Helpful Hints to Getting a Bowen Therapy Policy up and Running in the Public Health Service

HELPFUL HINTS TO GETTING A BOWEN THERAPY POLICY UP AND RUNNING IN THE PUBLIC HEALTH SERVICE.

Note. This is particularly written for nurses as that where my experience is.

You have to take a step backwards to make a leap forwards. It is no good trying to introduce a Bowen Therapy policy if you don’t have a Complementary Therapy umbrella Policy in place.

• UNION. Move a motion at your next branch meeting that the delegate can present to the next delegates meeting. ….make sure you have a seconder. “ The ………branch of the …………..(NSWNA, ANF etc) requests that head office write to the ………………Dept of Health urging them to develop a State Wide policy on the use of Complementary Therapies. You can point out that the union has a policy on the use of CTs by nurses but it requires that local policies be in place and that none exist in the public health service. • AREA HEALTH SERVICE. Request to address the appropriate committee that deals with new services – in our case the Health Service and Organisational Ethics Committee. – Go through your area DON. This would be a committee containing board members. Try to get some of them on side. There should be a staff rep. Set up meetings with your NUM, DON & Area DON to discuss the issue – try to get them on side. • HOLISTIC NURSES ASSOCIATION. Join this association in your state. The NSW secretary is Cindy Redmond [email protected] she should be able to put you in touch with the body in your state. Find out if any area health services in your state have any policies on CTs. Find out and list all the health facilities, public & private that use CTs. (This demonstrates precedence). • Put out notices requesting expressions of interest from anyone in your area health service to be on a CT working party. Try for a multi disciplinary group. Contact physios, pharmacists, OTs, Nurses & Drs. • Contact your local division of GPs to find out if any GP has an interest in CTs – Go & talk to them & see if they will support the formation of a CT policy through the division of GPs. • Area Nursing Council. If your area has such a council ask your rep to put the formation of a CT policy on the next meeting agenda. –Your area DON would know who the reps are if such a committee exists. • CNC group. If you have Clinical Nurse Consultants in your state request that they discuss CTs at their next meeting. Also do the same with the Nursing Unit Managers. • Start accumulating journal articles through your hospital librarian & CIAP to back your case. If you need a CIAP password use User Name nha1244 password peep4s. See if there has been a survey made of the demand for CTs in your State. There certainly has been such a survey in NSW. I can send photocopies of anything I have (within reason). • Locally – approach your DON with a health promotion proposal to run a staff clinic to improve staff health & reduce stress. Use my work to justify why it would be a good idea. All you need is a room, tables, antenatal mats & linen. I can give you more details & ideas if required. Try for a 6 week trial of 1 hour a day (4 clients). Your results will speak for themselves. Do this through your health promotion officer – usually found in public health unit or community health. They would help you with a proposal. It seems to be a good idea to work with staff before patients as you drum up an enormous amount of support. • Write something – even a case study for the AJOHN or your local health service newsletter. Get this stuff in everybody’s face.

My pathway was 1. Surveyed work done on staff. 2. On the strength of that survey put in a health promotion project for a 6 week program of Bowen for staff. 3. Ran that program. 4. On the strength of those results I now run 3 sessions a week for staff. 5. Wrote the policy & widely distributed it for comment. 6. Put the Bowen Policy on the agenda of the Area Nursing Council. 7. Met with the area DON. Had the backing of my NUM. Presented my staff findings to anyone who would listen. 8. Put CTs on the agenda at a meeting of the State Rural & Remote Nursing Council. 9. Compiled a list of interested people for a multidisciplinary group to work on a Ct policy. 10. Applied to put the policy to the Clinical Standards Committee but had to go to the Organisational & Ethics Committee first. 11. Agenda item at union meeting. 12. Published article in AJOHN 13. Am speaking at the Holistic Nurses Assn Conference in October. 14. I keep Emailing the people given the task of writing the CT policy offering help. 15. Did workshop with the NSW Nurses registration Board to write a proposal for a grant to do a research project. Mine will be Using Bowen Therapy to reduce nurses stress. As soon As the local Bowen Policy is in place I will start this. There is plenty of money available for nurses to do fairly simple research.

I have attached as much stuff as I can think of that I have used. I would be more than happy to give you any assistance or advice.

THE INITIAL SURVEY

BOWEN THERAPY “on the run” improves staff health.

21 staff at Byron and Mullumbimby Community Health were known to have received Bowen Therapy from 1 of 2 Bowen Therapists on staff in the past 12 months.

17 staff responded to a questionnaire -a response rate of 81%

Problems treated were:- Headache 4 Shoulder pain 6 Back pain 5 Respiratory problem 1 Sore neck 5 Stress 5 Ankle pain 1 Other 1

Staff were asked if treatment improved their ability to work that day. Yes 13 76% No 1 6% Unsure 3 18%

Did the treatment provide significant relief? Short term relief 6 35% Long term relief 9 53% No relief 2 12%

All respondents said they would accept a Bowen treatment at work for a similar or other problem.

Conclusion. . Bowen therapy treatments are an effective therapy for improving staff health and reducing time off work. . That lasting relief was achieved in 53% of staff (1 treatment) comparing favourably with a national survey (1999) where 49.95% of problems resolved in 1-2 treatments.

Anna Dicker. RN. Diploma Bowen Therapy.

This is the letter I sent to all staff to help establish the need for a project. 23.7.00 To All Staff of Byron/Bangalow/Mullumbimby Community Health.

I am starting some research into the efficacy of Bowen Therapy –particularly for staff health. Some of the staff have already had ‘on the run’ Bowen from Vicki or myself. The conditions that Bowen may help is huge. If you have something that you would like addressed please contact me – call or drop me a note..

Bowen Therapy is a powerful system of muscle and connective tissue therapy empowering the body to heal itself. The work consists of gentle, non-invasive but precise moves on specific areas. It can be safely used on anyone from newborns to the aged. Mr Tom Bowen developed this comprehensive therapy in Geelong leading to widespread and international teaching of the method, over the past 13 years. The technique is a wonderful tool for treating ailments and injuries. Many problems respond in 1 to 2 treatments. Treatments take 5-20 mins depending on the problem. Bowen is deeply relaxing and is beneficial even in the absence of any problem.

If the demonstrated need is significant I may be able to formalise Staff Bowen into my practice. I am convinced that Bowen Therapy is an effective, non-invasive, non-drug way of helping many people. Success rates have been given as high as 98% for some procedures. A national survey of Bowen Therapists showed that 80% of clients had their condition being treated relieved in 1-4 treatments with 50 % being relieved after 1 treatment.

Bowen may help: adrenal exhaustion ,allergies, angina pain, ankle problems, arthritis, asthma, back pain, bed wetting, bell’s palsy, breast lumps, breast pain, bronchitis, bunions, chest pain, circulation, coccyx pain, colic, constipation, coughs, diaphragm pain, digestive problems, depression, diarrhoea, abdo distension, diverticulitis, dizziness, ear infections, eczema, emphysema, eye disorders, eye strain, fever, flatulence, fluid retention, frozen shoulder, gall bladder pain, gall stones, glandular fever, groin strain, haemorrhoids, hammer toes, hay fever, headache, inguinal hernia, hiatus hernia, incontinence, indigestion, irregular milk supply, TMJ (jaw) problems, kidney problems, lactation, leg cramps, liver problems, lymphatic drainage, meniere’s disease, menopause, menstrual problems, migraine, nausea, oedema, plantar fasciitis, PMT, prostate, psoriasis, sacral pain, shin splints, sinus, sprung ribs, stress, infertility, overcrowding teeth, tennis elbow, thrush, thyroid problems, tonsillitis, varicose veins. Quite a list.

Regards,

Anna Dicker Byron Community health.

THIS IS THE HEALTH QUESTIONAIRE I USE FOR ALL PATIENTS & STAFF

BOWEN THERAPY

NAME:…………………………………D.O.B………………… ADDRESS:……………………………..PH:…………………… Date………………. Do you have any problems with? (tick). Head (including headaches)……………Jaw (include extensive dental work)………… Ear, nose or throat……………………...neck…………….shoulder………………… Arm, elbow or wrist…………………...upper back………lower back………………... Sciatica………………buttock pain…………...anal or perineal pain………………….. Lungs (include asthma)………….breast tenderness……………hip problems……….. Knee…….ankle………….quadriceps………..bunions………….heel spurs…………. Heart…………Kidney or bladder…………Liver or gallbladder……………………… Bowel…………Period pains………………………………………………… Blood pressure…………..Diabetes…………Prostate…………. Tension or stress……………….0------5------10

Details of any problems ………………………………………………………………………………………..………… ………………………………………………………………………………..………………… ………………………………………………………………………..………………………… ………………………………………………………………………………………………… ………………………………………………………………………………………………… …………………………………………………Consent. I give my consent Bowen Therapy and to my de-identified data being used for evaluation, research or publication purposes date & signature………………………………………………………..

Page 2

Plan of treatment………………………………………………………………………………………… ………………………………………………………………………………………………… ……………………………………………………………………… Date………………..Treatment1……………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………….. Date………………..Response to last treatment……………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………… Treatment2……………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………… Date………………..Response to last treatment……………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………… Treatment3……………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………… Date………………..Response to last treatment……………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………… Treatment4……………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………… Date………………..Response to last treatment…………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………… Treatment……………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………… Date………………..Response to last treatment……………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………… Treatment……………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………… Date………………..Response to last treatment……………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………… Treatment……………………………………………………………………………………… ………………………………………………………………………………………………… …………………………………………………………………………

PROJECT EVALUATION

BODY AND SOUL

A BOWEN THERAPY

HEALTH PROMOTION PROJECT

FOR STAFF

Dear Thank you for participating in this project. Now it is evaluation time. This, for me, is as important as the treatments themselves, so please take the time to consider the questions carefully and make full responses. As this will lead to a publication I have asked a lot and left a lot of room.

RSVP by March 1st. Please return the forms to Anna Dicker at Byron Community Health (MARKED BOWEN RESPONSE).

I have included a copy of your initial self assessment and the program that we undertook. This will refresh your memory of how you were before the program.

From our records you received treatments.

1) Have you experienced any reduction in pain or discomfort ? Put a X on the scale 0……………3………..5……………8……….10 none better much better v much better completely better area 1………………0……………..3………5……………8…………10 area 2………………0……………..3………5……………8…………10 area 3………………0……………..3………5……………8…………10 area 4………………0……………..3………5……………8…………10 area 5………………0……………..3………5……………8…………10 area 6………………0……………..3………5……………8…………10

area 7………………0……………..3………5……………8…………10 area 8………………0……………..3………5……………8…………10 Comments……………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………… 2) Have you noticed any increase in mobility? 0……………3………..5……………8……….10 none better much better v much better completely better area 1………………0……………..3………5……………8…………10 area 2………………0……………..3………5……………8…………10 area 3………………0……………..3………5……………8…………10 area 4………………0……………..3………5……………8…………10 Comments……………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………… 3) Do you notice any change in your sleep patterns? 0……………3………..5……………8……….10 none better much better v much better completely better Comments…………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………… 4) Have you noticed an effect on your stress levels? 0……………3………..5……………8……….10 none better much better v much better completely better Comments…………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………… 5) Have you noticed a change in your energy? 0……………3………..5……………8……….10 none better much better v much better completely better Comments…………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………… 6) Have you noticed a change in your feeling of well being? 0……………3………..5……………8……….10 none better much better v much better completely better Comments…………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ………………………

7) Do you think a staff support program such as this has a value in workplace stress reduction? No………….. Yes……………….Don’t know…………………. Comments…………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………… 8) Do you think there is a need for an ongoing program? No………….. Yes……………….Don’t know…………………. Comments…………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………… 9) This program ran for 6 weeks 8-8.30am Mon-Fri. Was this a convenient time? Is there any other format that you can think of that may be more suitable? eg. all day 1 day a week, after hours, evenings Gives reasons for your answers. Comments…………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………… 10) Do you see stress reduction programs for staff as a responsibility of the health service?……………………… No………….. Yes……………….Don’t know…………………. Comments…………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ………………………

As this project will be written up for publication your comments are important. Please give any overall comments about how you felt about the program in terms of how it was conducted. Did you find Anna and Vicki to be professional in their conduct?………………………………………………… Was your privacy protected?…………………………………………………………………………………… ….. Did you receive adequate information about the technique?………………………………………………………. Did you do any exercises that were prescribed for you?…………………………………………………………… Did you feel rushed for time?………………………………………………………………………………………. Were you on time?………………………………………………………………………………………… ………. Did you enjoy the atmosphere?………………………………………………………………………………… ….. Can you think of any improvements?………………………………………………………………………………. Comments…………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ………………………. Thank you for your time and participation. Vicki and I enjoyed doing it. We would like to thank the Health Service for allowing us to conduct the project and the Byron Physios for their patience with the invasion of their working area. You will receive a copy of the evaluation but at this stage we treated about 30 staff with about 90 treatments.

ANNA DICKER RN,RM DIP. BOWEN THERAPY. 20.1.01

PROPOSAL TO RUN STAFF HEALTH CLINIC USING BOWEN THERAPY.

NEEDS EVALUATION. (This summarises the results of the evaluation survey) The need was established in the evaluation of the pilot program run in Dec/Jan 2000/01.

The Bowen Therapy program provided significant pain relief for 81% of areas mentioned as being problems. The Bowen Therapy program provided significant improvement in mobility for 67% of areas mentioned as being problems. 41% of participants reported improved sleeping patterns 83% of respondents reported significantly improved levels of stress. 63% of respondents reported a positive effect on their well being 64% of respondents felt there had been a positive change in their energy levels. 93% of respondents felt that a program such as this had a place in workplace stress reduction. 96% of staff want an ongoing program. 86% of staff see workplace stress reduction programs as the responsibility of the health service.

TIME OF PROGRAM. Several people wanted a session at the end of the day and many wanted options during working time. Most people who participated were happy with the early time. While the hospital sanctioned staff to attend in working time community health staff did not seek that approval.

LOCATION. Physiotherapy dept is not really an option as it has to be prepared for the days appointments and is not available at the end of the day except Tuesday. The group room is a viable option using the tables and the antenatal mats. The massage table from physio could be used for those who need a head space. Linen would be needed for the tables –use through physio.

BOOKINGS. Bookings could be done through myself or could be self booked by access to a booking sheet left on my desk. Booked treatments would be restricted to 4 in any 3 month period to allow maximum access to all staff. 4 staff could be treated at the same time. Treatments take 30 mins on average so each day 8 staff could be potentially treated.

DOCUMENTATION. Documentation would be kept for each staff member, similar to the Body & Soul project but it is not anticipated that a file would be opened on each staff member, although this is a possibility. It would be very time consuming. OOS would be counted.

BODY AND SOUL

A BOWEN THERAPY CLINIC FOR STAFF

Thanks to the evaluation results of the pilot Bowen Project, support has been given to open a staff Bowen Clinic. Taking all comments into consideration 3 sessions will be offered each week by Anna Dicker.

ELIGIBILTY. This clinic is open to any staff employed by NRAHS who are working in the Byron/Mullumbimby sites. To allow access to a maximum no of staff, you will be generally able to have 4 treatments in any 3 month period. Special arrangements may occur for those with chronic problems. Bowen research has shown that 1-4 treatments give an 80% response rate.

COST. While this treatment is free a gold coin donation for each session would allow a massage table to be bought (cost $600) for a good one.

DATA. Confidential notes will be kept on each client and may be used for research purposes.

LOCATION. Group room in Byron Bay Community Health.

CLOTHING. Due to the lack of privacy please wear loose clothing (bring shorts & T shirt).

BOOKINGS. Book directly with Anna on 66856254 or access the booking sheet that I will leave on my desk.

TIME. TUESDAYS 8AM FRIDAYS 4PM FRIDAYS 4.45PM IT IS ESSENTIAL THAT PEOPLE BE PROMPT SO I CAN WORK ON SEVERAL PEOPLE AT ONE TIME.

DROP INS will be treated if I have room.

HEALTH PROBLEMS. You do not have to have a health problem to access Bowen Therapy. Stress relief will be a major objective. ANNA DICKER RN RM DIP BOWEN THERAPY.

POLICY AND PROCEDURE ON THE USE OF BOWEN THERAPY IN COMMUNITY NURSING PRACTICE.

Policy Number:

1.0 PURPOSE

To provide guidance to Registered Nurses (RNs) who provide Bowen Therapy within the Health Service.

Initiator: Byron Bay Community Nursing 2.0 POLICY

• Registered Nurses in the Northern Rivers Area Health Service practicing Bowen Technique must have a Diploma of Bowen Applicable To: Therapy and be registered as a full member of the Bowen Therapy Academy of Australia. • Bowen Therapists will maintain their professional competence by attending 3 refresher days, recognized by the Bowen Date Introduced: Therapy Academy of Australia, in each 2 year period. • The Bowen Therapist will hold current professional indemnity insurance as a Last Review Date: Bowen Therapist. • Any individual receiving Bowen Technique must give their verbal consent. • An information sheet on Bowen Next review Date: Technique will be provided for each client. • Bowen Therapy will be incorporated into the client’s treatment plan after consultation with the client’s case manager. Authority: • The nurse will provide the client with written information on any post treatment care or exercises. • All Bowen treatments will be documented Replaces: in the client’s progress notes together with a report on the client’s perception of the effects of the treatment. Key Words: • Nurses practicing Bowen Technique must be cognisant of the limit of their practice and refer to other health professionals as necessary.

3.0 BACKGROUND

Bowen Therapy is a series of precise gentle moves performed with the thumbs and fingers over muscle and connective tissue. . This technique was developed by Tom Bowen (1916- 1982) in Geelong Victoria. After serving in World War 11 he became interested in healing and noticed that certain moves on the body had profound effects. While working as an industrial chemist Bowen developed his technique independent of any medical or other modality training. He stated his work was ‘simply a gift from God’.36. In 1975 the Victorian Government inquiry into alternative health care studied his practice and verified that Bowen was seeing 13,000 patients a year. Because of systematic pauses between moves he was able to work on many patients at the same time. 37 This technique can produce rapid and lasting relief from pain and discomfort. It has been shown to elevate mood and relieve anxiety. It is safe to use on anyone from newborns to the aged and may help a wide range of conditions. 7,8,13,15,19,26,27,28,29,30,31,32,33,35,,36,38,39,40. Suitably qualified nurses visiting clients in their homes may use this therapy if the client desires. Various forms of healing are and always have been a part of nursing practice. Within the holistic provision of nursing care, nurses may incorporate complementary therapies. 6,9,10,16,18,20,21,22,23,24,25,,29,35,41. The use of a range of therapeutic approaches may enhance the health and well being of individuals. 1,4,5,6,11,12,14,16,17,28,34,35,41,42. Individuals have the right to the health care of their choice wherever possible. 2,3, There is a growing demand from the public for non invasive natural therapies. 1,4,5,6,11,12,14,16,17,28,34,35,41,42.

4.0 RESEARCH • Nurses practicing Bowen Technique are encouraged to initiate and participate in outcome based research in Bowen Therapy

5.0 REFERENCES

1. Astin, J.A., (1998) ‘Why Patients Use Alternative Medicine: Results of a National Study’, JAMA, 279(19), pp1548-1553. 2. Australian Health and Community Services Standards. (1999) Community and Primary Health Care Services Module, Bundoora: Quality Improvement Council. Standard 3.2.2, p15. 3. Australian Health and Community Services, (1999) Health and Community Services Core Module, Quality Improvement Council. Standard 5.1, p 21. 4. Cerrato, P.L., Amara, A., (1997) ‘Complementary Therapies: Use Research to Weigh the Aternatives’, RN, 60(2), 53-55. 5. Cole, A, & Shanley, E, (1998) ‘Complementary therapies as a means of developing the scope of professional nursing practice’, Journal of Advanced Nursing, 27(6), 1171-1176. 6. Corkhill, M., (1995) ‘Nursing and Natural Therapies, A need for policy?, The Australian Journal of Holistic Nursing, 2:2 pp 37-39. 7. Crean, B., (1999), Results of treatment Using Light Touch Remedial Therapy (Bowen Technique) on Patients Referred By GP’s Practice June to August 1999. Data from Lydon Clinic Heddersfield.& Halifax, UK. 8. Dicker, A.M., (2000), ‘Bowen Therapy Improves Staff Health’, A survey on the effects of Bowen Therapy on minor ailments. Data. 9. Guidelines For Use of Complementary Therapies in Nursing Practice, (1998) Nurses Board of Victoria. 10. Keegan, L., (1996) ‘Complementary Therapies. Nurses are Embracing Holistic Healing’. RN, 59(4), pp 59-60. 11. Kermode, S, Myers, S, Ramsay, L., (1998), ‘Natural and Complementary Therapy Utilisation on the North Coast of NSW, The Australian Journal of Holistic Nursing, 5:2, pp 7-13 12. King, M. O’B., Pettigrew, A.C., Reed, F.C., ‘Complementary, Alternative, Integrative: Have Nurses Kept Pace With Their Clients?’, Dermatology Nursing,12(1), 41-44, 47-50. 13. Kinnear H. & Baker, J., (2000). ‘Frozen Shoulder Research Programme’, UK, www.thebowentechnique.com/research.htm 25.10.2000 14. LaValley, J.W., Verhoef, M.J., (1995)’ Integrating Complementary Medicine and Health Care Services Into Practice’, CMAJ, 153(1), 45-49. 15. Lund, E., (1999) ‘Bowen and Lymphatic Drainage’, British Lymphology Society Newsletter, 24, pp 10-13. 16. McCabe, P., (1995), Complementary Therapy in Nursing Practice, Policy development in Australia, The Australian Journal of Holistic Nursing, 3:1, pp 4- 10. 17. McCabe, P., (1998) Revealing Common Ground, Comparing themes in Traditional Natural Medicine and Holistic Nursing, The Australian Journal of Holistic Nursing, 5:2, pp 41-46. 18. McKenna, H, Cutcliffe, J & McKenna, P., (2000) ‘Evidence-based practice: demolishing some myths’, Nursing Standard. 14(16), 39-42. 19. Nixon-Livy,M.J., (1999) ‘ Neurostructural integration Technique (Advanced Bowen Therapy)’, Positive Health, Aug 1999, 48-51. 20. Policy ‘Complementary Therapies in Nursing Practice’, (1998) NSW Nurses Registration Board. 21. Policy ‘Complementary Therapies in Nursing Practice’,(1998) Australian Nursing Federation. 22. Policy Guidelines For Practice of Complementary Therapies By Nurses And Midwives in Australia. Australian College of Holistic Nurses. 23. Policy on Complementary Therapies In Nursing Practice, (1998) Holistic Nurses Association of NSW. 24. Policy on Complementary Therapies in Nursing Practice, (1998), NSW Nurses Association. 25. Position Statement, Complementary Therapies in Australian Nursing Practice, (1998) Royal College of Nursing Australia. 26. Pritchard,A.G, (1993),’ The Psychophysiological Effects of the Bowen Technique Therapy’, Swinburne University, Melbourne. Psychophysiology Major research Project. 27. Rappaport, S., (1997), ‘Clinical Experiences of a Bowen Therapist’, Positive Health, 18, pp 62-64. 28. Rentsch, J., (2000) ‘Orthodox & Complementary Medicine A Joint Approach to Management’, Bowen Hands, 9(2), 12-13. 29. Rentsch, O.H, Rentsch, E.,(1997) Bowtech, The Bowen Technique, A Training & Instruction Manual. 30. Results of The National Survey of Bowen Therapists July 1999. Vic Bowen News, 2:5,5. 31. Rousselot, P., (2000) ‘Bowen Technique’, Clinicians Complete reference to Complementary/Alternative Medicine, Mosby, Missouri, 371-380. 32. Russell, J,K., (1994), ‘Bodywork-The Art of Touch’, Nurse Practitioner Forum, 5:2, pp 85-90. 33. Stammers, G., (1996) ‘Bowen Therapeutic Technique’, Journal of The Australian Traditional-Medicine Society, 2:3, 85-86. 34. Staub, C.E., Medical Options Program at Hugh Chatham Memorial Hospital, Elkin, NC, USA. 35. Stevensen, C.BSW., (1997) ‘Complementary therapies and their role in nursing care’, Nursing Standard, 11(24), 49-55 36. The Bowen Therapy Academy of Australia, Resource Portfolio, (1998). 37. Victorian Government. Report of the Committee of Inquiry into Osteopathy, Naturopathy and Chiropractic. 1975. 38. Whitaker, J.A., Marlowe, S., (1998) ‘The Bowen Technique: A healing modality, alleviates Myofacial pain of Fibromyalgia and Balances the Dysfunctional changes of the Autonomic Nervous System as measured by clinical assessment and Heart Rate Variability’. Abstract presentation at MYOPAIN ‘98, Silvi Marina, Italy. 39. Whitaker,J.A., Gilliam,P.P., Seba, D.B., (1997). ‘The Bowen Technique: a Gentle Hands-on Method That Affects the Autonomic Nervous System as Measured by Heart Rate Variability and Clinical Assessment’. Abstract presentation American Academy of Environmental Medicine 32nd Annual Conference La Jolla California. 40. Willocks,T., (1998) ‘The Bowen Technique: Some personal Experiences of What It Is, What It Does and What It Doesn’t, Positive Health, 29, pp 53-56. 41. Yeldham, M., (2000), Combining complementary therapies and nursing skills to supplement healing, The Australian Journal of Holistic Nursing, 7:1, pp 21- 25. 42. Zollman, C & Vickers, A., (1999) ‘Complementary medicine and the Patient’, BMJ, 319(7223), 1486-1489.

6.0 KEY WORDS Bowen Technique. Bowen Therapy. Community nurse. Complementary Therapy. Alternative Therapy.

CLINICAL STANDARDS Number:

for the practice of BOWEN TECHNIQUE by NURSES.

Manual :Protocol for Clinical Practice of Bowen Therapy Initiator :Anna Dicker Date : Review date : Authority :Northern Rivers Area Health Service Directorate :Nursing and Service Co-ordination

1.0 Safety Bowen Therapy is safely accomplished within the health setting. 6, 7, 13, 16, 17, 21, 22 1.1 Clients will be assessed for any contraindications to Bowen Therapy. 17 1.2 Clients will be assessed to determine their ability to perform any recommended exercises. 17 1.3 Clients will be given information on the technique and any required exercises.17 1.4 Treatment will be performed as taught and recorded in the Bowen Manual.17

2.0 Effectiveness Desirable outcomes can be achieved by using Bowen Technique on community clients. 7,10,13, 15 ,20, 22, 24, 25, 2.1 Clients will be reviewed after each treatment by a process of verbal questioning and the results will be documented. 2.2 Ensure that Bowen Therapy is preferred option of treatment as it is safe non- invasive and cost effective. 7, 10, 13.

3.0 Appropriateness Bowen Technique provides an appropriate treatment for a range of conditions. Consider Bowen Therapy as a treatment option. 17, 20, 22 3.1 Clients will be assessed for suitability and type of Bowen treatment.17 3.2 Consent will be obtained from clients before commencing any treatment. 3.3 Bowen treatment will be part of the client’s comprehensive care plan. 3.4 Clients will continue to be referred within the multidisciplinary team of health providers.17

4.0 Consumer Participation Consumers and consumer organisations are partners in a holistic approach to their health care. 1, 2, 3, 11, 26 .1 Education on Bowen Therapy will be provided for the clients to empower them to be actively involved in decisions affecting their well-being. 4.2 Written and verbal instructions and will be provided on any required exercises and post treatment advice. 4.3 Health consumers clients from culturally and diverse backgrounds including indigenous and disadvantaged people must be provided with a range of culturally appropriate and holistic care. 1, 2, 5, 11

5.0 Access Health services should continue to increase access to holistic care for the consumer. 1, 2, 3, 4, 5, 9, 11, 16, 19. 5.1 Access of clients to this therapy is dependant on the availability of a suitably qualified practitioner. 5.2 The Bowen Therapist will prioritise clients for access to this therapy.

6.0 Outcomes Health outcomes are not compromised by the use of Bowen Therapy in the home as opposed to other available forms of treatment. 16 6.1 Clients will experience some relief of symptoms shown as changes in pain level, range of movement and mood improvement. 6, 7, 10, 13, 15, 17, 18, 19, 20, 22, 24, 25 6.2 Clients prefer Bowen Therapy to other treatment modalities. 7, 10, 19. 6.3 With improved mobility resulting from Bowen Therapy falls can be prevented. 6.4 Reduced reliance on analgesia results in economic benefits.

7.0 Performance Indicators Performance indicators guide outcome measurement. 7.1 80% of clients report reduction in pain by using a recognised pain scale measure 7.2 80% of clients indicate reduced need for analgesics demonstrated by verbal reports. 7.3 80% of clients report increase in mobility as measured by spinal function activity test. 7.4 Self reported improvement in client well-being, demonstrated by verbal reporting and questionnaire results.

8.0 References 1. Australian Health and Community Services, (1999) Health and Community Services Core Module, Quality Improvement Council. Standard 5.1, 21. 2. Australian Health and Community Services Standards.(1999) Community and Primary Health Care Services Module, Bundoora: Quality Improvement Council. Standard 32.2, 15. 3. Astin, J.A., (1998) ‘Why Patients Use Alternative Medicine: Results of a National Study’, JAMA, 279(19), 1548-1553. 4. Cerrato, P.L., Amara, A., (1997) ‘Complementary Therapies: Use Research to Weigh the Aternatives’, RN, 60(2), 53-55. 5. Cole, A, & Shanley, E, (1998) ‘Complementary therapies as a means of developing the scope of professional nursing practice’, Journal of Advanced Nursing, 27(6), 1171-1176. 6. Crean, B., (1999), Results of treatment Using Light Touch Remedial Therapy (Bowen Technique) on Patients Referred By GP’s Practice June to August 1999. Data from Lydon Clinic Heddersfield.& Halifax, UK. 7. Dicker, A.M., (2000), ‘Bowen Therapy Improves Staff Health’, A survey on the effects of Bowen Therapy on minor ailments. Data. 8. Keegan, L., (1996) ‘Complementary Therapies. Nurses are Embracing Holistic Healing’. 59(4), 59-60. 9. King, M. O’B., Pettigrew, A.C., Reed, F.C., ‘Complementary, Alternative, Integrative: Have Nurses Kept Pace With Their Clients?’, Dermatology Nursing,12(1), 41-44, 47-50. 10. Kinnear H. & Baker, J., (2000). ‘Frozen Shoulder Research Programme’, UK, www.thebowentechnique.com/research.htm 25.10.2000. 11. LaValley, J.W., Verhoef, M.J., (1995)’ Integrating Complementary Medicine and Health Care Services Into Practice’, CMAJ, 153(1), 45-49. 12. McKenna, H, Cutcliffe, J & McKenna, P.,(2000) ‘Evidence-based practice: demolishing some myths’, Nursing Standard. 14(16), 39-42. 13. Nixon-Livy,M.J., (1999) ‘ Neurostructural integration Technique (Advanced Bowen Therapy)’, Positive Health, Aug 1999, 48-51. 14. Policy No 0g.00. Policy and Procedure for Diffusing Essential Oils Aromatherapy (Murwillumbah Hosp). 15. Pritchard,A.G, (1993),’ The Psychophysiological Effects of the Bowen Technique Therapy’, Swinburne University, Melbourne. Psychophysiology Major research Project. 16. Rentsch, J., (2000) ‘Orthodox & Complementary Medicine A Joint Approach to Management’, Bowen Hands, 9(2), 12-13. 17. Rentsch, O.H, Rentsch, E.,(1997) Bowtech, The Bowen Technique, A Training & Instruction Manual. 18. Results of The National Survey of Bowen Therapists July 1999. Vic Bowen News, 2:5,5 19. Staub, C.E., Medical Options Program at Hugh Chatham Memorial Hospital, Elkin, NC, USA 20. Stammers, G., (1996) ‘Bowen Therapeutic Technique’, Journal of The Australian Traditional-Medicine Society, 2:3, 85-86

21. Stevensen, C.BSW., (1997) ‘Complementary therapies and their role in nursing care’, Nursing Standard, 11(24), 49-55. 22. The Bowen Therapy Academy of Australia, Resource Portfolio, (1998). 23. Victorian Government. Report of the Committee of Inquiry into Osteopathy, Naturopathy,and Chiropractic. 1975. 24. Whitaker,J.A., Gilliam,P.P., Seba, D.B. (1997). ‘The Bowen Technique: a Gentle Hands-on Method That Affects the Autonomic Nervous System as Measured by Heart Rate Variability and Clinical Assessment’. Abstract presentation American Academy of Environmental Medicine 32nd Annual Conference La Jolla California.. 25. Whitaker, J.A., Marlowe, S.,(1998) ‘The Bowen Technique: A healing modality, alleviates Myofacial pain of Fibromyalgia and Balances the Dysfunctional changes of the Autonomic Nervous System as measured by clinical assessment and Heart Rate Variability’. Abstract presentation at MYOPAIN ‘98, Silvi Marina, Italy. 26. Zollman, C & Vickers, A., (1999) ‘Complementary medicine and the Patient’, BMJ, 319(7223), 1486-1489.

6.0 KEY WORDS

Bowen Technique. Bowen Therapy. Community nurse. Complementary Therapy. Alternative Therapy.

PRACTICE GUIDELINES Number : for Use of Bowen Therapy in Community Nursing Practice

Manual :Protocol for Clinical Practice of Bowen Therapy Initiator :Anna Dicker Date : Review date : Authority :Northern Rivers Area Health Service Directorate :Nursing and Service Co-ordination

1.0 Practice Guidelines I. Referral. 1.1.1 Referrals will be accepted through normal community nurse referral procedure.

1.2 Assessment. 1.2.1 Health problem questionnaire filled out. 1.2.2 Prioritisation of client for treatment. 1.2.3 Assessment of contraindications. 1.2.4 Risk Assessment of home environment to assess safe working area. 1.2.5 Assessment of clients ability to lie or sit for treatment.

1.3 Positioning. 1.3.1 Client assisted with positioning necessary to conduct Bowen Therapy. 1.3.2 Client assisted to remove any outer clothing as necessary.

1.4 Procedure. 1.4.1 Bowen Technique performed as taught and recorded in Bowen Training Manual. 1.4.2 Client assisted to rise in approved manner. 1.4.3 Required exercises demonstrated and supervised.

1.5 Post Treatment Instructions. 1.5.1 Written post treatment instructions given to client. 1.5.2 Verbal questioning to measure immediate response.

1.6 Evaluation 1.6.1 Measure immediate response to treatment by verbal questioning using recognised pain scale, spinal activity test and perception of well-being 1.6.2 Measure response to previous treatment by verbal questioning using recognised pain scale, spinal activity test and perception of well-being 1.6.3 Measure response to and satisfaction with Bowen Therapy at time of treatment termination by use of written questionnaire.

1.7 Documentation 1.7.1 Each treatment documented in client’s progress notes using standard Bowen Technique terms. 1.7.2 Reported treatment responses recorded in client’s notes. 1.7.3 Evaluation of questionnaires annually.

2.0 Protocol 2.1 Nurses will have a Diploma of Bowen Therapy and be a full member of the Bowen Academy of Australia. 2.2 Bowen Therapists will maintain their professional competence by attending 3 Bowen refresher days in every 2 year period. 2.3 The Bowen Therapist will hold current professional indemnity insurance as a Bowen Therapist. 2.4 Documentation will be checked by the NUM on an annual basis.

3.0 References 4.1 Rentsch, O.H, Rentsch, E., Bowtech, The Bowen Technique, A Training & Instruction Manual. 4.2 Bowtech information pamphlet. 4.3 Post treatment instructions. 4.4 Pain scale and spinal function activity questionnaire. 4.5 Consumer satisfaction survey.

PRACTICE AUDIT FORM Number :

Use of Bowen Therapy in Community Nursing Practice

Manual :Protocol for Clinical Practice of Bowen Therapy Initiator :Anna Dicker Date : Review date : Authority :Northern Rivers Area Health Service Directorate :Nursing and Service Co-ordination

How to use this practice audit form:

I. An external auditor should be used. II. All Bowen patient records to be audited yearly. III. There are 5 records to a form. The file number is recorded at the top of each page. IV. Place a tick in the appropriate row if the sample fulfils the indicator. V. The total audit results are to be collated into a summary report and the report signed by the auditor. VI. The summary report is to be given to the Bowen Therapist and to Quality Management.

File Number

Patient Assessment Checklist includes Source of referral noted Health Assessment completed Home risk assessment completed

Record of: Bowen Technique used Post Treatment instructions given Immediate response noted Response to previous treatment noted Client questionnaire completed

This is our checklist to do before going to the clinical Standards Committee

CLINICAL STANDARDS CHECK LIST Number :

for Use of Bowen Therapy in Community Nursing Practice

Initiator :Anna Dicker Date : Review date : Authority :Northern Rivers Area Health Service Directorate :Nursing and Service Co-ordination

CHECK LIST FOR THE DEVELOPMENT of CLINICAL STANDARDS & PRACTICE GUIDELINES

1 Determine the need for the development of the clinical standards & practice guidelines Alternate therapies being used in the community by nurses need to be governed by format policies and practice guidelines. The practice of Bowen Technique is one such therapy.

2 Contact a member of the Clinical Standards Committee for guidance on the project (work with this person throughout your project) Contact was made with Betty Oliveri in October 2000 to assist with policy formation.

3 Convene a multidisciplinary group to develop the clinical standard & practice guidelines Consultation was entered into with physiotherapists, occupational therapist, other Bowen Therapists, community nurses and NUM.

4 Define the purpose of and target audience for the clinical standard/ practice guideline The purpose of the clinical standards/practice guidelines are to identify best practice and standardise patient care throughout NRAHS. The target audience for the clinical standards/practice guidelines is all NRAHS staff who have an interest in Bowen Therapy, all Divisions of GPs, Australian Bowen Academy and its world wide offices and members, The Holistic Nurses Assn of NSW, NSWNA. There is great interest nationally and internationally in this policy.

5 Identify health outcomes and performance indicators Health outcomes and performance indicators as identified in practice guidelines.

6 Identify educational requirements for patients/staff Photocopied forms and handouts for patients. Inservice and demonstrations for Community Health staff.

7 Review the scientific evidence Refer to research folder containing evidence.

8 Formulate the standard/guideline, using the principles identified in the ‘Clinical Standards’ brochure and indicating the levels of evidence ratings as per table 1 or 2 of the Clinical Standards’ brochure.

Standards formed November 2000.

9 Distribute the document in its draft form for comment to all EO/DONs, DMS, PECS & appropriate specialty groups Document distributed to Australian Bowen Academy, Holistic Nurses Assn of NSW, PECS cluster managers, PECS nurse co-ordinator, Division of Gps x3. EO/DONs.

10 Formulate a dissemination and implementation strategy When strategy approved: Ensure supply of appropriate forms. Send policy and clinical standards/practice guidelines to Australian Bowen Academy for dissemination to national and international professional bodies.

11 Formulate an evaluation and revision strategy Following implementation, the document will be revised and updated on an annual basis involving all users.

12 When responses from the above groups have been received, address the necessary changes, check that ALL of the above requirements have been met, submit the clinical standards & practice guidelines, in draft format, with evidence of the principles and steps achieved, to the Clinical Standards Committee

13 Organise a convenient time for appropriate representatives to speak to the committee on the principles and steps achieved in developing the proposal

CLINICAL STANDARDS Number :

for Use of Bowen Therapy in Nursing Practice Manual :Protocol for the Clinical Practice of Bowen Therapy Initiator :Anna Dicker Date : Review date : Authority :Northern Rivers Area Health Service Directorate :Nursing and Service Co ordination

LEVELS OF EVIDENCE RATINGS

Table 1

Level I Evidence obtained from systematic review of relevant randomised controlled trials (with meta- analysis where possible) Level II Evidence obtained from one or more well-designed randomised controlled trials Level III Evidence obtained from well-designed non-randomised controlled trials; OR from well-designed cohort or case-control analytical studies, preferably multicentre or conducted at different times. Level IV The opinions of respected authorities based on clinical experience, descriptive studies or reports of expert committees

Table 2 National Guidelines Cochrane Review State Guidelines Professional Guidelines

When these documents are the source of evidence the full document should accompany the submission to the Clinical Standards Committee

LEVEL 11 EVIDENCE.

• . Kinnear H. & Baker, J., (2000). ‘Frozen Shoulder Research Programme’, UK, www.thebowentechnique.com/research.htm 25.10.2000 • Whitaker, J.A., Marlowe, S.,(1998) ‘The Bowen Technique: A healing modality, alleviates Myofacial pain of Fibromyalgia and Balances the Dysfunctional changes of the Autonomic Nervous System as measured by clinical assessment and Heart Rate Variability’. Abstract presentation at MYOPAIN ‘98, Silvi Marina, Italy. • Whitaker,J.A., Gilliam,P.P., Seba, D.B. (1997). ‘The Bowen Technique: a Gentle Hands-on Method That Affects the Autonomic Nervous System as Measured by Heart Rate Variability and Clinical Assessment’. Abstract presentation American Academy of Environmental Medicine 32nd Annual Conference La Jolla California.

LEVEL 111 EVIDENCE • Pritchard,A.G, (1993),’ The Psychophysiological Effects of the Bowen Technique Therapy’, Swinburne University, Melbourne. Psychophysiology Major research Project. • LEVEL 1V EVIDENCE

• Crean, B., (1999), Results of treatment Using Light Touch Remedial Therapy (Bowen Technique) on Patients Referred By GP’s Practice June to August 1999. Data from Lydon Clinic Heddersfield.& Halifax, UK. • Dicker, A.M., (2000), ‘Bowen Therapy Improves Staff Health’, A survey on the effects of Bowen Therapy on minor ailments. Data. • Figov, J., (1999) ‘Gentle Touch Bowen Therapy’, Positive Health, Sept 99, pp 47-49. • Lund, E., (1999) ‘Bowen and Lymphatic Drainage’, British Lymphology Society Newsletter, 24, pp 10-13. • Nixon-Livy,M.J., (1999) ‘ Neurostructural integration Technique (Advanced Bowen Therapy)’, Positive Health, Aug 1999, 48-51. • Rappaport, S., (1997), ‘Clinical Experiences of a Bowen Therapist’, Positive Health, 18, pp 62-64. • Rentsch, J., (2000) ‘Orthodox & Complementary Medicine A Joint Approach to Management’, Bowen Hands, 9(2), 12-13. • Rentsch, O.H, Rentsch, E.,(1997) Bowtech, The Bowen Technique, A Training & Instruction Manual. • Results of The National Survey of Bowen Therapists July 1999. Vic Bowen News, 2:5,5. • Rousselot, P., (2000) ‘Bowen Technique’, Clinicians Complete reference to Complementary/Alternative Medicine, Mosby, Missouri, 371-380. • Russell, J,K., (1994), ‘Bodywork-The Art of Touch’, Nurse Practitioner Forum, 5:2, pp 85-90. • Stammers, G., (1996) ‘Bowen Therapeutic Technique’, Journal of The Australian Traditional-Medicine Society, 2:3, 85-86. • Staub, C.E., Medical Options Program at Hugh Chatham Memorial Hospital, Elkin, NC, USA. • The Bowen Therapy Academy of Australia, Resource Portfolio, (1998). • Victorian Government. Report of the Committee of Inquiry into Osteopathy, Naturopathy and Chiropractic. 1975. • Willocks,T., (1998) ‘The Bowen Technique: Some personal Experiences of What It Is, What It Does and What It Doesn’t, Positive Health, 29, pp 53-56.

PROFESSIONAL GUIDELINES. • Guidelines For Use of Complementary Therapies in Nursing Practice, (1998) Nurses Board of Victoria. • Policy ‘Complementary Therapies in Nursing Practice’, (1998) NSW Nurses Registration Board. • Policy ‘Complementary Therapies in Nursing Practice’,(1998) Australian Nursing Federation. • Policy Guidelines For Practice of Complementary Therapies By Nurses And Midwives in Australia. Australian College of Holistic Nurses. • Policy on Complementary Therapies In Nursing Practice, (1998) Holistic Nurses Association of NSW. • Policy on Complementary Therapies in Nursing Practice, (1998), NSW Nurses Association. • Position Statement, Complementary Therapies in Australian Nursing Practice (1998) Royal College of Nursing Australia.

ASSOCIATED POLICIES

20 Policy No 0g.00. Policy and Procedure for Diffusing Essential Oils Aromatherapy (Murwillumbah Hosp).

Briefing paper to the Health Services and Organisational Ethics Committee on the Introduction of Bowen Therapy by Appropriately Qualified Registered Nurses.

BACKGROUND. Professional nursing bodies’ policies sanction registered nurses performing complementary therapies in their work. No AHS policies have been developed. Bowen Therapy is a gentle, non invasive therapy which consists of precise moves, using fingers and thumbs on specific areas of the body. Bowen technique was developed by Tom Bowen (1916-1982) in Geelong. He was self taught and although his work was not derived from any other therapy it has been noted that many of the points being worked on relate to acupressure points. Bowen’s work was verified by the Victorian Government Committee of Inquiry into Osteopathy, Naturopathy and Chiropractic 1975. The report verifies that he was treating about 13,000 people a year. Because of the systematic pauses between moves he was able to treat many people at the same time. The work has been taught to diploma level (V Tab accredited) since 1990, and is now being taught in 17 countries. Bowen technique can be used for a wide range of conditions as it appears to work by stimulating the body to heal itself. Application is beneficial for, but not limited to acute and chronic pain states. It will not interfere with any other medical treatment. As it is gentle, it can be safely used in acute pain, pregnancy, for the elderly and newborns. There is an 80% response rate with level 11, 111 and 1V research evidence of its efficacy. A treatment takes about 30 mins and because of regular pauses between moves several people could be treated at the same time.

THE CURRENT SITUATION. While the original aim of this policy was to enable any registered nurse/Bowen therapist to incorporate the treatment into Community Nursing practice it was pointed out that any policy should be area wide and not exclusive to the community. There is an increasing demand from the health service consumer for complementary therapies. Within the community setting some objectives that have been met are, decreased analgesia use, fewer falls because of increased mobility and the reduction of depressed states, particularly among the elderly. A policy with the required clinical standards, and practice guidelines has been widely distributed for comment over the past few months and is now in its finalised form. Staff Bowen Therapy Health Promotion Project. A pilot health promotion project for health staff ran in Byron Bay for 6 weeks. The objective was as a stress reduction project. On evaluation 83% of the respondents (28) reported significantly reduced stress levels. As an aging workforce there were plenty of physical problems reported that were not being actively treated. The therapy provided significant relief to 81% of those physical problems that staff had identified. It was felt that clients would experience similar relief and some multidisciplinary referrals have been received for clients with conditions ranging from chronic pain to emotional distress.

RECOMMENDATIONS. That the Northern Rivers Area Health Service recognise and allow the practice of Bowen Therapy by qualified staff, where appropriate, in the same way that other complementary therapies such as Feldenkreis, Cranio-Sacral Balancing, Pilates, Massage and Acupuncture, are currently practiced by physiotherapists. Also that a policy be developed to address the practice of all complementary therapies within the health service.

Anna Dicker RN RM Dip Bowen Therapy, Community Nurse Byron CH. 24.4.01

This article I wrote has been published in the April edition of the Australian Journal of Holistic Nursing.

USING BOWEN THERAPY TO IMPROVE STAFF HEALTH

BOWEN THERAPY. This interesting therapy is very much a modern discovery. The technique was developed by Tom Bowen (1916-1982) in Geelong Victoria. After serving in World War II he became interested in healing and noticed that certain moves on the body had profound effects. While working as an industrial chemist Bowen developed his technique independent of any medical or other modality training. He stated his work was ‘simply a gift from God’. He developed his gift into a system of using thumbs and fingers to make gentle but precise movements over specific points in the body. In 1975 the Victorian Government inquiry into alternative health care studied his practice and verified that Bowen was seeing 13,000 patients a year. Because of systematic pauses between moves he was able to work on many patients at the same time. During his career Tom taught only a few therapists. In 1974 he met Oswald Rentsch, an osteopath and natural therapist who studied with him for 2 ½ years. Over this time Rentsch and his wife Elaine documented Bowen’s technique, as he himself did not work from notes, charts or manuals. Bowen had requested that his technique not be taught until his death. The first seminar was held in 1986 and since then has spread to 16 countries. Teacher training commenced in 1992 and advanced training has been available since 1998. While a broad range of moves is available to address a wide range of problems there are many more moves still to be incorporated into the teaching regime.

HOW IT WORKS. As with many other complementary therapies the exact mechanism of action in unknown. Tom Bowen never wrote anything about his work or left any explanation as to why it worked so well. Several theories exist as to the technique’s actions. Rentsch explains that a balance and stimulation of energy occurs, resulting in a deep relaxation. The healing process begins once the body is relaxed. The Bowen moves are a system of gentle but precise mobilisations applied over muscles, tendons, nerves and fascia. The moves are performed using thumbs and fingers in a rolling motion. Moves are made over the sites of Golgi and spindle cell receptors (Rousselot,2000). These receptors are stimulated during the moves and change the stimulus received by the nervous system. Moves around joints stimulate proprio receptors, which transmit to the central nervous system. The slower vibrations over nociceptors may mimic the healing phase of the body giving profound relief of pain. Rousselot indicates Bowen most important effect is to catalyse a shift in the autonomic nervous system from sympathetic to parasympathetic dominance. This shift releases stress at a deep level. He also states that Bowen technique relaxes fascia, triggers segmental viscerosomatic spinal reflexes, clears trigger points, stimulates acupuncture points and meridians and regulates the lymphatic system by stimulating neuro lymphatic points.

RESEARCH. Studies are just starting to emerge about the efficacy and action of this technique. Whittaker and Marlow have found that Bowen Therapy has a positive effect on fibromyalgia patients. Another study by Whitaker, Gilliam and Seba demonstrated that Bowen Technique affects the autonomic nervous system by shifts in Heart Rate Variability, also giving considerable relief in fibromyalgia. Pritchard showed that Bowen Technique reduced subjects’ level of anxiety and enhanced their positive feelings. Bauman assessed the effect of TMJ treatment on masseter tension with 1/3 of patients experiencing significant improvement in symptom relief. Kinnear and Baker demonstrated an increase in range of movement in chronic shoulder pain and shoulder stiffness after treatment. Lund found a profound benefit in the treatment of Lymphodema using Bowen Therapy. Data from Crean has demonstrated efficacy of the treatment through case study and comparison data collection while Biroac has found Bowen Technique effective in the treatment of Restless Leg Syndrome. Figov has encouraging results from a pilot study using Bowen on patients with Blepharospasm. Norman studied the overall efficacy of the therapy from practitioner and patients point of view. While Tom Bowen himself had an efficacy rate of 88%, Norman found similar results. Practitioners reported >80% efficacy while patients rated the efficacy from 77- 100%. A National Survey of Bowen Therapists in 1999 found that >80% of problems were relieved in 1-4 treatments.

CONTRAINDICATIONS. There are no contraindications for use but one move is avoided on patients in pregnancy

APPLICATION. Bowen technique can be used for a wide range of conditions as it works to stimulate the body to heal itself. Application is beneficial for, but not limited to acute pain states. It will not interfere with any other medical treatment. As it is gentle, it can be safely used in acute pain, pregnancy, for the elderly and newborns. Conditions that patients have found relief from is endless but include: ankle sprains, arthritis, bedwetting, breast tenderness, lactation, engorgement, PMT, carpal tunnel syndrome, RSI, chest pain, chronic pain syndrome, coccyx pain, fibromyalgia, hamstring pain, knee pain, migraine, back pain, colic, pelvic imbalances, rotator cuff problems, sciatica, hammer toes, hallux valgus, plantar fasciitis, shin splints, stress, TMJ pain, overcrowding of teeth, asthma and infertility. Chronic disease sufferers with conditions such as multiple sclerosis, Parkinsons and Chronic Fatigue Syndrome have reported symptom relief.

POST TREATMENT INSTRUCTIONS. Patients are instructed to increase their water intake post treatment to aid lymphatic drainage and excretion of toxins. To support the new body movement patterns patients are advised not to stand or sit for longer than 1 hour on the day of treatment, to avoid body contact sports or vigorous exercise. Other forms of bodywork are contraindicated 5 days before or after treatment and return visits are 5-10 days apart, although often 1 treatment is sufficient to correct a problem. Some treatments require follow up exercises to be performed.

BOWEN ‘ON THE RUN’ IMPROVES STAFF HEALTH. Working in the Community Health setting the author gave many of the staff brief Bowen interventions for minor ailments. 21 staff at Byron Bay and Mullumbimby Community Health were known to have received Bowen Therapy from 1 of 2 Bowen Therapists on staff in the past 12 months. These were largely once off sessions performed ‘on the run’. These staff were surveyed by questionnaire.

18 staff responded to a questionnaire -a response rate of 86%

Problems treated were:- Headache 4 Shoulder pain 6 Back pain 6 Respiratory problem 1 Sore neck 5 Stress 5 Ankle pain 1 Other 1

Staff were asked if treatment improved their ability to work that day. Yes 14 78% No 1 6% Unsure 3 18%

Did the treatment provide significant relief? Short term relief 6 89% Long term relief 10 56% No relief 2 12%

It is to be noted that this efficacy rate of 89% compares favourable with Tom Bowen’s own results and those confirmed by Norman’s research and the national Practitioner survey of 1999. All respondents said they would accept a Bowen treatment at work for a similar or other problem. Some of the comments received were: “surprised that so little movements provided such relief”, “kept me at work –without treatment may have gone off on sick leave”, “saved a workers comp. claim”, “I was surprised how effective it was”. One staff member who felt on the edge of a ‘mini’ collapse wrote “the lightness in my back and limbs was amazing. I felt like I could leap and recalled this is how I felt in my 20s –I am now 42- so a great outcome for me was to have my body NOT collapse and to experience a ‘flashback’ of how a well maintained healthy me could feel”. This was astounding feedback from brief treatments that in many cases took about 7 minutes.

BODY AND SOUL PROJECT The encouraging results of this survey led to a proposal to commence a Health Promotion project for staff. This was called BODY & SOUL. The program was widely advertised and any staff working for the Byron Bay and Mullumbimby Health Service were invited to book in for treatments. Two therapists worked out of the physiotherapy room from 8-8.30am Monday to Friday. The program started on December 11th 2000 and ran for 6 weeks. The project was run as a formal health promotion project with the objective of lowering staff stress levels. however it was also hoped that some physical problems would also be alleviated during the treatment process. Staff were asked to fill out a questionnaire detailing any health problems and a self evaluation of where they felt their stress levels were on a scale of 1-10. Treatments were offered weekly. At each presentation staff were asked to evaluate the effects of the last treatment. Over the 6 weeks there were 30 staff treated with 90 treatments being given. Some people had 1 treatment, some had 6. The minimum number of people being treated a day was 1 and maximum was 6. Treatment times were strictly adhered to because of the physiotherapists needing the room straight after the session. Treatments took 20 – 30minutes. Clothing was not required to be removed which was useful to hospital staff who were often being released in working time. Other staff came before work or on their days off. Again the program was enthusiastically received with the majority of staff members reporting a beneficial effect of some sort. It has certainly got some Health Managers thinking about the benefits of a staff program such as this as staff are feeling valued and happier. Evaluation surveys are now being written up and returned. There is plenty of anecdotal evidence to prove that this project was a success. One staff member who rated himself with a stress level of 10 out of 10 felt that the treatment reduced his stress level to zero – a fact happily noticed by work colleagues! Most staff reported a marked drop in their stress levels and an improvement in their physical problem. As an aging work force there were plenty of physical problems reported that were not being actively treated. Comments received during the course of the 6 week program and in the early survey returns were evangelistic in their praise of how personal stress levels had dropped. Most staff felt the program to be a great morale booster and a team building exercise. The benefits of quiet reflective time and non sexual touch are an area that warrants more thought. While the program was a big commitment for the 2 Bowen Therapists, both felt incredibly energised after each session and well prepared for the day ahead.

WHAT NOW? Where to from here? Once the evaluation of the Body and Soul project has been completed, a long term program should be considered. This is quite a cheap program to run, able to treat several people at a time, needing only beds and a therapist, but producing maximum results. It could be a significant tool in keeping an aging health workforce on it’s feet. One does not have to have a physical problem to enjoy the benefits as has been clearly demonstrated by this project.

VISION FOR THE FUTURE. Bowen Therapy is cheap to learn and cheap to administer. You can do no harm with Bowen, everybody can benefit from it and anyone can learn it. What a powerful therapy to teach to people in countries with few resources. What a wonderful tool to work with when treating the elderly and chronically ill. What a help for parents to keep their children healthy. What a simple way to aid in stress management. With the health sector employing an aging workforce and the recruitment and retention of nurses being a current major issue, a staff support program of Bowen Therapy may be an imaginative way to prevent burnout and energise staff. This sort of program could also be taken into the corporate sector as an occupational health initiative.

BIBLIOGRAPHY.

1. Bauman J 1995 Bowen Therapy Academy of Australia, Bowen Hands, Dec. 2. Biroac, M., Restless Leg Syndrome –the effect of Bowen Therapy, 2000 data. 3. Crean, B., Results of treatment Using Light Touch Remedial Therapy (Bowen Technique) on Patients Referred By GP’s Practice June to August 1999. Data from Lydon Clinic Heddersfield.& Halifax, UK 4. Figov J 1999 Gentle Touch Bowen Therapy, Positive Health, Sept. pp47-49. 5. Kinnear H. & Baker, J., ‘Frozen Shoulder Research Programme’ UK 2000, website,www.thebowentechnique.com/research.htm 25.10.2000. 6. Lund E. 1999 Bowen and Lymphatic Drainage, British Lymphology Society Newsletter, 24:Spring. 7. Norman, A 1988 The Bowen Technique: a study of its prevalence and effectiveness. University of North Carolina of Chapel Hill. dept of Physical Education, Exercise & Sport Science. Undergraduate honour’s thesis. 8. Pritchard,A.G 1993. ‘The Psychophysiological Effects of the Bowen Technique Therapy’, Swinburne University, Melbourne. Psychophysiology Major research Project. 9. Rentsch, O.H, Rentsch, E 1997 Bowtech, The Bowen Technique, A Training & Instruction Manual. Results of The National Survey of Bowen Therapists July 1999. Vic Bowen News, 2:5,5 10. Rousselot P 2000 ‘Bowen Therapy’ , Clinicians’ Complete Reference to Complementary/Alternative Medicine, Mosby, Missouri, p376. 11. Victorian Government. Report of the Committee of Inquiry into Osteopathy, Naturopathy and Chiropractic. 1975, Government Printer, Melbourne, Appendix T. 12. Whitaker, J.A., Marlowe, S 1998 ‘The Bowen Technique: A healing modality, alleviates Myofacial pain of Fibromyalgia and Balances the Dysfunctional changes of the Autonomic Nervous System as measured by clinical assessment and Heart Rate Variability’. Abstract presentation at MYOPAIN ‘98, Silvi Marina, Italy. 13. Whitaker,J.A., Gilliam,P.P., Seba, D.B. 1997 ‘The Bowen Technique: a Gentle Hands- on Method That Affects the Autonomic Nervous System as Measured by Heart Rate Variability and Clinical Assessment’. Abstract presentation American Academy of Environmental Medicine 32nd Annual Conference La Jolla California.

Anna Dicker RN RM Ba HSc (Nursing) Dip Bowen Therapy Community Nurse Byron Bay Community Health.

This is a huge amount of work and I hope it is of use to you. Please don’t hesitate to contact me to discuss anything further. Good Luck and kind regards ,Anna

Note: In February 2002 the Health Service formed a committee to examine the use of Complementary therapies and in July 2002 the committee formally approved the use of Bowen therapy within the policies and guidelines as attached. Anna Dicker. [email protected]