Chapter 32 Complementary therapies in nursing practice

Ysanne Chapman, Melanie Birks

LEARNING OUTCOMES

Mastery of content will enable you to:

• Define key complementary therapies and related systems.

• Describe the use of complementary therapies in nursing practice.

• Explain the influence of the biomedical model on healthcare.

• Differentiate between the alternative therapies, complementary therapies, natural therapies, integrative healing and orthodox medicine and therapies in terms of their relationships to one another.

• Describe the influences of quantum physics and chaos theory on contemporary healthcare approaches and their potential for explaining human energy fields and centres.

• Identify the political, practice, educational and research issues and implications of incorporating complementary therapies into nursing practice.

• Reflect on your personal attitudes about complementary therapies and their use in contemporary healthcare.

• Suggest strategies for how complementary therapies could be integrated into nursing practice settings.

• Respect the choices of individuals, families and communities in relation to the use of complementary therapies in healthcare.

Complementary and alternative medicine (CAM) has been defined as ‘diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, satisfying a demand not met by orthodoxy, or diversifying the conceptual framework of medicine’ (Ernst and others, 2006:2). CAM is subject to national, cultural and individual differences, but all CAM therapists are bound by law to follow professional behaviour. Throughout the Western world, there has been an increase in the use of complementary therapies, not only to augment orthodox care in the prevention and treatment of illness, but also as a first-line choice by people to stay healthy. The use of complementary therapies by Australians is growing at a rate of 6% per year (National Institute of Complementary Medicine, 2012) in a healthcare industry that was previously defined and directed, for the most part, by Western biomedical approaches. Populations worldwide have been shown to be increasing their usage of natural medicine (Leach 2004a, 2004b). Furthermore, as clients increasingly utilise these therapies, registered nurses are called upon to provide evidence-based recommendations about their effectiveness.

Since 1 July 2003 the Australian Goods and Services Tax (GST) Act has required acupuncturists, herbalists and naturopaths to meet the definition of a ‘recognised professional’ to maintain GST-free status (New South Wales Health, 2002). A national survey of 8000 members of the Australian Traditional Medicine Society and 1500 members of the Australian Natural Therapists Association in 2002 examined practitioners’ disciplinary profiles, demographic characteristics, educational qualifications and memberships of complementary medicine associations (Hale, 2002). Responses (n = 4633) indicated that 97% intended to apply for continuation of GST-free status after 30 June 2003. The relatively high numbers of therapists making a living practising in Australia demonstrates a ready market of Australian consumers choosing to access their services. Xue and others (2007) confirmed that the use of complementary and alternative medicine in Australia is greater than earlier literature has suggested. Furthermore, these authors suggest that there is considerable variation in the use of different individual therapies across different states.

Given the increasing use of complementary therapies by clients in Australia and New Zealand, registered nurses require knowledge about the use and effectiveness of these specific practices so that they can assist clients to make informed, evidence-based decisions about these therapies (van der Riet and others, 2011). This chapter clarifies the relationship between complementary therapies and holistic nursing. Specific attention is given to defining common terms, reviewing the history of the movement towards contemporary healthcare, and the political, practice, educational and research implications of the safe and appropriate use of complementary therapies in Australian and New Zealand nursing practice.

• CRITICAL THINKING

Reflect on your opinion about the use of complementary therapies in achieving wellness.

1. Which complementary therapies have you used for yourself? What drew you to choose that particular complementary therapy? How successful was it in achieving the desired outcome?

2. What might you say to a patient in your care if they wanted to use that particular complementary therapy? Where could you find research evidence about its effectiveness?

Common terms and their relationships

Certain terms used in relation to complementary therapies need clarification. Some terms tend to be used synonymously, such as natural, alternative, integrative and complementary therapies, even though they have different meanings. Other terms are often used in connection with the use of complementary therapies, despite having tenuous relationships, such as holism and healing (Box 32-1).

BOX 32-1 COMMON TERMS

Alternative therapies refers to methods of treatment practised outside the confines of orthodox healthcare; therefore, this term is used less often than ‘complementary therapies’, which implies cooperation in integrating the best therapies from natural and orthodox sources for the betterment of human health.

Complementary therapies are therapeutic methods of treatment or activities which augment orthodox approaches to healthcare.

Healing is not necessarily the same as curing; rather, it is perceived by the person receiving it as a positive experience, in which one knows progress has been made on a forward path, moving closer to a fuller sense of self, whether it be towards improved health or inevitable death (Taylor, 1996).

Holism is an understanding of reality in terms of integrated wholes whose properties cannot be reduced to smaller units (Capra, 1982).

Holistic medicine is a branch of medicine which embraces the integrative approach of combining orthodox, complementary and psychological therapies, in the assumption that the mind is not separate from the body and that the whole person must be treated.

Holistic nursing means delivering knowledgeable, skilful and human-centred nursing care, which considers that people are greater than the sum of their parts.

Natural therapies are therapeutic practices which support healing processes by methods other than pharmaceutical medicines and surgery, e.g. nutrition, massage, aromatherapy and acupuncture.

Nursing is what happens between nurses and clients in the context of care and is facilitated by the humanity of both parties as they negotiate the illness experience together.

Orthodox medicine is traditional Western medicine which values a reductionist view of healthcare, reflected in the biomedical model, and relies mainly on pharmaceutical drugs and surgery for treatment.

Therapies are activities or treatments used in healthcare.

Capra F 1982 The turning point: science, society and the rising culture. London, Fontana/Flamingo; Taylor BJ, editor 1996 Complementary therapies in Australian nursing practice. Deakin, Royal College of Nursing Australia.

Relationship of terms

Complementary therapies in healthcare are therapeutic methods of treatment or physical and/or cognitive activities that attend to the holistic dimensions of a person’s being and health, and which augment orthodox approaches and/or are used as primary interventions. There is an increasing tendency in Australian and New Zealand healthcare to speak less of alternative therapies, as this implies an intention to act outside acceptable orthodox medicine which is based on sound and successful scientific principles and modes of treatment. Although some people may choose alternative approaches to their health problems, clients within the orthodox medical system tend to be managed by medical practitioners who may have varying knowledge or support of natural therapies. In some cases, an integrative approach is negotiated, in which complementary treatments are undertaken with carefully monitored drug regimens and surgical treatment. As nurses are employed most often in the hospital sector, any treatments they may negotiate with clients will of necessity be of a complementary nature, because ‘alternative’ assumes the intentional exclusion of orthodox treatment. Even so, clients may choose complementary therapies as their primary care. Indeed, nurses may encounter people from other cultures where the use of complementary therapies is the first line of intervention, for example the use of traditional therapies by Australian Aboriginal and Torres Strait Islander people. In New Zealand, the use of Rongoā Māori makes an important contribution to the health of Māori people (New Zealand Nurses Association, 2011).

Nursing care will not always be holistic in its intent or actual delivery. Some nurses may choose to work in relatively reductionist, fragmented or task-focused ways so that work is done safely and systematically in the time available and in a mode of delivery which fits a biomedical model of care. By focusing on the task at hand to get the work done safely, systematically and on time, nurses may still be able to focus on the humanity of the clients in their care.

Holistic nursing means delivering knowledgeable, skilful and human-centred nursing care, which considers that people are greater than the sum of their parts. Holistic nursing may sometimes, but not necessarily always, include the use of complementary therapies.

Nurses may use a kitbag of complementary therapies and still work in a clinical and fragmented or reductionist manner, devoid of the therapeutic use of self through interpersonal connection. Holistic nursing and complementary therapies are not, therefore, synonymous terms; nor do they necessarily have set and predictable relationships.

There are many therapies that can be used to complement Western orthodox healthcare; some of the more commonly used are discussed later (Box 32-2).

BOX 32-2 DEFINITIONS OF COMPLEMENTARY THERAPIES AND SYSTEMS

Acupressure. The practice of applying pressure to acupuncture points along the body’s meridian system to treat disease, relieve pain and balance the flow of qi (vital energy) in the body.

Acupuncture. The practice of inserting needles into specific points along the body’s meridian system to treat disease, relieve pain and balance the flow of qi in the body.

Aromatherapy. The use of essential oils, obtained from plants, for healing by inhalation or external application.

Ayurvedic medicine. Sanskrit for life (ayur) and knowledge (veda), thus ‘the science of life’. One of the oldest-known systems of healing, ayurveda approaches health as the balance of body, mind, emotion and spirit and uses an understanding of qualities of energy and the application of preventive and corrective treatments such as yoga, meditation, purification, regimens, dietary changes and herbal remedies.

Behavioural medicine. Originates from, and is deeply rooted in, scientific and empirical medicine, but it incorporates the subjective experience, which includes the personal meaning and cultural and interpersonal context of illness and healing, as well as the associated behavioural responses to physical illness (sickness).

Biofeedback therapy. The use of instrumentation to monitor, amplify and feed back physiological information, so that a client can learn to change or regulate the process being monitored.

Chelation. A process describing how certain molecules surround and bind to metal ions and the resulting variety of biochemical alterations that occur.

Chelation therapy. The use of chelation for purposes of treating atherosclerosis and other chronic degenerative diseases, consisting of a series of intravenous infusions with EDTA (ethylenediaminetetraacetic acid) accompanied by vitamins, minerals and other supplements.

Chiropractic medicine. A major school of Western medicine that focuses on the spine as integrally involved in maintaining health; providing primacy to the nervous system as the primary coordinator of function, and thus health, in the body; maintenance of optimal neurophysical balance in the body is accomplished by correcting structural or biomechanical abnormalities, or disrelationships, through the use of chiropractic adjustments.

Dance therapy. The use of dance for exercise and psychotherapeutic purposes, as the ‘combination of movement and breathing engages the body and mind’ (Kuhn, 1999).

Feldenkrais. An educational system that develops a functional awareness of the self in the environment; expressed in two parallel forms—awareness through movement (verbally directed movement) and functional integration (tactile kinaesthetic communication).

Guided imagery. Synonymous with imagery, self-hypnosis and visualisation, guided imagery uses the interconnection of mind and body to treat and heal disease by involving the client in imagining positive images to effect deliberate healing changes in the body.

Healing touch. Involves a systematic approach to healing using energy interventions that incorporate a variety of therapeutic manoeuvres (Hover-Kramer, 2002).

Herbology. Synonymous with phytotherapy and herbal medicine and involves the use of naturally occurring, non-patented herbs in healthcare.

Homeopathy. A unique approach to healing that uses extremely dilute medicines to trigger a person’s innate capacity to heal; based on the law of similars, the observation that medicines can produce in healthy people the same symptoms they cure in the sick; approaches the whole person in a systematic manner, using naturally occurring substances to restore health on physical, emotional and mental levels.

Humour. Used as therapy for its psychotherapeutic qualities, especially in the release of endorphins, which are active in pain relief.

Hypnotherapy. A psychotherapeutic method that uses hypnosis (a trance-like state) to facilitate the relaxation of the conscious mind and make use of heightened susceptibility to positive suggestion for the diagnosis and treatment of medical and psychological disorders.

Iridology. The study of the iris of the eye, which reveals changing conditions of the parts and organs of the body.

Light therapy. Uses light of various types as treatment for different reasons, e.g. full-spectrum light for osteoporosis; bright light for bulimia, menstrual disorders and delayed sleep syndrome; ultraviolet light used experimentally to reduce cholesterol and treat premenstrual syndrome; photodynamic light to treat cancer; and cold laser therapy for pain control, inflammation and dental infections (Kuhn, 1999).

Magnetic field therapy. Also known as biomagnetic therapy, magnetotherapy and electromagnetic therapy, this uses magnetic fields to treat and prevent disease (Kuhn, 1999).

Massage. A therapeutic method of rubbing, stroking, tapping and kneading the body (either a particular area or the whole body) for the purpose of treating physical and emotional disorders, increasing blood flow, reducing pain, and promoting relaxation, muscle tension release and general health and wellbeing.

Meditation. A technique originally developed as a spiritual discipline that uses intention to direct one’s focus on a word or a breath as a means to increase awareness of the present, reduce stress, promote relaxation and attain personal and spiritual growth.

Megavitamin therapy. A very large dose of a specific vitamin given for therapeutic or preventive purposes; also known as orthomolecular medicine.

Music therapy. The use of music for relaxation and psychotherapeutic purposes.

Naturopathic medicine. Assumes that health is a state of complete physical, mental and social wellbeing, not merely the absence of disease. Derived from nature cure, naturopathic philosophy states that ‘if nature gives the body, mind and emotions what they need to heal, that healing is the natural course’. Naturopathy uses an array of healing practices, such as diet and nutrition, homeopathy, acupuncture, acupressure, herbs, exercise, spine and soft-tissue manipulation, counselling and light therapy.

Osteopathy. A complete system of healthcare that teaches and practises the concepts of the body as a unit that possesses self-protecting and self-regulating mechanisms and that, because its structure and function are reciprocally interrelated, can achieve normalisation of function by restoring structural integrity through use of therapeutic (such as osteopathic technique) and diagnostic approaches that effectively, gently and functionally promote local and systemic homeostasis.

Phytotherapy. The therapeutic application of plants.

Qigong. A major branch of traditional Chinese medicine that denotes methods used to cultivate, regulate and harness qi (vital energy) for general self-preservation and health, healing, self defence, longevity and, particularly, spiritual development.

Reflexology. A therapeutic method that uses manual pressure applied to specific areas, or zones, of the foot that correspond to areas of the body, in order to relieve stress and prevent and treat physical disorders.

Reiki. A Japanese term for ‘universal life force’—the practice is based on the assumption that there are transcendental, inner light, cosmic, radiant and universal energies which, when properly attuned by the practitioner to the inner processes, can help the body to come into a natural state of balance and begin to heal (Kuhn, 1999).

Rolfing. Deep manipulation of connective tissue, soft tissue and fascia to improve the human structure, to balance the effects of gravity within the body and to bring about a state of health and wellbeing.

Spiritual healing. The systematic, purposeful intervention by one or more persons aiming to help another living being or beings (whether person, animal, plant or other living system) by means of focused attention, by touch or by holding the hands near the other being, without application of physical, chemical or conventional energetic means of intervention.

Tai Chi. An ancient Chinese system of meditative movements used to maintain a healthy mental and physical state.

Therapeutic touch. The use of the hands on or near the body with the intent to heal, through making adjustments to the human energy field.

Tibetan medicine. Based on the three principal elements in triadic theory: chi (space), schara (energy) and badahan (matter), which interact to form existence and are balanced through the individual’s attention to proper nutrition, good lifestyle habits, proper adjustment to seasons of the year and self-awareness of one’s physical and psychological predisposition.

Traditional Aboriginal medicine. A complex system closely linked to culture and beliefs of people, knowledge of their land and its flora and fauna. The approach is holistic—encompassing family life, food, shelter, warmth, water and exercise; manifested through ceremonies, healing songs and herbal medicine (Devanesan, 2000).

Traditional Chinese medicine. Also known as oriental medicine, a coherent system of medicine that views the human body as a whole and as a part of nature; while harmony within body functions and between the body and nature maintains health, disease occurs when this harmony is disrupted and can be restored by several therapeutic approaches such as Chinese herbal medicine, acupuncture/moxibustion, tui na (Chinese massage and acupressure), mind–body exercise and Chinese dietary therapy.

Visualisation therapy. A therapeutic method that uses imagery to correct unhealthy attitudes and views.

Yoga. An ancient Indian philosophy that uses gentle stretching exercises, breath control and meditation to gain self-mastery and self-realisation.

References: Devanesan D 2000 Traditional Aboriginal medicine practice in the Northern Territory. Paper presented at International Symposium on Traditional Medicine, 11–13 Sep 2000, Awaji Island, Japan. Online. Available at www.scribd.com/doc/35198563/Traditional-Aboriginal-Medicine-Practice 12 Jul 2012; Hover-Kramer D 2001 Creative energies: integrative energy psychotherapy for self-expression and healing. New York, Norton; Kuhn MA 1999 Complementary therapies for health care providers. Baltimore, Lippincott, Williams & Wilkins.

Adapted from Jonas WB and Levin JS 1999 Essentials of complementary and alternative medicine. Philadelphia, Lippincott, Williams & Wilkins.

The biomedical model of healthcare

During the 20th century, the biomedical model of healthcare was highly successful in diagnosing and treating human illnesses, providing cures, improving prognoses and relieving symptoms. As a knowledge-finding and verifying process, science can be traced to philosophers such as René Descartes, Sir Isaac Newton and Albert Einstein, who theorised about what constitutes truth and how it can best be located and proven. The biomedical approach is based on the principles of science, which values reducing problems to small, manageable parts for close scrutiny and effective management. The idea that the human body could be conceptualised as a machine, with discrete parts and functions, appealed to modern medicine and was incorporated into healthcare practices. The reduction of the complex human body to manageable parts that are then scrutinised closely has helped to generate biomedical knowledge and skills, resulting in the proliferation of medical and allied health specialties.

Another influence on the evolution of the biomedical model was the ascendancy of empirico–analytical (observable–testable) knowledge, which is generated and tested quantitatively through the scientific method. The scientific method is a set of rules on how to gain knowledge through a systematic and rigorous procedure. The objectives of the scientific method are to generate and validate empirical knowledge through rigorous means such as reliability, validity, control and manipulation of variables. Using this format helps to produce objective data that can be quantified in order to demonstrate the degree of statistical significance in cause-and-effect relationships. This method generates empirical knowledge, which provides descriptions of what is, predictions of what might be, and change through new discoveries.

The success of empirical knowledge is evidenced in nursing, medicine and other healthcare disciplines, in continued technological advances and in the constant evolution of newer and safer healthcare diagnostic and management procedures. The scientific model embraced by medicine has provided a framework for answering questions about the complexity of the human body. In turn, the knowledge generated has provided approaches to the care of people that favour reductionist healthcare, reflected in the care of body parts and of viewing the body as a machine.

The practice of medicine has undergone changes since the 1970s with the advent of the CAM movement (Kuhn, 1999). Using an integrated approach to medicine that combines the best of orthodox and complementary treatments and therapies ensures a move away from the reductionist biomedical model that had previously dominated healthcare (Kienle and others, 2011). The rise of ‘medical pluralism’, which values multiple forms of healthcare, provides more options for clients and also opens the way for cooperative and collaborative approaches to meet clients’ needs (Leach, 2006). Partly influenced by medicine’s shift towards pluralism and holistic forms of practice and by changes within its own discipline, nursing has turned increasingly towards nursing care incorporating complementary therapies to fulfil client demand.

Influences on contemporary healthcare approaches

The effects of some complementary therapies are not easily explained through orthodox science. Quantum physics and chaos theory are theoretical models for holistic healthcare, which may shed some light on why complementary therapies are effective. This section explores quantum physics and chaos theory as contemporary ideas that accommodate ancient beliefs in the existence of human energy fields and centres, and chi (qi) as vital energy.

Quantum physics

David Bohm developed a theory of quantum physics which considers the unbroken whole of matter and consciousness. Bohm (1995) suggested that

quantum theory is, at present, the most basic way available in physics for understanding the fundamental and universal laws relating to matter and its movement. As such, it must clearly be given serious consideration in any attempt to develop an overall world viewing … in this theory there is no consistent notion at all of what the reality may be that underlies the universal constitution and structure of matter. Thus, as we try to use the prevailing worldview based on the notion of particles, we discover that the particles (such as electrons) can also manifest as waves, that they can move discontinuously, that there are no laws at all that apply in detail to the actual movements of individual particles and that only statistical predictions can be made about large aggregates of such particles. If on the other hand we apply the worldview in which the universe is regarded as a continuous field, we find that this field must also be discontinuous, as well as particle-like, and that it is undermined in its actual behaviour as is required in the particle view of relation as a whole.

Bohm also suggested that physics should not only be concerned with the formulation of mathematical calculations to ‘predict and control the behaviour of large statistical aggregates of particles’, but that it should also be interested in providing some thinking about the nature of reality, even if it is ‘fragmentary and muddled’. As a practical example of the application of quantum physics to human thinking, Bohm suggested that the proper order of operation of the mind requires an overall grasp of what is generally known—not only in formal logical, mathematical terms, but also intuitively, for example in images, feelings and poetic usage of language.

Chaos theory

Gleick (1993) has described the emergence of chaos theory in the 1970s, a time when American and European scientists were:

seeking connections between different kinds of irregularity. Physiologists found a surprising order in the chaos that develops in the human heart, the prime cause of sudden, unexplained death. Ecologists explored the rise and fall of gypsy moth populations. Economists dug out old stock price data and tried a new kind of analysis. The insights that emerged led directly to the natural world—the shapes of clouds, the paths of lightning, the microscopic intertwining of blood vessels and the galactic clustering of stars.

By the 1980s chaos theory was beginning to reshape the scientific establishment, and applications could be found in all spheres of life. Computer images highlighted the underlying complexity in the human body and in nature. Research institutes used chaos theory to focus their investigations into diverse fields of inquiry. Chaos theory had a unifying effect on human inquiry because ‘it breaks across the lines that separate scientific disciplines. Because it is a science of the global nature of systems, it has brought together thinkers from fields that have been widely separated’ (Gleick, 1993). This tendency has halted the ever-intensifying move towards specialisation because it unifies inquirers through a focus on the universal behaviour of complexity, such as patterns appearing on different scales at the same time, randomness, jagged edges and sudden leaps.

According to some physicists, ‘chaos is a science of process rather than state, of becoming rather than being’ (Gleick, 1993). The state of complex dynamism and continuous flux is reflected in human beings, nature, the planets and the known universe. The complexity and dynamic nature of nursing positions it well for exploration within the context of chaos theory (Lett, 2001).

Human energy fields and centres

Evidence to support the existence of an energy field dates back to the 1940s and the work of neuroanatomist Harold Burr at Yale University in the United States. Burr (1972) demonstrated an energy field in salamanders and claimed that this field contained an electrical axis aligned to the brain and spinal cord. Since Burr’s discovery, electrophotography has been used to study the bodies of plants, animals (Kirlian and Kirlian, 1961) and the human body (Mallikarjun, 1978; Tiller, 1979).

A field of vibrational medicine emerged (Briggs and Peat, 1986; Gerber, 1988; Moss, 1979), based on the Einsteinian viewpoint that the human being ‘is a multidimensional organism made up of physical/cellular systems in dynamic interplay with complex regulatory fields’ (Gerber, 1988). Oschman (2000) described various intricate organic circuitry systems of the human body, applied that knowledge to some energy healing techniques and stated that, with increasing scientific validation, energy medicine will be the medicine of the future.

According to Kunz and Peper (1985), there are four major dimensions to the human energy field: the vital layer (the etheric field), the emotional layer (the aura), the mental layer (causal layer) and the intuitive layer (the astral body). Energy centres (or chakra) are located in areas of the human body: in the coccyx (base chakrum), sacrum (sacral chakrum), solar plexus (solar plexus chakrum), centre of the chest (heart chakrum), middle of the neck (throat chakrum), the brow (ajna chakrum) and the top and middle of the head (crown chakrum). Each of these energy field layers and centres are purported to be associated with various body organs and systems, and in energy healing they are adjusted by the healer by various techniques to achieve beneficial changes in the organs and systems and in the total physical, mental, emotional and spiritual dimensions of the person (Hover-Kramer, 2002).

Some complementary therapies assume the existence of a human energy field which can be manipulated by gentle touch on or close to the body to restore and maintain health. These approaches have been named healing touch (Hover-Kramer, 2001; Kreiger, 1973; Mentgen and Bulbrook, 1996); therapeutic touch (Benyon, 1994; Bryant, 1996; Smith, 1990; Smyth, 1996; Vaughan, 1995), Reiki (Bullock, 1997; Tattam, 1994; van Sell, 1996) and spiritual healing (Benor, 1995; Harpur, 1994; Hodgkinson, 1990; Krippner and Welch, 1992; Peel, 1988).

These therapies have their critics who denounce them as pseudoscience and challenge the practitioners to show empirical evidence to support the health-promoting claims (Glickman and Burns, 1996; Oberst, 1995). It is possible that energy-based healing techniques relying on the existence of a human energy field and centres may find increasing scientific validation, especially through research approaches which are shaped by quantum physics and chaos theory, as well as through orthodox biomedical measures that demonstrate and measure the observable effects of treatments.

Principles of complementary therapies

Regardless of how they can be explained scientifically, complementary therapies share certain common principles in their role in healthcare. According to Pizzorno (1996), the principles of natural therapies used to complement orthodox medicine and healthcare can be broadly stated as follows:

• The human body–mind has an innate drive towards healing and adaptation; treatment and care should support this process as far as is possible.

• Energy is vital to the system’s capacity to reorder itself; treatment and care should increase vitality, not deplete it.

• Treat the whole person. Health (and disorder) is the outcome of complex and interacting physical, personal, social and environmental factors.

• Disease is an entirety, which affects the whole person and presents as a pattern or patterns. All signs, symptoms and sensations are relevant.

• Find the cause. Treatment cannot be effective unless the underlying cause and predisposing factors are considered.

• Do no harm. Wherever possible, use therapies that support the healing capacity.

• Educate the client. The practitioner has a responsibility to educate the client regarding lifestyle factors, which may have contributed to ill-health.

• Support dignity and quality of life for clients in advanced disease.

• CRITICAL THINKING

Consider the above principles in the context of healthcare generally.

1. How do they relate to the fundamental philosophy of nursing?

2. Are any of these principles not in keeping with your perception of nursing? Which, if any, are missing?

Tracing the use of complementary therapies in nursing practice

Using contemporary scientific principles, Martha Rogers (1970) introduced energy field concepts into nursing more than 50 years ago (Vitale, 2006). Parallel to Rogers’ work, Jean Watson has continued in the same vein, linking the arts and sciences of nursing into her philosophy of human caring. Acknowledging that people are a unity of mind–body–spirit and part of the human–environment energy field, Watson (1999) postulates that caring–healing modalities are the essence of nursing. This impetus for something beyond the accepted view of nursing has opened new challenges for nursing and nurses. An almost evolutionary force has signalled nurses to widen their horizons to incorporate at least knowledge of complementary therapies, if not some degree of efficiency in the practice of them.

In Australian and New Zealand nursing settings, clients are demanding complementary therapy options in their care management plans (see Research highlight). Responding to consumer demand, professional organisations such as the Royal College of Nursing Australia (RCNA), the New South Wales Nurses Association, the Australian Nursing Federation, the Australian College of Holistic Nurses and the Holistic Nurses Association of New South Wales have all produced guidelines for nurses in the use of complementary therapies. Nurses are now accessing tertiary courses and units in complementary/natural therapies and naturopathy. Several private education providers also offer bachelor degrees in naturopathy and have indicated that up to 25% of their students are nurses (Borland, 1999). There is limited recent published data available regarding training for or actual use of complementary therapies by Australian nurses. Small studies, such as that undertaken by Leach (2004a) in South Australia, indicate an overall positive attitude towards the use of complementary therapies by nurses. This study found, however, that the educational preparation of nurses in the use of complementary therapies and the extent to which such modalities are employed is inconsistent. There is, nonetheless, increasing anecdotal evidence that points to considerable interest in, and increasing use of, complementary therapies by nurses in a number of generalist and specialist areas.

Nursing has traditionally been aligned with medicine, especially in medically dominated institutions such as hospitals. Although orthodox medicine and nursing is practised widely in hospitals, changes are evident in the healthcare system. The orthodox medical model is guided by the biomedical model of care, in which clients are regarded as biological entities for which diagnoses are made based on empirical evidence of malfunction in specific cells, organs and systems.

The history of nursing, however, embraces information about Florence Nightingale who used various natural therapies prevailing in the second half of the 19th century to counteract the medical use of toxic substances such as mercury, opium and antimony. At that time, medical theory held that disease had to be aggressively driven out by violent purging, sweating, salivation, bleeding and blistering (Griggs, 1982). There was little awareness of iatrogenic disease, so that when clients died in grave distress, as they often did, it was explained as the disease being too powerful for the treatment. Homeopathy, osteopathy, nature cure and naturopathy all emerged to some extent in response to the injury and death perceived to be caused by orthodox treatments (Griggs, 1982). A back-to-nature movement emerged in Europe, and during the second half of the 19th century numerous sanatoriums were established for treatment of the sick. A vegetarian diet, exercise, rest, hydrotherapy, fresh air, sunbathing, breathing exercises, prayer and fasting were among the therapies used in the return to Hippocratic medicine, which became known as nature cure. Germany and Austria were at the heart of this movement, and Florence Nightingale travelled to Germany in 1851 for her first nursing training. From her writings, it appears that Nightingale’s thinking was considerably influenced by nature cure philosophy, which espoused a vitalistic approach to healing and health promotion, and the need to work with nature to achieve a cure (McCabe, 2000).

RESEARCH HIGHLIGHT

Research focus

The use of complementary and alternative medicine is not a new phenomenon, yet its popularity continues to grow. This popularity is occurring broadly and is particularly evident in people with cancer. Nurses have an important relationship with the person with cancer, and their response to the use of complementary and alternative medicine in this group of patients is therefore significant.

Research abstract

This nursing research used a grounded theory methodology that employed semi-structured interviews with six nurses who worked in cancer settings. Analysis of the data generated indicated that nurses respond in a variety of ways to a patient’s use of complementary and alternative therapies. These responses included being supportive, sceptical and/or ambivalent. Factors that influence how the nurse responds include ambiguous definitions of complementary and alternative therapies, the nurse’s personal philosophy and their life experiences. Therapeutic efficacy, the motives of the patient and organisational culture were also important in influencing how a nurse might respond.

Evidence-based practice

• Nurses should routinely ask about and endeavour to understand their patients’ individual perspectives on the use of complementary and alternative therapies.

• Evidence-based guidelines are necessary to support the use of complementary and alternative therapies, both to eliminate confusion and aid decision making by patients and nurses.

• Education about complementary and alternative therapies is essential to ensure nurses are able to maintain an open mind to their patients’ choices in respect of complementary and alternative therapies.

Reference

Wang SYC, Yates P. Nurses’ responses to people with cancer who use complementary and alternative medicine. Int J Nurs Pract. 2006;12:288–294.

Nurses at the forefront of using natural therapies in the nature cure movement in healthcare included Elizabeth Kenny in Australia. Kenny used hydrotherapy in the treatment of polio, or infantile paralysis, in the Queensland epidemic of 1911. Hydrotherapy was applied via strips of woollen blanket wrung out in hot water and wrapped around the twisted limbs. Her treatment was rejected by the medical profession, starting Kenny on a 10-year struggle to win recognition for the benefits of her method.

Nurses have had a long history of using the principles of nature care and natural processes in their work. To some extent, though, the interest in complementary therapies in nursing practice may be seen as a late-20th-century phenomenon. The roots of nursing’s involvement in natural care approaches, however, can be traced even further back than Florence Nightingale. The renewed interest in complementary therapies is really a return by nursing to practices used previously, made all the more possible by a turn to holism and consumer demands for choices in healthcare.

Uses of complementary therapies in nursing practice

In the literature, there is very little agreement about categories and examples of therapies variously labelled as natural, alternative or complementary (Jacka, 1998; Jonas and Levin, 1999; Kuhn, 1999). In this section, different classifications of complementary therapies are reviewed and examples of the RCNA categorisation are described for, specifically, aromatherapy, therapeutic touch and healing touch, massage and meditation.

Classifications of complementary therapies

Texts vary on the categorisations of complementary therapies. For example, Kuhn (1999) includes herbology, nutrition, mind and body control, and alternative systems of medical practice, manual healing, bioelectrical applications and biological treatments. The use of naturally occurring non-patented herbs in healthcare is variously termed herbology, phytotherapy and herbal medicine. Although there are thousands of examples, some of the most popular herbs selected for a comprehensive description by Kuhn include aloe vera, bilberry, echinacea, garlic, ginger, ginkgo, ginseng, green tea, hawthorn, kava, liquorice, milk thistle, St John’s wort, valerian and vitex. Nutrition as a complementary way to health includes all the standard principles of the orthodox, scientific approach to the use of food and fluids, with emphasis on the need for organic foods, especially fruit and vegetables, reduced use of food additives and pesticides and the judicious use of special diets such as the macrobiotic diet, foods containing phytochemicals, fresh juices and fasting.

Mind and body control therapies include aromatherapy, biofeedback therapy (e.g. via electrodes on the frontalis and trapezius muscles and the fingers of one hand), dance therapy (Figure 32-1), guided imagery, hypnotherapy, meditation, qigong, Tai Chi and yoga (Figure 32-2).

FIGURE 32-1 Young adults participating in dance therapy.

Image: iStockphoto/Alina Solovyova-Vincent.

FIGURE 32-2 Yoga is a discipline that focuses on muscles, posture, breathing and consciousness.

Image: Shutterstock/Pete Saloutos.

Alternative systems of medical practice include acupuncture (Figure 32-3), ayurvedic medicine, homeopathy, naturopathic medicine and oriental medicine.

FIGURE 32-3 Acupuncture.

Image: Dreamstime/Yuri_arcurs.

Acupressure, chiropractic medicine, massage, reflexology, Reiki, rolfing and therapeutic touch are classified by Kuhn as manual healing.

Bioelectromagnetic applications include light therapy, magnetic field therapy and chelation therapy and are classified as biological treatments.

More recently, Braun and Cohen’s (2007) landmark Australian text Herbs and natural supplements: an evidence-based guide positions CAM parallel with mainstream medicine to work alongside conventional medicine to bring about enhanced health for its users. According to the RCNA position statement, complementary therapies used in nursing practice to augment client care can be grouped into categories, such as traditions of healing (including aromatherapy, acupuncture and reflexology), therapeutic use of self (including humour, therapeutic and healing touch, and visualisation therapy), physical therapies (including massage and hydrotherapy) and energy therapies (including meditation, guided imagery and music therapy).

Examples of complementary therapies

A selection of complementary therapies that may be used in nursing practice are described below.

Aromatherapy

Aromatherapy uses essential oils obtained from plants (Box 32-3) for healing by inhalation or external application. The oils may have been extracted from roots, flowers, bark, leaves and fruit rinds from a variety of plants. The mode of delivery of the therapy depends on the type of essential oil preparation and the reason for its use. For example, peppermint oil may be used as a stimulant via inhalation, and tea-tree (melaleuca) oil may be used on the skin as an antiseptic. Inhalation may be through diffusers and sprays, and external application may be through massage, bathing, facial compresses, masks, lotions and creams, and products used in hair care. In making a case for its use in the United Kingdom, Buckle (2007) reviewed a number of studies from the United States in which aromatherapy was used with effect by nurses in the management of wounds, nausea, agitation and venous access phlebotomy.

BOX 32-3 ESSENTIAL OILS AND THEIR USES

Bergamot: skin antiseptic, antispasmodic for gastrointestinal cramps, skin care tonic.

Chamomile: anti-inflammatory, antidepressant, antiemetic, antiseptic, hair care, stress reduction.

Eucalyptus: general antiseptic, expectorant, decongestant, antiviral, insect repellent.

Geranium: calms catecholamine release, balances mind and body, skin care astringent, antiseptic, tones scalp and decreases oiliness in hair care, insect repellent.

Jasmine: aphrodisiac, relieves anxiety and depression.

Lavender: relieves anxiety and depression, skin care antiseptic (Lavandula angustifolia), increases mucus elimination in respiratory diseases, hair care, headache relief.

Mint: awakens the mind, decongestant and expectorant, relaxes gastrointestinal system.

Neroli: antidepressant, antispasmodic, sedative.

Rose: skin astringent, antidepressant.

Rosemary: restores blood in anaemia and menses, increases digestion, antiseptic, diuretic, heals skin wounds.

Sandalwood: antidepressant, antiseptic for the urinary system, aphrodisiac.

Tea-tree oil: immunostimulant to treat acne, psoriasis, herpes, insect repellent, antifungal for ringworm, athlete’s foot, thrush.

Ylang-ylang: skin care, hair care, sedative, reduces tachycardia and blood pressure.

Adapted from Kuhn MA 1999 Complementary therapies for health care providers, Baltimore. Lippincott, Williams & Wilkins.

Nurses should be aware of the risks of using aromatherapy, as each oil can have adverse effects and people with lung disease and asthma and pregnant women should not inhale oils. The judicious use of essential oils is a specialised practice, which should be undertaken only by knowledgeable and skilful practitioners, especially when caring for people in the public domain (Buckle, 2003; Meyer, 2001; Price and Price, 1999). Short courses are available through local aromatherapy networks, and nurses should avail themselves of these to ensure that they are knowledgeable enough to use aromatherapy safely and effectively in nursing practice. A Cochrane systematic review of aromatherapy for the treatment of postoperative nausea and vomiting (see Research highlight overleaf) has been carried out by nurse researchers from the Queensland Centre for Evidence-Based Nursing and Midwifery (Hines and others, 2012).

• CRITICAL THINKING

In the healthcare environment it is often necessary to consider the effect of burning oil in a shared space. How do you ensure the rights of other patients, clients, residents and staff who may be affected by the aromas that are generated while still being sensitive to the needs of those under your care?

Therapeutic touch and healing touch

Therapeutic touch and healing touch have some similarities and are listed together, based on their shared assumption that healing occurs through adjustments to the human energy fields and centres.

Therapeutic touch (TT) is an energy-based healing technique that originated in America in 1972 via Dolores Krieger and Dora Kunz. It has become established in various healthcare professions, is the subject of various theses, is listed in Medline in various languages and is taught in 50 countries (Krieger, 1973).

Most studies reported in the literature relate to therapeutic touch, because it is the antecedent of healing touch (HT), named differently because of some philosophical and procedural variations. For the most part, HT cites as empirical evidence the research of its predecessor, TT. According to Mentgen and Bulbrook (1996), HT is ‘an energy-based therapeutic approach to healing’, which aims ‘to restore harmony and balance in the energy system to help the person to self-heal’. The therapy involves a physical assessment of the person, including the energy field, an intervention phase and a grounding phase. Gentle, light or no-touch techniques vary for energy pattern sensing and altering, depending on what is assessed in the person’s field. According to Mentgen and Bulbrook (1996), ‘a healer must trust that what occurs in this subtle, non-invasive work is for the highest good of the individual’.

RESEARCH HIGHLIGHT

Research focus

Postoperative nausea and vomiting (PONV) is a common and unpleasant phenomenon and current therapies are not always effective for all patients. Aromatherapy has been suggested as a possible addition to the available treatment strategies. This nursing research sought to establish what effect the use of aromatherapy has on the severity and duration of established PONV and whether aromatherapy can be used with safety and clinical effectiveness comparable to standard pharmacological treatments.

Research abstract

The literature was searched up to August 2011 including Cochrane Central Register of Controlled Trials; MEDLINE; EMBASE; CINAHL; CAM on PubMed; Meditext; LILACS; and ISI Web of Science as well as grey literature sources and the reference lists of retrieved articles. All randomised controlled trials (RCTs) and controlled clinical trials (CCTs) where aromatherapy was used to treat PONV were included. Interventions were all types of aromatherapy. Primary outcomes were the severity and duration of PONV. Secondary outcomes were adverse reactions, use of rescue antiemetics and patient satisfaction with treatment.

The nine included studies comprised six RCTs and three CCTs with a total of 402 participants. Compared with placebo, isopropyl alcohol vapour inhalation (also known as rubbing alcohol, commonly found in the type of ‘prep-pad’ used to clean skin prior to injection) was effective in reducing the proportion of participants requiring rescue antiemetics (RR 0.30, 95% CI 0.09–1.00, p = 0.05). However, compared with standard antiemetic treatment, isopropyl alcohol was not effective in reducing the proportion of participants requiring rescue anti-emetics (RR 0.66, 95% CI 0.39–1.13, p = 0.13) except when the data from a possibly confounded study were included (RR 0.66, 95% CI 0.45–0.98, p = 0.04). Where studies reported data on patient satisfaction with aromatherapy, there were no statistically significant differences between the groups (RR 1.12, 95% CI 0.62–2.03, p = 0.71).

Evidence-based practice

• Isopropyl alcohol was found to be more effective than saline placebo for reducing PONV but less effective than standard anti-emetic drugs.

• There is currently no reliable evidence to support the use of other aromatherapies such as peppermint oil to treat PONV.

• No included studies reported any adverse effects from the aromatherapies used.

Reference

Hines S, Steels E, Chang A, et al. Aromatherapy for treatment of postoperative nausea and vomiting, Cochrane Database Syst Rev. 2012;(4). doi: 10.1002/14651858.CD007598.pub2. CD007598.

LIMITATIONS OF THERAPEUTIC AND HEALING TOUCH

Although the research base of TT is considerable and growing, critics claim that it lacks scientific validation and that its conceptual basis is suspect as an energetic healing therapy (Oberst, 1995; Rosa, 1995). A common point of opposition to TT is the repudiation of the existence of a human energy field, as discussed earlier. While one author labels TT as ‘quackery’ (Rosa, 1995), another heralds its practitioners as ‘revolutionary’ (Peters, 1999). These kinds of contradictions are indicative of healthy scholarly debate about complementary therapies. The Cochrane systematic review by So and colleagues (2008) of touch therapies for pain relief found only modest treatment effects (see Research highlight on the opposite page).

Massage

Massage is a therapeutic method of rubbing, stroking, tapping and kneading the body (either a particular area or the whole body) for the purpose of treating physical and emotional disorders, increasing blood flow, reducing pain and promoting relaxation, muscle tension release and general health and wellbeing (Jonas and Levin, 1999). There are many varieties of massage (Box 32-4), including Swedish, Esalen, neuromuscular therapy and oriental.

BOX 32-4 TYPES OF MASSAGE

TRADITIONAL EUROPEAN

Swedish massages: uses massage strokes such as effleurage (gliding), petrissage (lifting, rolling, kneading), friction (circular), vibration and tapotement (percussion or tapping) to enhance blood flow through soft tissues.

CONTEMPORARY WESTERN

Esalen: uses slow, rhythmic hypnotic techniques to create deep relaxation and general wellbeing.

NEUROMUSCULAR THERAPY

Soft-tissue: manipulation to relieve pain and dysfunction by balancing the nervous and musculoskeletal systems.

Deep-tissue: uses fingers, thumbs and elbows with greater pressure to release muscular tension.

Sports: to enhance athletic performance by removing lactic acid, increasing range of movement and promoting healing through compression, trigger-point or direct pressure and cross-fibre friction.

Manual lymphatic drainage: light, slow, repetitive strokes to facilitate the lymphatic drainage of excess water, wastes and toxins.

STRUCTURAL AND FUNCTIONAL MOVEMENT INTEGRATION

Alexander technique: rebalances the body through awareness, movement and touch, by emphasising alignment of the spine, head, body, neck and torso.

Hellerwork: movement re-education for stress-free body movements for everyday activities.

Movement therapy: employs Alexander technique and Feldenkrais (see Box 32-2) to use movement to re-educate the body and mind.

Orthobionomy: enhances balance and wellbeing through gentle, non-invasive touch, dialogue and movement education.

Rolfing: deep-tissue work to bring major body segments into alignment.

Rosen method: induces relaxation and prevents illness through gentle touch and verbal support to release unexpressed, repressed or suppressed tensions.

Structural integration: includes rolfing and Hellerwork to retrain and align body movements.

Trager: sets of movements to release deep-seated psychophysiological tensions.

ORIENTAL

Jin Shin Jyutsu: a Japanese healing tradition of gentle application of the hands along energy pathways to promote wellbeing.

Shiatsu: balances the body through acupressure, stretching and movement.

ENERGETIC

Polarity therapy: involves hands-on techniques such as manipulation of pressure points and joints, massage, breathing exercises, hydrotherapy, exercise, reflexology and holding pressure points on the body.

Reiki: uses universal life-force energy to balance and amplify energy for healing and wellbeing.

Therapeutic touch: corrects imbalances by modulating the energy field surrounding the body.

OTHER

Bioenergetics: uses a combination of psychotherapy, breathing and bodywork to release trapped energy and tension.

Bonnie Prudden myotherapy: uses trigger points and corrective exercise to relieve pain and dysfunction.

Craniosacral therapy: gentle, non-invasive pressure to the bones and soft tissue of the skull and pelvis to release tensions and create balance.

Reflexology: uses manual pressure applied to specific areas, or zones, of the foot that correspond to areas of the body in order to relieve stress and prevent and treat physical disorders.

Zero balancing: painless, hands-on therapy to align body energy with body structure.

Massage techniques for structural and functional movement integration include Hellerwork, rolfing, structural integration, movement therapy, the Rosen method, Trager, Alexander technique and orthobionomy. Oriental methods include Jin Shin Jyutsu and Shiatsu. Energetic methods sometimes classified as massage include therapeutic touch, polarity therapy and Reiki. Other approaches to massage include reflexology, craniosacral therapy, Bonnie Prudden myotherapy, bioenergetics and zero balancing. The use of hot stones and aromatherapy oils complement massages and have been found to be therapeutic.

RESEARCH HIGHLIGHT

Research focus

Pain is a global public health problem affecting the lives of large numbers of patients and their families. Touch therapies (healing touch (HT), therapeutic touch (TT) and Reiki) have been found to relieve pain, but some reviews have suggested there is insufficient evidence to support their use. This systematic review aimed to evaluate the effectiveness of touch therapies (including HT, TT and Reiki) on relieving both acute and chronic pain, and to determine any adverse effect of touch therapies.

Research abstract

The literature was searched up to June 2008 including various electronic databases including the Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and others. Reference lists and bibliographies of relevant articles and organisations were checked. Experts in touch therapies were also contacted. Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) evaluating the effect of touch on any type of pain were included. Similarly, only studies using a sham placebo or a ‘no treatment’ control was included.

24 studies involving 1153 participants met the inclusion criteria. There were 5, 16 and 3 studies on HT, TT and Reiki respectively. Participants exposed to touch had on average of 0.83 units (on a 0–10 scale) lower pain intensity than unexposed participants (95% CI −1.16 to −0.50). Results of trials conducted by more experienced practitioners appeared to yield greater effects in pain reduction. It is also apparent that these trials yielding greater effects were from the Reiki studies. Whether more-experienced practitioners or certain types of touch therapy brought better pain reduction should be further investigated. Two of the 5 studies evaluating analgesic usage supported the claim that touch therapies minimised analgesic usage. The placebo effect was also explored. No statistically significant (p = 0.29) placebo effect was identified.

Evidence-based practice

• Touch therapies were found to have a modest effect on pain relief.

• Although the lack of sufficient data means that the results are inconclusive, the evidence that does exist supports the use of touch therapies in pain relief.

• There was some evidence that touch therapies reduce analgesic usage.

• The placebo effect has been also widely explored. No statistically significant placebo effect has yet been identified except through one study on children.

• No adverse effect of this treatment has yet been identified.

• More research on HT and Reiki in relieving pain is needed.

Reference

So PS, Jiang Y, Qin Y. Touch therapies for pain relief in adults, Cochrane Database Syst Rev. 2008;(4). doi: 10.1002/14651858.CD006535.pub2. CD006535.

Special instruction and practice is needed to ensure safe and effective results with many types of massage (Figure 32-4). Nurses need to remember, however, that they can incorporate a gentle foot or hand massage into hygiene activities when helping clients in the course of daily nursing care. If nurses intend to use specialised massage techniques, they need to seek instruction in appropriately accredited courses.

FIGURE 32-4 Massage therapy can be used effectively to relieve tension.

From Potter PA, Perry AG 2004 Fundamentals of nursing, ed 6. St Louis, Mosby.

Incorporating complementary therapies into nursing practice

A variety of political, practice, ethical, educational and research issues have arisen from integrating complementary therapies into Australian nursing practice. This section deals with the issues inherent in using complementary therapies in Australian nursing, and the implications for nurses intending to use them in their practice.

Political issues centre mainly on professional healthcare services, the ownership and control of knowledge and skills and the right to provide paid services to consumers. Practice issues arise from uncertainty about both the nature of nursing practice and its relationship to healthcare settings, and existing sources of education and expertise in complementary therapies. Ethical issues debate the introduction of complementary therapies in shared spaces or spaces of practice that are unknown to the receivers. Educational issues are linked to difficulties in incorporating complementary therapies into existing and future nursing curricula. Research issues are concerned with the evidence base for complementary therapies and overcoming constraints in generating funding and networks for exploring a wide range of questions related to the use of complementary therapies in present-day nursing practice. The chapter concludes with strategies for introducing complementary therapies into work settings.

Political issues and implications

Medical dominance in Western healthcare systems has been discussed by sociologists (Emke, 1992; Willis, 1989, 1994). In particular, Willis (1989) describes the tendency of middle-class men to control medicine and the healthcare systems they serve. An open marketplace for healthcare delivery existed in Australia before the establishment of medical schools, allowing a range of practitioners to practise in ways they deemed wise and beneficial for consumers (Willis, 1989). The power and control inherent in the ownership of professional knowledge have been acknowledged for some time (Morriss, 1987; Young, 1981), and are exemplified by the success of medical practitioners not only in controlling the policies and practices of their own work but also in substantially influencing the work of other health workers, such as natural therapists and nurses (Adamson and Kenny, 1993; Adamson and others, 1995; Bennett, 1995; Webb Inquiry, 1977).

In addition to the external pressures from medicine on complementary healthcare services, there have been internal political divisions within the various associations for natural therapies. While a number of complementary and alternative therapists are registered with, and regulated by, national boards within the Australian Health Practitioner Regulatory Agency (AHPRA), many are not. Practitioners of homeopathy, Reiki and music therapy, for example, are subject to self-regulation, a situation that the Australian National Therapists Association (ANTA) is seeking to rectify by petitioning for a national statutory code of conduct (ANTA, 2011). The division experienced by complementary healthcare practitioners in relation to registration issues has ramifications for nurses, because guidelines for the safe use of complementary therapies in nursing must be adopted from those existing in the originating disciplines of various complementary therapies.

Many nurses know what it is like to work in hierarchical structures such as hospitals and, given the medical dominance that is possible in these organisations, it seems reasonable that some nurses may be unenthusiastic about using complementary therapies in their everyday nursing work, especially in the absence of protective policy. As nurses negotiate the political issues inherent in using complementary therapies in their practice, they need also to be mindful of potential problems that could arise with natural therapists themselves, who may be concerned about the educational and practice standards of the therapies and who may also fear that their knowledge and skills may be unacknowledged and/or taken over by nurses. A solution to these problems may be reached from the outset through collaboration with natural therapists and their accredited associations to generate acceptable standards of education, research and practice for the safe use of complementary therapies in Australian nursing practice.

Managing political issues related to the use of complementary therapies in nursing practice requires nurses to be aware of established theories, models and dissertations in nursing scholarship. Nurses should also take any opportunities that present themselves to influence the multidisciplinary teams in which they work. A key to success in overcoming political opposition to the use of complementary therapies in nursing practice may lie in nurses acknowledging that the momentum for choices in healthcare has been, and continues to be, consumer-driven, and that nurses are responding to the present demand for complementary approaches to health concerns.

Practice issues and implications

Nursing in Australia has emerged as a strong and capable presence in the healthcare system, supported by the evidence of clinical competence and by the establishment of tertiary educational bases for undergraduate and postgraduate practice (Anderson, 1994). However, nurses may still be unsure of the validity of their own work and the freedom they may have within it to be the planners of nursing care that is based on consumers’ rights, demands and choices and nurses’ ability to provide it.

Improving practice in relation to nurses using complementary therapies starts with valuing nursing as a therapeutic activity. Finding ways to generate policies to guide nurses in the safe and effective use of complementary therapies in their everyday work is essential. Over recent years, regulatory authorities and professional organisations in Australia have produced guidelines for use of complementary therapies in practice that recommend and provide advice on the development of individual workplace guidelines according to the needs of each setting.

• CRITICAL THINKING

Conduct an internet search to locate published guidelines and position statements by Australian and New Zealand nursing organisations (also see Online resources).

1. Do these documents provide adequate guidance for nurses wishing to employ complementary therapies in their practice?

2. Is the role of the nurse in the use of complementary therapies clearly delineated?

3. Do the documents clearly define terms relating to the complementary therapies?

4. What elements of these policies clearly aim to protect the patient? The nurse?

Even with the available national guidelines to help them make careful decisions about appropriate therapies for nursing practice, nurses should also be guided by the experience of other practitioners, such as qualified consultants and experienced independent practitioners working in the area of complementary therapies.

Nurses may also derive some benefit from discussing the use of complementary therapies in forums such as interest groups, seminars and conferences, and/or in generating discussion and debate through publishing their ideas in journals. It may be possible for nurses to work with existing professional natural therapy organisations in order to influence the certification of registered nurses with natural therapy qualifications, to ensure that clients gain rebates from private-health-fund organisations.

CLINICAL EXAMPLE

Alice is 48 years old and has been admitted to your unit for palliative care following a lengthy battle with breast cancer. Shortly after admission, she lapses into a coma. Alice has a 20-year-old daughter, Jenny, who has developed an interest in complementary and alternative therapies over recent months as she has cared for her mother at home. Jenny wishes to use homeopathic remedies and give her mother frequent massages each day over what you believe to be the last days of her life.

• CRITICAL THINKING

Consider the following questions relating to the above scenario and debate your responses with your colleagues:

1. We are guided by ethical principles that require permission of the patient to provide care. Does that care include the use of complementary therapies?

2. What might be the implications of using complementary therapies on Alice, who is unconscious?

3. How might you ensure that the needs of Alice and of Jenny are met in this situation? Are there any other resources you may be able to employ?

4. What guidelines are available to you that may assist you in this situation?

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Common terms and their relationships

Relationship of terms

The biomedical model of healthcare

Influences on contemporary healthcare approaches

Quantum physics

Chaos theory

Human energy fields and centres

Principles of complementary therapies

Tracing the use of complementary therapies in nursing practice

Research focus

Research abstract

Evidence-based practice

Uses of complementary therapies in nursing practice

Classifications of complementary therapies

Examples of complementary therapies

Aromatherapy

Therapeutic touch and healing touch

Research focus

Research abstract

Evidence-based practice

LIMITATIONS OF THERAPEUTIC AND HEALING TOUCH

Massage

TRADITIONAL EUROPEAN

CONTEMPORARY WESTERN

NEUROMUSCULAR THERAPY

STRUCTURAL AND FUNCTIONAL MOVEMENT INTEGRATION

ORIENTAL

ENERGETIC

OTHER

Research focus

Research abstract

Evidence-based practice

Meditation

Research focus

Research abstract

Evidence-based practice

Research focus

Research abstract

Evidence-based practice

Incorporating complementary therapies into nursing practice

Political issues and implications

Practice issues and implications

Educational issues and implications

Research issues and implications

Strategies for introducing complementary therapies

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