Complementary therapies are becoming an increasingly important part of health care in the United States. Although the use of these therapies is becoming more accepted by biomedical health care providers, numerous challenges must be addressed before complementary therapies and their underlying philosophical perspectives will be an integral part of health care, particularly in Western countries. Many now use the term integrated health care to refer to the inclusion of complementary therapies within the biomedical model of care. What is needed is a transformation of the Western health care system so that it is not just adding complementary therapies to the present health care system, but changing the philosophical base for care to one that is grounded in a holistic, caring philosophy. Nursing is in a primary position to assume a leadership role in this transformation. The five introductory articles in this Online Journal of Issues in Nursing Topic address key concerns related to the use of complementary therapies within nursing and health care.
Snyder and Lindquist examine the scope of the field of complementary therapies and the multiple terms that have been and are used to distinguish these therapies from those traditionally used in Western biomedicine. According to the authors, if the Western biomedical model of health care truly embraces complementary therapies, a transformation of the system will occur. The caring holistic approach to care is a primary reason persons are seeking care from complementary therapists. The fit of complementary therapies with nursing is explored, and the authors question whether complementary therapies are new to nursing or a return to practices that were a part of nursing prior to the technological and pharmacological revolution that began in the 1950s.
Integrating complementary therapies into nursing practice is substantiated by Frisch in her discussion of the relationship between nursing conceptual models/theories and complementary therapies. The fit of complementary therapies within various nursing theories/models is examined: Modeling and Role Modeling (Erickson, Tomlin, and Swain); Adaptation (Roy); and Humancare (Watson). In our current health care system, health professionals must document the care provided. Nurses have met this challenge and developed classification systems for diagnoses, interventions, and outcomes. Frisch provides examples of how complementary therapies fit within several of these classification systems.
The increasing diversity of the American population has necessitated health care workers to become more aware of the multitude of health care practices that are used by persons around the world. Leonard states that it is imperative that nurses increase their sensitivity to patients' use of other health care practices. Culture, culture shock, and cultural competence are discussed. The author cautions that cultural competence does not require each nurse to be an expert about all cultural groups but rather to be sensitive to practices and demonstrate respect for practices that differ from those of biomedicine or one's own cultural background. Web resource sites for expanding one's knowledge about health care practices in other cultures are provided. In addition to individual practitioners being culturally competent, it is also necessary for health systems to strive for cultural competence. Knowledge about complementary therapies assists health care workers by expanding their knowledge about the health practices used in many cultures.
Competence extends to all aspects of practice. Frisch presents an overview of holistic nursing and the standards of care that have been developed by the American Holistic Nurses Association. A collaborative process was used to develop the standards. Many clinical agencies are considering practice guidelines that will guide practitioners in using complementary therapies. Nurses may wish to duplicate or modify the process used by the American Holistic Nurses Association to develop practice guidelines specific to their organization. Core values, knowledge, and skills for holistic nursing are elaborated. Nurses using or planning to use complementary therapies will find these values and skills helpful as they incorporate complementary therapies into their practice.
An issue alluded to in several of the articles is the fit between complementary therapies and nursing. Gaydos agrees with other contributors: complementary therapies are part of the essence of nursing. Differentiation between the prevailing empirical biomedical paradigm and the paradigm underlying complementary therapies is explored. Curricular considerations must include more than just providing content on techniques for various complementary therapies. Differences in philosophy, language, ethics, and research designs must be part of a faculty's deliberations. When beginning a new initiative, resources are helpful and Gaydos provides numerous resource sites along with specific examples of schools that have incorporated complementary therapies into the curriculum. In addition to including content on complementary therapies in nursing curricula, a need exists for continuing education courses on complementary therapies for practicing nurses.
The articles in this issue provide convincing evidence for nursing to incorporate complementary therapies within its practice, research, and education. In addition to the challenges noted in the articles, a number of other issues exit. For example, Americans pay for the majority of complementary therapies "out of the pocket" as they are not covered by health care plans. This practice makes it difficult for nurses to devote time to administering these therapies or teaching patients about them because these therapies are not viewed as a part of routine care. Regulation of complementary therapies, particularly their administration by non-licensed therapists, is another concern. Some states have passed legislation about the administration of complementary therapies. Agencies are developing guidelines for use of therapies within their facilities. Nurses must be involved in these processes so that they are not restricted in using therapies that have been and are an integral part of nursing. Numerous other questions about the use of complementary therapies within nursing exist. We invite you to develop a manuscript or letter to the editor related to complementary therapies and submit it to OJIN. Sharing ideas will contribute to complementary therapies being viewed as an integral part of nursing or ultimately a transforming of the health care system.