Nurses Vital to Integrating Alternative Medicine with Traditional

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Complementary Alternative Medicine
Medical authorities used to scoff at “alternative medicine,” which often aimed to treat not only the body but also the patient’s spirit. But now those forms of health care are becoming so integral to the medical establishment that nurses can aspire to specialize in them.

“Complementary and alternative medicine has never been more popular,” says the Mayo Clinic on its website. “Nearly 40 percent of adults report using complementary and alternative medicine, also called CAM for short. Doctors are embracing CAM therapies, too, often combining them with mainstream medical therapies — spawning the term ‘integrative medicine.'”

The revered Johns Hopkins University is a proponent and offers instruction, according to its website. “Our institutional approach to Complementary Alternative Medicine and Integrative Medicine is to meld the best of conventional medicine with the best of Complementary and Alternative Medicine from an evidence-based standpoint, taking into account the patient’s physical, mental and emotional needs. It is our intention to approach Integrative Medicine in a manner in line with the Hopkins approach to medicine, including clinical, research and academic perspectives across schools and including the multiple contributors to our health system.”

Alternative medicine is often based on ancient philosophies and techniques that originated in China and India, including acupuncture, Ayurveda and yoga. One oncologist’s analogy is that chemotherapy kills weeds while CAM deals with the soil where the weeds grow.

Defining CAM

The National Center for Complementary and Alternative Medicine (NCCAM) divides CAM therapies into five categories:

  • Alternative medical systems, or complete systems of therapy and practice
  • Mind-body interventions, or techniques designed to help enable the mind to influence bodily functions and symptoms
  • Biologically based systems, including herbalism
  • Manipulative and body-based methods, such as chiropractic and massage therapy
  • Energy therapies

Nurses’ roles in CAM

Despite the ancient roots of alternative medicine, there’s still a sense that CAM is something new.

“The growth of integrated health care facilities has been staggering” since the 1980s, says the American Holistic Nurses Association, adding that nurses are leading the way in the incorporation of complementary medicine.

The AHNA cited nurses whose CAM work has been fulfilling, giving an overview of what they do.

For instance, Esther Johnson, RN, BSN, PHN, CHPN, spearheaded the CAM portion of the Pathways program in Sunnyvale, California, serving an average of 350 patients per day and serving a total of 3,000 in the San Francisco Bay Area as of March 2016. Pathways specializes in pain and symptom management in home care and hospice, several of which are used in conjunction with traditional medicine. Johnson’s Integrative Therapies Team taught how to integrate complementary and alternative medicine into end-of-life caretaking “with techniques such as aromatherapy, guided imagery, music and comfort touch.”

Val Lincoln, RN, Ph.D., AHN-BC, was clinical lead of Integrated Services at the Woodwinds Hospital in Woodbury, Minnesota, where she coordinated a program for staff, patients and volunteers that included healing arts therapies such as acupuncture and massage, and training for all nurses in holistic practices. The hospital boasted that patient satisfaction increased and that physicians reported their patients “benefit from our holistic model and desire more.” Furthermore, the Picker Patient Satisfaction Survey’s award to Woodwinds’ Maternity Care Center cited it as “the nation’s highest patient satisfaction standard.”

Glenda Christiaens, MS, RN, AHN-BC, of Brigham-Young University, has specialized in visualization and positive affirmations, and established a four-hour clinic that teaches nursing students about guided imagery, meditation, music and relaxation.

Organizations that endorse CAM

Many CAM techniques work with specific afflictions.

Multiple sclerosis is a prime example. “In the United States today, the vast majority of people incorporate one form or another of CAM as part of their MS management,” notes the National Multiple Sclerosis Society, “most often in combination with their prescribed MS treatments.” The society notes that the American Academy of Neurology provides a guideline on the use of CAM in treating MS.

A 2012-2013 survey of 207 Parkinson’s disease patients in the Denver area reported that 85 percent used CAM in some form:

  • Vitamins: 66 percent
  • Prayer: 59 percent
  • Massage: 45 percent
  • Other relaxation techniques: 32 percent

The report added that 4.3 percent used medical marijuana and that “it ranked among the most effective CAM therapies, particularly for mood and sleep.”

Marijuana remains in a gray area among CAM treatments because some credit the substance with properties normally embraced in traditional medicine. The federal government has not endorsed marijuana in its natural state, but the FDA has approved two synthetic prescription drugs, Dronabinol and Nabilone, which are based on a component of cannabis, and considers them part of conventional medicine, not CAM.

A push for credibility

Skepticism over the medicinal properties of cannabis remains widespread, as do doubts about the medical value of alternative treatments.

This response to a query from a prospective holistic nurse on Allnurses.com combined both skepticism and advocacy:

 “Be careful — integrative medicine is often a code word for ‘alternative‘ medical treatments that have not stood up to scientific scrutiny,” wrote Cayenne6. “The integrative medicine practices that I know of sprinkle a bit of science-based medicine over a big steaming bowl of naturopathy, homeopathy and magical thinking. … Integrative medicine SHOULD mean creating a practice that is structured to provide high-quality education on risk reduction and lifestyle modifications, offering not just standard medical care but access to dietary counseling, mental health services, smoking-cessation services, and social services like signing up for Medicaid, accessing government aid programs, etc.”

Some structure was added in 2006, when the American Nurses Association officially recognized a specialty in holistic nursing. The ANA set forth these criteria:

  • A body of knowledge
  • Evidence-based research
  • Sophisticated skills
  • Defined standards of practice
  • A diversity of modalities from a broad range of health practices
  • A philosophy of living and being grounded in caring, relationships and interconnectedness

“Nurses need to realize that CAM covers a wide spectrum, from completely fraudulent to miraculous,” said CRNA Nick Angelis, CRNA, MSN, co-founder of the Grecian Garden, to writer Brianna Flavin of the Rasmussen College website. He explained that many CAM approaches “are validated by research but simply don’t fit into the fast pace of our conventional health system.”

But often there is also a lack of validation.

“One reason for the lack of research in alternative treatments is that large, carefully controlled medical studies are costly,” the Mayo Clinic points out. “Trials for conventional therapies are often funded by big companies that develop and sell drugs. Fewer resources are available to support trials of CAM therapies. That’s why NCCAM was established — to foster research into CAM and make the findings available to the public.”

Nevertheless, the underlying value of alternative medicine is often attitudinal. “When I went to nursing school, curriculum was just starting to move toward video education and away from the hands-on patient experience,” nursing coach Courtney “Nurse Courtney” Allen-Gentry, RN, MSN, PHN, AHN-BC, HWNC-BC, told Flavin.

“Many of my colleagues never learned how to provide direct patient care in a manner which teaches the humanity of the act. … Showing love and demonstrating humanity should not be considered an alternative practice.”

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