1) Position on the Role of Nurses in the Practice of Complementary and Alternative Therapies
CAM and Holistic Care
Complementary and alternative modalities (CAM) offer therapies that supplement conventional medical care. The National Center on Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health has categorized four major domains of CAM practices. In addition, NCCAM studies whole medical systems, which cut across all domains:
Whole Medical Systems
Whole medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of whole medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda, a whole medical system that originated in India.
Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms, such as meditation, prayer, mental healing, and creative outlets such as art, music or dance.
Biologically Based Practices
Biologically based practices in CAM use substances found in nature, such as herbs, foods, and vitamins.
Manipulative and Body-Based Practices
Manipulative and body-based practices include chiropractic medicine, massage, naturopathy, and osteopathic manipulation.
Energy therapies involve the use of energy fields, and include Qigong, Reiki, Healing Touch, and Therapeutic Touch, as well as bioelectromagnetic-based therapies that involve the unconventional use of electromagnetic fields.
Nursing and CAM
AHNA believes that inherent in the nursing role is the ability to touch the client's/patient's body, and to assess, plan, intervene, evaluate, and perform preventive, supportive, and restorative functions of the physical, emotional, mental, and spiritual domains. Therefore, it is expected that the nurse may draw upon and utilize principles and techniques of both conventional and CAM therapies, and that these would be within the scope of nursing practice. AHNA supports the integration of CAM into conventional health care to enable the client to benefit from the best of all treatments available. In their provision of holistic care, nurses employ practices and therapies from both CAM and conventional medicine.
Consistent with conventional nursing practice, nurses must be competent in the CAM therapies and practices they use. AHNA believes nurses integrate these practices into conventional care as part of a holistic practice. In addition, nurses support and assist clients with their use of CAM provided by other practitioners by:
- Identifying the need for CAM interventions
- Assisting clients in locating providers of CAM interventions
- Facilitating the use of CAM interventions through education, counseling, coaching, and other forms of assistance
- Coordinating the use of CAM among various health care providers involved in clients' care
- Evaluating the effectiveness of clients' complete care (conventional and CAM).
Practicing within a holistic nursing framework does not imply competency in effectively and safely utilizing CAM therapies and practices. A nurse practicing as a therapist of a specific conventional or CAM therapy must have the education, skills, and credentials ascribed for that therapy. The nurse also must operate within the legal scope of practice of the nurse's licensure and jurisdiction.
AHNA views nurses as being in a unique position in the implementation of CAM throughout the health care system in that registered nurses:
- Represent the greatest number of health care professionals, representing more than 2.1 million health care professionals and are employed in more diverse clinical settings than any other health care professional
- Are uniquely prepared to differentiate normality from illness, provide interventions for health promotion and illness-related care, and use a wide range of medical technology and the healing arts
- Are advocates for clients rather than specific products or practices, and therefore are in an excellent position to assure appropriate and adequate use of all types of services
- Are trusted and held in high esteem by consumer
These factors support nurses holding a leadership role in the implementation of CAM in various service settings and the coordination of CAM utilization by clients as part of an integrated approach to care.
2) Position on Holistic Nursing Ethics
Holistic nurses hold to a professional ethic of caring and healing that seeks to preserve wholeness and the dignity of self and others. (Standards of Holistic Nursing, Core Value 1.3)
Code of Ethics for Holistic Nurses
The fundamental responsibilities of a nurse are to promote health, facilitate healing, and alleviate suffering. Inherent in nursing is the respect for life, dignity, and the rights of all persons. Nursing care should be given within a context mindful of the holistic nature of humans, understanding the body-mind-spirit connection. Nursing care is unrestricted by considerations of nationality, race, creed, color, age, sex, sexual preference, politics, or social status. Given that nurses practice in culturally diverse settings, professional nurses must have an understanding of the cultural background of clients in order to provide culturally appropriate interventions.
Nurses provide services to a diverse array of clients that may include individuals, families, groups or communities. Each client should be treated as an active participant in his or her health care and should be included in all nursing care planning decisions.
When providing services to others, each nurse has a responsibility towards the client, co-workers, nursing practice, the profession of nursing, society, and the environment.
Nurses and Self
The nurse has a responsibility to model health care behaviors. Holistic nurses strive to achieve harmony in their own lives and assist others striving to do the same.
Nurses and the Client
The nurse's primary responsibility is to the client needing nursing care. The nurse strives to see the client as whole and provides care that is professionally appropriate and culturally consonant. The nurse holds in confidence all information obtained in professional practice and uses professional judgment in disclosing such information. The nurse enters into a relationship with the client that is guided by mutual respect and a desire for growth and development.
Nurse and Co-workers
The nurse maintains cooperative relationships with co-workers in nursing and other fields. Nurses have a responsibility to nurture each other and to assist nurses to work as a team in the interest of client care. If a client's care is endangered by a co-worker, the nurse must take appropriate action on behalf of the client.
Nurses and Nursing Practice
The nurse carries personal responsibility for practice and for maintaining continued competence. Nurses have the right to utilize all appropriate nursing interventions, and have the obligation to determine the efficacy and safety of all nursing actions. Wherever applicable, nurses utilize research findings in directing practice.
Nurses and the Profession
The nurse plays a role in determining and implementing desirable standards of nursing practice and education. Holistic nurses may assume a leadership position to guide the profession towards holism. Nurses support nursing research and the development of holistically oriented nursing theories. The nurse participates in establishing and maintaining equitable social and economic working conditions in nursing.
Nurses and Society
The nurse, along with other citizens, has the responsibility for initiating and supporting actions to meet the health and social needs of the public.
Nurses and the Environment
The nurse strives to create a client environment that is one of peace, harmony, and nurturance so that healing may take place. The nurse considers the health of the ecosystem in relation to the need for health, safety, and peace of all persons.
3) Position on Nursing Research and Scholarship
Holistic nursing is defined as “all nursing practice that has healing the whole person as its goal.” (AHNA 1998)
Holistic care refers to approaches and interventions that address the needs of the whole person: body, mind, emotion, and spirit. Nursing is the care and treatment of the human response to actual or potential health problems, concerns or life processes. Thus, nursing research and scholarship should assist its practitioners to: (1) understand the holistic nature of human experiences of health, healing and illness; and (2) evaluate the affects of holistic nursing actions on the client's health, healing, illness and recovery.
Holistic Nursing Knowledge Base
Holistic nurses possess a rich knowledge base that reflects their formal academic and continuing education preparation and also includes a wide diversity of practices and modalities outside of conventional medicine. They must be knowledgeable about the best evidence available for both conventional and CAM therapies, and therefore recognize several ways of knowing – rational/scientific, intuitive, and aesthetic. In addition to developing evidence-based practice using research, practice guidelines, and expertise, holistic nurses strongly consider the person’s values and healthcare practices and beliefs.
Nursing scholarship involving intuitive and aesthetic understanding of phenomena and situations is necessary to comprehend the dimensions of holistic nursing that encompass: (1) the art of care, (2) the wholeness of the client's experiences and meaning of patterns that emerge, (3) the beauty of authentic interaction; and (4) the knowledge of that which is perceived through non-verbal, non-objective expression. Nursing scholarship involving rational/empirical understanding is necessary to demonstrate: (1) basic mechanisms of nursing actions and integrative therapies; (2) clinical safety, efficacy and treatment outcomes of holistic modalities; and (3) the interactive nature of body/mind/emotion/spirit.
Qualitative and Quantitative Research
AHNA supports nursing research and scholarship that builds scientific knowledge through quantitative research and that extends human understanding through qualitative investigation. Because many phenomena of concern to nursing remain unknown or undocumented, exploratory, qualitative research is a highly effective method for expanding holistic nursing’s developing body of knowledge. Further, many aspects of the human responses to health, illness and life processes are subjective and qualitative research is the most feasible method of obtaining information and understanding of the human condition. Sensitive measurement instruments that assess and document the interactive nature of each client's biological, psychological, emotional, sociological, and spiritual patterns are needed as well as ongoing evaluation of nursing interventions assessing usefulness in promoting wellness and preventing illness.
Qualitative research is often used to gain a general sense of phenomena and to form theories that can be tested using further quantitative research. As holistic medical practices become more and more common, it is imperative that the efficacy of alternative approaches be researched and evaluated. Holistic nursing is both an art and a science, and as such, quantitative research and analysis is critical.
AHNA endorses and supports nursing scholarship relevant to learning, documenting and comprehending that which is the science and art of holistic nursing with the goal of producing dependable and relevant information to practitioners and the public.