The Role of the Nurse in Supporting Client Use of Complementary and Alternative Therapies

The current healthcare system is on the verge of great change, and driving this change is the popularity of complementary and alternative methods of healthcare. As the use of complementary and alternative methods (CAM) becomes increasingly common, traditional allopathic practitioners must incorporate knowledge of alternative therapies into their standard Western medical practice to accommodate client preferences, safeguard patients, and further client healing.

The Role of the Nurse in Supporting Client Use of Complementary and Alternative Therapies
The current healthcare system is on the verge of great change, and driving this change is the popularity of complementary and alternative methods of healthcare. As the use of complementary and alternative methods (CAM) becomes increasingly common, traditional allopathic practitioners must incorporate knowledge of alternative therapies into their standard Western medical practice to accommodate client preferences, safeguard patients, and further client healing. Clients are often unwilling to disclose their use of nontraditional methods to physicians (Chiravalle & McCaffrey, 2005; Fowler & Newton, 2006; Mantle, 2006; Tracy et al., 2005), so nurses are uniquely positioned to learn about client care preferences and client use of alternative and complementary therapies (Brolinson, Price, & Ditmyer, 2001). Because CAM provides multiples benefits to patients such as cost efficiency, less invasiveness, and greater control and choice over personal health, and because promoting client health and safety is a nursing priority, nurses must actively support the addition of complementary and alternative health care options in traditional health care settings, must promote the inclusion of complementary and alternative therapies in nursing school curriculum, and must actively educate themselves and their clients regarding the safe use of nontraditional methods. In doing so, nurses will improve client satisfaction and outcomes, and will empower their patients and themselves as healers.
CAM use by consumers has been growing steadily since the 1990’s (Brolinson, Price, & Ditmyer, 2001). According to Eisenberg et al (1998), in 1997, visits to alternative practitioners, totaling 629 million, represented a 47% increase over visits in 1990, with 42% of American adults spending $27 billion dollars on CAM (as cited in Brolinson, Price, & Ditmyer, 2001). Of this amount, between 12.2 and 19.6 billion dollars were spent out-of-pocket by consumers for CAM, a greater amount than out-of-pocket payments for hospitalization and close to half the amount paid out-of-pocket to physicians (Center for Medicare and Medicaid Services, 1997, as cited in Barnes, Powell-Griner, McFann, & Nahin, 2004, para. 4). In 2002, the results of a national survey of 31,044 American adults 18 years old and older, found when prayer for health is included, 75% of those surveyed used CAM and 62% had used CAM during the 12 month period preceding the study (Barnes, Powell-Griner, McFann, & Nahin, 2004). CAM’s increasing popularity points toward the necessity of its inclusion in traditional settings.
As patient advocates, nurses must request that complementary and alternative methods be made readily available to clients in hospitals and clinics, stressing the noninvasiveness and cost effectiveness of alternative therapies (Fowler & Newton, 2006). Many complementary and alternative methods, such as massage, therapeutic touch, use of essential oils, and Reiki can be practiced by nurses and have been shown to have positive impact on pain reduction and patient recovery time (Mantel, 2006; Vitale & O’Connor, 2006). Other positive facets include CAM’s potential to prevent reoccurrence of disease and increase the quality of life (Beebe-Dimmer et al, 2004; Henderson & Donatelle, 2004, as cited in Fowler & Newton, 2005), to ease the stress associated illness and hospitalization (Tracy et al, 2005), and to facilitate long term positive behavioral changes (Mantle, 2006). Alternatives, such as acupuncture which has a long history of use (White & Ernst, 2004) and proven efficacy in pain management (Zang-Hee, 2001), should be made available to patients. By lobbying for the inclusion of CAM and influencing the development of policies and procedures relating to CAM use in traditional healthcare settings (Fowler & Newton, 2006), nurses will further patient’s healing and assert themselves as healers within the current healthcare modality.
To lobby successfully for CAM inclusion and provide safe care to their patients, nurses must be knowledgeable about the effectiveness and safety of CAM (McDowell & Burman, 2004). The extensive variety of alternative practices points toward the need for inclusion of CAM education in nursing school curriculum and the importance of CAM related continued nursing education (McDowell & Burman, 2004). Studies indicate that while interested in promoting CAM, lack of knowledge, training, and time prevents nurses from endorsing or implementing complementary and alternative methods (Tracy et al, 2005). In addition, because CAM not only positively impacts patient health, the potential for negative impact, such as combining certain herbal medicines with Western medicines (Fowler & Newton, 2006), makes both nursing education and patient education imperative.
Because patients may engage in alternative practices that may be potentially harmful, nurses are an important link in patient education regarding the use of CAM. In 2002, Norred reported that 34% of patients use alternative herbal therapies that either potentiate or interfere with standard medicines (as cited in Fowler & Newton, 2006, para. 18). Examples of potentially harmful combinations include the use of St. John’s Wart with warfarin and the use of nettles with cardiac glycosides, for St. Johns Wart potentiates warfarin and interferes with anticoagulation (Fowler & Newton, 2006), and nettles enhance the effects of cardiac glycosides (Mantle, 2006). Many patients do not inform their primary care providers about their CAM use (Fowler & Newton, 2006; Mantle, 2006; Tracy et al., 2005), so nurses must educate their patients about safe uses, preventing possible complications. Additionally, patients should also be made aware of methods that do not interfere with traditional medical treatments. Offering suggestions for methods that compliment and enhance traditional therapies, such as use of prayer, mediation, yoga, massage, acupressure, and Bach Flower and homeopathic remedies (Mantle, 2006), enhances patient knowledge, especially in patient populations who do not have prior knowledge of CAM (Fowler & Newton, 2006). Health screening and fairs are excellent avenues for furthering patient education. In educating their clients about complementary and alternative methods, nurses not only empower their clients, they empower themselves as healers.
As healers, nurses take on many roles when assisting clients to attain and maintain health. They act as confidant, educator, clinician, and advocate when providing care, serving as a bridge between client and physician. Because nurses are “one of the largest groups of health professionals…in contact with the public” (Brolinson, Price, & Ditmyer, 2001), nurses have tremendous impact patient health practices. By lobbying for inclusion of CAM in traditional health care settings, continuing professional education and expanding nursing school curriculum to include CAM, and educating patients on safe and effective complementary and alternative therapies, nurses can once again serve their patients, affording them greater choices and opportunity for healing and self-empowerment.

Barriers to Supporting Client Use of Complementary and Alternative Therapies

Intervention 1: Patient Education in the Use of Complementary and Alternative Therapy

Disadvantage 1: Knowledge Deficits Related to Inadequate Understanding of Complementary and Alternative Therapies

Inadequate nursing knowledge related to complementary and alternative methods of treatment (CAM) prevents nurses from adequately educating patients regarding CAM use. Because the potential for negative interaction between traditional allopathic medical treatment and nontraditional alternative methods exists (Fowler & Newton, 2006; Mantel, 2006), both nursing and patient education are imperative to ensure the safe provision and utilization of CAM. Studies indicate that while interested in promoting complementary and alternative methods of treatment, lack of knowledge regarding CAM prevents nurses from endorsing nontraditional methods (Tracy et al, 2005). The extensive variety of complementary and alternative therapies points toward the need for inclusion of CAM in nursing curriculum and the importance of CAM related continuing education for nurses (McDowell & Burman, 2004). According to Brolinson, Price and Ditmyer, the majority of nurses perceive their education in this area to be “fair to poor” (2005, para. 23), with only one in four nurses perceiving the acquisition of adequate preparation and education regarding CAM use in their coursework (2005).

Disadvantage 2: Perceived Potential for Discrimination by Clients Leads to Nondisclosure of Complementary and Alternative Therapy Use

Client perceived bias by medical professionals against the use of complementary and alternative therapies leads to inadequate client disclosure of CAM use. While it has been shown that an increasing number of Americans use complementary and alternative treatments (Eisenberg et al., as cited in Brolinson, Price, & Ditmyer, 2001), most do not disclose CAM use to their healthcare providers (Chiravalle & McCaffrey, 2005; Fowler & Newton, 2006; Mantle, 2006; Tracy et al., 2005). This nondisclosure directly leads to inadequate client education regarding the safety and efficacy of CAM, for awareness of client need and healthcare practice directs the focus of client education efforts.

Intervention 2: Lobbying for Inclusion of Complementary and Alternative Therapies within Traditional Care Settings

Disadvantage 1: Knowledge deficits related to the Benefits of Complementary and Alternative Methods of Treatment Leads to Inadequate Promotion

Without a strong knowledge base, nurses can not lobby effectively for the inclusion of complementary and alternative therapies in hospitals and clinics. Knowledge is essential in identifying complementary and alternative methods appropriate to and beneficial in traditional settings. Lack of nursing education and familiarity with the myriad of complementary and alternative methods currently available (Brolinson, Price, & Ditmyer, 2001) directly undermines CAM promotion by nurses, for nurses are unwilling to promote complementary and alternative therapies due to lack of knowledge about the safety, efficacy, and benefits of non-allopathic methods of treatment (McDowell & Burman, 2004; Tracy et al., 2005).

Disadvantage 2: Inadequate Insurance Coverage of Complementary and Alternative Methods of Treatment Renders Lobbying Efforts Ineffective

Lack of insurance coverage for complementary and alternative methods is a stumbling block to the inclusion of CAM within traditional healthcare facilities. While a large percentage of complementary and alternative therapy is paid for out-of-pocket by consumers (Center for Medicare and Medicaid Services, as cited in Barnes, Powell-Griner, McFann, & Nahin, 2004), consumer use of complementary and alternative methods correlates positively with insurance coverage (Wolsko, Eisenberg, Davis, Ettner, & Phillips, 2002); expanded insurance coverage of CAM is necessary before its acceptance within traditional settings can be accomplished. Successful lobbying by nurses for CAM inclusion in hospital and clinical settings will be hampered until insurance coverage of alternative treatment modalities is deemed adequate by financial managers within traditional settings.

References

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Chiravalle, P., & McCaffrey, R. (2005). Alternative therapy applications for postoperative nausea and vomiting. Holistic Nursing Practice. 19(5), 207-210. Retrieved from Expanded Academic ASAP database (A137016222).

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Mantle, F. (2006). What’s the alternative? Complementary and alternative remedies can have significant side effects when combined with conventional treatments. Fiona Mantle urges emergency nurses to be aware of the problems that can arise from their use. Emergency Nurse, (14)1, 16-19. Retrieved January 14, 2007, from Expanded Academic ASAP database (A144869682).

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Tracy, M. F., Lindquist, R., Savik, K., Watanuki, S., Sendelbach, S., Kreitzer, M. J., et al. (2005). Use of complementary and alternative therapies: A national survey of critical care nurses. American Journal of Critical Care, 14(5), 404-415. Retrieved January 14, 2007, from Expanded Academic ASAP database (A136510788).

Vitale, A. T., & O’Connor. (2006). The effect of Reiki on pain and anxiety in women with abdominal hysterectomies: A quasi-experimental pilot study. Holistic Nursing Practice, 20(6), 263-274. Retrieved May 26, 2007, from Expanded Academic ASAP database (A155294447).

White, A., & Ernst, E. (2004). A brief history of acupuncture. Rheumatology 43(5), 662. Retrieved May 26, 2007, from Research Library database. (Document ID: 626689341).

Wolsko, P. M., Eisenberg, D. M., Davis, R. B., Ettner, S. L., & Phillips, R. S. (2002). Insurance coverage, medical conditions, and visits to alternative medicine providers: Results of a national survey. Archive of Internal Medicine. 162(3), 281-287. Retrieved October 28, 2007, from ProQuest database.

Zang-Hee, C., Young-Don, S., Jae-Yong, H., Wong, E., Chang-Ki, K., Kyung-Yo, K. et al. (2001). fMRI neurophysiological evidence of acupuncture mechanisms. Medical Acupuncture: A Journal For Physicians By Physicians, 14(1). Retrieved May 26, 2007, from http://www.medicalacupuncture.org/aama_marf/journal/vol14_1/article1.html