Discussion of complementary and alternative therapies occurs throughout the nursing curriculum at the University of Washington School of Nursing in Seattle thanks to a grant from the National Center for Complementary and Alternative Medicine (NCCAM), which is part of the National Institutes of Health.
Over the last six years, 30 faculty members have participated in Complementary and Alternative Camp or the Faculty Integrative Health Program at Seattles Bastyr University, which specializes in natural health arts and sciences education, says Jane Cornman, ARNP, PhD, a senior lecturer at UW and project lead on the grant. Margaret Heitkemper, RN, PhD, FAAN, is the principal investigator.
[Faculty participants] learned about Chinese medicine, acupuncture, homeopathy, naturopathy a huge list, Heitkemper says.
As part of the curriculum, participants returned to UW with lesson plans designed to incorporate a complementary modality into at least one of their classes. Because of that immersion into complementary and alternative medicine (CAM), the school subsequently developed a graduate certificate in Complementary and Alternative Medicine/Healthcare: An Integrative Approach. The program emphasizes developing an evidence base for CAM practice as well as an introduction to the five domains of CAM modalities:
– Alternative medical systems, such Chinese medicine.
– Mind-body interventions, such as meditation or prayer.
– Biologically-based treatments, such as herbal products.
– Manipulative and body-based methods, such as massage.
– Energy medicine, such as Therapeutic Touch.
The first thing were trying to get the nursing students to do is to assess patients use of any kind of CAM modality because a lot of patients are using supplements and herbal products and theyre not really talking about it to their healthcare provider, Cornman says.
Knowledgeable nurses can work with patients in a non-judgmental way to alert them to possible negative drug interactions or to direct them towards useful complementary modalities, she said. For instance, were not training nurses to do acupuncture, but they could refer, they know the literature, so they know for what conditions acupuncture might be a good resource for this patient. Thats the direction were going in.
Thats the direction many Americans are going as well. Research by NCCAM indicates interest in CAM is strong nationwide. According to their 2002 survey of over 31,000 adults, 36 percent had used CAM for conditions ranging from insomnia to back pain the last 12 months, while over 49 percent had used CAM at some point in the past. The study included the five UW domains.
When prayer for healing is added to the mix, those numbers jump to 62 percent and 74 percent, respectively. Use of peppermint was cited by more than 11 percent of adults who reported use of natural products. More than 25 percent of respondents who used CAM did so at the suggestion of conventional medical professionals.
Integrating CAM Into Practice
Integrative medicine has become a way of life for Patty Aamodt, RN, MSN, AHN-BC, a senior lecturer at the Washington State University Intercollegiate College of Nursing in Spokane and founder and director of The Academy for Healing Arts in Yakima, Wash. Aamodt carries vials of peppermint oil and lavender oil in her purse for use when she needs relief from headaches or indigestion, or overall relaxation.
When Aamodts daughter was hit in the head with a softball, Aamodt used non-contact Therapeutic Touch on her child to not only reduce her anxiety, pain, and discomfort, but to also help flatten the swelling on her forehead.
There were no black eyes, no pain. My daughter said, Mom, will you please stopI want to leave the seam of the ball on my forehead! she said.
Certified in aromatherapy, hypnotherapy, healing touch, clinical guided imagery, and other CAM techniques, Aamodt has an arsenal of modalities to infuse into her nursing care in her private practice at The Academy. She is quick to point out that she doesnt use the techniques as an alternative to allopathic approaches, but as an adjunct.
I use them in conjunction, integrated with everything else that I use, Aamodt says. If I have an acute injury, still get me to the best ER around.
Thats how she teaches her course on Therapeutic Touch at WSU as well.
Students are encouraged to incorporate it into their nursing practice, along with any of the other skills they take into the patients room with them, she says. For example, they could use Therapeutic Touch in conjunction with pain medications for their patients.
Theres a lot of evidence-based practice out there and research to support particularly Therapeutic Touch and has been since the early 1970s. Is it unequivocal? No, Aamodt says. But she notes that Therapeutic Touch has consistently been shown to elicit the relaxation response of the parasympathetic nervous system.
Creating a Space
For the past five years, Terri Nosack, RN, HN, BSN, MBA, CPHQ, incorporated holistic modalities into her nursing practice as well. When her father was dying she used her knowledge of aromatherapy, guided imagery, sound, prayer, and healing touch to put him at ease his final days.
I could see that these modalities helped to calm his breathing, his pulse, his posturing. He just appeared more at peace, more calm, Nosack says.
As a partner in SW Washington Holistic Health, based in Rigefield, Wash., Nosack is working to bring awareness to the healthcare community regarding the value of integrating CAM therapies. She and her business partner Debbie Nesbitt, RN, HN, CH, NLP, provide experiential and interactive sessions as guest lecturers at local nursing schools, medical facilities and businesses.
In her workshops, Nosack might discuss how lavender promotes relaxation and how peppermint perks people up and combats nausea. She might use guided imagery to help clients decrease stress by imagining themselves in a calmer place, or facilitate a drum circle to promote relaxation through rhythmic sounds and entertainment.
Holistic nursing and modalities embrace the interconnectedness of body, mind, spirit and emotions, promoting relationship-centered health care, which helps nurses understand their clients’ unique beliefs and values, instead of just going through the motions of getting them ready for the next test or the next round of medicine, Nosack says. We are getting very high-tech and low-touch in the traditional setting. Holistic nursing puts the care back in health care.