the National Center for Complementary and Alternative Medicine (NCCAM) describes complementary and alternative medicine as “a group of diverse …
HPNA Position Statement Complementary Therapies
Background Studies have shown that use of complementary and alternative therapies in the United States is common and has increased over the past decade1 Reasons for this trend are varied, but include: Consumer dissatisfaction with conventional medical care and clientprovider relationships; Increased consumer desire to participate in healthcare decision-making and in self-care; Consumer concerns regarding side effects of medications commonly used to control disease and symptoms; Growing numbers of people with chronic, incurable conditions; Concern about costs of healthcare; and Increasing cultural diversity of the American population and exposure to different models of health beliefs and healing Complementary therapies, also known as integrative therapies, encompass a broad spectrum of approaches and philosophies Although many definitions exist, the National Center for Complementary and Alternative Medicine NCCAM describes
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 medicine2 Another panel convened by the National Institutes of Health defined complementary and alternative CAM therapies as: A broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being Boundaries within CAM and between the CAM domain and the domain of the dominant health system are not always sharp and fixed3 Some authors use the terms complementary and alternative interchangeably; however, the latter term generally is reserved for those treatment approaches
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that are used alone In contrast, complementary therapies are used in addition to conventional therapies The NCCAM categorizes complementary therapies into five domains: alternative medical systems, mind-body interventions, biologically-based therapies, manipulative and body-based methods, and energy therapies2 See Table 1 Over 200 complementary therapies have been identified These therapies can involve interaction with providers eg, massage therapists, chiropractors or unsupervised use eg, self-care Self-use remains the predominant method of utilization1 In general, complementary therapies are less well studied than conventional therapies However, substantial scientific evidence exists for some complementary therapies These approaches include patient education and cognitive-behavioral therapies for symptom management, which are now widely incorporated into standard healthcare practice Thus, the complementary therapies are not necessarily distinguished from conventional therapies
based on the strength of the scientific evidence Moreover, some complementary therapies may become part of mainstream healthcare as studies demonstrate their effectiveness4-5 Conventional healthcare has its roots in Western philosophy, is guided by scientific methods and focuses on treatment of disease In contrast, complementary therapies often are embedded in Eastern philosophical traditions, guided by a holistic approach, and focused on the human experience of illness and wellness However, these distinctions are not precise Many providers of conventional healthcare, including nurses and physicians, approach the client from a holistic perspective, incorporate psychosocial therapies, and recognize the importance of provider-client partnerships and respectful communication These qualities do not belong only to the practitioner of complementary therapies Likewise, not all practioners of complementary therapies are holistic in their approach Thus, discerning the difference between
conventional and complementary approaches to care often is difficult Nursing has long embraced the holistic approach reflected in the philosophical and theoretical underpinnings of many complementary therapies6 The art and science of nursing requires that nurses address the biopsychosocial and spiritual needs of clients who are receiving nursing care The natural fit between complementary therapeutic approaches and nursing care may be particularly strong in hospice and palliative nursing Similar to the growing popularity of many complementary therapies, hospice and palliative care developed outside mainstream healthcare in response to consumer dissatisfaction with conventional healthcare at the end of life5 There also is a mutual emphasis in both complementary therapies and hospice/palliative care on chronic conditions for which there is no cure, on symptom management, and on enhanced quality of life5 Because complementary therapies may be particularly effective in managing symptoms and
promoting wellness at the end of life, hospice and palliative nurses need to be fully informed regarding many types of 2
complementary therapies and the implications of incorporating these therapies into comprehensive care at the end of life Nursing roles include providing information to assist clients in making decisions about complementary therapies; understanding and communicating to others how complementary therapies affect mainstream healthcare; being knowledgeable about specific types of complementary therapies; making appropriate referrals to complementary therapists; providing some types of complementary therapies as part of standard nursing care; acquiring additional training to administer specific therapies; and conducting and disseminating research about complementary therapies Nurses play a central role in assisting clients in making decisions about all types of therapies, including complementary therapies Client decisions should be based on accurate answers to the
following questions: What are the specific goals of the therapy cure, palliation of symptoms, avoidance of side effects from other therapy? Is there scientific evidence that the therapy is effective in achieving the stated goals? What are the expected benefits from this therapy? What are the risks, if any, associated with the therapy? What is the nature, prevalence and severity of side effects from this therapy? Does this therapy interfere with or augment the effects of other therapy that the client might be receiving? What are the financial costs of the therapy? Are any or all of the costs covered by the clients insurance? What are the qualifications of the practitioner? If appropriate, is the practitioner certified and/or licensed? Does the practitioner carry malpractice insurance? Is the client receiving the therapy as part of a clinical trial? If so, who is funding the trial? Has human subjects approval been obtained? Although a number of complementary practitioners are
regulated, many are not; therefore, nurses need to be familiar with any legislative and regulatory issues that could affect clients decisions about receiving care from complementary therapy practitioners7 Another important role for nurses is the incorporation of complementary therapies into their practice Basic nursing education provides the expertise to provide some therapies such as client education Current nursing education is insufficient, however, to prepare nurses to practice many types of complementary therapies In some cases, basic educational requirements to ensure safe and competent practice have not been established6 Moreover, most state nurse practice acts currently do not provide sufficient guidance regarding nurses roles and responsibilities in providing complementary therapies8,9 Despite the lack of clarity regarding nursing practice and complementary therapies, nurses must
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seek to obtain appropriate education and credentialing in order to practice within the scope
of their licensure The growing interest in complementary therapies also has led to increased federal and private funding to study the safety and efficacy of these treatments One major development was the establishment in 1998 of the National Center for Complementary and Alternative Medicine NCCAM as part of the National Institutes of Health NIH The mission of the NCCAM is to stimulate, develop, and support research on complementary and alternative medicine Other governmental and private funding agencies also support this research Nurses in many settings play an important role in designing, conducting, and participating in research on complementary and conventional therapies In their role as educators and advocates, nurses also communicate research findings to clients and the public Position Statement: The Hospice and Palliative Nurses Association HPNA is committed to a comprehensive model of care that addresses physical, emotional, and spiritual concerns of persons at the end of life
through the use of conventional and complementary therapies It is the position of the HPNA Board of Directors to: Acknowledge the increasing use of complementary therapies and recognize that this trend has important implications for nursing practice, education, and research Recognize that many complementary therapies provide a holistic approach to managing symptoms and promoting wellness at the end of life The holistic approach is consistent with nursings historical and philosophical approach to practice Recognize the current and potential role of complementary therapies in the amelioration of symptoms and enhancement of quality of life for hospice and palliative care clients Assert that hospice and palliative nurses must possess sufficient knowledge about these therapies to guide clients in making decisions about their care and to incorporate these therapies into a comprehensive plan of care Support basic and continuing nursing education focusing on complementary therapies for
hospice and palliative care clients Support and encourage the competent practice of complementary therapies for the purpose of promoting holistic end-of-life care Affirm that some complementary therapies are within the scope of nursing practice Promote regulatory and legislative clarification regarding the scope of nursing practice as it relates to complementary therapies Promote increased insurance coverage for safe and effective complementary therapies
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Encourage the conduct and dissemination of methodologically sound research that examines the efficacy, costs, and adverse effects of complementary therapies
Definition of Terms: Complementary and Alternative medicine: a group of diverse therapeutic approaches and health care systems, practices, and products that are not presently considered to be part of conventional medicine2 Alternative therapies: complementary and other unconventional therapies that are used instead of conventional medical and surgical therapies2 In
contrast, complementary therapies are used together with conventional medicine2 A broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period Complementary and alternative medicine CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being Boundaries within CAM and between the CAM domain and the domain of the dominant health system are not always sharp and fixed3 Holistic nursing practice: approaches and interventions that address the needs of the whole person10 Holism refers to the context or philosophy of care, rather than to a set of specific therapies11,12 Integrative therapies: Integrative medicine combines mainstream medical therapies and CAM therapies for which there is some high-quality
scientific evidence of safety and effectiviness2 References: 1 Eisenberg DM Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey JAMA 1998;28018:1569-1575 2 National Center for Complementary and Alternative Medicine What is complementary and alternative medicine CAM? October 21, 2002 Available at: http://nccamnihgov/health/whatiscam/ Accessed November 6, 2002 3 Defining and describing complementary and alternative medicine Panel on Definition and Description, CAM Research Methodology Conference, April 1995 Altern Therap Health Med 1997;32:49-57 4 McAlindon TE, LaValley MP, Gulin JP, Felson DT Glucosamine and chondroitin for treatment of osteoarthritis: A systematic quality assessment and meta-analysis JAMA 2000;283:1469-1475 5
5 Pan CX Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life A systematic review J Pain Symp Manage 2000;20:374-387 6 Gaydos HLB
Complementary and alternative therapies in nursing education: Trends and issues Online J Issues Nurs 2001;62:5 7 Cohen MH Legal issues in complementary and integrative medicine A guide for the clinician Med Clinics North Am 2002;86:185-196 8 Sparber A State boards of nursing and scope of practice of registered nurses performing complementary therapies Online J Issues Nurs August 31, 2001 2001;63: Manuscript 10 Available at http://wwwnursingworldorg/ojin/topic15/tpc15_6htm Accessed November 6, 2002 9 Geddes N Nursing and alternative medicine Legal and practice issues J Holist Nurs 1997;15:271-281 10 American Holistic Nurses Association Position on the role of nurses in the practice of complementary and alternative therapies 2002 Available at: http://wwwahnaorg/about/statementshtmlrole Accessed November 6, 2002 11 Frisch N Nursing as a context for alternative/complementary modalities Online J Issues Nurs May 31, 2001 2001;62: Manuscript 2 Available at
http://wwwnursingworldorg/ojin/topic15/tpc15_2htm Accessed November 6, 2002 12 Saks M Alternative therapies: are they holistic? Comple Therapies Nurs Midwifery 1997;31:4-8
Approved by the HPNA Board of Directors November 2002 To obtain copies of HPNA Position statements, contact the National Office at Penn Center West One, Suite 229, Pittsburgh, PA 15276 Phone 412 787-9301 Fax 412 787-9305 Website wwwHPNAorg
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Table 1 Major Domains of Complementary and Alternative Medicine Domain Practices Alternative Medical Systems Traditional Chinese medicine Techniques include: acupuncture, herbal medicine, oriental massage, Qi gong Ayurveda traditional Indian medicine Treatments include: diet, exercise, meditation, herbs, massage, exposure to sunlight, controlled breathing Homeopathic medicine Small doses of plant extracts and minerals to stimulate the bodys defense mechanisms Naturopathic medicine Practices include: diet and nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy,
spinal and soft tissue manipulation, therapeutic counseling, pharmacology, and physical therapies involving electric currents, ultrasound, and light therapy Patient education Cognitive-behavioral approaches Meditation Hypnosis Dance Music therapy Art therapy Prayer and mental healing Herbal therapies Special dietary therapies Orthomolecular therapies varying combinations of chemicals Biological therapies Chiropractic Osteopathic manipulation Massage therapy Biofield therapies Practices include therapies intended to affect energy fields, such as Qi gong combines movement, meditation, and controlled breathing to enhance the flow of the bodys energy, Reiki channeling spiritual energy, and Therapeutic Touch laying-on of hands Electromagnetic therapies Involve the use of pulsed fields, magnetic fields, and alternating current or direct current fields
Mind-body Interventions
Biological-based Therapies
Manipulative and Body-based Methods
Energy Therapies
Adapted from the National Center
for Complementary and Alternative Medicine website http://nccamnihgov/health/whatiscam/indexhtm
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