Position Statement on the Use of Complementary and Alternative Therapies in the Practice of Nursing

The intent of this position statement is to provide clarification about the role of the registered nurse (RN) in the use of complementary and alternative therapies (CAT).

POSITION

It is the position of the New York State Nurses Association that:

• Complementary and alternative therapies (CAT) are an adjunct to conventional medical regimes, and the RN has an integral role in the coordination and facilitation of such therapies. 
• RNs can, and often use, holistic nursing therapies that can be described as complementary or alternative in nature.
• RNs should obtain and maintain appropriate education and clinical experience in order to maintain competency in CAT.
• RNS should be familiar with the Nurse Practice Act and perform only those therapies inherent in the RN’s scope of practice.
• RNs have an ethical and professional responsibility to support an individual’s choice regarding health care and educate the patient about various therapeutic options and the risk and benefits associated with each.

BACKGROUND

The nursing profession has a long history of viewing and caring for individuals in a holistic manner. Holistic care refers to approaches and interventions that address the needs of the whole person: body, mind, and spirit. Florence Nightingale recognized the importance of caring for the whole person and encouraged interventions that enhanced individuals' abilities to draw upon their own healing powers. She considered touch, light, aromatics, empathetic listening, music, quiet reflection, and similar healing measures as essential ingredients to good nursing care. Today's education of registered nurses is built upon these same principles (American Holistic Nurses Association, 2001).

RNs recognize cultural, psychosocial, and spiritual needs that can impact upon health care practices, choices and preferences for treatment or non-intervention.  Inherent in the nurse’s role is the ability to assess, intervene and evaluate preventive, supportive, and restorative functions of a patient’s physical, emotional, mental and spiritual domains. According to the 2002 National Health Interview Survey conducted by the Centers for Disease Control (CDC), 62% of American adults use some form of complementary or alternative therapies.

The World Health Organization (2013) defines CAT as “a broad set of health practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health care system.” The growing interest in the use of CM may be ascribed to a number of factors including (Ping, 2015):

1. The recognition of the potential benefits of these therapies;
2. Limitations and side effects of orthodox treatment approaches;
3. An increasing expectation for a more holistic approach to providing care;
4. Quality of life issues;
5. Improving control in the treatment process;
6. Clients’ expectation of better communication with practitioners; and
7. Adoption of particular healing systems compatible with specific cultural backgrounds.

It is essential in any health care setting, that both the patient and the health care practitioner understand and appreciate the difference between curing and healing.  Curing involves specific actions to eliminate or modify a condition and may lead to healing.  Healing involves the patient’s participation in a transformational process. Healing arts are those interventions that foster an individual's healing process, i.e., a return of the individual toward a state of wholeness in which body, mind, and spirit are integrated and balanced, and the person is able to reach deeper levels of personal understanding (American Holistic Nurses Association, 2001). 

Professional nurses are increasingly offering patients a variety of choices of therapies as part of a comprehensive care plan.  Patients are seeking out practitioners who are willing to participate in a more diverse treatment plan combining conventional, alternative and complementary therapies. The literature describes the use of CAT in individuals with neurological diseases such as dementias, multiple sclerosis, neuropathies, spinal cord injury, and epilepsy (Fowler & Newton, 2006). The combination of conventional and alternative techniques is commonly referred to as integrative medicine. Although CAT therapies do not work for everyone, treatments such as acupuncture and healing touch therapies have been proven to help with nausea, pain, and other side effects of cancer treatment.

The National Center for Complementary and Alternative Medicine (NCCAM) defines complementary and alternative medicine as, “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine” (Hokanson & Moyad, 2003).  In 1992, the National Institute of Health (NIH) established an Office of Alternative Medicine (OAM) with a dual focus:

1. to develop research centers focusing on clinical conditions such as aging, cancer and pain; and
2. to conduct research focused on the evaluation of specific complementary. In addition, OAM is charged with establishing a clearinghouse to supply information to the public and health care practitioners on complementary therapies.

Classification of CAT Therapies

NCCAM (2003)

Alternative and complementary therapies are rooted in nursing’s history and many are derived from traditional nursing care approaches.  RNs often combined therapies in their everyday care of patients.  These therapies have given nursing a degree of autonomy and have enabled nursing to enrich its own practice and venture into entrepreneur opportunities.  As of 2006, questions about CAT modalities are included in the NCLEX-RN examination thereby requiring professional nurses to be knowledgeable and current with such practices.   

RECOMMENDATIONS

The New York State Nurses Association recommends that RNs incorporating CAT therapies into their nursing practice should:

• Provide full disclosure when offering CAT to patients, including discussing the pros and cons of all therapeutic options available to the patient.
• Be cognizant of the ethical and cultural issues and considerations surrounding CAT in order to fully function as an advocate for quality, comprehensive care of patients.
• Discuss with the patient, and family when appropriate, available options regarding CAT and support the patient’s choice.
• Incorporate the Holistic Nurses Association’s Standards of Holistic Nursing Practice and the American Nurses Association’s Code for Ethics for Nursing into their practice.
• Continually seek avenues to raise community awareness about the benefits of CAT in wellness and preventative medicine.
• Conduct, support and/or participate in research to study the effectiveness of CAT as nursing interventions.
• Support continued funding of the federal Office of Alternative Medicine and urge professional nursing organizations to work collaboratively with that office.
• Advocate for the adequate coverage and access of CAT by federal, state and insurance programs.
• Advocate that health care practitioners and health care facilities provide the patient with the opportunity to obtain conventional and CAT by accepting and integrating the availability of such therapies into the health care delivery system.
• Advocate that nursing programs integrate CAT concepts and information into their existing curricula.

Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.

Approved by the NYSNA Board of Directors on 8/08/07
Reviewed and revised March 23, 2018

References

• American Holistic Nurses’ Association. Position on the role of nurses in the practice of complementary and alternative therapies. Retrieved October 18, 2006, from http://www.ahna.org/about/statements.html#role
• Duryea, B. (2005). Marching to the beat of a different drummer. Complementary and alternative medicine. Imprint, 52(2) 55-57.
• Fowler, S., & Newton, L. (2006). Complementary and alternative therapies: the nurse's role. Journal of Neuroscience Nursing 38(4):261-4.
• Hawks, J. H., & Moyad M. A. (2003). Complementary and preventive medicine. CAM: Definition and classification overview. Urologic Nursing, 23(3), 221-223.
• Helms, J. E. (2006). Complementary and alternative therapies: A new frontier for nursing education? Journal of Nursing Education, 45(3), 117-123.
• Nurse’s handbook of alternative & complementary therapies. (1999). Springhouse, PA: Springhouse Corporation. (pp. 28-60).
• Parkman, C. A. (2002). Cam therapies and nursing competency. Journal for Nurses in Staff Development. 18(2), 61-67.
• Ping, L. S. K. (2015). Role of complementary medicine in nursing and health care professionals. SOJ Nur Health Care 1(2): Page 2 of 2 1-2.  Retrieved March 23, 2018 from https://pdfs.semanticscholar.org/1204/8e3322b3227e6abdb526cb186e8b17d9c7b4.pdf.
• Silva, M. C., & Ludwick, R. (2001, November 1). Ethical issues in complementary/alternative therapies. Online Journal of Issues in Nursing. Retrieved July 7, 2006, from http://www.nursingworld.org/ojin/ethicol/ethics_7.htm