Abstract
We are presenting an integrative paradigm of care. We will review the basis for its evolution from prior series and parallel models. In this paradigm, healing and palliation (when indicated) are introduced in parallel with curative measures as soon as any diagnosis, especially a critical one, is made. Frequently palliative measures address patient symptoms, such as pain, anxiety, delirium, or depression, and are geared towards comfort care at the end of life. Our view of healing care is that it actively addresses the cognitive, emotional and spiritual needs of the patient and family, and includes the elements of palliative care as a complement. Because a loss is often experienced in many conditions, even in the absence of death, bereavement is represented in our model as an ongoing, continual process throughout a disease process. While we will be drawing mainly from experiences with children, the proposed model is applicable to all ages. In order to implement this model most effectively, it will be important to shift from our mindset of “doing to” to one that includes “being with” our patients and their families. The uniqueness of this paradigm, in contrast to other models, is its comprehensiveness and universality. It is appropriate for patients of any age, at any stage of their disease or illness, regardless of the severity or duration of their condition.
This is a preview of subscription content, access via your institution
Relevant articles
Open Access articles citing this article.
-
When a child dies: a systematic review of well-defined parent-focused bereavement interventions and their alignment with grief- and loss theories
BMC Palliative Care Open Access 12 March 2020
-
Building Bridges, Paediatric Palliative Care in Belgium: A secondary data analysis of annual paediatric liaison team reports from 2010 to 2014
BMC Palliative Care Open Access 22 May 2018
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Milstein JM . Detoxifying death in the neonate: in search of meaningfulness at the end of life. J Perinatol 2003;23:333–336.
Frager G . Palliative care and terminal care in children. Child Adolesc Psychol Clin N Am 1997;6:889–909.
Engel GL . The need for a new medical model: a challenge for biomedicine. Science 1977;196:129–136.
Lerner M . Healing and curing: the starting point for informed choice. In: Choices in Healing. Cambridge, MA: MIT Press; 1994.
Kleinman A . The Illness Narratives: Suffering, Healing and The Human Condition. New York, NY: Basic Books; 1988.
Charon R . Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA 2001;286:1897–1902.
Charon R . Narrative medicine: form, function, and ethics. Ann Int Med 2001;134:83–87.
Meyers FJ, Linder J . Simultaneous care: disease treatment and palliative care throughout illness. J Clin Oncol 2003;21:1412–1415.
Children's International Project on Palliative / Hospice Services (ChIPPS). Compendium of Pediatric Palliative Care. Alexandria, VA: National Hospice and Palliative Care Organization; 2000.
Milstein JM, Little TH . Invoking spirituality in medical care. Alt Therap 2000;6:118–120.
Toedter LJ, Lasker JN, Jannssen HJEM . International comparison of studies using the perinatal grief scale: a decade of research on pregnancy loss. Death Studies 2001;25:205–228.
Potvin L, Lasker JN, Toedter LJ . Measuring grief: a short version of the perinatal grief scale. J Psychopathol Behav Assess 1989;11:29–45.
Fauri DP, Ettner B, Kovacs PJ . Bereavement services in acute care settings. Death Stud 1999;24:51–64.
Bailey SE, Dunham K, Kral MJ . Factor structure of the grief experience questionnaire. Death Stud 2000;24:721–738.
Tudehope DI, Iredell J, Rodgers D, Gunn A . Neonatal death: grieving families. Med J Aus 1986;144:290–292.
Worden JW . Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner. 3rd ed. New York: Springer Publishing Company; 2002.
Janoff-Bulman R, Frieze I . A theoretical perspective for understanding reactions to victimization. J Soc Iss 1983;39:1–17.
Williams ME, Hadler NM . Sounding board: the illness as the focus of geriatric medicine. New Engl J Med 1983;308:1357–1360.
Winnicott DW . Human Nature. London: Free Association Books; 1988.
Benner P . From Novice to Expert. Excellence and Power in Clinical Nursing Practice. Boston, MA: Addison-Wesley; 1984.
Reynolds M . Reflecting on paediatric oncology nursing practice using Benner's helping role as a framework to examine aspects of caring. Eur J Oncol Nurs 2002;6:30–36.
Milstein JM, Gerstenberger AE, Barton S . Healing the caregiver. J Alt Compl Med 2002;8:917–920.
Razavi D, Delvaux N . Communication skills and psychological training in oncology. Eur J Cancer 1997;33(Suppl 6):S15–S21.
Kubler-Ross E . On Children and Death. New York: Simon & Schuster; 1997.
Stuart MR, Lieberman JA . The Fifteen Minute Hour: Applied Psychotherapy for The Primary Care Physician. Westport, CT: Praeger Publishers; 1993.
Acknowledgements
This work was presented in part at the Southern Society for Pediatric Research in February of 2002. I thank Tanya Jarvik for editorial assistance, Stephen H Bennett for technical assistance and encouragement, and Roberto D Paez, Debora A Paterniti, Bonnie J Raingruber, and Theodore Zwerdling for manuscript review.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Milstein, J. A Paradigm of Integrative Care: Healing with Curing Throughout Life, “Being with” and “Doing to”. J Perinatol 25, 563–568 (2005). https://doi.org/10.1038/sj.jp.7211358
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7211358
This article is cited by
-
When a child dies: a systematic review of well-defined parent-focused bereavement interventions and their alignment with grief- and loss theories
BMC Palliative Care (2020)
-
Building Bridges, Paediatric Palliative Care in Belgium: A secondary data analysis of annual paediatric liaison team reports from 2010 to 2014
BMC Palliative Care (2018)