Jennifer Larson, NurseZone feature
Dalton, RN, CNP, realized Western medicine didn’t always provide the perfect
solution for some conditions when one patient kept presenting with a recurring
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.
Dalton is co-founder and one of three nurse practitioners at Wellspring for
Women, a health care practice designed to provide holistic care.
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
her colleagues, Cece Huffnagle, RN, CNP, and Pamela Chandler, RN, MS, are not
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.
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
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.
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.
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.
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.”
Snyder, BSN, MSN, Ph.D., is also not surprised to see complementary medicine
receiving strong support from nurses.
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.
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.
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.
additional 13 percent of the boards were discussing the matter at the time of
all nurses agree they need to be certified in certain alternative therapies.
certification is economically driven,” said Roxanne Struthers, BSN, MS, Ph.D.,
assistant professor at the University of Minnesota School of Nursing.
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.
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.
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.
the Patients’ Needs
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
are asking for it,” said Struthers.
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.
need to understand where it might be helpful, the basic concepts of it,” she
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.
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.’
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.
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.”
Meets West In Nursing Schools
of nursing schools are beginning to incorporate complementary and alternative
medicine into their curricula.
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.
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.
different schools of thought on whether specific therapies should be taught in
the nursing school classroom. Some do include specifics, while others do not.
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
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.
schools start teaching about complementary medicine?
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
different paradigms that separate Western biomedicine, and complementary and
alternative medicine can complicate the issue of how to incorporate both into
“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.”
Gaydos added, broadening research methodologies might be one remedy.
complementary therapies become more mainstream, some believe there is a risk
they’ll be molded into the framework of what’s acceptable by Western
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
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.
a whole different way of thinking,” Sparber said.
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.
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
time to talk more about transforming the health care system to fully incorporate
both paradigms, Snyder said.
the best of Western medicine, but we look at these [complementary]therapies with
the holistic perspective that nursing often uses,” she said.
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
of Westernization of complementary therapies may be the increased research,
which has granted them some additional credibility in the eyes of skeptics.
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.
combination is often reassuring to people who see value in both paradigms.
are really, I think, looking for the blend of the two,” Dalton said.
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
Visit these Web sites for more information on holistic nursing or complementary medicine:
American Holistic Nurses Association
White House Commission on Complementary and Alternative Medicine Policy
National Center for Complementary and Alternative Medicine
Jan. 18, 2002. © 2002. NurseZone.com. All Rights Reserved.