University of Arizona College of Nursing Clinical Assistant Professor Patricia Daly, PhD, FNP-BC, ENP-BC, has been an emergency and urgent care nurse practitioner for more than 25 years. A 2013 graduate from the UA College of Nursing PhD program, she has championed integrative nursing techniques throughout her career. Currently, she investigates mindful-eating interventions to address obesity in adolescents and adults. We sat down with her recently to discuss her history with integrative health care.
How do you incorporate integrative health into pain management?
My interest actually began when I was working in emergency room nursing. Back then, adult and child patients were often kept in the same area, and working with children was a real focus of mine. Whenever I’d have to suture someone I’d explain that they’ll want to focus their attention away from the pain. For children the kindest thing you can be is fast, but you also want to engage their mind somewhere else. I began telling children participatory stories to help that distraction. It’s actually a real integrative therapy called guided imagery, a powerful psychological strategy that enhances coping skills. I can time the story to the length of the suture, so if need be it can be a very long story. But the child is always the hero. Interestingly, adults who happened to overhear these stories started asking me to tell them stories, too. They would also be the heroes if the story, but I’d always start out with, ‘You just won the lottery. Where are you going to travel?’ and go from there. It was a really effective use of integrative therapy and I still employ it today.
You’re a big advocate of alternative pain management. Can you tell us about that?
In all my years in the ER, I have never written a prescription for more than six narcotic pills because I think pain management is not done best with pharmacological agents. Considering today’s opioid epidemic, that’s really important. Almost every narcotic addict is addicted because one of us wrote the first script. They told them, ‘Take this for pain,’ when they should have said ‘You’re going to have pain and that’s not going to kill you, but that drug might kill you.’ I teach nurse practitioners that when someone is drug-seeking that person has a health care issue: its addiction. If you just write them a prescription for some medicine you’ve done nothing but perpetuate the problem. I tell students ‘Okay, try to go in that room and make it a win-win. You are not giving the narcotic pain prescription and the patient’s going to leave satisfied. That is your goal.’ That person is suffering and so it’s important to listen to the patient, and that’s what integrative health is about: the whole person.
How has integrative care changed over the years?
From my perspective, nursing has always been integrative. In the ‘70s, the definition of nursing was ‘helping people cope with illness or changes in their life cycle.’ That’s why nursing was always strong in hospice, always strong in end-of-life care. Comparatively, disease-focused models, or germ theory, for the most part doesn’t work. Health has to do with how much sleep you get, what you eat and other lifestyle choices. It’s important to realize that almost all of pharmacology imitates what your body does. Why can a Yogi lower their blood pressure at will without a beta-blocker? How can someone walk across hot coals without serious injury? The receptors that drugs tie to in your brain or other parts of your body didn’t grow there because they thought you might make a drug someday that might go there. That’s your body chemistry. For some people it’s very controllable, and that’s where eastern medicine kind of came from. There is something more than we can measure, and I feel like nurses always know that.
How do you inform your students about the importance of integrative care?
I talk to students about balance constantly. In nursing, that’s especially true because a lot of them are overachievers. They can work all night. They have so much compassion, and they are so giving of themselves to the point where they don’t fill themselves back up. In the end, it’s about life balance. That’s true for almost every patient, too: You help them try to find some life balance, and integrative nursing is the way that’s done.