Alternative modalities of care,

alternative systems of health and

complementary therapies

Submitted by

Anita Pariya (Bag)

1st year, M.Sc.Nursing

Govt. College of Nursing

Burdwan
Itroduction
In Western culture, alternative medicine is any healing practice "that does not fall
within the realm of conventional medicine",or "that which has not been shown
consistently to be effective." In some instances, it is based on historical or cultural
traditions, rather than a scientific (e.g. evidence-based) basis. Critics assert that the terms
“complementary” and “alternative medicine” are deceptive euphemisms meant to give an
impression of medical authority. Richard Dawkins has stated that "there is no alternative
medicine. There is only medicine that works and medicine that doesn't work."

The American National Center for Complementary and Alternative Medicine (NCCAM)
studies examples including naturopathy, chiropractic medicine, herbalism, traditional
Chinese medicine, Ayurveda, meditation, yoga, biofeedback, hypnosis, homeopathy,
acupuncture, and nutritional-based therapies, in addition to a range of other practices.

Alternative medicine practices are as diverse in their foundations as in their

methodologies. Practices may incorporate or base themselves on traditional medicine,
folk knowledge, spiritual beliefs, or newly conceived approaches to healing. Jurisdictions
where alternative medical practices are sufficiently widespread may license and regulate
them. The claims made by alternative medicine practitioners are generally not accepted
by the medical community because evidence-based assessment of safety and efficacy is
either not available or has not been performed for these practices. If scientific
investigation establishes the safety and effectiveness of an alternative medical practice, it
then becomes mainstream medicine and is no longer "alternative", and may therefore
become widely adopted by conventional practitioners.

Because alternative techniques tend to lack evidence, or may even have repeatedly failed
to work in tests, some have advocated defining it as non-evidence based medicine, or not
medicine at all. Some researchers state that the evidence-based approach to defining
CAM is problematic because some CAM is tested, and research suggests that many
mainstream medical techniques lack solid evidence.

A 1998 systematic review of studies assessing its prevalence in 13 countries concluded

that about 31% of cancer patients use some form of complementary and alternative
medicine. Alternative medicine varies from country to country. Edzard Ernst says that in
Austria and Germany CAM is mainly in the hands of physicians, [12] while some estimates
suggest that at least half of American alternative practitioners are physicians. In
Germany, herbs are tightly regulated, with half prescribed by doctors and covered by
health insurance based on their Commission E legislation.

The term 'alternative medicine' is generally used to describe practices used independently
or in place of conventional medicine. The term 'complementary medicine' is primarily
used to describe practices used in conjunction with or to complement conventional
medical treatments. NCCAM suggests "using aromatherapy therapy in which the scent of
essential oils from flowers, herbs, and trees is inhaled in an attempt to promote health and
well-being and to help lessen a patient's discomfort following surgery" as an example of
complementary medicine. The terms 'integrative' or 'integrated medicine' indicate
combinations of conventional and alternative medical treatments which have some
scientific proof of efficacy; such practices are viewed by advocates as the best examples
of complementary medicine.

Ralph Snyderman and Andrew Weil state that "integrative medicine is not synonymous
with complementary and alternative medicine. It has a far larger meaning and mission in
that it calls for restoration of the focus of medicine on health and healing and emphasizes
the centrality of the patient-physician relationship." The combination of orthodox and
complementary medicine with an emphasis on prevention and lifestyle changes is known
as integrated medicine.

Characterization

There is no clear and consistent definition for either alternative or complementary

medicine.In Western culture it is often defined as any healing practice "that does not fall
within the realm of conventional medicine", or "that which has not been shown
consistently to be effective."

Self characterization

The National Center for Complementary and Alternative Medicine (NCCAM) defines
CAM as "a group of diverse medical and health care systems, practices, and products,
that are not currently part of conventional medicine."

The Danish Knowledge and Research Center for Alternative Medicine (Danish
abbreviation: ViFAB. ViFAB is an independent institution under the Danish Ministry of
the Interior and Health. ViFAB's webstite: www.vifab.dk/uk) uses the term “alternative
medicine” for: - Treatments performed by therapists who are not authorized health care
professionals. - Treatments performed by authorized health care professionals, but which
are based on methods otherwise mainly used outside the health care system. People
without a health care authorisation must be able to perform the treatments.

The Cochrane Complementary Medicine Field finds that what is considered

complementary or alternative practices in one country may be considered conventional
medical practices in another. Their definition is therefore general: "complementary
medicine includes all such practices and ideas which are outside the domain of
conventional medicine in several countries and defined by its users as preventing or
treating illness, or promoting health and well-being."

For example, biofeedback is commonly used within the Physical Medicine &
Rehabilitation community, but is considered alternative within the medical community as
a whole, and some herbal therapies are mainstream in Europe, but are alternative in the
United States. David M. Eisenberg, an integrative medicine researcher, defines it as
"medical interventions not taught widely at US medical schools or generally available at
US. hospitals," NCCAM states that formerly unproven remedies may be incorporated
into conventional medicine if they are shown to be safe and effective.

Barrie R. Cassileth, a researcher of complementary and alternative medicine, has

summed up the situation as "not all mainstream physicians are pleased with CAM, with
current efforts to integrate CAM into mainstream medicine, or with a separate NIH
research entity for "alternative" medicine.

Scientific community

Institutions

The United States' National Science Foundation has defined alternative medicine as "all
treatments that have not been proven effective using scientific methods." In a consensus
report released in 2005, entitled Complementary and Alternative Medicine in the United
States, the Institute of Medicine (IOM) defined complementary and alternative medicine
(CAM) as the non-dominant approach to medicine in a given culture and historical
period. A similar definition has been adopted by the Cochrane Collaboration, and official
government bodies such as the UK Department of Health. Proponents of evidence-based
medicine, such as the Cochrane Collaboration, use the term alternative medicine but
agree that all treatments, whether "mainstream" or "alternative", ought to be held to the
standards of the scientific method.

Scientists

Numerous mainstream scientists and physicians have commented on and criticised

alternative medicine.

There is a debate among medical researchers over whether any therapy may be properly
classified as 'alternative medicine'. Some claim that there is only medicine which has
been adequately tested and that which has not. They feel that health care practices should
be classified based solely on scientific evidence. If a treatment has been rigorously tested
and found safe and effective traditional medicine will adopt it regardless of if it was
considered alternative to begin with. It is thus possible for a method to change categories
(proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof.
Prominent supporters of this position include George D. Lundberg, former editor of the
Journal of the American Medical Association (JAMA).

Stephen Barrett, founder and operator of Quackwatch, argues that practices labeled
"alternative" should be reclassified as either genuine, experimental, or questionable. Here
he defines genuine as being methods that have sound evidence for safety and
effectiveness, experimental as being unproven but with a plausible rationale for
effectiveness, and questionable as groundless without a scientifically plausible rationale.
He has concerns that just because some "alternative" have merit, there is the impression
that the rest deserve equal consideration and respect even though most are worthless. He
says that there is a policy at the NIH of never saying something doesn't work only that a
different version or dose might give different results.

Edzard Ernst, professor of complementary medicine, characterizes the evidence for

many alternative techniques as weak, nonexistent, or negative, but states that evidence
exists for others, in particular certain herbs and acupuncture.

Richard Dawkins, an evolutionary biologist, defines alternative medicine as a "set of

practices which cannot be tested, refuse to be tested, or consistently fail tests." He also
states that "there is no alternative medicine. There is only medicine that works and
medicine that doesn't work." He says that if a technique is demonstrated effective in
properly performed trials, it ceases to be alternative and simply becomes medicine. A
letter by four Nobel Laureates and other prominent scientists deplored the lack of critical
thinking and scientific rigor in National Institutes of Health supported alternative
medicine research. In 2009 a group of scientists made a proposal to shut down the
National Center for Complementary and Alternative Medicine. They argued that the vast
majority of studies were based on unconventional understandings of physiology and
disease and have shown little or no effect. Further, they argue that the field's more-
plausible interventions such as diet, relaxation, yoga and botanical remedies can be
studied just as well in other parts of NIH, where they would need to compete with
conventional research projects.

Popular press

The Washington Post reports that a growing number of traditionally trained physicians
practice integrative medicine, which it defines as "conventional medical care that
incorporates strategies such as acupuncture, reiki and herbal remedies." The Australian
comedian Tim Minchin, in his nine minute beat poem "Storm", states that alternative
medicine is that which "has either not been proved to work, or been proved not to work",
and then he quips "You know what they call 'alternative medicine' that’s been proved to
work? Medicine."

Classifications

NCCAM has developed one of the most widely used classification systems for the
branches of complementary and alternative medicine. It classifies complementary and
alternative therapies into five major groups which have some overlap.

Whole medical systems: cut across more than one of the other groups; examples include
Traditional Chinese medicine, Naturopathy, Homeopathy and Ayurveda.

1. Mind-body medicine: takes a holistic approach to health that explores the

interconnection between the mind, body, and spirit. It works under the premise
that the mind can affect "bodily functions and symptoms".
2. Biologically based practices: use substances found in nature such as herbs, foods,
vitamins, and other natural substances.
 3. Manipulative and body-based practices: feature manipulation or movement of
body parts, such as is done in chiropractic and osteopathic manipulation.
4. Energy medicine: is a domain that deals with putative and verifiable energy fields:

 Biofield therapies are intended to influence energy fields that purportedly

surround and penetrate the body. No empirical evidence has been found to
support the existence of the putative energy fields on which these
therapies are predicated.
 Bioelectromagnetic-based therapies use verifiable electromagnetic fields,
such as pulsed fields, alternating-current or direct-current fields in an
unconventional manner.

United States

A botánica, such as this one, caters to the Latino community and sells folk medicine
alongside statues of saints, candles decorated with prayers, and other items.

A 2002 survey of US adults 18 years and older conducted by the National Center for
Health Statistics (CDC) and the National Center for Complementary and Alternative
Medicine indicated:[43]

 74.6% had used some form of complementary and alternative medicine (CAM).
 62.1% had done so within the preceding twelve months.
 When prayer specifically for health reasons is excluded, these figures fall to
49.8% and 36.0%, respectively.
 45.2% had in the last twelve months used prayer for health reasons, either through
praying for their own health or through others praying for them.
 54.9% used CAM in conjunction with conventional medicine.
 14.8% "sought care from a licensed or certified" practitioner, suggesting that
"most individuals who use CAM prefer to treat themselves."
 Most people used CAM to treat and/or prevent musculoskeletal conditions or
other conditions associated with chronic or recurring pain.
 "Women were more likely than men to use CAM. The largest sex differential is
seen in the use of mind-body therapies including prayer specifically for health
reasons".
 "Except for the groups of therapies that included prayer specifically for health
reasons, use of CAM increased as education levels increased".
 The most common CAM therapies used in the US in 2002 were prayer (45.2%),
herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic
medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%),
progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and Visualization
(2.1%)
In 2004, a survey of nearly 1,400 U.S. hospitals found that more than one in four offered
alternative and complementary therapies such as acupuncture, homeopathy, and massage
therapy.[65]

A 2008 survey of US hospitals by Health Forum, a subsidiary of the American Hospital

Association, found that more than 37 percent of responding hospitals indicated they offer
one or more alternative medicine therapies, up from 26.5 percent in 2005. Additionally,
hospitals in the southern Atlantic states were most likely to include CAM, followed by
east north central states and those in the middle Atlantic. More than 70% of the hospitals
offering CAM were in urban areas.[66]

The National Science Foundation has also conducted surveys of the popularity of
alternative medicine. After describing the negative impact science fiction in the media
has on public attitudes and understandings of pseudoscience, and defining alternative
medicine as all treatments that have not been proven effective using scientific methods,
as well as mentioning the concerns of individual scientists, organizations, and members
of the science policymaking community, it commented that "nevertheless, the popularity
of alternative medicine appears to be increasing."[27]

In the state of Texas, physicians may be partially protected from charges of

unprofessional conduct or failure to practice medicine in an acceptable manner, and thus
from disciplinary action, when they prescribe alternative medicine in a complementary
manner, if board specific practice requirements are satisfied and the therapies utilized do
not present "a safety risk for the patient that is unreasonably greater than the conventional
treatment for the patient's medical condition."[67]

Denmark

45.2 % of the Danish population aged 16 or above had in 2005 used alternative medicine
at some point in life. 22.5 % had used alternative medicine within the previous year. [68]

The most popular types of therapies within the previous year (2005) are:

 Massage, osteopathy or other manipulative techniques (13.2 percent)

 Reflexology (6.1 percent)
 Acupuncture (5.4 percent)

More results of statistical surveys on alternative medicine in Denmark is available on

ViFABs (Knowledge and Research Center for Alternative Medicines) home page
Use among medical students

68 % of the medical students in Denmark were in 2008 using or had used alternative
therapy. The most commonly used types of alternative medicine were:

 Herbal medicines and Dietary supplements (50 percent)

 Acupuncture (18 percent)
  Reflexology (18 percent).

Education

In the United States, increasing numbers of medical colleges have started offering
courses in alternative medicine. For example, in three separate research surveys that
surveyed 729 schools (125 medical schools offering an MD degree, 25 medical schools
offering a Doctor of Osteopathic medicine degree, and 585 schools offering a nursing
degree), 60% of the standard medical schools, 95% of osteopathic medical schools and
84.8% of the nursing schools teach some form of CAM. [70][71][72] The University of
Arizona College of Medicine offers a program in Integrative Medicine under the
leadership of Andrew Weil that trains physicians in various branches of alternative
medicine which "...neither rejects conventional medicine, nor embraces alternative
practices uncritically."[73] Accredited Naturopathic colleges and universities are also
increasing in number and popularity in Canada and the USA. (See Naturopathic medical
school in North America).

Similarly, "unconventional medicine courses are widely represented at European

universities. They cover a wide range of therapies. Many of them are used clinically.
Research work is underway at several faculties," but "only 40% of the responding
[European] universities were offering some form of CAM training."

In contrast to unconventional schools in Britain, no conventional medical schools offer

courses that teach the clinical practice of alternative medicine. The British Medical
Acupuncture Society offers medical acupuncture certificates to doctors, as does the
College of Naturopathic Medicine UK and Ireland.

Herbal medicine etc.

Due to the uncertain nature of various alternative therapies and the wide variety of claims
different practitioners make, alternative medicine has been a source of vigorous debate,
even over the definition of alternative medicine. Dietary supplements, their ingredients,
safety, and claims, are a continual source of controversy. In some cases, political issues,
mainstream medicine and alternative medicine all collide, such as in cases where
synthetic drugs are legal but the herbal sources of the same active chemical are banned.

In other cases, controversy over mainstream medicine causes questions about the nature
of a treatment, such as water fluoridation. Alternative medicine and mainstream medicine
debates can also spill over into freedom of religion discussions, such as the right to
decline lifesaving treatment for one's children because of religious beliefs. Government
regulators continue to attempt to find a regulatory balance.

Jurisdiction differs concerning which branches of alternative medicine are legal, which
are regulated, and which (if any) are provided by a government-controlled health service
or reimbursed by a private health medical insurance company. The United Nations
Committee on Economic, Social and Cultural Rights - article 34 (Specific legal
obligations) of the General Comment No. 14 (2000) on The right to the highest
attainable standard of health - states that

"Furthermore, obligations to respect include a State's obligation to refrain from

prohibiting or impeding traditional preventive care, healing practices and
medicines, from marketing unsafe drugs and from applying coercive medical
treatments, unless on an exceptional basis for the treatment of mental illness or
the prevention and control of communicable diseases."

A number of alternative medicine advocates disagree with the restrictions of government

agencies that approve medical treatments. In the United States, for example, critics say
that the Food and Drug Administration's criteria for experimental evaluation methods
impedes those seeking to bring useful and effective treatments and approaches to the
public, and that their contributions and discoveries are unfairly dismissed, overlooked or
suppressed. Alternative medicine providers recognize that health fraud occurs, and argue
that it should be dealt with appropriately when it does, but that these restrictions should
not extend to what they view as legitimate health care products.

In New Zealand alternative medicine products are classified as food products, so there
are no regulations or safety standards in place.

In Australia, the topic is termed as complementary medicine and the Therapeutic Goods
Administration has issued various guidances and standards. Australian regulatory
guidelines for complementary medicines (ARGCM) demands that the pesticides,
fumigants, toxic metals, microbial toxins, radionuclides and microbial contaminations
etc., present in herbal substances should be monitored, although the guidance does not
request for the evidences of these traits. However, for the herbal substances in
pharmacopoeial monographes, the detailed information should be supplied to relevant
authorities

The production of modern pharmaceuticals is strictly regulated to ensure that medicines

contain a standardized quantity of active ingredients and are free from contamination.
Alternative medicine products are not subject to the same governmental quality control
standards, and consistency between doses can vary. This leads to uncertainty in the
chemical content and biological activity of individual doses. This lack of oversight means
that alternative health products are vulnerable to adulteration and contamination. This
problem is magnified by international commerce, since different countries have different
types and degrees of regulation. This can make it difficult for consumers to properly
evaluate the risks and qualities of given products.

Denmark Herbal and dietary supplements is the designation of a range of products,

which have in common their status as medicine belonging under the Danish Medicines
Act.In the Danish Medicines Act there exist four types of herbal and dietary supplements:
Herbal medicinal products, Strong vitamin and mineral preparations, Trad Some dietary
itional botanical medicinal products and Homeopathic medicinal products. supplements
fall within a special category of products, which differ from the above in that they are not
authorized medicinal products. Dietary supplements are regulated under the Food Act and
are registered by the Danish Veterinary and Food Administration.

Alternative therapists

Criticism

The NCCAM budget has been criticized [97] because despite the duration and intensity of
studies, there have been exactly zero effective CAM treatments supported by scientific
evidence to date.[98] Despite this the National Center for Complementary and Alternative
Medicine budget has been on an exponential rise (with no apparent accountability to
taxpayers[citation needed]) to support complementary medicine. In fact the whole CAM field
has been called by critics the SCAM.

In a Huffington Post article on homeopathy in France a comment was made "Why is it

that when your car is broken you don't seek out an "alternative mechanic?" There really
is no such thing as alternative medicine--only medicine that has been proved to work and
medicine that has not." Dr. Arnold Relman, editor in chief emeritus of The New England
Journal of Medicine Speaking of government funding studies of integrating alternative
medicine techniques into the mainstream, Dr. Steven Novella, a neurologist at Yale
School of Medicine wrote that it "is used to lend an appearance of legitimacy to
treatments that are not legitimate." Dr. Marcia Angell, executive editor of The New
England Journal of Medicine says, "It's a new name for snake oil."

Alternative and evidence-based medicine

Testing of efficacy

Many alternative therapies have been tested with varying results. In 2003, a project
funded by the CDC identified 208 condition-treatment pairs, of which 58% had been
studied by at least one randomized controlled trial (RCT), and 23% had been assessed
with a meta-analysis.[101] According to a 2005 book by a US Institute of Medicine panel,
the number of RCTs focused on CAM has risen dramatically. The book cites Vickers
(1998), who found that many of the CAM-related RCTs are in the Cochrane register, but
19% of these trials were not in MEDLINE, and 84% were in conventional medical
journals.

Most alternative medical treatments are not patentable, which may lead to less research
funding from the private sector. Additionally, in most countries alternative treatments (in
contrast to pharmaceuticals) can be marketed without any proof of efficacy—also a
disincentive for manufacturers to fund scientific research. Some have proposed adopting
a prize system to reward medical research. However, public funding for research exists.
Increasing the funding for research on alternative medicine techniques is the purpose of
the US National Center for Complementary and Alternative Medicine. NCCAM and its
predecessor, the Office of Alternative Medicine, have spent more than $2.5 billion on
such research since 1992; this research has largely not demonstrated the efficacy of
alternative treatments.

Some skeptics of alternative practices say that a person may attribute symptomatic relief
to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or
the cyclical nature of an illness (the regression fallacy), or the possibility that the person
never originally had a true illness. In the same way as for conventional therapies, drugs,
and interventions, it can be difficult to test the efficacy of alternative medicine in clinical
trials. In instances where an established, effective, treatment for a condition is already
available, the Helsinki Declaration states that withholding such treatment is unethical in
most circumstances. Use of standard-of-care treatment in addition to an alternative
technique being tested may produce confounded or difficult-to-interpret results. Cancer
researcher Andrew J. Vickers has stated:

"Contrary to much popular and scientific writing, many alternative cancer

treatments have been investigated in good quality clinical trials, and they have
been shown to be ineffective. In this article, clinical trial data on a number of
alternative cancer cures including Livingston-Wheeler, Di Bella Multitherapy,
antineoplastons, vitamin C, hydrazine sulfate, Laetrile, and psychotherapy are
reviewed. The label "unproven" is inappropriate for such therapies; it is time to
assert that many alternative cancer therapies have been "disproven.""

Testing of safety

Interactions with conventional pharmaceuticals

Forms of alternative medicine that are biologically active can be dangerous even when
used in conjunction with conventional medicine. Examples include immuno-
augmentation therapy, shark cartilage, bioresonance therapy, oxygen and ozone therapies,
insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with
chemotherapy drugs, radiation therapy or anesthetics during surgery, among other
problems An anecdotal example of these dangers was reported by Associate Professor
Alastair MacLennan of Adelaide University, Australia regarding a patient who almost
bled to death on the operating table after neglecting to mention that she had been taking
"natural" potions to "build up her strength" before the operation, including a powerful
anticoagulant that nearly caused her death.

To ABC Online, MacLennan also gives another possible mechanism:

"And lastly there's the cynicism and disappointment and depression that some
patients get from going on from one alternative medicine to the next, and they
find after three months the placebo effect wears off, and they're disappointed and
they move on to the next one, and they're disappointed and disillusioned, and that
can create depression and make the eventual treatment of the patient with
anything effective difficult, because you may not get compliance, because they've
seen the failure so often in the past".
Potential side-effects

Conventional treatments are subjected to testing for undesired side-effects, whereas

alternative treatments generally are not subjected to such testing at all. Any treatment—
whether conventional or alternative — that has a biological or psychological effect on a
patient may also have potentially dangerous biological or psychological side-effects.
Attempts to refute this fact with regard to alternative treatments sometimes use the
appeal to nature fallacy, i.e. "that which is natural cannot be harmful".

An exception to the normal thinking regarding side-effects is Homeopathy. Since 1938

the U.S. Food and Drug Administration (FDA) has regulated homeopathic products in
"several significantly different ways from other drugs." Homeopathic preparations,
termed "remedies," are extremely dilute, often far beyond the point where a single
molecule of the original active (and possibly toxic) ingredient is likely to remain. They
are thus considered safe on that count, but "their products are exempt from good
manufacturing practice requirements related to expiration dating and from finished
product testing for identity and strength," and their alcohol concentration may be much
higher than allowed in conventional drugs.

Treatment delay

Those who have experienced or perceived success with one alternative therapy for a
minor ailment may be convinced of its efficacy and persuaded to extrapolate that success
to some other alternative therapy for a more serious, possibly life-threatening illness. For
this reason, critics argue that therapies that rely on the placebo effect to define success are
very dangerous. According to mental health journalist Scott Lilienfeld in 2002,
"unvalidated or scientifically unsupported mental health practices can lead individuals to
forgo effective treatments" and refers to this as "opportunity cost". Individuals who spend
large amounts of time and money on ineffective treatments may be left with precious
little of either, and may forfeit the opportunity to obtain treatments that could be more
helpful. In short, even innocuous treatments can indirectly produce negative outcomes.

Between 2001 and 2003, four children died in Australia because their parents chose
ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than
conventional therapies. In all, they found 17 instances in which children were
significantly harmed by a failure to use conventional medicine.

Unconventional cancer "cures"

Perhaps because many forms of cancer are difficult or impossible to cure, there have
always been many therapies offered outside of conventional cancer treatment centers and
based on theories not found in biomedicine. These alternative cancer cures have often
been described as "unproven," suggesting that appropriate clinical trials have not been
conducted and that the therapeutic value of the treatment is unknown. However, many
alternative cancer treatments have been investigated in good quality clinical trials, and
they have been shown to be ineffective.
A. Ayurveda is that knowledge of life, which deals elaborately and at length with

conditions beneficial or otherwise to the humanity, and, to factors conducive to the

happiness, or responsible for misery or sorrow besides indicating measures for

healthful living for full span of life. For more details,

B. Yoga is a science as well an art of healthy living physically, mentally, morally

and spiritually. It’s systematic growth from his animal level to the normalcy, from

there to the divinity, ultimately. It’s no way limited by race, age, sex, religion, cast

or creed and can be practiced by those who seek an education on better living and

those who want to have a more meaningful life. For more details,

C. Naturopathy or Nature Cure believes that all the diseases arise due to

accumulation of morbid matter in the body and if scope is given for its removal, it

provides cure or relief. For treatment it primarily stresses on correcting all the

factors involved and allowing the body to recover itself. The five main modalities of

treatment are air, water, heat, mud and space. For more details, click here

D. Homeopathy has been practiced in India for more than a century and a half. It has

blended so well into the roots and traditions of the country that it has been

recognised as one of the National Systems of Medicine and plays an important role

in providing health care to a large number of people. Its strength lies in its evident

effectiveness as it takes a holistic approach towards the sick individual through

promotion of inner balance at mental, emotional, spiritual and physical levels. For

more details,

E. Unani postulates that the body contains a self–preservative power, which strives

to restore any disturbance within the limits prescribed by the constitution or State of

the individual. The physician merely aims to help and develop rather than supersede

or impede the action of this power. For more details,

 F. Siddha is very similar to Ayurveda. In the Siddha system, chemistry had been

found well developed into a science auxiliary to medicine and alchemy. It was

found useful in the preparation of medicine as well as in transmutation of basic

metals into gold. The knowledge of plants and mineral were of very high order and

they were fully acquainted with almost all the branches of science. For more details,

G. Acupressure is the application of pressure or localized massage to specific sites on

the body to control symptoms such as pain or nausea. This therapy is also used to

stop bleeding. It is derived from traditional Chinese medicine, which is a form of

treatment for pain that involves pressure on particular points in the body knows as

“Acupressure points”. A practitioner puts pressure on specific points on the body

with his or her fingers in order to relieve pain and discomfort, prevent tension–

related ailments, and promote good health. This treatment is gaining popularity in

India and several private practitioners have a booming practice.

H. Acupuncture is an ancient Chinese form of medicine, which involves the insertion

of pins in certain vital points of the body. It is used for the treatment of chronic pain

conditions such as arthritis, bursitis, headache, athletic injuries, and posttraumatic

and post surgical pain. It is also used for treating chronic pain associated with

immune function dysfunction such as psoriasis (skin disorders), allergies, and

asthma. Some modern application of acupuncture is in the treatment of disorders

such as alcoholism, addiction, smoking, and eating disorders.

Modern methods of treatment – Telemedicine

Telemedicine generally refers to the use of communication and information technologies
for the delivery of clinical care. It may be as simple as two health professionals
discussing a case over the telephone, or as complex as using satellite technology and
video–conferencing equipment to conduct a real–time consultation between medical
specialists in two different countries.

The Department of Information Technology (DIT) had taken up the initiative for defining
the Standards for Telemedicine Systems in India, through the deliberations of the
committee on “Standardization of digital information to facilitate implementation of
Telemedicine system using IT enabled services” under the chairmanship of the Secretary,
DIT. Simultaneously, DIT undertook another initiative, in a project mode, for defining
“The framework of Information Technology Infrastructure for Health (ITIH) ” to
efficiently address information needs of different stakeholders in the healthcare sector.
The department has issue specific guidelines for practicing telemedicine in India.

Nursing as a Context for Alternative/Complementary Modalities

With increasing consumer and professional interest in alternative and complementary
care, Registered Nurses (RNs) are incorporating alternative/complementary modalities
into their practices. While these modalities give nurses additional tools to meet client
needs, many of these modalities are taught and used by non-nursing professionals leading
nurses to question if and under what circumstances these modalities are included in
nursing’s scope of practice. Exploration of the two major frameworks that define nursing
and articulate nursing’s worldview, Nursing Theory and Nursing’s Taxonomies of Care,
reveals that complementary/alternative modalities can easily be brought into a nursing
context. Further, professional nursing thought can provide direction to the practice of
complementary/alternative modalities by adding qualities of assessment, reflection, and
holism to the performance of the techniques. Examples are provided for incorporating
alternative/complementary practices into care that is clearly identified as professional
nursing.

Nursing as a Framework for Alternative/Complementary Modalities

With nationwide interest in complementary healthcare, nurses have actively incorporated

alternative/integrative modalities into their practice. Registered Nurses regularly attend
continuing educational sessions on techniques such as acupressure, guided imagery,
humor, massage, meditation, and therapeutic touch/healing touch. Review of continuing
educational offerings advertised in holistic nursing newsletters and websites indicates that
many nurses learn these techniques in sessions alongside other healthcare providers and
are taught by non-nurses. In such situations, nurses may raise questions related to their
legal scope of practice and the use of alternative/complementary modalities within
professional nursing. When these techniques are taught by and practiced by individuals
who are not nurses as well as by nurses, questions such as, "May a nurse practice guided
imagery as an RN?", "May a nurse perform simple massage or therapeutic massage?" and
"May a nurse practice therapeutic touch(TT) as a private, independent professional?"
become critically important and not easily answered. While the practice of nursing is
regulated by each state, ability to bring alternative/complementary modalities into a
nursing context assists in defining the practice as part of professional nursing. When
operating from a nursing perspective, nurses recognize that the ability to perform and use
these techniques can be greatly enhanced when they integrate these techniques into the
context of professional nursing. The purposes of this paper are to explore how a
professional nursing context provides a discipline-specific direction to the practice of
complementary/alternative modalities by adding qualities of assessment, reflection, and
holism to the performance of the techniques, and to provide examples for nurses to
incorporate alternative/complementary practices into care that is clearly identified as
professional nursing.

Alternative/Complementary Modalities

Alternative/Complementary modalities have been defined as treatment techniques whose

goals are to evoke healing, taking into account the body-mind-spirit connection of every
individual (Dossey, 1995). The use of the word ‘alternative’ became popular in the 1990s
when holistic medicine was considered a new or emerging field. Then, ‘alternative’
medicine meant practices and healing techniques that were not generally taught in
medical schools (Eisenberg, et.al., 1993), thus, alternative to the prevailing view.

The establishment and naming of the National Institutes of Health (NIH) Office of
Alternative Medicine in 1992 reflected this definition. Over time, however, it became
clear that such a definition was inadequate because many of the modalities were brought
into medical school curricula, were taught as legitimate methods of care, and were
incorporated in medical practice (Wetzel, Eisenberg, & Kaptchuk, 1998). Further, the use
of the word ‘alternative’ implied that certain techniques were used instead of
recommended, biomedical treatments. The word ‘complementary’ gained popularity in
the field conveying the idea that the modalities or techniques could be used to
complement and enhance the biomedical treatments. Thus, the branch of practice was
renamed ‘CAM’, complementary and alternative medicine, and when the NIH office was
elevated to a center, it was also renamed as the National Center for Complementary and
Alternative Medicine (NCCAM). According to the current NCCAM factsheet, CAM
refers to healing philosophies and approaches that Western medicine does not commonly
use, accept, study, understand, or make available (NCCAM,2001).

Many have implied that alternative care means holistic care, however, that notion has
been justly criticized on the grounds that holism is defined more by the context of the
care, than by the actual treatment techniques employed (Saks, 1997).

Nursing, however, is an holistic approach at its essence. Review of every nursing theory
in use today indicates that each of the theories define nursing by taking into account the
whole person (George, 1995). Likely, it is because nursing is an holistic discipline that
nurses have demonstrated great enthusiasm for the techniques and modalities associated
with the field of complementary and alternative care as these techniques assist nurses to
address the physical, mental, emotional, and spiritual dimensions of care. A study
conducted in 1996 of nurses who defined themselves as ‘holistic nurses’ (N=708)
revealed that a majority of them defined their practice in relation to
alternative/complementary modalities (Dossey, Frisch, Forker, & Lavin, 1998).
Modalities most frequently used by these study respondents were: acupressure,
aromatherapy, biofeedback, guided imagery, healing presence, humor, journaling, music
therapy, meditation, relaxation, and therapeutic touch/healing touch.
The Context for Professional Nursing

There are two ways of thinking about nursing that underpin professional nursing practice
and help nurses to understand and articulate a worldview. These are the nursing
theories/conceptual models for practice and the current nursing taxonomies. Each of these
approaches provide a unique and discipline-specific view of care, distinct from the care
of other health professionals. Thus, alternative/complementary modalities performed
from within a context of a nursing theory/model take on meaning from within the theory
as the modalities become part of purposeful action to achieve goals of care prescribed
from within the theoretical point of view. Modalities performed and documented
according to one of the standard taxonomies explicitly bring the modalities into the
domain of nursing and make the performance of the technique part of nursing activities
addressing a defined phenomena of concern. Each of these frameworks and their
relationship to alternative/complementary modalities will be addressed below.

Nursing Theories/Conceptual Models

Nursing theory is the foundation of professional nursing practice (George, 1995). Theory
articulates a worldview, suggesting how nurses interpret practice events and think about
care. Each theory addresses the concepts of nursing’s metaparadigm in a different way,
exploring the relationships between and among the concepts of person, health, nurse, and
environment. Theory-based practice is reflective practice – nursing is both providing care
and thinking about care to ensure it is consistent with stated values and principles.

Modalities incorporated into practice from within a framework of nursing theory are
given meaning from within the theory. Some of the modalities are compatible with the
principles and concepts of specific nursing theories. In other cases, the theories
themselves provide a mandate for a specific kind of nursing intervention. Nursing theory
provides the language, concepts and worldview to reflect on nursing care and on the use
of alternative/complementary modalities. Several examples from selected nursing
theories are discussed below.

The first example of use of alternative/complementary modalities and nursing theory will
be drawn from the Modeling and Role-Modeling Theory of Erickson, Tomlin and Swain
(1984). The concepts of "Modeling" and "Role-Modeling" are central to the theory.
Modeling is the process by which the nurse develops an image of the client’s world,
giving the nurse ability to understand the world from the client’s perspective, and Role-
Modeling occurs when the nurse plans interventions to role-model health behaviors
congruent with the client’s worldview (Frisch & Bowman, 1995; Erickson et al., 1998)
The theory is based on adaptation and through a specific assessment of adaptive potential,
the Adaptive Potential Assessment Model (APAM), the nurse is guided to assess the
client’s strengths, areas of positive adaptation, and state of arousal (Bowman, 1997;
Erickson & Swain, 1982). Professional nursing from within this framework requires that
the nurse build a model of the client’s world and from within that model the nurse must
role-model health behaviors to assist the client regain/attain health. Nursing care is
planned only after discussion and mutually agreed-upon goals of care.
The concept of ‘modeling’ guides the nurse to specific modalities. When a nurse models
the client’s world, the nurse attempts to enter into the client’s worldview. The nurse
observes the client, and adapts his/her own timing and pacing to that of the client. If the
client is in a state of excitement and breathing at a rapid rate, the nurse matches his/her
breathing and actions to that of the client’s. If the client is in a state of exhaustion, the
nurse sits, is slow in movements, and paces him/herself to match the client’s level of
energy. If the client expresses anxiety and a desire to feel more calm, the nurse models
the anxiety and, through conscious role-modeling, demonstrates for the client a means to
slow breathing rate, relax, and take control of the anxiety first at the physical level and
second at the cognitive, reflective level. The modalities of progressive relaxation,
imagery, guided imagery, and hypnosis are techniques that are used to carry out the
concepts of modeling and role-modeling. Thus, the techniques are used within the theory,
not simply as modalities to help a client relax. The techniques become methods to carry
out the basic principles of professional nursing practice. As integral to the theory, these
techniques permit the nurse to assess the client within a holistic perspective, relfect and
use the APAM model, plan care based on level of arousal according to the theory, and
evaluate outcomes according to level of arousal and ability to self-regulate these feelings.
The modalities, carried out by a professional nurse, have depth that is provided by a
theoretical worldview and permit a sophisticated level of assessment.

Secondly, Roy’s Theory of Adaptation will be explored. Central to this theory are the
concepts of focal, contextual and residual stimuli (Roy & Andrews, 1991). The focal
stimuli are the conditions immediately confronting the client, the contextual are all other
stimuli present, and the residual stimuli are those beliefs, attitudes and conditions that
have an indeterminate effect on the present condition. The nurse, operating from within
this framework, assesses the stimuli and takes action to promote the client’s adaptation in
physiologic needs, self-concept, role function, and relations of interdependence nursing
health and illness. Roy states that the "nurse acts as a regulatory force to modify stimuli
affecting adaptation"

Particularly with regard to contextual stimuli, there are several alternative/complementary

modalities that permit the nurse to alter the stimuli and change unhealthy or noxious
environmental stimuli to ones that are either neutral or wholesome.

Music therapy and aromatherapy are specific modalities that change the environment in
which the client finds him/herself and are expressly designed to change the context of
care from one that is deleterious to one that is supportive. These modalities can easily be
seen as nursing activities promoting positive adaptation. Music therapy is a systematic
application of music to produce relaxation and desired changes in emotions, behaviors,
and physiology (Guzzetta, 2000) and armoatherapy is the use of essential oils to offer
symptomatic relief or to enhance a sense of well being (Buckle, 1998; Stevenson, 1994).
Used from within Roy’s Adaptation Model of Nursing, these two modalities take place
within the nursing process and are interventions aimed at manipulating stimuli affecting
client health. Given the use of the theory, the assessment of the need for the modality
becomes part of reflective, holistic nursing care, and outcomes are interpreted from
within the framework of adaptation, stimuli, stress and a specific worldview.
Thirdly, there are several nursing theories that incorporate the concept of ‘human energy
field’ and ‘environmental energy field’, specifically Rogers’ Theory of Unitary Human
Beings, Newman’s Theory of Expanding Consciousness, and Parse’s Theory of Human
Becoming (Frisch, 2000). All energy-based modalities are congruent with these theories.
While Therapeutic Touch (TT) is a modality developed by and researched by nurses
(Keiger, 1979; Quinn, 1988; Straneva, 2000), other energy-based modalities such as
Reiki and Healing Touch techniques are widely used by and taught to non-nurses. The
theoretical frameworks for techniques involving human and environmental energy fields
are nursing theories and the philosophies of Eastern traditions (Slater, 2000). For nurses
engaged in energy-based techniques, bringing the techniques into a worldview of nursing
permits the nurse to assess and practice with the benefit of reflection on the meaning of
energy exchange and its effect on creating a reality for the nurse and client.

Lastly, in relation to Jean Watson’s theory of Humancare, nurses will recognize the most
important aspect of all nursing activities are those actions that promote professional,
compassionate, human to human interaction (Watson, 2000) . For the theory of
Humancare, the very basis of nursing is interaction and connection between two human
beings. The modality of healing presence is a significant, important technique to provide
trust, support and to initiate the caring encounter necessary for nursing to take place.
Healing presence is one of the modalities stated frequently by holistic nurses in the
survey of modalities used in nursing practice discussed above. Watson’s theory elevates
the importance of this nursing action to its rightful state in care – it is the pre-requisite for
any professional nursing activity. From within the worldview of the theory of
Humancare, a nurse will identify presence as a very necessary nursing action. Presence is
often described as ‘being in the moment’ (Dossey,1995), or ‘being with’ rather than
‘doing to’ (Paterson & Zderad, 1976). There are three levels of presence defined for
nursing practice: physical presence (being there), psychological presence (being with),
and therapeutic presence as the nurse’s reflectively relating to the client as whole being to
whole being using all of his or her resources – body, mind, emotion and spirit
(McGivergin & Daubenmire, 1994). It is the final level, that of therapeutic presence, that
fits best with the notion of Humancare. While many do not consciously think about
healing presence as a modality, it requires skills of centering, openness and intuition to
employ for the good of client care. The theory of Humancare reminds nurses that healing
presence is indeed a modality and one that has not received sufficient attention,
development and research as would be assumed, given how fundamental it is to the
discipline.

Through examples from four distinct nursing theoretical frameworks, several

complementary/alternative modalities have been discussed as appropriate to incorporate
into professional nursing. If one accepts the ideas that 1) professional nursing is based on
theory and 2) that theory-based practice is reflective practice, the use of the modalities
within theory becomes thoughtful and considered as a means to understand and interpret
a nurse’s actions. Nursing theory provides a means to understand modalities and permits
nurses to assess and incorporate new aspects of care into a larger, more holistic, and very
professional, worldview.
Nursing Taxonomies of Nursing Practice

Taxonomies of nursing practice are the classification systems that provide frameworks
for naming and documenting the phenomena of concern of professional nursing. The
most widely known and used of these taxonomies is the NANDA Classification of
Nursing Diagnoses (NANDA, 2001). Originally presented to the nursing community in
the 1970's the NANDA taxonomy is a statement of nursing problems and concerns. Over
the years many nurses have worked within this (and other nursing diagnostic systems, for
example the Omaha and Saba systems) to identify and name all phenomena of concern to
nursing. The current NANDA taxonomy lists over150 nursing diagnoses, organized
according to domains based on health patterns. Work presented at the last meeting of
NANDA indicated that the nursing diagnostic taxonomy will include statements of
problem, risk for problem, and opportunity or readiness to enhance a current condition
(Jones, et al., 2000). Thus, the current taxonomy of diagnoses presents a statement of
conditions (both problems and opportunities to promote/enhance wellness) that have been
identified by nurses as within the autonomous domain of nursing.

Newer taxonomies for nursing include the Nursing Interventions Classification (NIC) ,
now in its third edition (McCloskey & Bulechek, 2000) and the Nursing Outcomes
Classification (NOC), now in its second edition (Johnson, Maas, & Moorhead, 2000).
These taxonomies list nursing activities that have been identified by nurses as actions
they perform on behalf of patients/clients while providing direct and/or indirect care and
measurable, core outcomes that are sensitive to nursing interventions. Taken together, the
NANDA, NIC and NOC provide as comprehensive a list as is available of the concerns,
actions, and expected outcomes of nursing practice. These lists are remarkably useful for
nurses using complementary/alternative modalities in practice.

Complementary modalities may be used by nurses and non-nurses alike; however, when
used as part of nursing practice, the care should be documented in a nursing context.

While some modalities require additional certification and/or licensure in some states,
(for example, massage therapy), most of the modalities used by nurses require a nursing
license and documentation that makes clear that the care provided is within the scope of
professional nursing practice. When a complementary/alternative modality is used to
address a concern identified as a nursing diagnosis, the action becomes an identified
nursing intervention planned to address/remedy a nursing problem or concern. For
example, when music therapy is provided to assist individuals obtain adequate sleep, the
NANDA diagnosis of disturbed sleep pattern is the identified nursing problem and the
intervention ‘music therapy as provided through tape recorded music at times of
wakefulness’ is a nursing intervention identified by the nursing community as within the
domain of professional nurses. Likewise, when the nursing problem is fear related to
undergoing medical diagnostic procedures (such as an MRI), and the nursing intervention
is ‘guided imagery to assist the client with relaxation and distraction during the
procedure’, the problem, intervention and outcome can be documented from within the
taxonomic frameworks as nursing. To provide an example of a wellness-oriented nursing
concern, when the nursing concern is readiness to enhance spiritual well-being related to
a time in life when a client is examining his personal beliefs, values, and sense of future,
the nursing intervention ‘meditation facilitation to focus awareness on an image or
thought and to find a place of inner peace’is being used to address an identified nursing
concern. A last example is the use of the intervention Therapeutic Touch (TT) as a
technique to assist the client experiencing impaired comfort related to severe itching. The
technique is being used to provide a non-pharmacologic treatment of condition affecting
the client’s comfort and well-being. In each of these cases, the nursing activity is a
complementary/alternative modality (music therapy, guided imagery, meditation, TT).
Practice within the nursing context emphasizes that the modality is being used to address
the human response to actual/potential health problems. Table 1 provides a summary of
selected nursing diagnoses and interventions to indicate possible pairings of nursing
concerns and actions.

Table 1: Selected Nursing Diagnoses and Nursing Interventions: Possible Pairings of

Nursing Concerns and Complementary/Alternative Interventions
Nursing
Nursing Intervention(s) Rationale
Diagnosis/concern
Impaired Comfort Acupressure, TT to decrease perceived pain
Disturbed Sleep
Massage to promote relaxation, rest
Pattern
Social Isolation Animal-Assisted Therapy to provide affection
Impaired Coping Humor to facilitate appreciation of that
which is funny, to relieve
tensions
Hopelessness Hope instillation to promote a positive sense of the
future
to facilitate a sense of inner
Spiritual Distress Spiritual support
peace
Spiritual Well-Being Spiritual growth facilitation to support growth/reflection
reexamination of values
Anxiety or Fear Guided imagery, relaxation to reduce sense of anxiety
therapy, biofeedback, calming
techniques
Impaired
Art therapy to facilitate expression
Communication

When documented from a nursing framework, the nurse is making it clear that the
modality is being used to address an issue that has been accepted by the nursing
community as within the domain of nursing and within the phenomena of concern to
professional nurses. Nurses documenting practice using these systems are accomplishing
three important things: appropriate documentation of care, identification of work as
within the scope of professional nursing, and building a body of knowledge for nurses on
the use of specific interventions.
The taxonomies provide both a framework that helps nurses think in a holistic manner
about what they are doing as nurses and increased justification for having a nurse perform
the activities. The taxonomies themselves are atheoretical, meaning that they are not
grounded in any of the nursing theories, they are simply a list of diagnoses, interventions
and outcomes. These diagnoses, interventions and outcomes, however, can be used with
nursing theory to guide the reflective interpretation of client conditions and selection of
appropriate nursing interventions. Within the framework of nursing taxonomies, the
alternative/complementary modalities become part of the nursing process – the
documentation of nursing assessments, concerns, interventions and outcomes.

Discussion

Alternative/complementary modalities are techniques used in healthcare practice to help

clients achieve specific outcomes.

Techniques, however, are just techniques, and can be used at the level of "doing things"
without the reflection, thought, or interpersonal exchange required of and expected from
professional nursing. Nurses are in an excellent position to adopt
complementary/alternative modalities into practice that addresses assessed client needs
and to use these techniques to achieve the goals of nursing. Use of theory and nursing
classification systems help nurses use these complementary/alternative modalities
professionally. Documentation of these techniques through either nursing theory or
current nursing taxonomies makes the practice explicitly that of professional nursing.
Care directed by nursing theory and/or care according to a standard nursing taxonomy is
care that is generally regarded by the profession as within the domain of nursing. Thus,
documentation of care from a nursing framework provides for practice which is
recognizable as nursing, and legally defensible as within nursing’s scope of practice.
Addtionally, using modalities within nursing practice gives nurses an enhanced set of
tools for practice – making the practice professional, whole and client-centered

Complementary Therapies in Nursing Practice

PETER, a Registered Nurse, had recently joined the staff of a Christian Nursing Home.
His caring manner and cheerful attitude had already made him popular with the residents.
One day the Director of Nursing happened to walk into a room where Peter was attending
to a resident and found him lighting some incense sticks which were in a jar on the
locker. At the same time she noticed a crystal hanging from the light above the bed. Later
as she spoke with Peter about this, she discovered he was keen to incorporate a number of
alternative therapies into his nursing care. Many of these proposed interventions and the
philosophies behind them, were incompatible with the Christian ethos of the Nursing
Home and the beliefs of the majority of staff and residents.
AN APPEALING OPTION...

Peter is just one of a growing number of nurses who are eager to incorporporate
alternative therapies and techniques into their nursing practice. Wide exposure through
magazines, books and television programs, has resulted in a growing acceptance by lay
people and health professionals, of what was once considered to be fringe medicine.
There is no doubt that alternative medicine with its focus on prevention, wholeness and
healing for the total person, is steadily gaining in popular appeal within our society.

While alternative therapies are being integrated into orthodox medicine by a growing
number of registered Medical Practitioners, many in the nursing profession have begun to
practise what they now term 'complementary therapies'. These therapies have
considerable appeal to nurses, because they fit in well with prevailing nursing philosophy
and offer an extra dimension of care. After all, nursing has long recognised that a person
is more than just a body, and therefore good nursing practice needs to take into account
all dimensions of our being - physical, psycho-social and spiritual. The holistic approach
to health and healing is not new, but has in fact been the traditional focus of nursing.

BUT JUST A MOMENT...

Attractive as complementary therapies might appear, it is appropriate to ask some

searching questions before hastening to integrate them into our nursing practice or
attempting to influence others to do so. We need first to objectively evaluate
complementary therapies as a nursing intervention. Some questions we need to ask...

Are there sound reasons for believing that some or all are beneficial for health and
wholeness? What are their underlying principles and philosophies? What are the
intentions of those who promote and practice them?

A POSITIVE APPROACH...

We all look forward to a time when as much emphasis is given to the healing process as
to the disease process. It would be naive to consider that our current technologies, wonder
drugs, and collective store of (Western) medical wisdom holds all the answers for our
health needs and well being. Some complementary therapies may prove to be a valuable
means to stimulate and support the healing response. We cannot afford to "throw out the
baby with the bath water" as the old saying goes. but should rather approach new
therapies (and for some societies they will be ancient ones ) positively and objectively. In
the discussion paper, "Complementary Therapies in Relation to Nursing Practice in
Australia" circulated by the Royal College of Nursing Australia in 1996, it was
encouraging to note that the authors' first recommendation was, "that the act of nursing
itself be identified as therapeutic in recognition of the need to document in everyday
nursing care plans the importance of the human presence in nursing care."
SOME SERIOUS CONCERNS...

However the RCNA discussion paper made little attempt to evaluate complementary
therapies as a nursing intervention, or more importantly, their underlying philosophies.
Many alternative therapies have ancient origins, and share a common philosophy based
on the concept of ENERGY - said to be a controlling force which governs the whole
body and enables the body systems to operate. This energy is said to flow through
invisible channels called meridians and is known by many names. The ancient Chinese
called it Ch'i, or Q'i. Hindus call it prana. It is believed that ill health occurs when this
energy is interrupted or becomes unbalanced. Therapies which work on the premise of
energy or life force. include, reflexology, acupuncture, acupressure, therapeutic touch,
meridian massage, chiropractic and homeopathy

Not all practitioners of these therapies subscribe to the universal energy philosophy, but
may simply assert that here is a therapy which works, even though science may not yet be
able to explain how it works. Nonetheless in many cases this idea is either central and
overt, or hidden beneath the surface in the theory which underlies the practice. Indeed the
authors of the RCNA discussion paper stated, "the notion of people open to and
continuous with, the environment in a dynamic interchange, by virtue of the human
energy field, is central to understanding holistic nursing and nursing interventions that
operate on the assumption that interactions within and between all living systems are
fundamental energy exchanges."

In the light of this, the questions posed earlier become most necessary. For me it raises at
least three areas of concern

1) Nursing ethics require a respect for the beliefs of our patients/clients, requiring that
there be no undue intrusion of the nurse's own religious or philosophical beliefs. This
value would surely be violated by therapies practiced with an underlying religious
meaning to which the patient/client may not subscribe.

2) The energy field theory is a speculative assumption which has not yet been
scientifically validated, despite a considerable amount of research. The authors of the
discussion paper appear to subscribe to the view that scientific proof is of no great
importance in regard to complementary therapies. Yet the credibility of the nursing
profession and its standing in the health field will not be served well by rushing to adopt
such (as yet) unfounded theory. The uncritical adoption of any theory or practice, is
surely not in the best interests of the profession or indeed the people we serve - our
patients and clients.

3) Biblical truth and principle is at odds with the Eastern mysticism, philosophies and
religious beliefs which underlie some popular therapies. One notable example,
"Therapuetic Touch",1 is becoming increasingly popular in Australia and is now taught
in some nursing courses.
Therapuetic Touch' is a practice which has become a concern to Christian nurses
worldwide as it is based on an ancient mystical belief system called TAOISM which
focuses on the metaphysical. The healer is presumed to be a channel of universal energy,
which flows through the body of the patient. The general consensus is that the healing
method and the religious message are inseparable. Last year a proponent of Therapuetic
Touch was invited by a Christian education group to conduct a course in Australia. Yet it
is hard to see how this therapy with its underlying principles and philosophy, can be
equated with Christian healing. While some practitioners may attempt to equate the
'energy' said to be involved, with the Holy Spirit, it is worth noting that the Bible teaches
that "The relationship between believers and the Spirit of Christ is personal and moral.
The Holy Spirit is not an impersonal energy to be directed and modulated by us." (A.
Miller 1987)

A NEED FOR DISCERNMENT...

The authors of the RCNA discussion paper give every indication of enthusiasm for the
incorporation of complementary therapies in nursing practice. New Age philosophies and
ideas are supported, and in many of the arguments put forward, there is a correlation
between the 'energy field' models of nursing and complementary therapies. This is a
serious concern. However, as many alternative therapies can be neutral, there is need to
somehow discriminate between the theory or philosophy adopted to explain them, and the
benefits which could be derived. As we look more closely into the various therapies we
soon discover that there is a great deal of variation in the nature, value and scientific basis
for individual therapies. There is also a great deal of difference in the meaning placed on
the therapies by those who practice them.

At a time of change and growth for nursing, it is important that we should be open to new
ways, and even new roles, in order that we may improve and enhance the care we
provide. Yet it is necessary that we subject all new trends, practices or theories, to a
careful analysis and evaluation. In the case of complementary therapies, we would be
remiss if we do not sound a note of warning amidst the enthusiasm and eagerness to
introduce this new dimension into nursing practice. Nurses are looking for new ways to
make them more independent, and so practices which enable this, will be readily adopted.
By looking at both sides of the question and encouraging more critical analysis, nursing
Bodies such as the RCNA can help to ensure that nurses will not enter hastily into major
new spheres of practice, without careful consideration of the relevant social, ethical and
practice issues. Christian nurses also need to have a voice in the profession on this issue.
That will mean evaluating and responding to new trends and practices in the light of
Christian values and principles, and being prepared to respond appropriately within our
sphere of influence.

Place of Complementary Therapies in Nursing

As noted earlier, Nightingale suggested the use of complementary therapies in the care of
patients. Early fundamental nursing texts include therapies such as back rubs (a form of
massage), heat and cold, and nutrition. Thus, complementary therapies have a long
history in nursing. However, as nurses began to be employed primarily in hospitals that
largely supported the Western biomedical approach to care, more of the nurses’ time was
allocated to collaborative activities associated with the medical plan of care including the
monitoring of the patient’s status. Time demands provided nurses with less opportunity to
administer those aspects of nursing that included complementary therapies.

In the late 1950s, the nursing process was introduced. This four part problem-solving
approach to nursing included assessing, planning, intervening, and evaluating. Eventually
a fifth element, diagnosis, was added. In addition to the honing of assessment skills, the
process also drew attention to interventions. Distinction was often made between
dependent or collaborative actions and independent actions or interventions. The latter
was often relegated to more advanced courses. As graduate education of nurses for
clinical practice increased, interest in and use of independent nursing interventions grew.
Complementary therapies provide opportunities for nurses to function autonomously.

Within nursing, the term intervention has often included therapies that are now classified
as complementary therapies. A number of the interventions included in the first two texts
on independent nursing interventions (Independent Nursing Interventions [Snyder, 1985 ]
& Nursing Interventions: Treatments for Nursing Diagnoses [Bulechek & McCloskey,
1985 ]) included complementary therapies such as music, imagery, progressive muscle
relaxation, journaling, reminiscence, and massage. The subsequent development of the
identification and classification of nursing interventions in the International Council of
Nurses Project (ICNP) and the National Intervention Classification Project (NIC) has
broadened the scope of the term intervention to encompass all nursing activities
(International Council of Nurses, 1997; McCloskey & Bulechek, 1996 ). Thus, the term
intervention as it is conceptualized in nursing does not distinguish complementary
therapies from other activities nurses perform such as monitoring the status of a patient or
coordinating care. To distinguish complementary therapies from the broader domain of
interventions, the authors titled their third edition on independent nursing interventions,
Complementary/Alternative Therapies in Nursing (Snyder & Lindquist, 1998).

Nurses have and do use numerous complementary therapies to help patients achieve
positive health outcomes. Table 2 lists complementary therapies commonly used by
nurses. A subsequent article in this journal discusses the educational preparation of
nurses to administer complementary therapies and which therapies should be included in
the various curricula. Many nurses have pursued courses to prepare them to administer
other therapies such as acupuncture, hypnosis, spiritual direction, and Reiki.

Are there any complementary therapies that are not within the purview of nursing?

These authors believe that competence in performing a therapy and its use to achieve an
outcome that is within the scope of nursing are the guiding principles to use to determine
if a therapy can be administered by a nurse. The Royal College of Nurses (RCN) has
formulated 11 beliefs to guide the use of complementary therapies (Buckle, 1997 ). One
of the beliefs is that the nurse works in partnership with the patient to determine the
suitability of a therapy. Another belief notes that, where possible, therapies that have a
research base should be selected. What is paramount, according to the RCN, is that the
nurse must have the necessary preparation to administer the therapy and that she/he
follows the established practice protocols and standards of care and practices within the
local legal requirements.

In recent years, exposure to other cultures has increased the scope of therapies classified
as being complementary therapies. It is incumbent on nurses to increase their knowledge
about various complementary therapies. This does not necessitate a nurse becoming
prepared to administer a multitude of therapies but rather to have a broad knowledge so
as to understand therapies patients may be using or considering to use. It is also important
that health histories obtain information about a patient’s use of complementary therapies.
Patients are sometimes reluctant to convey this information as they may feel that the
health professional is not accepting of these practices. Obtaining this information requires
an openness on the part of the nurse, and it may require the nurse to re-state the question
or use probes. Seeking this information is important as interactions between some herbal
preparations and prescribed medications and the impact that other complementary
therapies may have on a biomedical treatment requires that health professionals be aware
of all therapies a patient is using so that the plan of care is coordinated and safe.

The increasing public interest in complementary therapies provides an opportunity for

nursing to share with the public and colleagues in other disciplines how these therapies
have been a part of nursing for centuries. Also, nursing needs to convey that a holistic,
caring philosophy has been and is an integral part of nursing. Additionally, nurses have
conducted a considerable amount of research on complementary therapies such as
imagery, music, therapeutic touch, massage, humor, reminiscence, animal-assisted
therapy, and prayer. With the knowledge gained from these studies nurses are in a prime
position to take the lead on interdisciplinary complementary therapy research teams.

Use of complementary therapies is a part of nursing’s heritage. Administration of

complementary therapies provides an opportunity for nurses to act autonomously in the
delivery of care. Also, inclusion of complementary therapies in the plan of care allows
nurses to demonstrate caring in a holistic fashion, which is a key characteristic of nursing.

Conclusion –

The increasing public interest in complementary therapies provides an opportunity for

nursing to share with the public and colleagues in other disciplines how these therapies
have been a part of nursing for centuries. Also, nursing needs to convey that a holistic,
caring philosophy has been and is an integral part of nursing. Additionally, nurses have
conducted a considerable amount of research on complementary therapies such as
imagery, music, therapeutic touch, massage, humor, reminiscence, animal-assisted
therapy, and prayer. With the knowledge gained from these studies nurses are in a prime
position to take the lead on interdisciplinary complementary therapy research teams.
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AYUSH System
AYUSH: An Overview 03
Market Size and Growth Drivers 04
Evolution of AYUSH 05
Emerging Opportunities 06
Government Initiatives 07
Challenges Faced 09