ARLINGTON, VaNurses often take an active role in integrating
complementary and alternative medicine (CAM) with conventional care
in the hospital setting, said a panel of nurses at a session of the
Comprehensive Cancer Care 2000 conference.
Patients want more than they are getting now from the medical
system, said Janice Post-White, RN, PhD, associate professor,
School of Nursing and Center for Spirituality and Healing, University
Drugs, diagnostics, treatments, and cure are essential components of
cancer care, she said, but patients want more. They want care.
They want you to spend time with them. They want you to communicate
hope. They want a compassionate presence from the beginning of life
to the end. That presence, she said, is precisely what nurses
Susan Bauer, RN, DNSc, assistant professor of nursing and medicine,
University of Massachusetts at Worcester, agreed. Patients
often feel abandoned by health care professionals. Nurses step in
when other conventional therapies are no longer effective or
available, she said.
Stepping in and providing that compassionate presence means
overcoming barriers to change not only within the institution but
also within oneself, ones patients, and among ones
colleagues, the panelists said.
Find key people within your institution who are interested in
working with you on CAM, Dr. Post-White advised, adding that
not all colleagues will offer support in the early stages of a CAM
program. Selectively introduce CAM to patient populations who
already use CAM. Ask them what they are doing. Choose one unit to
start with, not the entire institution, and integrate CAM into
existing programs there.
Integrating CAM into other interventions means documenting outcomes,
she added. Not documenting what we have done and what outcomes
resulted would put us back decades, when evidence about CAM was only
anecdotal, she said.
Dr. Post-White cited a survey of patients indicating that meditation
led the choices of CAM therapies, followed by herbal remedies, humor,
massage, therapeutic touch, progressive muscle relaxation, and
prayer. An American Cancer Society study of breast cancer patients,
she said, concluded that CAM allowed patients to feel more hopeful,
participate in their own care, and better cope with the emotional
aspects of their cancer.
The use of CAM in children also is increasing. In a survey of
children with cancer, Dr. Post-White and her colleagues found that
parents sought out CAM to manage side effects of chemotherapies, to
cope with emotional aspects of the disease, or simply to feel more
hopeful. For childhood cancers, the top CAM intervention was prayer,
she said, followed by nutritional supplements, megavitamins, and
At Minnesota, she said, massage therapists are giving massage to
parents of children with cancer. In one research study, the children
watch and then they too receive a massage. The primary outcome proved
to be lessening of the parents anxiety.
Dr. Post-White also pointed out that only 57% of patients told their
health care team that they were using CAM. You have to know if
patients are using CAM to check on any interactions with
chemotherapy, she warned. Herbals are often impure or
contain high levels of calcium or phosphorous.
Providers should inquire about CAM use by asking direct,
nonjudgmental questions, she said. Conceivably, the institution could
be held liable for not knowing what patients are using or for not
informing patients about any risks associated with CAM use. So a
knowledge base on potential interactions had to be developed within
Close cooperation with the pharmacy department is indicated
when patients bring in their own herbals and other supplements,
Dr. Post-White said.
Dr. Bauer said the nursing profession needs to takes steps to change
policy regarding CAM. She urged greater participation at conferences
and expert panels for nurses as a starting point.
She also said that establishing standards of practice in CAM is an
ethical and legal responsibility for the profession. Consistency of
training is needed, integrated into formal nursing training and as
continuing education for working nurses.
She urged combining strengths and resources with other
disciplinespharmacy, medicine, massageto bring students
together and teach them in the same classroom when content overlaps.