Diane Wind Wardell

Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals.

In recent years, the term integrative medicine has gained acceptance in medical academia. The Consortium of Academic Health Centers for Integrative Medicine defi nes this term as “the practice of medicine that reaffi rms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.” 1 Integrative oncology has been specifi cally described as both a science and a philosophy that focuses on the complex health of people with cancer and proposes an array of approaches to accompany the conventional therapies of surgery, chemotherapy, molecular therapeutics, and radiotherapy to facilitate health. 2 The SIO and its Medline -indexed journal ( Journal of the Society of Integrative Oncology ), founded by leading oncologists and oncology professionals from major cancer centers and organizations, promote quality research and appropriate application of useful, adjunctive complementary modalities T he Society for Integrative Oncology (SIO) is an international organization dedicated to encouraging scientifi c evaluation, dissemination of evidence-based information, and appropriate clinical integration of complementary therapies. Practice guidelines have been developed by the authors and endorsed by the Executive Committee of the SIO. Guidelines are a work in progress; they will be updated as needed and are available on the SIO Web site ().

A Pilot Study of Healing Touch and Progressive Relaxation for Chronic Neuropathic Pain in Persons With Spinal Cord Injury

This pilot study assessed the role of Healing Touch (HT), an energy-based therapy, in modulating chronic neuropathic pain and the associated psychological distress from post spinal cord injury. Twelve veterans were assigned to either HT or guided progressive relaxation for six weekly home visits. The instruments selected showed sensitivity, although there was a large variation among the groups. There was a significant difference in the composite of interference on the Brief Pain Inventory (t = -2.71, p = .035). The mean score of the fatigue subscale of the Profile of Moods decreased (ns) in the HT group and in the subscale of confusion yet remained stable in the control group. The Diener Satisfaction With Life Scale showed increased well-being in the HT group and no change in the control group. Participants reported various experiences with HT sessions indicating that it may have benefit in the complex response to chronic pain.

Factors influencing disclosure of abuse by women of Mexican descent.

PURPOSE The purpose of this study was to describe the factors that influence disclosure of abuse by women of Mexican descent. Few published studies describe the experiences of women of Mexican descent with a history of intimate partner abuse, specifically in terms of their process of disclosure of abuse. METHODS A qualitative research design was used to conduct this study in south Texas adjacent to the United States-Mexico border. Twenty-six key informants were recruited from two different sites. An open-ended approach with a semistructured interview guide was used to collect the narrative information from the 26 participants. RESULTS The findings illuminated that many factors hindered disclosure. Some of these factors included protecting their partners, avoidance of worrying their mothers, and fear of losing their children. CONCLUSIONS The study may help healthcare providers to understand the complexity of disclosure by women with a history of intimate partner abuse and may help explain why women do not readily disclose their abusive situations. CLINICAL RELEVANCE This study on the disclosure decision process of abuse by women of Mexican descent provides some understanding on the cultural or situational factors that hindered or encouraged disclosure; ultimately this knowledge can help healthcare providers and others to provide for the womans health, welfare, and safety.

Taxonomy of spiritual experiences

Spiritual experiences are often associated with health crises, with little information about the structure of the experience. A taxonomic analysis was conducted on data from a group of healers, unveiling a structural model of spiritual experience comprised of three domains: circumstances, manifestation and interpretation. Circumstances included the aspects of setting, situation, and timing. Manifestation incorporated the modes of awareness and the phenomena of the experience. Components of interpretation included personal meaning and congruence with social norms. The examples reflected the orientation of the study population. Further research could examine the applicability of the taxonomy to other religious or spiritual orientations and may assist in clinical assessment of spiritual experiences.

Women's anticipations of hormonal replacement therapy

Middle class Caucasian womens anticipations about hormonal replacement therapy (HRT) for perimenopausal symptoms were investigated to expand an understanding of elective use of HRT. This focused ethnography used both interviews and participation in discussion groups established for perimenopausal women as sources of data. Two investigators augmented validity. Inductive and deductive analysis yielded six typologies of anticipations: trusting in nature, fixing, skeptical experimenting, restabilizing, life enhancing, and trusting in science. These findings have clinical and theoretical implications related to issues of non-compliance, health seeking behaviour, provider-recipient interaction, and the focus of scientific investigation.

Ethical Principles Applied to Complementary Healing

With the public and professional shift to an interest in alternative/complementary therapies and holistic health, existing assumptions about the relationship between providers and clients are being challenged. This study explores the ethical approaches and underlying principles in the expectations of three organizations espousing holistic health and touch therapies. An analytic technique using a qualitative approach was applied to the documents of written ethical codes and standards from these organizations and was augmented by field exposure from previous work with each of the groups of healers. The emphasis on and approach to the principles of paternalism and autonomy from the groups provided contrasts with general biomedical approaches. All groups gave attention to the constructs of nonmaleficence, beneficence, and autonomy, with a strong emphasis on virtue ethics. The shift in the expression of the principles of paternalism and client agency allowed the healers to employ the therapeutic effects of placebo, suggestion, optimism, hope, and surrender with the avoidance of noicebo effects.

Using a Healing Touch Intervention in Older Adults With Persistent Pain A Feasibility Study

The purposes of this pilot study were to determine the feasibility of using a Healing Touch (HT) intervention with noncommunity-dwelling older adults experiencing persistent pain and to determine an HT protocol. Data were collected at multiple time points from 20 noncommunity-dwelling older adults experiencing pain. Residents were assigned to the HT group that included techniques specific for pain or a Presence Care group. Outcome variables included measures for pain, activities of daily living, and quality of life. The pain measures showed decreases that were not statistically significant for both groups. The measure for activities of daily living showed a non–statistically significant improvement over time for the HT group. Quality of life decreased for the HT group and improved for the Presence Care group although not significantly. The practitioners were able to complete all seven of the 30- minute HT sessions. The findings indicated that both groups showed some improvement in their pain scores with other measures being variable. HT is a feasible intervention for the elderly with pain. Overall, the findings highlight the complex nature of pain in older adults.

Perimenopausal Women's Alienation

A feminist perspective was used to interpret data gathered from perimenopausal women using hormonal replacement therapy. Silence was the most pervasive and disquieting theme. These women parroted biomedical cognizance and iterated little authentic expression of experience. This silence reflected the womens existential position of the double other, marginalized first by being a woman and second by reason of medical norms for women being based on reproductive function. This position of alienation is explored within the context of Western culture and the patriarchal values of rationality and science. Implications are drawn for holistic nurses to facilitate womens physical awareness and articulation of their personal experiences.

Holistic nurses' stories of healing of another.

The purpose of this study was to uncover the essence and meaning of healing through narrative accounts of holistic nurses, using a qualitative, descriptive design integrating narrative and story inquiry. Twenty-five stories were collected. Seven stories revealed personal healing and have been published in a prior article. Eighteen stories, the focus of this analysis, revealed healing of another. A hybrid method blending narrative and story guided the overall process for the study. Nine themes emerged describing healing of another within three story segments: The Call to Healing, The Experience of Healing, and Insights. The theme within The Call to the Healing Encounter was Drawn by Compassion to the Vulnerability and/or Suffering of Another. Five themes describe the Experience of Healing: Connection: Cocreating Relationships; Taking Risks and Dealing With Skeptical Colleagues; Use of Modalities and Actions as Tools in Developing Self as an Instrument of Healing; Profound, Ineffable Events; and Using Metaphor and Rituals to Describe Healing. Three themes describe Insights: Mutual Transformation, Change, and Reciprocity; Gratitude for the Healing Encounter; and Leaving a Legacy. The metastory, a reconstructed story created by the researchers, was the final phase of research synthesizing and demonstrating themes of healing of another. Results were compared to existing healing literature.

Holistic nurses' stories of personal healing.

The purpose of this study was to uncover the nature, experiences, and meaning of personal healing for holistic nurses through their narrative accounts. The study employed a qualitative descriptive design with methods of narrative and story inquiry. Participants were nurse attendees at an American Holistic Nurses’ Association conference who volunteered for the study. They were invited to share a story about healing self or another. Twenty-five stories were collected; seven were about personal healing, and these are the focus of this analysis. Data were analyzed using a hybrid approach from narrative and story inquiry methods. Eleven themes were clustered under three story segments. The themes within the Call to the Healing Encounter are the following: recognition of the need to resolve a personal or health crisis, knowledge of or engagement in self-care practices, and reliance on intuitive knowing. Themes under the Experience of Healing are the following: connections; profound sensations, perceptions, and events; awareness of the reciprocal nature of healing; inner resolution: forgiveness, awakening, and acceptance; use of multiple holistic approaches; and witnessing manifestations of healing. The themes for Insights are the following: gratitude and appreciation and ongoing journey. A metastory synthesizing the themes is presented, and findings are related to existing literature on healing.