Complementary and alternative therapies refer to healing philosophies and approaches not included in the primary health care system, such as holistic approaches and psychoneuroimmunology research which indicates how mind, body and spirit interact.
Even though Registered Nurses (RNs) should not be expected to provide intensive therapies, having some knowledge of complementary and alternative medicine (CAM) therapies is still valuable for nurses.
Spirituality
Many of the complementary and alternative medicine therapies utilized by nurses as complementary and alternative medicines have spiritual roots. Nursing has an established tradition of accepting spiritual values and beliefs into care delivery; yet due to technology and an increased focus on medical science delivery, many spiritual elements of holistic healing have become less prominent over time. Current Joint Commission standards mandate nurses assess patients’ spiritual needs in patient-centric care plans; thus nurses need to reclaim this part of holistic healing for patient safety’s sake.
Psychoimmunology and neurobiology research supports the theory that thoughts, perceptions, and feelings influence immunity, mood, and recovery from illness. Nurses should become familiar with various approaches to wellness that promote mental, emotional and physical well-being such as visualization, imagery, music therapy massage hypnotherapy support groups as well as available dietary supplements/herbs that may improve general health.
Immigrants from different parts of the world bring with them various traditions, including health care practices that fall under what Americans refer to as complementary and alternative therapies (CALT). Common CALT practices in America include acupuncture, meditation and herbal preparations while other cultures employ techniques that we would consider unconventional such as soul retrieval, kampo medicine, curanderismo or psychic surgery.
Nurses need to understand how these treatments are utilized and their efficacy. But there can also be potential hazards and ethical concerns from using complementary and alternative therapies, including those from complementary and alternative medicine practices that fall outside their scope of practice or questionable therapies, which could harm both patients and nurses themselves. Furthermore, using such techniques without adequate education or training could put both at risk.
Nutrition
Complementary or alternative therapies encompass an array of practices. According to the National Center for Complementary and Alternative Medicine (NCCAM), complementary or alternative medicine therapies fall into various categories including mind-body therapies, alternative health care systems, biological-based therapies, manipulation/body-based therapies and energy therapies. Nurses should become familiar with all available therapies so that they may discuss with their patients which ones they may utilize or consider using.
Registered nurses have long employed holistic techniques in their practices. Due to its holistic philosophy and approach to patient care, nursing has proven an ideal environment for employing alternative/complementary methods that address mental, physical, emotional and spiritual aspects of patient care.
Nurses have conducted extensive research on therapeutic techniques like guided imagery, music therapy, massage, humor therapy and animal assisted therapy that provide a more holistic and integrated approach to client care.
Nursing modalities typically serve as complementary therapies, meaning they supplement biomedical therapies rather than replacing them. However, alternative therapy may also be applied as an umbrella term and indicate when therapy replaces one of them entirely.
Some modalities can be beneficial, yet misapplication may harm both nurses and patients. According to NCCAM, harm may arise when complementary/alternative treatments are applied inappropriately, for conditions for which they were never intended – including inappropriate combinations of therapies like combining acupressure treatment with pain medications.
Harm can also result from nurses failing to take an accurate medical history and failing to recognize that certain therapies could be potentially hazardous, like when an Ojibwe woman used boiled bark as a treatment for foot gangrene.
Massage
Massage therapy has long been an ancient healing art that is now offered in hospitals and clinics around the world. Massage provides an effective relaxation technique that relieves pain while increasing circulation to relieve anxiety and depression, reduce cortisol (stress hormone) levels while increasing oxytocin (love hormone). Massage can therefore be useful for managing conditions like chronic stress, insomnia, fibromyalgia, migraines and many others.
Nurses play an essential part in bringing complementary therapies into health care systems. Nurses have extensive anecdotal experience and research conducted on complementary therapy practices; therefore they provide leadership for integration within Western biomedical models of health care.
Massage utilizes various techniques, such as effleurage (light pressure), friction, tapotement (kneading), and vibration. Essential oils may also be added to massage oil in order to increase relaxation and increase effectiveness of treatment.
Massage can provide both rehabilitative and preventive care for pregnant women or after surgery, and as part of their nursing practice – such as during childbirth or to encourage new mothers to hold and interact with their infants during the first months after birth. Massage therapy is widely utilized in hospice settings as well as units dedicated to mental health problems; nursing assistants or unpaid volunteer practitioners sometimes perform it for these units; massage is also often utilized by private practices and community health settings like home care programs or physician offices for such purposes.
Acupuncture
Acupuncture, an ancient form of Chinese healing rooted in traditional Chinese medicine, works by balancing the flow of vital energy – known as qi or chi – along pathways known as meridians. Treatment typically involves placing fine needles at specific points on the body to balance this vital energy flow and alleviate chronic conditions like back problems and nerve issues like shingles rashes or carpal tunnel syndrome; migraines; fibromyalgia or menstrual cramps. Acupuncture fits within this holistic whole-person approach by targeting emotional, spiritual and physical wellbeing at once.
Nursing has a rich tradition of employing complementary and alternative therapies, dating back to Florence Nightingale who advocated their use in her hospital. Some such techniques include hot and cold application, massage therapy, nutritional supplement use and hot/cold application therapy. Nursing research has focused on these therapies with many being subject to clinical trials with positive results.
At the same time, nurses must keep in mind that not all complementary and alternative therapies have been subjected to rigorous scientific testing, notes Ruth Lindquist of Complementary and Alternative Therapies in Nursing Practice book co-editorship. Accordingly, when suggesting therapies that have not yet been scientifically verified they must proceed with caution when making recommendations. “Nurses must use caution when suggesting particular therapies without scientific backing,” Lindquist states.
Lindquist cautions nurses to be aware that many complementary and alternative therapies may interact with conventional medications, including herbs with potential to increase antidepressant and blood-thinning effectiveness. Before initiating any complementary or alternative therapy plan, a nurse must notify her doctor as well as be informed if their hospital permits or supports such practices.
Herbal Medicine
Herbal medicine encompasses an expansive array of practices, products, and beliefs outside the traditional Western biomedical model. Also referred to as integrative or holistic medicine, herbal therapies may be used alongside conventional medical treatment to address illness and disease. Many practitioners believe herbal remedies offer an alternative solution that has positive results for body, mind, and spirit health.
Nurses may provide complementary and alternative therapy as part of an integrated plan of care for their patients, including complementary and alternative medicine therapies. It is crucial that they are competent at administering such methods, knowing whether they fall within the scope of nursing practice, as well as understanding if these therapies interact with any medications or supplements the patient might already be taking.
An important consideration in complementary and alternative therapy is cost. Individuals from more privileged societies tend to be better able to afford these methods and gain more access to them than others; nurses should be sensitive to this ethical principle by making sure all clients can access recognized complementary and alternative therapies when appropriate for their condition.
Studies of clinical and academic nurses’ attitudes regarding complementary and alternative therapies revealed that both groups agreed that using multiple forms of these approaches is effective (Siedlecki, 1998). Nutrition therapy, music therapy and herbal therapy were frequently utilized. Both groups also lacked awareness regarding other techniques like touch therapy and hypnosis that might also prove beneficial for treatment.
Nurses must recognize that even though complementary and alternative therapies are considered “natural,” they can still have adverse side effects when administered incorrectly. Nurses should be mindful that taking herbal supplements, for instance, could interfere with existing medication or lead to serious reactions for certain individuals.
