Healing Health Care at St. Charles Medical Center

Bend, Oregon

An Interview with Nancy Moore and Cori Westby

Mary Amdall-Thompson RN MS CNS

St. Charles Medical Center is a national leader in healing health care and is consistently cited as one of Oregon’s 100 best places to work. In 2000, St. Charles Medical Center was honored in receiving the Norman Cousin’s Award for relationship-centered care. The selection committee noted St. Charles as “the best hospital in the country with regard to the sacredness of care.” In addition, Solucient, a leading source of health care intelligence, listed St. Charles as one of the nation’s top 100 hospitals in the areas of quality of care, financial performance, operational efficiency and adaptation to the environment. Its unique healing environment and innovative approaches to care of the whole person (mind, body and spirit) are widely acclaimed.

The Sisters of St. Joseph of Tipton, Indiana, founded St. Charles in 1918. Its current facility opened in 1975. The hospital has 181 beds, including a 12-bed Rehabilitation Center. It also boasts is a Level II Trauma Center, the only Oregon hospital east of the Cascades with that designation. There are over 200 physicians on staff, representing 40 specialties and subspecialties of practice. St. Charles offers every medical service except organ transplantation and care for critical burns.

The mission statement of St. Charles hospital reads: “To improve the health of those we serve in a spirit of love and compassion.” You may visit their web site at www.scmc.org

Nancy Moore, RN, PhD, Senior Vice President of Clinical and Healing Services and Cori Westby, RN of Patient Support Cluster were interviewed in July 2004. A transcript of that interview follows a brief summary of their professional careers.

Nancy Moore has practiced as a Registered Nurse since1966. She was educated in a diploma-nursing program and has additional education in literature and psychology. Nancy has been at St. Charles Medical Center since 1980. Her passion has always been to make a difference in health care. During her years as a bedside nurse, she observed that interactions with patients help facilitate healing. She understands how advances in technology and the hectic pace of nursing practice tend to pull nurses away from caring for the whole person. During her doctoral studies in psychology, she had the opportunity to work with Leland Kaiser, a health care futurist at the University of Colorado. His mentoring helped her develop a philosophy of healing health care. She also worked with the Fezter Institute in a national network for relationship-centered care. These experiences taught her what was needed to bring the health care professions in a new paradigm of health care and fed her passion to make a difference. She is co- author of Patient Focused Healing: Integrating Caring and Curing in Health Care. She contributed to Integrating Complimentary Medicine into Health Systems and Holistic Nursing: A Handbook for Practice, 4^th edition.

Cori Westby has been a Registered Nurse since 1986. Prior to nursing she had a practice in psychological counseling. She set up a human resources networking program at a community college that taught her about communities. In 1997, as a holistic nurse, she started her own clinic helping people learn to heal themselves using energetic based modalities. Her experiences continue to contribute to St. Charles and its mission of a progressive healing health care.

Amdall-Thompson – Where did the concept for the healing health project begin?

Moore – In 1989, during the time I was doing my doctoral work, St Charles was looking at patient focused restructuring. The hospital leadership did not want to lose sight of their mission in the process of restructuring. In fact they wanted to enhance the mission. I was the project leader for determining how we would enhance our mission, working with a team of people in the hospital. For my doctoral work, I was also able to do site visits, literature review and attend conferences. I brought back that information and as a result the healing health philosophy was developed.

The home base for the national Association of Healing Health Care Projects is at St Charles. It is a simple ethic of healing our relationships, our community and ourselves. It is a virtual organization, open to anyone to belong. Each organization takes that ethic and defines it locally, so it looks different at North Hawaii Community Hospital than it does at St. Charles.

Amdall-Thompson – How many other health care systems have adopted a similar philosophy?

Moore – I am aware of five or six others including Woodwinds Campus in Minnesota, North Hawaii Community Hospital and Peace Health System of Alaska, Washington and Oregon. Some have not adopted the entire philosophy but have adopted pieces of it.

An epiphany in this philosophy came to me while I was working with the task force. The hospital was asking the question, “What would it mean to enhance our mission while going through this change process?” I was exploring what we could do for patients and was thinking of, perhaps, a wellness program. A nurse raised her hand and said, “What about us?” In my wisdom at the time I said, “We will get to ‘us’ later. First we have to take care of the patients.” It became so clear as we went through all the emotional upheaval of a major change initiative that it would not matter what we created for patients. We could change the whole organization, have a beautiful facility, state of the art program, but if the people providing the care and these services weren’t themselves healed and cared for in the process, it would be an empty shell. Nobody would want it. So the light bulb was that the essence of healing is in our relationships. We are a human service. Who we are and how we work together are what our patients receive. We are people caring for people.

Amdall-Thompson – When did St. Charles adopt the concept of healing health?

Moore – It was in the early 1990’s. I would have to go way back to Sister Catherine. She was the spiritual leader in the community, our president and CEO for many years. She had a belief in the sacredness of people – the caregivers and patients, and that the environment is important to healing. But even so, it wasn’t perfect here. When I came in 1980, we had just had a strike in nursing. Then, in 1985, some of the nurses went to workshops on Therapeutic Touch and we started doing it in the hospital. That helped us begin to understand healing and what healing means.

Amdall-Thompson – Do you know why your nurses decided to attend Therapeutic Touch workshops?

Westby – Well, for one, because they wanted to learn to heal themselves. They realized that learning Therapeutic Touch is how they could heal themselves and become a role model for patients and those around them. That was the basis for the energetic modalities that we have done and Therapeutic Touch is one that we have stood by. The original premise was for nurses to heal themselves so that they could be a role model for patients. Because, if we can’t heal ourselves, how can we possibly heal others?

Moore – Cori was a pioneer in bringing Healing Touch to the hospital. She was the primary advocate for Healing Touch.

Westby – That was a spin off of Therapeutic Touch. They are not the same, yet there are a lot of similarities. An energetic modality is an energetic modality.

Amdall-Thompson – Your website has learning modules for implementing the Healing Health Care Projects. Is this the training you require for your care providers?

Moore – These learning modules were written by Board members of the Association of Healing Health Care Projects. There is a module that is the Healing Health Care Philosophy for St. Charles. This philosophy is the strategic initiative of the hospital. All managers are responsible for implementing it. It is a guide for everything that we do.

Susan Mazer and Dallas Smith, also Board members of the association, are musicians (learning module “Sing a Song for the Sick and Tense”) who have developed products that we use in the hospital. One is called a “C.A.R.E Channel” – continuous, ambient, relaxation environment. It is programmed for the day-night cycle and has beautiful nature videos and music that our patients can turn on. Our nurses use it when giving pain medications as an adjunct to the pain medication to help the patient relax. There is now a C.A.R.E. Channel with guided imagery. Rosemary Johnson in our surgery center is the voice for the guided imagery on that C.A.R.E. Channel.

Amdall-Thompson – What is required of your staff to be involved with healing health?

Moore – Everybody, including the CEO, is responsible for healing heath care. For nurses in particular, we have a caring model, developed by Sharon Dingman, that we use. It is very simple. For example, you sit with the patient for five minutes, introduce yourself, tell the patient your role, and find out how the patient prefers to be addressed while using a touch modality. During this time the nurse and patient work in partnership to explore the patient’s needs and develop a plan of care.

There is also Healing Health Care Resources. All of our caregivers have been trained in non-invasive pain modalities such as intentional breathing, guided imagery, and progressive relaxation.

Westby – We could also include Therapeutic Touch as a modality in our “bag of things to play with.” We try to teach nurses a variety of modalities that they can use.

Amdall-Thompson - Do you teach these modalities to all nursing staff or just to those who want to learn?

Moore – Not Therapeutic Touch. Therapeutic Touch is for those who are really drawn to it.

Westby – For those nurses who are interested in Therapeutic Touch, we have a special training program. We expect that all nurses learn the caring model and be able to provide, or find someone who can provide, specific services. All nurses need to know what is available. We are in the process of revamping the training to teach nurses that there is information they need to know about pain and anxiety management and what tools they can pull out of their “bag of tricks.”

Amdall-Thompson – Does that mean you do not expect all nurses to know how to perform these modalities perfectly, but at a minimum to know where there is a resource from which to draw?

Moore – Healing Health Care Resources are a job expectation for nurses. They need to know intentional breathing and those types of skills. There was a push for developing competencies a few years ago. Everybody got on board, but if you don’t keep refreshing skills, you loose competency. That is what Cori was referring to. We are re-focusing on Healing Health Care Resources and supporting the staff consistently so we can guarantee to every patient who is admitted that he/she will have access to healing modalities, including intentional breathing, guided imagery, relaxation methods, the C.A.R.E. Channel and other things that create a healing environment. If the patient wants Therapeutic Touch, the nurse knows how to contact someone who does Therapeutic Touch.

Amdall-Thompson – How many nurses in your facility have expertise in Therapeutic Touch?

Westby – Close to 40.

Amdall-Thompson – Do you offer on-going training so staff can refresh their skills?

Moore – Yes.

Amdall-Thompson – How frequently?

Moore – Two times each year we have a class on Therapeutic Touch. Then we have a shorter refresher for people like me who don’t do it as often. Sometimes I am called if there is no one else available to do Therapeutic Touch.

Amdall-Thompson – Do you have on-going training for some of the other modalities such as relaxation techniques?

Moore – We have not offered on-going training. That is one of the things we are reinstituting.

Westby - We are doing that now. Each cluster or area such as the surgical or medical floor finds a mentor, someone who is interested in teaching these modalities to keep nurses stimulated and keep their skills fresh.

Moore - Every department has at least one Healing Health Care Resource mentor. They might have one for each shift. That mentor is responsible for helping the manager on that unit keep the staff educated and ensure that patients have access to healing modalities.

Amdall-Thompson – Other than the services you have already described, are there others that you offer at St. Charles?

Moore – We have massage therapy, provided in a couple of ways. We have a massage therapist who works with our Center for Health and Learning and provides massage for employees or the public at a nominal cost.

Westby – Massage at $1 a minute.

Moore – We also have volunteer massage therapists in our Cancer Center and for all of our caregivers as an employee benefit. Each department has so many hours of massage. They can arrange for a massage therapist to come to the department to do massage therapy for the staff. In addition, employees can get a massage at the Center for Health and Learning for the $1 per minute charge.

Westby – We provide this to give back to the caregivers, so they can get their therapy too. We want to keep our health caregivers healthy.

Amdall-Thompson - Do you offer other things such as weight management for your staff?

Moore – We have all kinds of services for staff in our Center for Health and Learning. We have a chronic symptom reduction program. We have nurse health coaches to work with those who want to create a health plan to improve their life style. We have support groups, yoga, relaxation, meditation, weight reduction classes, exercise classes, energetic, and all kinds of classes.

Amdall-Thompson – What fiscal support is necessary to maintain these services? Does it cost a lot of money to offer these services for your patients and staff?

Moore – Because this is a pervasive, cultural, strategic initiative of the hospital, it is not a separate line item. It is integrated into every department’s budget. We have invested a lot too, when we talk about healing ourselves, in seminars. We have found that not everybody has the benefit of growing up and learning the best skills for healthy relationships in their family of origin. So we have 2½ day seminars that focus on personal growth and development. Every employee attends these seminars with the expectation that the skills learned will be used to directly deal with conflict in a respectful way rather than avoid conflict.

Even though we have invested a great deal of money in things like these seminars and programs, we are a low cost provider. We are a “good deal” for our community. I have looked at our average charge for hospital stays. The total cost per adjusted discharge has risen 1% (factoring in health care inflation rates) from 1992 to 2003. So we have really kept costs down. Oregon is one of the low cost places in the nation for health care and we are one of the lowest cost hospitals in Oregon. So, providing these services has not made us an expensive place to come for care. I think it works because people have better communication skills, better team relationships and the healing environment is not just for patients. It affects me and Cori and all of us.

Amdall-Thompson – Are patients charged a specific fee for these services?

Moore – No, we do not charge specifically for these services.

Amdall-Thompson – So, let’s say a patient wants Therapeutic Touch and some other relaxation modality. There is no charge for any of it?

Moore – There is no extra charge for any of the healing health care modalities. They are simply things that are in the nurse’s “bag of tools.” These are therapeutic interventions that nurses do.

Amdall-Thompson – Have you looked at the amount of sick time or requested personal time off in relation to the healing health environment?

Moore – We have not looked at sick time. Taking personal time off that is an employee benefit is considered part of taking care of one’s self.

Moore – Our employee turn over rate is low. In 2000, we had a 10% turn over rate in nursing positions. In 2003 the turn over rate was 6%. So, the turn over rate keeps going down.

Amdall-Thompson – When you started the healing health care philosophy at St. Charles, was there any resistance to it?

Moore – Yes, some people thought it was kind of “woo – woo.”

Westby – Initially there was some fear. There were people who weren’t sure what this were going to mean for their job and how it would affect them.

Amdall-Thompson – So, the resistance did not come from a particular group?

Westby – No. We were just at the beginning of instituting healing health care. Some wondered, “What does that mean for me?”

Amdall-Thompson – Was there more resistance from physicians?

Moore – There was a big resistance from physicians. The physicians reacted when we first brought Therapeutic Touch to the hospital. I remember them saying that they were afraid that this was going to be the beginning of opening the doors to alternative therapies.

Amdall-Thompson – Did their concerns get resolved?

Westby – Yes, through experience and having it come forth more and more. I think it has been a benefit to all to see that we are doing fine and even better in the long run. We have seen some miracles.

Amdall-Thompson - Is there any residual resistance from physicians?

Moore – There are still some physicians and community members who don’t think we should be doing Therapeutic Touch. The other healing health modalities are very much accepted as part of our culture at St. Charles. There are physicians who come here because of our reputation.

Amdall-Thompson – Why do you think that Therapeutic Touch has been singled out? Why not guided imagery or some of the other modalities?

Moore - I think that the energy concept seems very strange to people. I think that there was fear, especially in the beginning, that we thought we (nurses) were the healers. The opportunity for us at the time, when we were going through all this turmoil, was for us to really think about healing and “what does healing mean?” Out of that we were then able to articulate that we (nurses) are not the ones doing the healing. We are using Therapeutic Touch and all of the other modalities to create an environment where healing can happen and to enhance the patient’s own healing process.

Amdall-Thompson – There are many who believe that it is the patient who does the healing and the nurse is there to facilitate the healing process.

Westby - We are learning to empower the community, our members, and our patients to give them the chance to heal themselves. That is part of this whole healing health care system. It also includes us – permission for ourselves to heal.

Amdall-Thompson - Do patients request specific healing health care services?

Moore – Yes, they request Therapeutic Touch. One area that turned out to have a lot of requests is the pre-surgery clinic. A lot of patients like to have Therapeutic Touch before their surgery.

Amdall-Thompson – Is that the most frequently requested service?

Westby - It depends on which department. In pre-surgery it is. It allows the people to prepare themselves to heal. It is a nice preparation for surgery. For the other departments, it is a difficult question. It depends on what the need is. There are different modalities for different needs. It may be positive guided imagery or intentional breathing. The nurse has the opportunity to use whatever fits the circumstances.

Amdall-Thompson – Do physicians request these services?

Moore – Yes, often it happens right at the bedside. He asks the nurse to perform the service or find someone who can perform the service.

Amdall-Thompson – So it is not done as a written order?

Moore – Sometimes the physician will write an order.

Westby – It is usually a verbal request, not really an order.

Amdall-Thompson – What do physicians most frequently request? Or does it depend on the patient?

Westby - Sometimes patients know exactly what they want and the physician relays that wish to the nurse. Or if the physician is not sure, he can discuss the possibilities with the nurse. Most often it is Therapeutic Touch because that is a modality we have been involved with for a long time.

Amdall-Thompson – Have you done any research about the effectiveness of the services you offer?

Moore – We have not. For a long time we did satisfaction surveys after treatment. One hundred percent said that these services helped reduce their anxiety and helped them relax. Most said that if the service was given for pain, it helped reduce their pain.

Westby – Yes, especially during recovery. The reduction in the need for narcotics was very much demonstrated when done in collaboration with Therapeutic Touch or Healing Touch.

Amdall-Thompson – If a nurse were to express an interest in starting a similar program or adopting a similar philosophy of care, what would you advise them to do?

Moore – I would advise them to gather articles, read about it – books on holistic nursing and other materials, talk to their nurse manager and nurse executive to give them information about the philosophy, visit other organizations providing these services, do conference calls to find out what is working and what is not.

Westby – The American Holistic Nurses Association is a good resource because they deal with these questions all the time.

Amdall-Thompson – Have you had people visit your organization to see what you do?

Moore – We do have a formal site visit program. Every couple of months another hospital comes to look at what we are doing in our healing health care program.

Amdall-Thompson – Would you be willing to have nurse’s contact you by e-mail to ask more about your healing health care program?

Moore/Westby – Either one of us could be contacted: nmoore@scmc.org or cwestby@scmc.org.

Amdall-Thompson – Is there anything else I have not asked you that should be included?

Moore – We do have an on-call acupuncturist in our rehabilitation unit. She is not being utilized as much as we thought she would be, but we are looking at it and think there may be other opportunities for that service. We have an advisory group – physicians, acupuncturists, chiropractors, nursing, spiritual care – who look at different alternative therapies and develop recommendations to the medical staff and the hospital.

Westby – As nurses we are looking at several ideas, for example aromatherapy. We are trying to incorporate it. Some departments want to do it more than others. Obviously when you are considering using aromas, you cannot be too invasive. We are looking at whether it could be useful before surgery or during recovery.

Moore – One of the healing health care resource mentors on our surgical specialty unit is doing a study on aromatherapy.

Westby – The Intensive Care Unit is doing the same thing.

Moore – We have a service standard for everybody that is called “therapeutic presence”. It is very simple. It means being with others with the intention of helping and caring – active listening etc. Healing health care is part of the fabric of St. Charles Medical Center. That means that everyone at St. Charles is responsible for healing health care.

Mary Amdall-Thompson RN MS CNS is a Registered Nurse and Clinical Nurse Specialist with over 36 years of experience in nursing. She taught junior medical students in a university setting for 6 years and was a guest lecturer for nursing students for 22 years. She was the Program Executive for Professional Services for the Oregon State Board of Nursing for 22 years, answering scope of practice questions, supervising the investigation of complaints and drafting administrative rules and policy/position statements for the Board. During that time she presented continuing education programs (35-40 each year) to licensees of the Board and consumer groups. She is an Associate Editor for the Alternative Journal of Nursing and the President of the Community Based Care Nurses Association.