy, and mandates nurses to provide patient-centered care, prevent disease, and reduce acute care interventions, while improving outcomes and reducing costs (ANA, 2015). For decades, holistic nursing has encompassed principles of whole-person care, and at the core of this specialty practice, “holistic nursing care is person and relationship centered and healing oriented, rather than disease and cure oriented” (AHNA & ANA, p. 1)

A Stitch In Time

Now that the healthcare industry has started to embrace the bigger picture of how to deliver patient-driven health care, while reducing costs, the demand and utilization of therapeutic approaches that support this model are rapidly growing. Patient health education is at the core of the patient-centered care model, and no other clinically trained health professional is better poised to fill this role than the nurse – and more specifically, the holistic nurse. This is important for the following reasons:

  •  Patient health education is contained within nursing scope of practice.
  •  Physicians have very limited time with their patients.
  •  Nurses spend more time with patients and are often the first or last to have contact with them during a medical office visit.

Fields & Barry (2016) go on to clarify this bigger picture: Delivering primary care within a value-based model involves much more than changing contracts and compensation. It requires a proactive clinical focus, in which patients at high risk for disease progression are identified for early intervention, patient education services are expanded, care is coordinated across sites and specialties, and redundant, non-evidence-based treatments are eliminated—all with three key objectives: making patients healthier, providing high-quality care, and reducing the total cost of care. (p. 2)

More than a decade ago, the Institute of Medicine reported the need for ongoing education and training of health professionals to meet the changing needs of healthcare consumers. The report, “A Bridge to Quality” from the 2003 Health Professions Education Summit, called for innovative approaches in education to equip health professionals with new skills and roles in order to best respond to the shifting needs of populations (Greiner & Knebel, 2003).

Laboring in the Field For many decades, holistic nurses worked in acute care, as well as private care settings, carrying a vision of whole-person, patientcentered care as a dream for the future of medicine. While holding that vision, they served their patients with compassionate presence and a whole-person perspective often in facilities that had no time or attention for either the patient’s or the nurse’s needs as individuals. In 1976, a small group of holistic nurses and mental health professionals, who worked together in Boston, recognized a critical missing piece in healthcare delivery essential for authentically inviting and engaging patients more deeply with their own care. Health information needed to be demystified for patients, providing them with a “whole picture of health” that clarified the how and why of their particular condition or concern. Collaborating together, this group of pioneers developed whole health continuing education courses for nurses and health professionals, and the National Institute of Whole Health (NIWH) was born.

Research and Accreditation

Since 1980, NIWH has been conducting hospital-based research on its patient health education model, which includes Behavioral Engagement with Pure Presence™ (BEPP), a health behavior change model. The most recent studies of this model were conducted with a Central Michigan University (CMU) group of patients and four physician practices (Clipper, 2015), and a Blue Cross Blue Shield-funded physician practice study at Michigan State University (MSU) (Aldasouqi, Clipper, Berkshire, & Lopes, 2016). Two medical researchers from CMU and MSU respectively utilized the Consultation and Relational Empathy (CARE) Measure Survey both pre- and post-intervention to assess the effectiveness of NIWH’s BEPP model. The study demonstrated 27.5-35 percent improvements in both patient satisfaction surveys and physician satisfaction surveys (Aldasouqi et al., 2016). During the past 41 years, NIWH’s important and visionary work has blazed the trail for whole person care. Through its professional partnerships and
advisory board members, NIWH has worked to effect communication with the national commissions on nursing and physicians.

The NIWH tenets of whole person care include:

  • placing patients at the center of their healthcare decision making,
  •  treating the patient as a whole person, and
  • evidence-based patient health education for disease prevention and disease management.

The standards and subject matter for the NIWH Whole Health® Education Program are based on the Health and Medicine Division (HMD, formerly known as the Institute of Medicine) guidelines, referenced as “Population Health” (IOM, 1998). This specialty focuses on the leading chronic care conditions and the specific education and evidence-based knowledge nurses need to empower their patients with selfdirected health information and self-care skills. The NIWH curriculum educates nurses to look at the totality of the individual’s lifestyle and environment and help patients discern and choose what they can do to eliminate or reduce chronic conditions. NIWH’s 5 Aspects of Whole Health™ guide the course presentation, assignments, and testing.

The convergence of 21st century medicine with holistic care is an enormous opportunity for nurses to offer compassionate, patient-centered, holistic nursing. Nurses can work as patient health educators within medical practices, for hospitals or other healthcare facilities, conduct a private practice in health and wellness education, or work collaboratively with referrals from medical providers. By utilizing patient health educators, physicians can better serve their patients, comply with guidelines, and improve their practice income. Patients receive the information they need to take real control of their health while insurance payers save on avoided procedures and chronic care costs. Especially now as health care reaches a “tipping point” with new pay-for-performance standards, the NIWH patient health education model offers a win-win-win for patients, payers, and providers.
 

 For more information on the AHNA, visit www.ahna.org

The Science of How What We Believe Becomes Our Reality – Part I

thoughts become things"Mind is the Master Power that molds and makes, and we are mind. And ever more we take the tool of thought, and shaping what we will, bring forth a thousand joys, or a thousand ills. We think in secret, and it comes to pass, environment, is but our looking glass."    James Allen

At some point we have all heard the adage "Thoughts are things," which serves as the central tenet of such popular New Age philosophies like the Law of Attraction, featured in best-selling books like The Secret by Rhonda Byrne. And while many skeptics have been quick to dismiss the idea of "As a man thinketh, so is he" (Proverbs 23:7) as nothing more than a pop psychology platitude, the ongoing findings of medical science are telling a different story.

In an article from the January – February 2013 edition of Harvard Magazine Cara Feinberg profiles the pioneering work of Dr. Ted Kaptchuk, Director of the Program in Placebo Studies at Beth Israel Deaconess Medical Center in Boston, a Harvard Medical School teaching hospital. In the article, Feinberg chronicles the exciting findings made by Dr. Kaptchuck and his team in conducting a "clinical drug trial" charting the effects of prescription medication vs. acupuncture in relieving the pain of the trial participants:

"Two weeks into Ted Kaptchuk's first randomized clinical drug trial, nearly a third of his 270 subjects complained of awful side effects. All the patients had joined the study hoping to alleviate severe arm pain: carpal tunnel, tendinitis, chronic pain in the elbow, shoulder, wrist.

In one part of the study, half the subjects received pain-reducing pills; the others were offered acupuncture treatments. And in both cases, people began to call in, saying they couldn't get out of bed. The pills were making them sluggish, the needles caused swelling and redness; some patients' pain ballooned to nightmarish levels.

"The side effects were simply amazing," Kaptchuk explains; curiously, they were exactly what patients had been warned their treatment might produce (emphasis added)." Even more startling, "…most of the other patients reported real relief, and those who received acupuncture felt even better than those on the anti-pain pill. These were exceptional findings: no one had ever proven that acupuncture worked better than painkillers.

But Kaptchuk's study didn't prove it, either – the pills his team had given patients were actually made of cornstarch; the "acupuncture" needles were retractable shams that never pierced the skin. The study wasn't aimed at comparing two treatments. It was designed to compare two fakes (emphasis added)."

Although Dr. Kaptchuk doesn't contend that patients can simply "think themselves better" his study – along with many others conducted on the placebo effect – does prove a very important, and critically under looked, fact in health care: "patients' perceptions matter, and the ways physicians frame perceptions can have significant effects on their patients' health."

Beliefs are powerful things and what we tell ourselves and others tell us can make us better or worse. We all have "our narrative" and we tell it over and over again both to ourselves and to others. We believe it, we expect it and we project it. When we change our beliefs and our story, we change the outcomes.

One of the better known studies which demonstrates how changing our narratives can change our outcomes (and our lives) is the 1980s breast cancer support group study that was written up in the journal Advances. All of the women had breast cancer that had metastasize before the study began.

Their prognosis was poor but they became a group who listened to each other's stories, supported each other, cared about one another and helped each other manage their symptoms and disease. They also helped each other change their story. It is not surprising that the women in this support group lived on average 18 months longer than breast cancer patients with the same degree of metastasis.

This article has previously appeared on Huffington Post

Doctor-Patient Communication is the #1 Problem in Medicine

At the 2015 National Health Policy Conference held in Washington, D.C., members of the Agency for Healthcare Research and Policy agreed that the need for research focusing on the doctor-patient relationship was urgent in order to address the current crisis of patient dissatisfaction, medical-error, malpractice claims and physician burnout.

Patients are not happy, doctors and medical teams are not happy, and the health care system is struggling to adapt measures to turn the tide of this growing problem. The 2012 Institute for HealthCare Communication (IHC) report regarding research on the impact of poor communication revealed the following:

  • Research conducted during the 10 year period of 1995-2005 has demonstrated that ineffective team communication is the root cause for nearly 66 percent of all medical errorsduring that period.
  • This means that when healthcare team members do not communicate effectively, patient care often suffers.
  • Further, medical error vulnerability is increased when healthcare team members are under stress, are in high-task situations, and when they are not communicating clearly or effectively.

The research from the IHC reports cites that 50% of all malpractice is the result of poor communication between doctor and patient.

The IHC report states: "Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors. Studies conducted during the past three decades show that the clinician’s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care."

IHC goes on to make an alarming statement that “Extensive research has shown that no matter how knowledgeable a clinician might be, if he or she is not able to open good communication with the patient, he or she may be of no help.”

And, while the addition of nurse health coaches to the medical team has been viewed by some as a solution to the communication problem, the relationship between the physician or primary care provider and the patient cannot be corrected by these additional team members. In fact, not addressing the underlying cause of doctor-patient discomfort may even increase the distrust and discomfort the patient experiences with their doctor or primary care provider.

As physicians, physician assistants and nurse practitioners are the diagnostic experts in our medical care system, ensuring the communication between these providers and their patients is critical, as research data demonstrates.

A recent pilot study, conducted through Central Michigan University (CMU), on the effects of a communication model, Behavior Engagement with Pure Presence, on patient and physician satisfaction has just concluded, and will be published shortly. The study was funded by Blue Cross and Blue Shield Foundation of Michigan.

The Primary Investigator (P.I.) of this study, Dr. Christine Clipper, wanted to thoroughly test the Behavioral Engagement model by including renowned endocrinologist, Dr. Opada Alzohaili, who was trained in the model's communication skills and had previously earned high patient satisfaction survey ratings. Dr. Alzohaili's post-pilot patient satisfaction scores were significant, revealing 100% improvement on all measures of patient perception of relational empathy during their encounter with the doctor, in contrast to his pre-pilot patient satisfaction scores.

Dr. Clipper's research data demonstrated that Behavioral Engagement with Pure Presence has "…a psychological effect on the patient's perception of the patient-provider relationship. The patient perception of relational empathy with their doctor increased through improved provider communication skills through applying the Behavioral Engagement model."

Further research on the application of the model includes a pilot study on the Behavioral Engagement model in Electronic Medical Record Communication, funded by the U.S. Department of Health and Human Services/ MI Dept. of Community Health;
and a randomized controlled clinical trial study with funding from major national health care organizations.
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Dr. Georgianna Donadio is the Director of the National Institute of Whole Health and author of the multi-award winning, Amazon bestselling book, Changing Behavior.