Holistic Nursing: Complementary Therapies Increase in Popularity, Raise New Issues

By Jennifer Larson, NurseZone feature writer

Carol Dalton, RN, CNP, realized Western medicine didn’t always provide the perfect solution for some conditions when one patient kept presenting with a recurring infection.

Since it was the 1970s and Dalton lived in Boulder, Colorado, there was a wealth of opportunities to learn about “alternative” therapies. Dalton took classes to learn about herbology, therapeutic touch, nutrition, and other alternative therapies and began to consider incorporating them into her nursing practice.

Today, Dalton is co-founder and one of three nurse practitioners at Wellspring for Women, a health care practice designed to provide holistic care.

Holistic care, at its core, is about providing care that recognizes the mind-spirit-body connection of persons, according to the American Holistic Nurses Association. In keeping with that philosophy, Wellspring provides the option for chiropractic services, acupuncture, hypnotherapy, psychotherapy and other complementary therapies.

Dalton and her colleagues, Cece Huffnagle, RN, CNP, and Pamela Chandler, RN, MS, are not alone.

Studies show that people are becoming more accepting of complementary medicine, and so are many health care professionals. However, with the rise in popularity came a rise in questions about how complementary therapies fit in with the accepted Western system of medicine, or biomedicine, in the United States.

A 1998 study in the Journal of the American Medical Association acknowledged a significant growth in the use of complementary and alternative therapies by American citizens. In 2000, then-President Bill Clinton created the White House Commission on Complementary Medicine and Alternative Medicine Policy to address the issues that were beginning to evolve, as complementary medicine became more widespread.

Three nurses serve on the commission, which is currently working on a draft of recommendations. The Commission has been hearing testimony and gathering research for a report to be issued later this year.

Nursing is not immune to the popularity of complementary medicine or the new issues surrounding its use in practice, such as licensure, certification, and the incorporation of complementary therapies in nursing school curricula.

Complementing Nursing Care

According to Andrew Sparber, RN, MS, the liberalization of licensure laws is associated with the increased use of complementary therapies by physicians and other health care providers. Complementary therapies have especially taken root in the profession of nursing.

“I think it’s mirroring what we’re seeing going on in the country anyway,” Sparber said. “Nurses have been doing a lot of this as practitioners for a long time, like healing touch. That’s an extension of what nurses do anyway.”

Mariah Snyder, BSN, MSN, Ph.D., is also not surprised to see complementary medicine receiving strong support from nurses.

“A number of complementary therapies have been used in nursing for years, and no one really raised questions about it,” said Snyder, professor emeritus at the University of Minnesota School of Nursing.

In an article in the Aug. 31, 2001, issue of Online Journal of Issues in Nursing, Sparber wrote that 47 percent of the state boards of nursing in the United States have taken positions allowing nurses to perform a range of complementary therapies. The Arizona Board of Nursing established the first statement in 1991, and Kentucky followed.

According to Sparber, the state boards, which identify the basic education and competencies for nursing practice, discussed the need for nurses to have documented knowledge and competencies in alternative therapies. Many of the boards also mentioned the need for credentialing.

An additional 13 percent of the boards were discussing the matter at the time of Sparber’s article.

But not all nurses agree they need to be certified in certain alternative therapies.

“I think certification is economically driven,” said Roxanne Struthers, BSN, MS, Ph.D., assistant professor at the University of Minnesota School of Nursing.

To get paid for services in the U.S. health care system, it makes sense to have certification, she said. But if a nurse wants freedom from regulations to make the best choices he or she sees fit for a certain patient, then certification might not be the best avenue.

Some therapies fit under the scope of nursing, like certain aspects of healing touch therapy, Sparber said, and many state boards would categorize them within the realm of nursing, thus mitigating the need for special certification.

But proof of training and proof of safe practice could help nurses who might be asked to show they can do that kind of work, he added.

Fulfilling the Patients’ Needs

While nurses disagree over the need for certification, almost all nurses who identify themselves as “holistic nurses” or complementary practitioners agree that it’s crucial for nurses to have some basic knowledge of complementary medicine.

“Consumers are asking for it,” said Struthers.

Patients often approach their nurses with questions and want answers, Dalton added, recommending that young nurses learn more about nutrition and supplements, as well as information about “at least a smattering” of alternative treatments, like acupuncture, Chinese herbs, and massage therapy.

“They need to understand where it might be helpful, the basic concepts of it,” she said.

Nurses are really in the ideal position to integrate the complementary therapies with Western biomedicine, said Sparber and Snyder. With that position comes the necessity of increasing one’s knowledge about a variety of therapies to be prepared for patients who are using alternative therapies, especially the ones who are reluctant to tell the nurse, Snyder added.

“People might not volunteer that,” she said. “You want to make them feel all right about sharing and that you respect the use of these therapies.’

When patients begin asking their nurses about certain therapies, it’s also important to know the origin and philosophy of the therapies, too, said Struthers, who is a member of the Ojibwa Chippewa tribe and became acquainted with Native American healing therapies early in life.

“It would be even better to understand the background and the origin on how those [healing modalities] came about and how those are all integrated into a whole,” Struthers said. “Otherwise, it’s just another modality, and that’s when the modality starts losing meaning.”

East Meets West In Nursing Schools

A number of nursing schools are beginning to incorporate complementary and alternative medicine into their curricula.

New York University’s Division of Nursing has the first holistic nurse practitioner program in the U.S., and the program prepares each student to sit for the certification exam from the American Holistic Nurses Association.

The University of Minnesota School of Nursing received a grant from the National Institutes of Health’s National Center for Complementary/Alternative Medicine, or NCCAM, to examine the inclusion of complementary therapies in curricula in nursing, as well as other disciplines like medicine and public health. The University of Virginia School of Nursing’s Center for the Study of Complementary and Alternative Therapies is another program that receives NIH funding for research.

There are different schools of thought on whether specific therapies should be taught in the nursing school classroom. Some do include specifics, while others do not.

At the University of Minnesota, the undergraduate skills level classes include introductions to healing touch, massage, and music therapy, while the graduate program requires completion of a course called “Health History and Therapeutics.” This course devotes four or five sessions to complementary therapies.

“Even if they don’t practice the therapies, they need to have knowledge about them, so when they’re interviewing people, they can ask about them and answer questions about them,” Snyder said.

Will more schools start teaching about complementary medicine?

“I think it’s just a matter of time,” Sparber said, adding that medical schools are starting to recognize the need to address complementary therapies in their curricula.

But the different paradigms that separate Western biomedicine, and complementary and alternative medicine can complicate the issue of how to incorporate both into one curricula.

In “Complementary and Alternative Therapies in Nursing Education: Trends and Issues,” H. Lea Barabato Gaydos, RN, Ph.D., wrote, “A major critique and concern of CAT is that their efficacy is difficult to substantiate using scientific methods with our current technology. The concern about the lack of research on CAT effectiveness warrants caution as nursing educators seek to integrate these therapies into nursing curricula.”

But, Gaydos added, broadening research methodologies might be one remedy.

As complementary therapies become more mainstream, some believe there is a risk they’ll be molded into the framework of what’s acceptable by Western medicine standards.

“I think there is a Westernization of all these modalities,” Struthers said. “I’m not saying it’s bad or good. I’m just saying that’s what is happening. People sometimes have a need to have it fit into what’s appropriate for them.”

Western medicine is often described as “disease-centered” or focused on one body part at a time, while complementary medicine takes a broader perspective that incorporates the person’s spirit, body and mind and works toward achieving harmony and balance.

“It’s a whole different way of thinking,” Sparber said.

Some believe that the Western system of health care may alter complementary medicine, which has a distinctly different view of health care, until it’s no longer holistic or recognizable as complementary medicine.

According to Snyder, NCCAM has noted that a complementary therapy should no longer be classified as a complementary therapy when it becomes an accepted treatment for a specific condition. But the defining line between Western medicine and complementary medicine is constantly changing

It’s time to talk more about transforming the health care system to fully incorporate both paradigms, Snyder said.

“We keep the best of Western medicine, but we look at these [complementary]therapies with the holistic perspective that nursing often uses,” she said.

It is important to document the use of complementary therapies in a nursing context, if the therapies are used as part of nursing practice, noted Noreen Cavan Frisch, RN, Ph.D., FAAN in “Nursing as a Context for Alternative/Complementary Modalities,” in the Online Journal of Issues in Nursing. If massage is used to address a nursing diagnosis, it must be identified as a nursing intervention, perhaps to promote relaxation in a person who has disturbed sleep patterns.

One aspect of Westernization of complementary therapies may be the increased research, which has granted them some additional credibility in the eyes of skeptics.

People who are better acquainted with the Western system of medicine are usually more comfortable with therapies that have been tested and studied. When Dalton first became interested in herbs, there were anecdotes about the effectiveness of an herb called feverfew in treating migraine headaches, but little scientific research existed. Now there have been double-blind studies showing its efficacy.

That combination is often reassuring to people who see value in both paradigms.

“Patients are really, I think, looking for the blend of the two,” Dalton said.

More guidance on the issues cropping up around complementary medicine may come when the White House Commission issues its final report, which is scheduled for March 7.

Jan. 18, 2002. © 2002. NurseZone.com. All Rights Reserved.