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Editorial: Merging Rehabilitation Nursing with Complementary and Alternative Therapies
During the past 10 years, complementary and alternative medicine (CAM) has grown dramatically. Much of this growth has been driven by patients and families who are seeking alternative modalities of care. What is the role of rehabilitation nursing with regard to CAM? Although the evidence supporting its efficacy is mounting, what specific parameters exist to prescribe its use within our varied practice settings?
According to the recently published report Commentary and Alternative Medicine in the United States (Board on Health Promotion and Disease Prevention [BHPDP], 2005), there is a growing use of CAM, with the reported prevalence ranging from 30% to 62% among adult Americans. CAM can take many forms, including prayer, acupuncture, herbal remedies, dietary supplements, meditation, yoga, chiropractic care, massage, relaxation, and imagery. Data support that women are more likely than men to seek CAM, with the patterns of usage varying according to race; usage also tends to be higher among those who are better educated. This report further reveals that consumers of CAM frequently employ more than one type of such therapy, and use it to manage symptoms such as pain, headache, stiffness, head or chest colds, anxiety, and depression. While CAM usually is combined with conventional medical care, its use often is not disclosed to healthcare providers. Interestingly, the highest users of CAM typically have diseases that cannot be cured, such as diabetes and arthritis, and may have some associated discomfort or unpleasant medication side effects.
CAM use is not restricted to adults. Adolescents also are regular CAM consumers. In a study of 401 adolescents aged 12–18 years, Braun, Bearinger, Halcon, and Pettingell (2005) discovered that more than 68% used CAM, with the primary objective of reducing physical pain. As with adults, the adolescents were not inclined to reveal their CAM use to healthcare providers.
How can we efficaciously incorporate CAM into practice? First, we must be cognizant that CAM is very prevalent among many of our patients, their families, and colleagues. For some, CAM may have been an integral part of an individual’s upbringing; herbal remedies, aroma therapy, prayer, and other forms of CAM may have been commonplace and part of the daily routine. As clinicians, we need to determine constantly and sometimes creatively the CAM use of our patients and identify the positive, negative, and ethical ramifications when combined with more traditional care modalities. To achieve these ends, we must stay well informed about CAM to make evidence-based decisions.
When 1,000 nurses were surveyed randomly regarding knowledge of CAM, 79% indicated that they viewed themselves to be poor to fairly prepared (Brolinson, Price, Ditmyer, & Reis, 2001). Although the majority of the respondents did not practice CAM, another third indicated use of three CAM modalities (massage, multivitamins, and meditation/relaxation). These were also the same CAM modalities the nurses recommended to others. Decisions regarding the use of CAM should not be based solely on the healthcare provider’s personal preference. Pivotal to the decision-making process should be a critical evaluation of whether strong, research-based evidence supports the utilization of a particular CAM with patients who have particular characteristics and needs. More importantly, we also need to determine whether the CAM outcome will occur as anticipated when applied to our specific rehabilitation settings and patient population.
Other central elements to ascertaining the appropriateness of a CAM is its administration requirements, the inclusion and exclusion criteria for candidates, signs and symptoms of positive and negative outcomes, dosing, and efficacy timeline. In Complementary and Alternative Medicine in the United States (BHPDP, 2005), the importance of rigorous research studies to determine the effectiveness and safety of various CAM treatments is emphasized strongly. This report forcefully recommends comparing the perceptions, patterns, prevalence, outcomes, and costs of combinations of CAM with conventional medical treatments. It also suggests developing and implementing a national CAM surveillance system, practice-based research networks, and research centers to work with the networks.
CAM is here to stay. As a result, rehabilitation nurses have a responsibility to become well informed about CAM and must work with other healthcare professionals, patients, and their families to make evidence-supported decisions regarding its use. For those who want to contribute to building the scientific foundation regarding use of CAM in the various rehabilitation settings, Rehabilitation Nursing welcomes your manuscripts as we work together and with others to expand our rehabilitation knowledge.
Board on Health Promotion and Disease Prevention. (2005). Complementary and alternative medicine in the United States. Washington, DC: National Academies Press.
Braun, C.A., Beringer, L. H., Hamcon, & Pettigell, S. L. (2005). Adolescent use of complementary therapies. Journal of Adolescent Health, 37(1), 76.
Brolinson, G., Price, J., Ditmyer, M., & Reis, D. (2001). Nurses’ perceptions of complementary and alternative medical therapies. Journal of Community Health, 26, 175–189.