December 2006 / January 2007

ALTERNATIVE NURSING PRACTICE Creating Inroads for Integrative Healthcare
—Toni Gilbert

With increasing client and professional interest in alternative and complementary care, registered nurses are incorporating alternative and complementary modalities into their practices outside the traditional health care setting. Alternative nursing is defined using nursing theory and models of assessment, reflection, and holism. Nursing and the concept of holism provide a framework for the practice of complementary/alternative modalities inside and outside the institutional setting. Further, charting of nursing diagnosis and nursing interventions with alternative/complementary therapies demonstrate how they are incorporated into the nursing process. Examples provided are a partial list of certification resources that are advantageous in a professional alternative nursing practice.

Reviews of holistic nursing websites support the premise that registered nurses are incorporating complementary and alternative medicine (CAM) into their practices outside of traditional nursing occupations (http://www.naturalhealers. com). While some institutions have the monetary capital to encourage nurses to integrate CAM practices into their workplace, most do not. For many administrators it is a simple equation: If insurance covers the cost of complementary and alternative modalities, the scientifically researchable ones are integrated; if insurance doesn’t pay for them, they are not incorporated.

Scores of individuals pursue careers in nursing because they yearn to work in a compassionate manner, but traditional nursing positions are often perceived as stressful and the environments uncaring. In some workplaces, the nurses’ quality-ofliving perspectives are often overlooked or not considered important.

Many studies have addressed the dissatisfaction that nurses find in their jobs, and some quit their mainstream nursing positions so that they can work in an environment that is more satisfying. These departing nurses will tell you that they want to find an outlet to more fully express their innate talents. They may even seek an education outside the nursing profession in a related caring field such as psychology or theology. They seek situations that match their value systems, and that harmonize with their holistic beliefs. They want the freedom to practice caring in a way that seems more natural to them.

Large numbers of nurses are attracted to CAM modalities, but they must be creative when integrating their healing techniques into their practices outside of the mainstream workplace. The typical alternative nursing practices include such modalities as aromatherapy, herbal medicine, energy work, meditation, guided imagery, medical massage and craniosacral therapy to name just a few. (http://www.ahna.org). Nurses with alternative practices can be found in business and homebased offices as well as in beauty and health settings such as spas, cruise ships, and wellness centers.

Go to www.wellness-institute.org

ALTERNATIVE NURSING PRACTICE DEFINED
According the fact sheet at the National Center for Complementary and Alternative Medicine (NCCAM), complementary and alternative medicine (CAM) refers to philosophies and approaches that Western medicine does not ordinarily accept, use, study, understand, or make available. Complementary medicine or practices are used together with conventional medicine.

Alternative medicine or practices are those that are used in place of traditional methods http://www.nccam.nih,gov/health/watiscam/).

Alternative nursing uses the science of traditional nursing education and nursing theory as a framework for complementary and alternative healing modalities in alternative nursing practices. Alternative nurses build upon the traditional practice of nursing by adding healing modalities that are currently outside mainstream healthcare. Staying within state guidelines, nurses practice esoteric skills and document this care within the nurses’ scope of practice. This moves their practice outside of and in place of traditional nursing care.

REGULATION OF PRACTICE
The practice of nursing is regulated by each state and the ability of nurses to bring alternative and complementary modalities into a nursing framework depends upon how each state defines CAM and integrates it into the profession. Nurses wanting to work outside the current traditional healthcare system while maintaining a nursing license must contact their state’s board of nursing and ask for a contact person who can help with the legalities of setting up an alternative nursing practice (Amdall Thompson).

Complementary and alternative interventions advantageous in alternative nursing practice. CECs from accredited nursing organizations. Polarity Healthcare Seminars Polarity therapy, kinesiology, chakras, craniosacral Randall Gibson, M.Ed, CMT (330)-836-5060 www.polarityhealthcare.com Beyond Ordinary Nursing Susan Ezra, RN, HNC Terry Reed, RN, MS, HNC Guided imagery (650) 570-6157 www.integrativeimagery.com Healing Touch Certifi cation Program Energy therapy (303)-989-7982 www.healingtouch.net Archetypal Tarot Counseling Toni Gilbert, RN, MA, HNC Tarot counseling, dream interpretation (541) 327-7749 www.altjn.com/events/atc.htm Aromatherapy for Health Professionals R. J. Buckle Associates (215) 546-3122 www.rjbuckle.com Astrology for Nurses Samten Williams, RN, BSN (513) 561-0757 www.samtenwilliams.com The Institute for Meditation and Psychotherapy (978) 526-4095 www.meditationandpsychotherapy.org Wild Iris Medical Education Herbal Medicine Alan Clark, MD (707) 937-0518 www.nursingceu.com

NURSING THEORY IN PRACTICE
In her article Nursing as a Context for Alternative/ Complementary Modalities, Noreen Cavan Frisch, Ph.D., explains how nursing theories that form conceptual models for practice, and taxonomies such as nursing diagnoses, provide a unique and discipline specific view of professional care. Theories help to articulate new worldviews, and they suggest how nurses think about care. Each theory addresses concepts of the nursing paradigm in different ways. For instance, Dr. Callista Roy’s theories ask the nurse to explore the relationships between the client, the health of the client, and their significant others, and the environment where healing takes place (Roy). Such theories ensure that the nursing practice is consistent with recognized nursing principles and values.

Nursing theory provides the concepts, language, and worldview to conceptualize nursing care and, at the same time, a framework that tells how, why, and when to use alternative and complementary modalities. As CAM modalities are documented according to theory and with the standard taxonomies, they are then acknowledged in peer-reviewed journals, and the modalities are slowly brought into the domain of nursing activities. For instance, Margaret Neuman’s theory of pattern recognition gives the nurse a conceptual framework for applying modalities that are based on recognizing patterns of archetypal expression in such insight-producing therapies as astrology, Tarot counseling, guided imagery, and dream interpretation. Neuman’s theory explains how client insights lead to an expanded awareness that is a necessary component of growth and development (Neuman). This fits nicely with what health psychology researchers such as Jeanne Achterberg and others have told us for over thirty years—that careful attention to the development of the mind and spirit are what is needed for optimal psychological and physical healing to occur (Achterberg).

Go to www.altjn.com

Alternative and complementary modalities that are incorporated into an alternative nursing practice that is consistent with nursing theory are given significance by those theories. For instance, Martha Roger’s theoretical contribution brings reflection upon human and environmental energy fields and guides the practice so that the nurse can incorporate concepts of energy exchange such as Reiki and Therapeutic Touch for the benefit of client healing (Neuman). Jean Watson’s philosophy and theory of human caring opens the door for deep relating in an authentic relationship and facilitates nursing’s expansion into the spiritual aspects of the person being cared for. In part, Watson’s theory makes ministerial duties an accepted part of the nursing domain (Barrett). Just as nursing theory is used to thoughtfully understand and interpret a nurse’s action, the actions need proper documentation in order to incorporate them into a professional context.

Table 1. Selected Nursing Diagnoses with Possible Complementary and Alternative Interventions

Nursing Diagnosis	Nursing Intervention	Rationale
Post Trauma Syndrome	guided imagery, hypnosis	to decrease anxiety
Readiness for Enhanced Knowledge	spiritual support, astrology, art therapy	to facilitate enhanced self-esteem
Hopelessness	spiritual support, tarot counseling, guided imagery	to increase belief in transcendent values
Readiness for Enhanced Self-Concept	meditation, dreamwork	to increase actions that are congruent with expressed thoughts and feelings
Energy Field Disturbance	energy work such as Therapeutic Touch,Reiki	to facilitate postoperative healing

DOCUMENTATION IN AN ALTERNATIVE PRACTICE Documentation of nursing care using CAM modalities makes it clear that the care provided is practiced within the scope of the nursing profession. Using taxonomies such as NANDA Classification of Nursing Diagnoses makes a statement of client problems and nursing concerns as well as opportunities to promote wellness. As nurses use the classification system, they are accomplishing three important things: identification of work as within the scope of professional nursing, appropriate documentation of care, and adding to a body of knowledge for nurses to use about specific interventions (Cavan Frisch). Table 1 is an example of how nursing diagnoses (together with nursing theory) guide the interpretation of the client’s situation and the selection of appropriate nursing care.

The documents of nurses who use CAM chart the traditional assessment phase that begins with first contact with the client. Nurses cordially greet the client, while conducting a visual scan for clues about health and hygiene. They tune into intuitive sensations at the moment of the first encounter, and continue to seek further evidence for support. During the initial interview the nurse gains a perspective on the philosophy or religion the family values are based upon. This forms the foundation for the nurse to gain an understanding of client’s world, from their point of view, as the nurse listens to their biographical stories. The nurse furthers her understanding by paying attention to the client’s emotional state and asking about that person’s experiences and beliefs about health.

Eventually, the nurse and the client plan interventions that fit a client’s perceived needs. The nurse plans holistically, considering the individual’s values when creating treatments that treat the whole person. They discuss things such as diet and exercise changes, visualization, and various religious and nonreligious rituals such as prayer and meditation. The care given is documented in a nursing context using nursing diagnosis, goal-directed actions, and measurable outcomes.

OBSERVATIONS OF LAY ALTERNATIVE PRACTITIONERS
Generally speaking, unlicensed alternative practitioners in the healing arts are intelligent and gifted. The masters among them are usually self-taught and have focused upon their subject and perfected their craft. Some among the alternative community have much to offer the nursing profession and should be given consideration when offering health professionals continuing education.

But, just as with professional practitioners, lay people may not reach their full potential as healers until they have been practicing their healing techniques for 10 to 20 years. However, careful attention should be used when consulting a lay practitioner. A good rule of thumb might be to consider the lay person an apprentice if they have less than ten years experience in the techniques that they offer. If they have less than three years experience, they should not be taken as seriously, for they may be at an idealistic stage, or they may be someone who is looking to cash in on the healthcare market.

Further, when working with the lay alternative practitioner, keep in mind that they are not required to employ the same professional guidelines that the licensed nurse must follow. The lay person’s customs, conduct, and knowledge may not be the same as that of the trained licensed nurse.

INTEGRATION WITHIN THE NURSING PROFESSION
Nursing theorists have made a difference in the way that the profession is perceived, experienced, and practiced, but because the nursing field has been slow to change, some nurses have sought higher education degrees outside of the nursing profession. In part, this has enhanced the growth of the ever-expanding role of the professional nurse. Pioneering alternative nurses explore esoteric therapeutic modalities and then introduce them to nursing in language that can be understood. Modalities such as astrology and Tarot then become integrated with traditional ones to become a part of the new holistic paradigm of complementary and alternative care.

Although we have a long way to go before we place a fully integrated holistic profession within the walls of our institutional workplaces, traditional practice and alternative practice nurses can be proud of what they are accomplishing within the hallowed halls of the nursing profession.

TONI GILBERT, RN, MA, HNC is Editor of the Alternative Journal of Nursing. toni@tonigilbert.com

REFERENCES Achterberg J (1985) Imagery in Healing: Shamanism and Modern Medicine. Boston: Shambhala. pp. 113–161. American Holistic Nurses Association (2005) Practitioner Directory. http://www.ahna.org Amdall-Thompson M (2003) Considering Private Practice as a Holistic Nurse? What you Need to Know. Alternative Journal of Nursing April 2003. http://www.altjn.com/archives/1.asp Barrett E (2000) The Theoretical Matrix for a Rogerian Nursing Practice. New York: Hunter College. http://medweb.uwcm.ac.uk/martha/ Cavan Frisch N (2001) Nursing as a Context for Alternative/Complementary Modalities. Online Journal of Issues in Nursing. http://www.nursingworld.org/ojin/topic15/tpc15_2.htm Holistic Nursing Schools and Careers (2005) http://www.naturalhealers.com National Institutes of Health (2005) http://nccam.nih.gov/health/whatiscam/ Neuman M (1999) Health as Expanding Consciousness. Second edition. New York: to Excel. Roy C (1999) The Roy Adaptation Model. Boston College William F. Connell School of Nursing. http://www2.bc.edu/%7Eroyca/ Watson J (2005) Theory Evolution. University of Colorado Denver and Health Sciences Center School of Nursing http://www2.uchsc.edu/son/caring/content/evolution.asp

2nd Cover Story:

THE NEUROSCIENCE OF THE SOUL . . . David Ryback