Why Learn About CAM?
If CAM isn’t used yet at every health care facility, then why should nurses learn about it? “Patients are using them. Time and time again, research finds that the majority of the population is using integrative health products, and this rate is much higher for patients with higher socioeconomic status and/or patients who suffer from chronic health conditions,” says Jessie Hawkins, PhD, director of the Franklin School of Integrative Health Sciences. “Without guidance from their care providers, patients are left to self-educate through online sources. This results in reduced efficacy at best and injury at worst.”
With so many patients using CAM, Mollie Aleshire, DNP, MSN, FNP-BC, PPCNP-BC, FNAP, DNP program director and clinical associate professor at the University of North Carolina at Greensboro School of Nursing says, “It is essential that nurses have knowledge about common CAM and obtain information to elicit use of CAM therapies from the patient history.”
“It’s important to help patients get information from reliable sources and to know if a suggested alternative treatment, such as herbal supplements, may interfere with the medications they are currently prescribed or may be detrimental to their health,” says Tina M. Baxter, APRN, GNP-BC, president and CEO of Baxter Professional Services, LLC.
“Patients are now looking for alternative therapies. A lot of people don’t want to go with pharmaceutical drugs anymore,” says Jennifer Burns, NMD, founder of Burns Integrative Wellness Center. “It’s nice to have other modalities to help the patients.”
“It’s important for nurses to learn about alternative therapies because they offer patients new avenues that may improve their conditions and overall health,” says Linda Steele, PhD, MSN, BSN, APRN, ANP-BC, program director for Walden University’s nurse practitioner programs.
The Most Commonly Used CAM
According to Baxter, there are eight most commonly used CAM therapies in health care: acupuncture, aromatherapy, hypnosis, massage therapy, meditation, Tai Chi, therapeutic touch, and vitamins/herbal supplements. These, she says, are the most researched and studied.
“For example, aromatherapy oils are now used post-op in some hospitals to reduce anxiety and pain after surgery so that patients will require less pain medications. Meditation has been used in psychiatry through progressive muscle relaxation, guided imagery, and mindfulness meditation to augment the practices of cognitive behavioral therapy and dialectic behavioral therapy. Tai Chi has been shown to improve balance and flexibility for older adults and thereby reducing falls in long-term care and community settings,” explains Baxter. “Herbal supplements such as CBD oil have shown some efficacy in reducing seizures, pain, and anxiety. Hypnosis is a treatment that is offered for smoking cessation and obesity treatment. Massage therapy and acupuncture have been demonstrated to be beneficial in addiction treatment. Therapeutic touch has been demonstrated to help with pain in some instances by manipulating the energy fields that surround the body.”
Audrey Christie, MSN, RN, a self-employed holistic wellness practitioner, says that CAM has become more common because of evidence illustrating their benefits. “Things like aromatherapy in labor and delivery units, as well as mindfulness and meditation or Reiki-style practices, are becoming more and more mainstream,” Christie says. “They can help with pain reduction, mindset, relaxation, anxiousness, and many other aspects of the body-mind connection. In recent years, science has been beginning to catch up to what we have known intuitively for years.”
Hilary Erickson, RN, BSN, a labor and delivery nurse and creator of Pulling Curls says that if patients are pregnant with breech babies, she will often recommend that they see a chiropractor, as she believes that a skilled practitioner may help prevent them needing a C-section.
Christie makes another good point: “All therapies were once considered alternative—even antibiotics. We know that there is far more to healing than just applying a chemical compound or mechanical procedure to the human form—that intrinsic mind and spirit aspect can be a real determining factor in whether or not a patient gets better.”
Don’t be like your patients and simply look up information about CAM online. If you want to implement it into your practice, it’s necessary for you to get some kind of formal education.
“Integrative health is a concept that is rapidly growing and expanding worldwide. Sales of dietary supplements are up year after year, and the industry itself is a multi-trillion-dollar global market. Patients are using alternative therapies, and that use is increasing,” says Hawkins. “Continuing education in integrative health is one of the best career investments a nurse can make.”
But there are other reasons to study CAM. “Nurses should be skilled in the therapy before providing it, and it should abide within hospital policies so that they can maintain the standard of care the hospital wants them to provide—and so that they are protected,” cautions Erickson.
A number of our sources recommend that nurses first look to the American Holistic Nurses Association for educational opportunities in CAM. The organization offers certification as well as online training programs.
“There are some complementary certificates available, such as the two-year program with alternative therapies expert Dr. Andrew Weil,” says Steele. “Many nurses also get certified as a licensed massage therapist or acupuncturist.” Steele also notes that some conferences, like the annual one offered by the American Academy of Nurse Practitioners, may offer CAM single sessions and in-depth training.
“We train nurses to become board certified health coaches, herbalists, and aromatherapists. We focus on these specific areas because they are the dominant integrative health fields in nursing practice,” says Hawkins, speaking of the Franklin School of Integrative Health Sciences.
“These therapies complement a nurse’s practice by providing additional tools that can be used to boost overall quality of life as well as patient compliance with wellness programs. For example, much of the research on aromatherapy is specific to pre-procedural applications such as anxiety relief before a surgical intervention. For many applications of herbs and essential oils, there is high quality evidence supporting its use,” explains Hawkins. “Sometimes this evidence also clarifies its use. For example, recent research we conducted found that children with an autism spectrum disorder respond differently to pre-procedural aromatherapy than the general population. This helps to demonstrate not only that these interventions work, but with which populations they are found to be effective.”
Most nurses can streamline their training at Franklin because they have general health education. Nurses train via interactive distance learning—so they can still work—and most complete their programs within a year.
While many institutions teach CAM, Christie advises nurses to use caution: “Only spend time and money on accredited schools. The kind of education they need depends entirely on the state in which they are practicing.”
“Medicine is evolving, as is the state of health. It’s critical to explore options and be at the forefront of new therapies. In fact, most nurses took an oath to continue educating themselves,” says Christie.
CAM and Patients
While many patients will be using some form of CAM, you may encounter some who aren’t. As a result, you’ll need to explain it to them to make them comfortable.
“Never force them,” says Christie. “I try to come from a place of explaining it on their level. If you think of something like a breathing technique and work from there—often in conversation and assessment—you can find a connection to discuss with the patient and make them comfortable. If they never get to comfortable, I try to send them with some education to learn more about the therapy on their own time.”
Steele suggests that nurses begin by giving basic tips to their patients to improve their overall health and wellness. “Ask the patient to identify what types of therapies they have heard about and what their level of comfort with them is. Always assure them that they will have access to different medical recommendations, including alternative therapies, if and when they are ready to take that step,” says Steele. “Stress the idea of complementary medicine and nursing as a blend of both Western traditional medicine and Eastern modalities, which are more than 2,000 years old. Patients become much more comfortable when they realize they have choices in their health care.”
Baxter says that she explains to patients that there is research and evidence for the prescribed therapy as well as how the therapy may benefit them. “I would be very careful, as some clients are concerned about promoting a specific religion when you talk of medication and Tai Chi. I encourage the clients to think of it as learning to ‘quiet your mind’ and ‘learning to move your body to promote healing’ as opposed to supporting a particular ideology,” she says.
Cautions to Keep in Mind
With any kind of health therapy, there are cautions to be aware of. For example, just because vitamins and other supplements are sold over the counter, that doesn’t mean that they are safe at all times. Steele says that there are still precautions nurses should take. “As with any medical or physical therapy, all have side effects and can cause potential harm or injury to the patient,” she says.
“Avoid a one-size-fits-all approach. Like medications, what works for one person may not work for another. I have clients who do not respond well to aromatherapy but may respond better to some acupressure,” says Baxter. “I would make sure that if I am recommending any treatment, I would first research it for the evidence that it may be effective and make sure that you are qualified to provide the service that is offered. For example, Tai Chi is of great benefit to older adults, but I am not a certified instructor. I do know some basic moves from a video that I will often demonstrate to the other health care providers to show them the movements, but I refer clients to a certified instructor if they want to take the class.”
Hawkins stresses that nurses need to know if their individual state or facility where they practice allows alternative therapies. Some don’t. But they also need to know how the therapies, if allowed, will affect their patients as well.
“Nurses should be aware that alternative therapies are not free from risks and contraindications. Many of these therapies interact with conventional medications or treatments, and many others pose risks to patient health,” says Hawkins. “There are also restrictions on how these therapies should be used, even on otherwise healthy patients. For example, some essential oils can slow breathing in infants. Others can cause someone who does not typically burn to get a sunburn. Studying integrative health provides the framework needed to keep patients safe.”