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 Reader Comments: Corey Resnick, ND, Dan Cherkin, PhD, Karen Sherman, PhD, Susan Luck, RN, J. Schwartz, MA, Mary Elaine Southard, RN  
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: American Association of Naturopathic Physicians board member Corey Resnick, ND, corrects a Top 10 item ... Group Health Institute researchers Daniel Cherkin, PhD, and Karen Sherman, PhD comment on the fascinating and previously unpublished qualitative finding from their quantitative LBP trials ... Susan Luck, RN, BS, MA, HNC, CCN, offers comments on essential benefits, coaching and nurses ... Jan Schwartz, MA suggests that the Council of Colleges of Acupuncture and Oriental Medicine may be behind the 8-ball on internet-based learning ... Mary Elaine Southard, RN, MSN wonders if we need a board of integrative practice to kick in the practice of integrative nursing ...

Corey Resnick, ND
1.  Correction: Integrator note on opposition to Michael Cronin, ND for AANP president mistaken

In the Integrator Top 10 People from 2010 I asserted that Michael Cronin, ND, president-elect of the American Association of Naturopathic Physicians, had "taken on a candidate backed by the association's administration and 3 past presidents." This stimulated the following corrective note from Corey Resnick, ND, AANP treasurer.
"Thanks for another informative issue of the Integrator Blog. I wanted to note one correction in your article about Dr. Cronin. I thought his inclusion in your Top 10 for 2010 was most appropriate. Michael was not among the slate of candidates put forward by the AANP Nominating Committee and it's true that some past AANP presidents publicly backed Dr. [Tim] Birdsall for the president-elect position. However, I'm not aware of any evidence that AANP administration or staff endorsed, campaigned for or against, or backed any of the candidates in the recent election contrary to your comment to that effect."
Comment:  Apologies for this belated publication of this correction.

Dan Cherkin, PhD
2. Group Health researchers Cherkin and Sherman: "Fun to weave together patient comments" on CAM treatment

The Integrator article on "positive side effects" included those reported by Dan Cherkin, PhD and his colleague, Karen Sherman, PhD, at Group Health Research Institute. They analyzed previously unpublished comments of patients associated with their earlier reports from low-back pain trials. I sent Cherkin notice of my use of his work.
"Thanks for letting us know about this, John.  It was fun to weave together the fascinating comments of the participants in several of our trials into a story. These comments were all a by-product of our RCTs, which needed to emphasize the quantitative findings.  It is remarkable what one might discover if we actually ask people to share their experiences in words rather than numbers!"
Sherman, also in the e-loop, added this comment:
"Thanks, John. We've certainly struggled as do all researchers to fully understand the benefits of CAM from the patients perspective. I am happy for you to share our work."
Karen Sherman, PhD
: I responded in part to the Cherkin-Sherman work as a sometimes patient of integrative practitioners. The list they reported is, to me, a significant under-explored vein of wealth. This is particularly valuable for an era that has aspirationally branded itself as "patient-centered" but falls short in living up to the brand. I take this opportunity to replay their remarkable findings. In a patient-centered era, shouldn't all research seek to capture and routinely report qualitative outcomes? Certainly NCCAM has good reason to lead the way in pushing this direction, given the patient-demand that led to formation of NCCAM. Here, again, were the "unanticipated benefits" in their findings:
"Our analysis identified a range of positive outcomes that participants in CAM trials considered important but were not captured by standard quantitative outcome measures. Positive outcome themes included increased options and hope, increased ability to relax, positive changes in emotional states, increased body awareness, changes in thinking that increased the ability to cope with back pain, increased sense of well-being, improvement in physical conditions unrelated to back pain, increased energy, increased patient activation, and dramatic improvements in health or well-being. The first five of these themes were mentioned for all of the CAM treatments, while others tended to be more treatment specific.

Susan Luck, RN, BS, MA
3.  Susan Luck, RN: Regarding the IOM on essential benefits and "noctors and durses"

Low involvement of the integrative practice community in commenting on the IOM's call for comments on the "essential benefits package" prompted a response from holistic nurse policy leader Susan Luck, RN, BS, MA, HNC, CCN. Luck also referenced a blog post in which opponents of the IOM's support for nurses dubbed independent nurse practitioners "noctors."
"Great summary of year's events. A few thoughts: I, along with many nurses did respond to the opportunity to comment to the IOM on CAM and integrative health care. They did write back that our comments were being read and would be posted on their website for public viewing.
"The thrust of my comments were to bring the over 3 million nurses into wellness and prevention initiatives as they are practicing in all sectors of health care and can greatly impact the health of individuals and communities. Building on nursing skills, and developing new ones, including coaching, and education in integrative care and CAM modalities.
"They can not only be part of a collaborative and integrative care team, but can be independent practitioners and providers and need to receive direct reimbursement for prevention education and coaching services.
"Nurses DO NOT want to be Noctors but perhaps physicians can become more like nurses, providing more care and compassion... and then we can respectfully refer to them as Durses."
Comment: I share Luck's bias that we could stand to have a few more "durses" out there. The recent study showing diabetics respond to better to empathetic practitioners is yet more evidence of the importance of what nurses have typically brought to the bedside and exam table better than most doctors. 

Jan Schwartz, MA
4.  Jan Schwartz, MA: Acupuncture schools should consider mixed online instruction

In Round-up #40 I included the list of the goals of the Council of Colleges of Acupuncture and Oriental Medicine. This stimulated a response from Integrator adviser Jan Schwartz, MA, co-owner of Education and Training Solutions. Schwartz' firm specializes in online learning.
"In the article about the CCAOM's goals in Round-up #40, I noted with interest the last two goals. I hope the CCAOM is communicating with the ACAOM [Accreditation Commission for Acupuncture and Oriental Medicine]. The latter has been studying the issue of online learning for at least a year now with no decisions that I know of. Goals 4 (Promote the effective use of technology) and 5 (Enhance faculty development and student learning) go hand in hand these days.

"The jury is no longer out on the efficacy of hybrid or blended learning-it's been proven to be effective. Hybrid courses are a great way to introduce faculty (and students) to technology and web-based learning. (By definition, hybrid means that between 30% and 79% of the course is online, which provides for much flexibility). I'd like to see ACAOM move forward with standards for allowing schools to come into the 21 st century and use technology to make use of a proven method of delivery of education that can enhance student learning and faculty development.  I speak not as an acupuncturist, but as a faculty member at an accredited acupuncture school.  (Full disclosure: I make my living through online education)."

Comment: Since observing my spouse earn an MPH via an online program at U Mass Amherst over a 3 year period while we lived in Costa Rica, Nicaragua, then Seattle, I have been a fan of quality online instruction. For clinical degrees, hybrids seem the way things are moving. My guess is that some of the resistance from the "CAM" academics is left over trauma from being tarred with charges of mail-order diplomas.

Mary Elaine Southard, RN, MSN
5. Mary Elaine Southard, RN, MSN: Time for a Board of integrative practitioners?

coverage of efforts to set standards for health coaches, and coaching by holistic nurses, led to this thoughtful submission from Mary Elaine Southard, a coach who is part of the World Health and Healing Collaborative.
Holistic Nursing: Why States Are Afraid
of Opening the Gates to Better Health

"After completing a post master' s certificate in Holistic Nursing in 2002, I looked forward to a new role as a nurse practitioner.  I had been in the profession 25 years by then, working as a Clinical Nurse Specialist in cancer care.  My previous masters program prepared me for consultant, advocate and program specialist but I was looking for an expanded role and possibly broader financial opportunities.

"Eight years later, I am still not
practicing as a Holistic Nurse Practitioner
in the state in which I reside."

"Holistic Nursing spoke to me on so many levels.  Nutrition, energy, herbs, homeopathy, cultural perspectives in health and healing. Seeing the limitations of conventional care made me open to learning other traditions and approaches, to assist patients in including non- traditional modalities into their plan of care.

"Eight years later, I am still not practicing as a Holistic Nurse Practitioner in the state in which I reside.  Former classmates residing in adjoining states have similar practice restrictions. Public acceptance of Complementary or Integrative therapies has grown and there are centers throughout the country providing integrative care.   To some State Boards of Nursing, Holistic Nursing remains too much on the fringe.  When I requested a hearing at the SBON, the question posed was "How can we guarantee that if you hang out a shingle, you will provide quality care to the residents of this Commonwealth?" Good question, but how does any licensing board guarantee that of the professionals under their watch.  I choose to go to one of the most prestigious nursing academic institutions in the country, a nationally recognized program and became Board Certified in my specialty.  So, exactly what is the bias to Integrative Care?

"When I read articles suggesting that states want to expand the role of nurses due to our growing health care crisis, I question the approach and logic to denial of holistic practitioners. Limiting access to practitioners is also limiting access to care. Holistic NP's bring a unique skill-set and knowledge base of BOTH traditional and nontraditional modalities, offering patients options and choices.

  "As holistic nurses, we need to
claim our role as practitioner,
educator, coach and consultant."

"Is it time for states to adopt a Board of Integrative Practitioners?  Many national nursing leaders whom I have spoken to think not. Fragmentation of nursing at this critical time in health care reform is not the answer.  Recognizing reciprocity of CRNP's and non restrictive licensure would allow nurses to practice in underserved areas. New state-wide initiatives dedicated to managing chronic care patients are in need of primary providers.  Holistic NP's  are an invaluable asset to the health care team by providing cost effective treatment options and engaging patients in taking a more active role in their health. As health coaches, HNP's encourage, support and address core behavior patterns.  Non-nursing practitioners, some who have limited education or experience, are providing "holistic consultations" with no correlation to medical history, knowledge of medications or drug interactions. As holistic nurses, we need to claim our role as practitioner, educator, coach and consultant.  Better health care is a team approach and Holistic NP's are an integral member of that team."

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Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......moreJohn Weeks
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