powerpoint presentation · o avoiding expressing personal beliefs to clients in ways that ......

HMCL221

www.endeavour.edu.au

Session 05a

Introduction to

Complementary Medicine

Clinical Practice

© Endeavour College of Natural Health www.endeavour.edu.au 2

Session 5

Therapeutic Relationship:

• Healing presence

• Placebo effect

• Boundaries and ethics


Session 5

Therapeutic Relationship:

• Guiding patient expectations

• Patient values

• Social and ethnic diversity

considerations


Session 5

Other clinical considerations:

• Professionalism

• Professional responsibility/liability

• Time management


Session 5

Other clinical considerations:

• Financial considerations

• Different clinical approaches:

group visits, community

acupuncture, etc.


Session 5

Tutorial activity

Online discussion of the therapeutic

relationship and other clinical considerations

in a complementary medicine consultation.


Healing Presence

Quality possessed by practitioner,

which inspires healing in others.

Aura of knowledge and experience recognisable as

wisdom, which the practitioner projects engendering

confidence in the practitioner’s ability and skill.


Healing Presence

Watch this video:

Healing Presence

Key Concepts:

o Practitioners who inspire self-healing in others

o Generates meaning in the relationship

o Non-specific effect

o A state of Being, Empathy, active listening and deep

caring

o “Words can be medicine”- words generate the world

around us

https://www.youtube.com/watch?v=erS0maqhpWk


Healing Presence

What characterises Healing Presence?

Reading

HMCL221 SN05 Reading-Fostering a Healing Presence

Attributes and Belief Systems of Person(s) that

Characterize Healing Presence (page 4)

o Therapeutic Relationship

o Empathy

o Compassion

o Charisma

o Spirituality

o Intention

(McDonough-Means, Kreitzer, & Bell, 2004)


Healing Presence

Attributes and Belief Systems of Person(s) that

Characterize Healing Presence (page 4) cont’d

o Transpersonal Communication

o Healee psychology

o Optimism

o Expectancy and Belief

o Surrounding physical environment

(McDonough-Means, Kreitzer, & Bell, 2004)


Discussion Forum

Tutorial Participation Activity

Look through the questions posed in the reading Fostering

a Healing Presence under the section Questions for

Consideration on page 9. Choose any two questions and

provide your opinion of possible answers to the questions

or conclusions that could be made.

HMCL221


Session 05b

Introduction to


Practice


Placebo

Oxford Dictionary definition

Placebo

noun (plural placebos)

1. A medicine or procedure prescribed for the

psychological benefit to the patient rather than for any

physiological effect.

2. A substance that has no therapeutic effect, used as a

control in testing new drugs.


Placebo

Science can’t explain the

placebo effect.

Watch this video and be prepared

to be amazed:

The Placebo Effect

https://www.youtube.com/watch?v=Zh94cEGrZqY


ConclusionsWe could hypothetically conclude when combining what we

have learnt about Healing Presence with Placebo that:

Greater Healing Presence perceived in a

practitioner may lead to greater patient confidence

in the practitioner’s ability and therefore due to the

effect of placebo increase healing outcomes for

the patient.


Professional Boundaries

o Are essential to a good practitioner–patient

relationship

o Protect both patients and practitioners

o Recognised in most Codes of Conduct for health

practitioners

BUT…

In reality, it may sometimes be difficult to decide at what

point the fine line of professional boundaries has been

over stepped and where it might become necessary for

a practitioner to terminate the relationship with a

patient.


Professional Boundaries

Professional boundaries are integral to Good Practice. Good

practice involves a practitioner:

o Maintaining professional boundaries.

o Never using professional position to establish or pursue an

exploitative or other inappropriate relationship with anybody

under their care. This includes those close to the patient, such

as their carer, guardian or spouse or the parent of a child

client.

o Avoiding expressing personal beliefs to clients in ways that

exploit their vulnerability or that are likely to cause them

ddistress.

(Medical Board of Australia, 2009)


Examples of CAM practitioners Code of

Conduct & Ethics

o ANTA

http://www.australiannaturaltherapistsassociation.com.au

/downloads/anta_codeofethics.pdf

o ATMS

http://www.atms.com.au/uploads/pdf/New_ATMS_Code

%20of%20Conduct.pdf

o NHAA

http://www.nhaa.org.au/index.php?option=com_content&

view=article&id=81&Itemid=76

http://www.australiannaturaltherapistsassociation.com.au/downloads/anta_codeofethics.pdf

http://www.atms.com.au/uploads/pdf/New_ATMS_Code of Conduct.pdf

http://www.nhaa.org.au/index.php?option=com_content&view=article&id=81&Itemid=76


General Code of Professional

Ethics in Clinico Always respect the rights and dignity of the clinic

client;

o Always maintain the utmost standard of

professional competence and behaviour;

o Ensure that all information about the consultation

and treatment being offered to the client is

understood. All consultation, assessment and

treatment must be carried out with the informed

consent of the clinic client;(Endeavour Clinic Handbook, 2014)


General Code of Professional

Ethics in ClinicContinued…

o Always ensure client confidentiality and

privacy;

o Take care to ensure a high standard of

hygiene and promote safe practices.

(Endeavour Clinic Handbook, 2014)


Patient Expectations

o Meeting or failing to meet the care patients hope for is an

important predictor of patient satisfaction.

o Identification and clarification of patient expectations is

an essential part of the consultation process.

o Unrealistic patient expectations need to be identified and

discussed with the patient by the practitioner in the early

stages of the practitioner-patient relationship and also as

they arise throughout the treatment process.

o Unmet expectations may increase the likelihood of

complaint or even claim against a practitioner.



Patient expectations of doctors:

1. Confident - “The doctor’s confidence gives me confidence.”

2. Empathetic - “The doctor tries to understand what I am feeling &

experiencing, physically and emotionally, and communicates that

understanding to me.”

3. Humane - “The doctor is caring, compassionate, and kind.”

4. Personal - “The doctor is interested in me more than just as a

patient; he/she interacts with me, and remembers me as an

individual.”

5. Forthright - “The doctor tells me what I need to know in plain

language.”

6. Respectful - “The doctor takes my input seriously and works with

me.”

7. Thorough - “The doctor is conscientious and persistent.”

(Bendapudi et al., 2006)



o Managing unrealistic patient expectations

• Most issues of patient dissatisfaction and complaints regarding

health care result from poor communication between practitioner

and patient.

• Establishment of a sound patient-practitioner relationship

(therapeutic relationship) and clear, open communication are the

keys to preventing/minimising unmet expectations.

• “What are you hoping to achieve from this appointment?” (What

are your expectations?) can be a relevant question for a

practitioner to ask in the first consultation.

(www.fluenceportland.com, n.d.)

http://www.fluenceportland.com/


Discussion Forum

Draw on your knowledge about Healing Presence and the

influence Placebo Effect may have on Healing Presence.

Discuss on the Forum how Healing Presence may effect

Professional Boundaries and Patient Expectation.

In particular take into consideration a patient’s needs,

wants and vulnerabilities when they are not well and how

that may influence how they may interact with a practitioner

who portrays characteristics of Healing Presence. Provide

possible positive and negative interactions between the

patient and practitioner.

HMCL221


Session 05c

Introduction to


Practice


Patient Values

Patient values and beliefs are linked to

culture and heritage and are therefore

best discussed under Social and Ethnic

Diversity coming up next.


Social and Ethnic Diversity

Key Concepts:

o Social Norms

o Cultural Diversity

o Cultural Desire

o Cultural Awareness

o Cultural Competency

o Heritage

o Cultural Care


Social Norms

o The idea of norms provides a key to understanding

social influence in general and conformity in particular.

o Social norms are the accepted standards of behaviour of

social groups – ranging from friendship and work group,

health care settings and governments etc.

o Behaviour which fulfils these norms is called conformity,

and most of the time roles and norms are powerful ways

of understanding and predicting what people will do.

o Norms provide order in society.

(http://alearningaday.com/2

012/03/on-day-care-centre-

norms.html, n.d.)

http://alearningaday.com/2012/03/on-day-care-centre-norms.html


Cultural Diversity Australian PopulationTOP 10 COUNTRIES OF BIRTH FOR THE OVERSEAS-BORN

POPULATION

Country of birth Persons Proportion of all

overseas-born

Median age Sex ratio(a)

'000 % years

United Kingdom 1 101.1 20.8 54 101.7

New Zealand 483.4 9.1 40 102.8

China(b) 319.0 6.0 35 79.8

India 295.4 5.6 31 125.2

Italy 185.4 3.5 68 104.7

Vietnam 185.0 3.5 43 84.6

Philippines 171.2 3.2 39 60.6

South Africa 145.7 2.8 39 96.9

Malaysia 116.2 2.2 39 83.5

Germany 108.0 2.0 62 90.6

Born elsewhere overseas 2 183.8 41.2 44 95.6

Total overseas-born 5 294.2 100 45 96.1

(a) Number of males per 100 females.

(b) Excludes Special Administrative Regions and Taiwan Province.

(ABS, 2013)


Cultural Desire

o Cultural desire is defined as the motivation to become engaged in the process of becoming culturally aware, culturally knowledgeable, culturally skillful, and seeking cultural encounters.

o It stands in contrast to the feeling of "having to" participate in this process.


Cultural Desire

o Cultural desire includes a genuine passion to be

open and flexible with others, to accept

differences and build on similarities, and to be

willing to learn from others as cultural

informants. This type of learning is a life-long

process which has been referred to as cultural

humility.


Cultural Competence

o Cultural desire is the pivotal and key construct of cultural competence, for it is the healthcare provider’s desire that evokes the entire process of cultural competence.

o Cultural competence refers to an ability to interact effectively with people of different cultures and socio-economic backgrounds.

o Cultural desire involves the concept of caring.

o It has been said that people don't care how much you know, until they first know how much you care.

(Campinha-Bacote, 2003)


Cultural Knowledge and Awareness

o Cultural knowledge is the familiarisation with selected cultural characteristics, history, traditions, values, belief systems and behaviors of the members of other ethnic groups.

o Cultural knowledge is not stereotyping, it is ongoing learning, understanding and accepting other’s culture, race ethnicity, nationality, religion, customs or belief systems.

(Adams, 1995)


Cultural Knowledge and Awareness

o Cultural intelligence is a person's capability to function effectively in situations characterised by cultural (or social) diversity.

o Cultural intelligence is a critical capability that enhances individual and organisational effectiveness. It also enhances interpersonal interactions in a wide range of social contexts.


Cultural Care

o Cultural Care is the provision of health care

across cultural boundaries that takes into

consideration the context in which the client lives

as well as the situations in which the client’s

health problems arise.

(Jarvis, 2012)


Cultural Competence Cultural Care

o Culturally sensitive implies that caregivers possess

some basic knowledge of the constructive attitudes

toward the diverse cultural populations found in the

setting in which they are practising.

o Culturally appropriate implies that the caregivers apply

the underlying background knowledge that must be

possessed to provide a given person with the best

possible health care.

o Culturally competent implies that the caregiver

understand and attends to the total context of the

individual’s situation, including awareness of immigration

status, stress factors, other social factors, and cultural

similarities and differences. (Jarvis, 2012)


Guide for Cultural Care - RESPECT

o R = realise that you must know and understand your

heritage and that of the client

o E = examine your client within the context of their

cultural boundaries

o S = select questions that are not complex, and do not

ask too rapidly

o P = pace questions throughout physical examination

o E = encourage your client to discuss their understanding

of health and illness to you

o C = check for your clients understanding of your

recommendations

o T = touch your client within the boundaries of his or her

heritage (Jarvis, 2012)


Cultural Competence Checklist

o http://www.asha.org/uploadedFiles/Cultural-

Competence-Checklist-Personal-Reflection.pdf

(www.flickr.com, n.d.)

http://www.asha.org/uploadedFiles/Cultural-Competence-Checklist-Personal-Reflection.pdf

http://www.flickr.com/


Demographic Risk Factors

o Tobacco smoking

o Excessive alcohol

o Poor diet and nutrition

o Physical inactivity

o Excessive sun

exposure

o Insufficient

vaccination

o Unprotected sexual

activity

Demographic factors include age, sex and population

subgroups. Examples of demographic risk factors

include:


Health Disparity

o A health disparity is an unusual and disproportionate

incidence and/or prevalence of a specific health

condition in a population group, such as:

• High incidence of diabetes among Indigenous Australians

• High incidence of kidney failure among Indigenous Australians

• Obesity prevalence is higher among lower SES

(Office of Public

Engagement, University

of Minnesota, n.d.)


National Health Priority Areas

o Australian Institute of Health and Welfare

http://www.aihw.gov.au/national-health-priority-areas/

• Cancer

• Cardiovascular disease

• Diabetes

• Obesity

• Arthritis and Musculoskeletal Problems

• Mental health

• Dementia

http://www.aihw.gov.au/national-health-priority-areas/


Demographic Profile of CAM Users

o In terms of their health, CAM users tend to have more

than one medical condition, but might not be more likely

than non-users to have specific conditions such as

cancer or to rate their own general health as poor.

o The estimated use of CAM among Australian population

varies. It is widely known that more than 50% of people

in their experience with cancer use some form of CAM

therapy.

o The evidence suggests that people who visit a

naturopath or herbalist tend to be female, of middle age

and have higher education and income. (Bishop & Lewith, 2010; Chi-Wai Lui et al., 2012)

HMCL221


Session 05d

Introduction to


Practice


Professionalism

o The old model of medical professionalism

valued qualities such as

• Detachment

• Paternalism

• Restricted communication with patients

• Ethically grounded in beneficence


Professionalism

o New medical professionalism encompasses:

• Empathy

• Emotional engagement

• Open communication

• Patient-centredness

• Ethically grounded in patient autonomy.


Professional Responsibility/Liability

o A professional practitioner is obligated to provide care or

service that meets the standard of practice for his/her

profession – i.e. It is their responsibility.

o Professional Liability is the legal obligation of health care

professionals or their insurers to compensate patients for

injury or suffering caused by acts of negligence, as a

result of the practitioner not meeting their professions

standard of practice.


Time Management

A patient’s time is valuable and is to be respected.

Schedule patients efficiently

Manage flow and time of consultation


Time Management

Timely management of SOAP Consultation process.

o Introductions 3-5 mins

o Case taking 30-40 mins

o Examination 5-10 mins

o Assessment 5-10 mins

o Treatment/Treatment Planning/Prescription 10-30 mins

o Strategising case management with the patient 5-10mins


Financial Considerations

o Health care must be of value to patients and take into

consideration cost containment and customer safety,

convenience, service and satisfaction while being financially

viable to provide by the practitioner.

Patient Value

Patient health outcomes : Cost of delivering the outcomes

o Access and affordability of health care closes health

disparities.

(Bishop & Lewith, 2010)


CAM practitioners contribute to

value-based health care

• Patient-centred

• Individualised care according to level of

self-efficacy – achievable steps

• Goal based

• Evidence-based

• Education focussed

• Culturally sensitive and competent

• Patient empowerment

• Supportive of change

• Most importantly - realistic, ethical, safe


Different Clinical Approaches

o Individual Practitioner Multi-modality Clinic

o Clinical Specialist – e.g. specialising in women’s health

o Multi-practitioner multimodality practice

o Integrated Health Practice – Conventional and

Complementary Medicine practitioners

o Multiple roomed or cubicle practice e.g. acupuncture

o Community Clinic – price conscious provision of services

to lower socio economic groups.

o Mobile practice


Multimodality Holistic Clinic

https://www.wellnationclinics.com.au/

https://www.wellnationclinics.com.au/


Integrated Health Practice

Conventional and Complementary Medicine

practitioners e.g. http://niim.com.au/

o Integrative General

Practice

o Medical Specialists

o Complementary Medicine

o Family Medicine

o Anti-Ageing Medicine

o Psychiatry Services

o Psychology and

Counselling Services

o Naturopathy

o Osteopathy

o Exercise Physiology

o Acupuncture & Chinese

Medicine

o Myotherapy

http://niim.com.au/


Multiple roomed or cubicle practice

e.g. acupuncture

(http://www.citycollegeofacupuncture.com/cpd.html, n.d.)

http://www.citycollegeofacupuncture.com/cpd.html


Community Clinic

o Leichhardt Women’s Community Health Centre provides

low-cost and affordable medical, allied and

complementary health care and education to improve

women’s health. It is a non-government and not for

profit. http://www.lwchc.org.au/

o In Community Acupuncture, the cost of a treatment is

less because the acupuncturist's time and space are

shared. Groups of five or six people receive acupuncture

simultaneously. http://www.chrispickrell.com/rcac/

http://www.lwchc.org.au/

http://www.chrispickrell.com/rcac/


Mobile practice

(http://www.ahh.net.au/mobile-massage-brisbane/, n.d.)

http://www.ahh.net.au/mobile-massage-brisbane/


Good Luck in your

Mid-semester Exam

Quiz


References

Australian Bureau of Statistics (ABS). (2013). 2071.0 - Reflecting a Nation:

Stories from the 2011 Census, 2012–2013. Retrieved from

http://www.abs.gov.au/ausstats/[email protected]/mf/2071.0

Adams, D.L. (1995). Health issues for women of colour: A cultural diversity

perspective. Thousand Oaks: SAGE Publications.

Bendapudi, N.M., Berry, L.L., Frey, K.A., Parish, J.T., & Rayburn, W.L.

(2006). Patients’ perspectives on ideal physician behaviours.

Mayo Clinic proceedings. Mayo Clinic, 81(3), 338–344.

Bishop, F.L., & Lewith, G.T. (2010). Who uses CAM a narrative review of

demographic characteristics and health factors associated with

CAM use. Evidence-based Complementary and Alternative

Medicine, 7(1), 11–28.

Campinha-Bacote, J. (2003). Many faces: Addressing diversity in health

care. Online Journal of Issues in Nursing, 8(1), 3.

http://www.abs.gov.au/ausstats/[email protected]/mf/2071.0


References Jarvis, C. (2012). Physical examination & health assessment (6th ed.). St

Louis, MO: Elsevier Saunders.

McDonough-Means, S.I., Kreitzer, M.J., & Bell, I.R. (2004). Fostering a

healing presence and investigating its mediators. Journal of

Alternative and Complementary Medicine (New York, N.Y.),10(1),

S25–S41.

Medical Board of Australia. (2009). Good medical practice: A code of

conduct for doctors in Australia. Retrieved from

http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx

Porter, M.E. (2014). Value-based health care delivery. Institute For

Strategy And Competitiveness, Harvard Business School.

Retrieved from

http://www.hbs.edu/faculty/Publication%20Files/3_13615129-

eeec-4987-bf1a-1261ff86ae69.pdf

http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx

http://www.hbs.edu/faculty/Publication Files/3_13615129-eeec-4987-bf1a-1261ff86ae69.pdf

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