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

Why Do We Need Emotions?

Most of us perceive the brain as serving “thinking” or intellectual functions. A person often thinks of his or her personality as what is going on “from the neck up.” In fact, several parts of the brain — not just the thinking cortex — contribute to who a person is and how their personality is formed. 

The Cortex Of Survival

The cortex is what we refer to as the smart brain. Most of us know individuals who are brilliant academically or intellectually, yet they are emotionally dysfunctional almost in the extreme. We often presume erroneously that the thinking brain should be “smart” enough to exercise dominion over emotions.

However, the missing piece of information here is that emotions actually are a survival-adaptation mechanism that each of us develops as we process our early environment and social conditioning. Some of us learn to be assertive or aggressive in our environments. Others may learn to become passive or try to become invisible to stay safe and secure.

Nothing is more powerful in a human being than the drive to survive. Hence, emotions win the day in the battle between thinking and feeling. It is helpful to understand that emotions represent how we learned to adapt in our surroundings and environment, especially during the first five years of development.

More Input

Our familial input taught us, as Ivan Pavlov taught his dogs, how to respond to the stimuli we received as infants and toddlers. This embedded neurological conditioning is not overcome by the thought process; the thought process for humans is the newest component to the primordial brain. The survival adaptive portion of the brain is where the personality forms and where people become conditioned to create and interact within relationships.

Relationships And Conditioning

Frustrating interpersonal issues may come from the drive to survive and the interpretation of the stimulation and environment that conditioned us, rather than from being difficult or having bad intent. Understanding that can allow a person to begin to be “kinder and gentler” toward himself and others.

In summary, emotions enable us to live and survive in our world. We cannot think them into changing. However, we can step back and appreciate the service and challenge they offer us in our daily lives. We can also explore techniques that allow us to have greater control over our emotions.

For a free chapter download of the award-winning bestselling book Changing Behavior: Immediately Transform Your Relationships with Easy to Learn, Proven Communication Skills, visit: http://www.changingbehavior.org

Tylenol for a Broken Heart?

Here is a very interesting bit of research. Although I have shared this information on a national blog I write for, the information was so interesting that I wanted to share it again, here with you.

Last year there was a study conducted at the University of Kentucky, College of Arts and Sciences, that 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 which 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 amount of 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-today 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 scanning which were able to identify when the participants had feelings of social rejection occur.

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 that the physical pain is experienced in. 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 recommendation that we “take two Tylenol and call me in the morning” for heartache as well as for headache!

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

With all good wishes,

Copyright 2011, G. Donadio All Rights Reserved

Infertility and Stress

When a couple desires to have a child together and they are unable to conceive, it can be a time of great stress and upset for both partners. The inability to conceive, and the resulting longing that accompanies it, can be one of the most painful and difficult things a couple can experience together.

A number of years ago, in the New England Journal of Medicine, an article appeared that caught my eye because at that time there were a significant number or couples in my practice who were experiencing infertility. The article stated that often, regardless of the advances in medical technology and the various in-vitro methods available, a woman will ony become pregnant when her body is ready to carry a conception to term.

This wisely suggests that there are a number of reasons a woman may not conceive when she wishes to; and that the body’s innate intelligence knows when the best time and condition for a successful conception and birth of her baby is. The article also went on to say that stress is the number one reason women do not conceive when they wish to.

This is well demonstrated with women who adopt a baby when they cannot conceive, settle into motherhood, only to find that they are pregnant – something they or their doctors did not think would happen. The discussion of why women, in other cultures, become pregnant more easily that women in the US always leads back to our lifestyle and the abundance of stressful living we have in the US.

How does stress actually cause infertility? Here are the facts –

1. When we become stressed for periods of time, our body must make more cortisol, an adrenal hormone that deals with stress adaptation.

2. To provide this additional cortisol, the body diverts the production of sex hormones into the production of cortisol. This reduces fertility. Under stress, sex and reproduction is the first thing the body ignores.

3. Excess levels of cortisol interfere with oxytocin, the hormone required for fertile egg implantation in a woman’s uterus lining.

4. Excess stress over time suppresses the immune function as well as interferes with healthy digestive function that can lead to malnutrition.

If you or someone you know wants to conceive and is having a difficult time, they may greatly benefit from becoming familiar with this information and finding ways to decrease their anxiety about becoming pregnant, or reduce their lifestyle that may be causing high levels of physical stress.

With all good wishes,

Copyright 2011 G. Donadio

Delicious and Nutritious

Good news – it is berry picking and eating season.  Blueberries, raspberries, strawberries and blackberries can once again be found in grocery store isles, “pick your own” farm stands and local organic coops.

Blueberries, raspberries, blackberries and strawberries are some of the more popular berries found in the grocery produce section. However, other berries, such as mulberries, boysenberries, huckleberries and cranberries are also popping up this season.

Not only are berries of all kinds delicious, but they have been shown, as all fruits and vegetables have, to contain phytosterols that provide many health benefits and work overtime to prevent disease. Research does show that berries are among the fruits highest in antioxidant content and that they are excellent sources of several phytochemicals that seem to help block cancer development.

Researchers at Clemson University looked into the cancer fighting potential of various types and berries. In the Journal of Medicinal Foodthe scientists note: “Plants are proven sources of useful anti-tumor and chemo-preventative compounds. Hence, identification of phytochemicals useful in dietary prevention and intervention of cancer is of paramount importance.”  

The research team went on to further conclude that “Juice from strawberry, blueberry, and raspberry fruit significantly inhibited mutagenesis.” Meaning – that berries have high levels of anti-cancer properties that make them an ideal part of any diet.

Some of the best ways to enjoy berries and get the best health benefits from them is to blend them together in fresh fruit salads. A bowl of fresh berries acts as a “health tonic” that is not only delicious, but easy and convenient to prepare as well as one of the most intense disease prevention treats you can find.

Another popular and easy way to enjoy berries is in smoothies, either plain with a dollop of ice cream or yogurt; or with crushed ice chips and a sliced banana to add thickness and more delicious nutrients.

Enjoy these wonderful fruits, become nourished and prevent disease all at the same time.

With all good wishes,

Copyright 2011 G. Donadio


Men, Women and Apologies

For most of us it does not come as a surprise that men and women really do think, behave and are in many fundamental ways different from one another. We also know that hormones play a large role in these differences.

Now science is beginning to unravel the specifics on how males and female brains function in large part because of male and female hormones which craft our brain development and orient our behaviors.

Two new studies look at the brain function of men and women and offer some interesting observations regarding the subject. One study is from the University of California in collaboration with the University of New Mexico, led by researcher Richard Haier, a psychology professor at the University of California.

The findings of their study shows that generally men have 6.5 times the amount of gray matter relating to general intelligence compared with women. Women on the other hand have nearly 10 times the amount of white matter related to intelligence compared to men.

“These findings suggest that human evolution has created two different types of brains designed for equally intelligent behavior,” said Haier. But apparently these types of intelligent behaviors manifest differently.

Women apologize more often than men do, according to a new study led by researcher Karina Schumann, a doctoral student in social psychology at the University of Waterloo in Ontario, Canada. It’ appears it not that men are reluctant to admit wrongdoing, they simply have a different perception regarding what they feel rises to the level of requiring an apology.

The research team saw no difference in the number of times men and women acted in ways that elicited apologies, but there was a distinct difference in the male and female perception of what constituted a situation that requires an apology.

“Men aren’t actively resisting apologizing because they think it will make them appear weak or because they don’t want to take responsibility for their actions,” says Schumann. “It seems to be that when they think they’ve done something wrong they [men] do apologize just as frequently as when women think they’ve done something wrong. It’s just that they think they’ve done fewer things wrong.”

“Ladies” – did we really need research to confirm this?

With all good wishes,

Copyright 2011 G. Donadio

Just What ARE Emotions?

Most of us perceive our brain as being for “thinking” or intellectual functions.  We often think of ourselves, our personality as what is going on “from the neck up”.  In fact, there are several parts to our brain which contribute to who we are and how we form our personality – not just our cortex.

The cortex is what we refer to as our “smart brain”.  Most of us know individuals who are brilliant academically or intellectually, yet – they are emotionally dysfunctional almost in the extreme. We often presume erroneously that our thinking brain should be “smart” enough to exercise dominion over our emotions.

However, the missing piece of information here is that our emotions actually are a survival adaptation mechanism that each of us develops as we process our early environment and social conditioning.

Some of us learn to be assertive or aggressive in our environments to adapt and some of us may learn to become passive or try to become invisible to stay safe and secure. Nothing is more powerful in the human being than its drive to survive. Hence, our emotions win the day in the battle between thinking and feeling.

It is helpful of us to understand that our emotions represent how we learned to adapt in our surroundings and environment, especially during the first 0-5 years of our development. Our familial “input” taught us, as did Pavlov with his dogs, how to respond to the stimuli we received as infants and toddlers.

This embedded neurological conditioning is not overcome by the thought process, as the thought process for humans is the “newest” component to our primordial brain. It is in the survival adaptive portion of our brain where we form our “personality” and where we become conditioned to create and interact within relationships.

When we understand the possibility that interpersonal issues which frustrate us may come not from “being difficult” or “bad intent” but rather from our drive to survive and our interpretation of the stimulation and environment we were conditioned by, then we can begin to be “kinder and gentler” towards ourselves and others.

In summary, our emotions are the way we learn to live and survive in our world. We cannot “think them” into changing, but we can step back and appreciate the service and challenge they offer us in our daily lives. We can also explore techniques that allow us to have greater control over our emotions.

With all good wishes,

Copyright 2011, All Rights Reserved G. Donadio

More than Skin Deep

Any teenager can attest to how distressing a face full of acne is.  Clear, unblemished skin is universally the number one and most important feature in attracting others. This basic law of attraction is because our skin is the largest component to our immune system – and healthy skin reflects a healthy body, which is required for reproducing.

In the US, hundreds of millions of dollars are spent yearly on acne and blemish remedies and cover-ups. Our skin’s appearance is tied to our sex appeal and for most people being attractive to others is important. 

In the 30 years I have been practicing Whole Health nutrition, working with young adolescents to clear up their skin problems and facilitate their sense of self-esteem and well-being, is one of the most rewarding experiences I’ve had in my practice. Educating teenagers about where and why acne develops provides them with the ability to make choices that can change the course of their outbreaks.

It all starts with androgens, which are reproductive hormones secreted into the blood stream by the productive organs and our stress adaptation system – our adrenal glands.  Androgens are potent “chemicals” that our liver must deal with by reducing their potency.

The liver detoxifies the blood and when dealing with androgens, the liver produces blood plasma proteins which bind up and inactivate the majority of androgens, so that only a small percent of androgens are free to enter our cells.

During adolescence, the body is going through a huge hormonal change and all parts of the body needs time to adjust to and regulate hormone secretions. Because of the complex functions of hormones,  a young body can become physically and even psychologically overwhelmed by the effect of androgens on the body functions and the brain.

How acne develops is when the androgens enter the cells, a specific enzyme converts the presenting androgens and makes them more active. The active androgens enter the nucleus of the cell and interacts with genetic material. This can lead to highly stimulated oil glands, and it is these highly stimulated oil glands that lead to the formation of acne.

Thee are several factors that determine the degree and amount of acne:

a) amount of androgens entering the cells 

b) how well the liver controls the active androgens

c) the person’s nutrition and liver function

d) the amount of waste and/or toxins being re-absorbed into the liver from the bowel environment and – THIS IS THE KEY –

e) the amount of exercise the adolescent is doing that will utilize the androgens to build and create muscle tissue (rather than acne), thus reducing the amount of androgen that might be absorbed into the cells.

Especially in young males, but this applies to females as well, the fastest and easiest way to clear up adolescent acne, is have the person EXERCISE vigorously. Through the use of androgens by the body to build muscle rather than be available to interact with genetic material in the cell, rather quickly the androgens are re-directed to enhance strength and development rather than creating skin problems. The young patients and their parents think its a miracle, but its actually simple biochemistry.

In addition, healthy eating of lots of vegetables and fruits to keep the bowel clean, drinking plenty of water, skin hygiene and proper amounts of sleep, all help the liver, bowel and adrenals to function properly, which supports an overall healthy body with resultant glowing, attractive skin. 

The expression “it’s more than skin deep” clearly applies to acne and skin blemishes. You may want to share this information with someone having acne issues because if they use it – they will see a difference. 

With all good wishes,

Copyright 2011 G. Donadio All Rights Reserved

Alternative for Dealing with Seasonal Allergies

One of the most important aspects of being able to address a health issue you may have is to understand the cause and effect of how and why you are experiencing your symptoms and what they represent.

Seasonal allergies are for many the down side to the beauty of spring and summer. Itchy, runny eyes and nose, sneezing, coughing, and even wheezing can dictate an individual’s activity choices, where they can go and even what they can eat. None of this is desirable and much of it has been shown to be preventable.

To understand how you can take control of your seasonal allergies, let’s explore where they come from. When foreign proteins found in many airborne substances, such as pollen, dust mites and rag weed.

When mucous membranes that come in contact with these foreign proteins are not immunologically competent enough to break down these proteins, the membrane secrete mucous, fluids and histamine. This causes the itching, swelling, irritation and watery excretions that make seasonal allergies so challenging.

To improve allergy symptoms, steroid or steroid like medications, are often prescribed. These are anti-inflammatory chemicals that reduce the allergic immune reaction to the foreign proteins. By building up our immune and adrenal system we can enable our bodies to be better able to handle these allergens, which cause the allergy reactions.

Our adrenals are located either on top of or within the kidneys and produce cortico-steroids and other natural anti-inflammatory as part of our “national guard” system. Hans Selye, MD, PhD, who spent over 50 years researching the adrenals and immune system, discovered the important nutrition and lifestyle components to keeping this important body system working well: 

  • a diet or supplementation rich in B, C, E,  and A vitamins; unsaturated fatty acids, such as fish oils, adequate protein intake and minerals to aid in the production of natural allergy fighting anti-inflammatory.
  • adequate sleep and rest
  • elimination of infections
  • reduction of emotional stress
  • moderate exercise – avoid over exertion
  • avoidance of traumas, dental and medical surgery
  • elimination of extreme temperatures indoors and out

Seyle’s research demonstrated that by taking good care of our adrenal and immune system, allergies may be greatly reduced, and in some cases eliminated.

Women and Depression

It comes as no surprise to women that there is a relationship between their hormone fluctuation and the potential for experiencing depression. Studies of this kind have not been pursued until fairly recently.

The prestigious National Institutes of Health (NIH) recently looked at this subject and explored the potential relationship to hormonal dysfunction and depression in women.

The recently published report was a review on how the female reproductive system interacts with the Hypothalamus-Pituitary-Adrenal (HPA) axis. This is a major regulatory mechanism of the body’s stress response.

With the important data that women are twice as likely as men to experience depression, it is this mechanism which sets up a biochemical environment for depression, that the NIWH investigators looked closely at.

Stress in women impacts the reproductive hormones which can upset patterns of ovulation, hormone secretion and implantation. Mediated through the HP-axis, tThis upset can contribute to the lost of menses and to infertility.

If the stress becomes chronic and exert an ongoing imbalance on the female reproductive hormones, behavior and mood disorders and depression can significantly increase.

When the powerful reproductive – love hormone, oxytocin is suppressed due to excessive stress hormones, fertilized eggs cannot implant into the uterus. This significant result of chronic stress is believed to be a primary cause of infertility in American women.

A key to preventing or correcting the problem is to create a more balanced, less stressful lifestyle. When our body’s stress adaptation system becomes overwhelmed, many disorders and conditions can develop, depression being just one of them.

The NIH investigators reported that regarding postpartum depression, ongoing hyper-secretion of the stress hormone cortisol during  pregnancy creates a temporary drop in adrenal function following delivery. This hormonal change coupled with the plummeting levels of estrogen after giving birth may be an important factor in post-partum depression and possibly in immune dysfunctions, such as postpartum thyroid conditions.

With all good wishes,
© by NIWH 2011 All rights reserved