Though attitudes about, research about, and clinical opinions regarding complementary and alternative medicine (CAM) – also known as integrative medicine – represent a mixed bag of reactions and information, the fact remains that patients often desire to utilize CAM practices or medicines. Some researchers identify four distinct types of CAM: “ a) natural products, b) mind-body medicine, (c) manipulative and body-based practices, and (d) other CAM therapies” (Pinzón-Pérez, Palacio, & Fajardo, 2012, p. 163). Some patients desire such options for cultural reasons; traditional Eastern medical practices, as opposed to traditional Western medical practices, frequently include the use of alternative methods such as acupressure and acupuncture and the use of herbs and herbal supplements. Such methods have made their way into Western medicine, with traditional Western physicians instructing patients to supplement their health regimens with herbal supplements and visits to acupuncturists. The purpose of this literature review is to focus on CAM in the context of nurse practitioner (NP) practice in the clinical setting and demonstrate the propriety of allowing NPs to employ CAM.
The idea of incorporating CAM into NP practice is not unfounded. At its core, NP practice is connected to nursing practice, so much like nursing practice NP practice should be a “remarkably flexible, responsive, crucial, and enduring health resource” (Salmon, 2010, p. 18). Furthermore, NP practice is always evolving and must be responsive to societal factors (Salmon, 2010); societal factors may also include cultural and economic factors. The flexibility that is so critical to the healthcare profession gives the profession a means for adapting to the changing needs of patients and the integration of technology as well as the changing face of healthcare itself. Moreover, the notion of integrative healthcare also contains the idea of holistic healthcare which in turn necessitates that healthcare practitioners like NPs consider how to support the entire well-being of an individual. Consequently, healthcare practitioners must and do “learn, practice, and collaborate in service” to the patient, their loved ones, and the larger community “in ways that are grounded in sciences and arts and extend across boundaries and conventions” (Salmon, 2010, p. 19). This expectation that NPs will respond to both patients and the larger communities of which they are a part and in ways that incorporate both sciences and arts serves as a clear invitation to consider and incorporate CAM. Consequently, this means that the future of nursing and nursing education must continue to adapt and pioneer “elements of the practices and traditions from other disciplines and cultures,” a phenomenon which has occurred for many decades and which will continue to occur (Salmon, 2010, p. 19). In fact, the literature has in the past and continues to reflect “a strong orientation toward integrative health” (Salmon, 2010, p. 19), indicating that as far as the profession itself is concerned, the use and integration of CAM into clinical practice is not just a great idea. It is, in fact, necessary to provide quality care that is both responsive and flexible.
The endorsement of CAM in clinical nursing practice is not limited to the nursing profession. Pinzón-Pérez, Palacio, and Fajardo (2012) note that the National Institutes of Health (NIH) officially considers CAM to be “important modalities for treatment” though they may not be “generally considered part of conventional medicine” (as cited in Pinzón-Pérez, Palacio, & Fajardo, 2012, p. 163). The National Center for Complementary and Alternative Medicine (NCCAM) defines integrative medicine as a “combination of conventional and CAM therapies that have been tested for safety and effectiveness” (Pinzón-Pérez, Palacio, & Fajardo, 2012, p. 163). In other words, just as NPs musts focus on evidence-based practice with regard to conventional medicine, NPs who intend to use CAM therapies have an obligation to employ those therapies which are evidence-based. Several other recognized professional and/or regulatory organizations also endorse the use of CAM therapies as a means of implementing integrative care; these organizations include the American Holistic Nurses Association (AHNA), National Commission for Health Education Credentialing (NCHEC), and Center for Complementary and Alternative Medicine at the NIH (Pinzón-Pérez, Palacio, & Fajardo, 2012). This indicates that oversight, credentialing, regulatory, supportive, and professional entities in the healthcare field consider the use of CAM therapies to be critical. This suggests that the use of CAM is expected at both the individual and institutional levels.
The expectations of professional and regulatory organizations should not be the sole reasons that healthcare professions and institutions should incorporate CAM into their practices. The fact that many practitioners are not confident in the use and prescription of CAM therapies cannot be ignored (Boehmer & Karpa, 2011). Yet resources exist which can support professionals and organizations in the use of CAM. One such resource is the natural medicine clinical decision tool (Boehmer & Karpa, 2011). This tool focuses primarily on the use and prescription of herbal and natural products (H/NP), the medicine side of CAM (Boehmer & Karpa, 2011). Research has shown that not only does such a resource enhance the knowledge and confidence of practitioners it also increase the likelihood that practitioners will discuss H/NP options with patients (Boehmer & Karpa, 2011). This tool contributes to the professional development and education of its employees which in turn enhances the organization’s prestige; it also demonstrates a way of proactively responding to the increasing interest and use of H/NPs by patients which has already been identified as critical (Salmon, 2010). It also offers professionals and organizations a means of securing patient safety, since such resources are able to cross-reference traditional prescription medications with H/NPs for interactions and contraindications (Boehmer & Karpa, 2011).
Institutions which endorse or are considering endorsing the use of CAM therapies have more than databases like the natural medicine clinical decision tool (Boehmer & Karpa, 2011) available to them for implementing the integration of CAM with conventional medicine. Gaboury, Boon, Verhoef, Bujold, Lapierre, & Moher (2010) offer the Models of Team Healthcare Practice (MTHP) framework as a way of equipping professionals with “seven possible practice models of health care” which enable practitioners to practice integrative healthcare (IHC) “from an organizational perspective” (p. 289). In their mixed methods examination of practitioners’ views of such a framework, Gaboury et al. (2010) indicate that MTHP is an ideal framework for viewing CAM because many times healthcare institutions and their constituent departments “may not ‘fit’ under a single model [of IHC] when more than one model of collaboration occurs at a single site” (p. 289). This demonstrates that in spite of the differences between different arenas of practice within a single healthcare organization, CAM therapies can be used in a way which does not threaten organizational practice and enables practitioners to employ CAM in pursuit of IHC, allowing them to employ an “integrative model of practice” (Gaboury et al. (2010) which reflects a proactive approach to patient well-being (Salmon, 2010).
Concerns regarding the safety and appropriateness of CAM therapies in NP practice remain which is understandable given the evidence-based orientation of healthcare practice. However, the literature is highly suggestive regarding the necessity of employing IHC. Additionally, professionals and organizations do not have to reinvent the wheel to pursue CAM and IHC; tools, including technology and frameworks, exist to support professionals and organizations in their IHC/CAM efforts including therapies, medications, and practices.
- Boehmer, S., & Karpa, K. (2011). Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center. BMC Health Services Research, 11, 279-
- Gaboury, I., Boon, H., Verhoef, M., Bujold, M., Lapierre, L. M., & Moher, D. (2010). Practitioners’ validation of framework of team-oriented practice models in integrative health care: A mixed methods study. BMC Health Services Research, 10, 289-298. doi:10.1186/1472-6963-10-289
- Pinzón-Pérez, H., Palacio, L. M., & Fajardo, E. (2012). Complementary and alternative medicine: A new professional arena for clinical nurse specialists and health educators. Salud Uninorte, 28(1), 162-170.
- Salmon, M. (2010). The commons: Nursing education, societal relevance, and going it together. Alternative Therapies in Health & Medicine, 16(5), 18-20.