Mind Body Integration:

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Mind Body Integration Culture Change Kathie
Nichols, BSN RN CRRN Nancy Flinn, PhD OTR/L Age
and Disability Odyssey, August 18, 2009
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Courage Center

• Courage Center is an 80-year old community-based
  rehabilitation and resource center
• 48 bed inpatient rehabilitation facility (SNF)
• Outpatient rehabilitation services at 4 sites in
  the metro area and the community (PT, OT, SLP)
• Vocational and Psychological services
• Drivers assessment and treatment at 9 sites
  throughout the state
• Health, wellness and fitness programs for
  individuals with disabilities
• Independent Living Skills Program
• Chemical dependency treatment (outpatient)
• Chronic Pain Program (inpatient)

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Issues in Health Care Today

• Staff experience stress and burnout
• Unacceptably high rate of turnover
• Shortages of some professions made this even
  more challenging
• Changes in health care continuum
• Patients more acute throughout the system

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Costs of losing staff

• It has been estimated that training a new staff
  member (including recruitment) costs an
  organization about 40,000
• Use of Traveler or Agency staff is very
  expensive and can be avoided if facilities retain
  staff
• Use of Travelers or Agency staff make it
  difficult to develop continuity across programs
• Mission of the organization become diluted by
  large numbers of itinerant staff

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Staff concerns

• Nurses and therapists show higher rates of
  burnout and secondary stress due to their
  supportive care giving role
• Nurses and staff who empathize with clients can
  share clients emotional reactions
• Constant sharing of clients stress can lead to
  draining of emotional resources
• Sleeping difficulty, emotional detachment,
  increased rates of job dissatisfaction.
• (J. Watts, HICPRO 9 (27), www.hcpro.com,
  Strategies for Nurse Managers)

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Mind Body Integration at Courage Center

• Courage Center was experiencing similar issues
  in our organization.

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Mind Body Integration at Courage Center

• Matt Sanford is a paraplegic who has run an
  adapted yoga class for 10 years
• He proposed training in mind body techniques for
  staff
• Phase I started January 2008 with a 2 ½ day
  immersion weekend at Camp Courage
• Project continued for one year

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Mind Body Integration at Courage Center

• Course was run as a research project so that
  data could be collected and shared more freely
• The training model was a 2 ½ day immersion, 8
  weekly 1 ½ hour session,
• 8 monthly 1 ½ hour sessions
• Data collected at beginning, 2 months,
• 8 months, and 12 months

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Mind Body Integration Research Project

• The project was modeled as an initial intensive
  session (immersion weekend), which tapered over
  the year to less frequent interactions to support
  and maintain behavior change

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Mind Body Integration Project at Courage Center

• Weekly and monthly sessions focused on
• Learning new techniques
• Active problem solving about difficulties with
  implementation
• Staff learning the process of relaxation and
  practicing it in their daily interactions

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Mind Body Integration Research Project

• Data was collected across a variety of areas
  because we werent sure what the results would
  be.
• Job Stress Survey
• Workplace Satisfaction Survey
• Physical measures of HR, BP and flexibility
• Flanagan Quality of Life Survey
• Commitment to profession and employer
• Measures of use of the techniques
• Qualitative measures

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Pre-Test Data Areas of Concern

• Commitment to the profession and commitment to
  the organization were very concerning.
• 62 of participants reported that they had
  seriously considered leaving Courage in the last
  year
• 28 had seriously considered leaving their
  professions in the last year

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Pre-Test Data Areas of Concern

• Job Stress and Job Pressure levels were high
• Qualitatively, staff reported burn out,
  compassion fatigue, and being consumed by the
  emotional experiences of their clients
• Staff turnover high

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Mini-Lab
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Staff Impact of Mind Body Integration

• Program was initially promoted to staff as a
  client-care technique
• Staff soon came to realize that it was important
  for self care
• Staff reported improvements in health and coping
  after using the techniques on themselves

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Staff Impact of Mind Body Integration

• Other staff noticed changes, and wanted training
  themselves
• This built momentum for the Phase II group of
  staff to start the program in November 2008

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My treatments have changed because I am able to
treat with better compassionate boundaries
without giving too much of myself. Prior to this
experience I feel that I gave too much of myself
while trying to fix my clients. Now that I am
able to establish the rapport and work as hard as
my clients do, I can let them know that I am
there for them and willing to put in 100 if they
are too. I dont feel as tired and burnt out when
I finish a treatment session.
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Applications to therapy

• Staff found that focusing on client concerns and
  slowing down treatment improved their outcomes
• Using these techniques, staff were better able
  to understand what their clients were feeling
  without owning those client experiences
• Staff reported doing fewer activities during a
  session, but getting better results

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Applications to therapy

• Staff also felt that they could more effectively
  teach clients to manage some of their own
  concerns
• Clients recognized the benefits of these
  techniques and requested them
• Clients reported practicing these techniques on
  their own

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A client Ive been working with had sustained
SCI, along with multiple orthopedic injuries
Consequently, he experienced significant pain in
his low back, knees and feet. He initially had
frequent complaints of low back pain, which
limited his participation in therapy. One day we
worked on having him ground his feet and elongate
his spine, then added deep breathing with eyes
closed and facial muscles relaxed. Almost
immediately, he noticed a decrease in low back
pain. He continues to use this simple technique
for pain management and it has contributed to
greater activity tolerance and less reliance on
pain meds.
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Applications to Client Care

• Integrated these techniques into nursing
  interactions with clients
• Particularly helpful as integrated into a pain
  management project
• Staff were taught to use these techniques as a
  part of relaxation, increasing sense of control,
  and focusing on self awareness.

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How Mind Body Integration works at Courage Center

• Client Centered care and Relationship Based care
• While Courage Center has always been a
  client-centered organization, this project
  allowed us to integrate that concept more
  completely.

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Examples of Client-Centered Care
I feel less pressured to obtain specific results
using specific interventions and Im noticing
that the more I invite the client to make
decisions regarding their treatment and their
priorities, the better outcomes we have during
each treatment session. When the treatment
becomes more of a partnership than an
intervention I provide to the client, we are both
more energized and positive about the experience.
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Outcomes from the Project
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Use of Techniques

• At the conclusion of the Mind Body Integration
  Project, staff reported frequent use of these
  techniques
• Staff reported using these techniques with an
  average of 61 to 80 of their client
  interactions.
• This is a high rate of use of the techniques,
  and implies that it is useful with a wide range
  of clients

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Workplace Satisfaction
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Workplace Stress

• While the frequency of stressful events remained
  the same, the severity and the effects of these
  stressful events decreased
• This suggested that the environment had not
  changed, but staffs ability to manage in that
  environment was improved

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Commitment to Courage Center and to the profession

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Significant Improvement in Quality of Life

• Primarily due to
• increased satisfaction with close relationships
  with spouses or SO
• with helping and encouraging others
• learning
• participating in active recreation

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Staff Perspective on the Project
The desire to bring this cultural change to the
larger organization was evident in the words of
one participant who said, I want as many other
therapists as possible to experience this and
reclaim the reason they became therapists.
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Qualitative Findings Four Themes

• Increased awareness of the need for self care
• Compassionate boundaries
• Renewed commitment to client-centered focus
• The change in the culture

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Mind Body Integration at Courage Center

• Through the Phase I and into Phase II, staff
  report changes in expectations and interactions,
  both with clients and with other staff.
• This change in culture is difficult to achieve,
  and would not have occurred without the prolonged
  support of the training program

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Problems with Project

• This model of training did not work for nursing
  staff because of the way their work is scheduled
• We needed to design a model specifically for
  nursing staff
• We also needed to design a training model for
  everyone else in the organization
• Less intensive
• Less hands-on

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Future of Mind Body Integration at Courage Center

• Phase II Project
• Phase III Project

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Phase II

• Trained 27 staff, primarily therapists
• This project started in November of 2008, and
  will complete in October of 2009
• Funding for Phase II was obtained through
  philanthropy, partly because we had data to
  demonstrate change
• Although we have not completed the project, it
  appears that this phase will be as effective as
  Phase I

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Phase III

• Funding for this Phase raised through
  philanthropy
• Will focus on nursing
• Will be designed around nursing staffing
  requirements
• Introduction, two full day sessions, and
• five-six monthly two hour sessions.

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Future of Mind Body Integration at Courage Center

• We are trying to use more of our own staff, and
  less external staff, so that this becomes
  self-sustaining
• We are examining the possibility of doing
  training for other organizations to help spread
  the techniques elsewhere.

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Questions? Answers?
kathie.nichols_at_couragecenter.org nancy.flinn_at_coura
gecenter.org