Alternative Modalities [PDF]

Zitiervorschau

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 moreplausible 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: 

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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]        

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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)

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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 immunoaugmentation 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 RoleModeling 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 Diagnosis/concern

Nursing Intervention(s)

Rationale

Impaired Comfort

Acupressure, TT

to decrease perceived pain

Disturbed Sleep Pattern

Massage

to promote relaxation, rest

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

Spiritual Distress

Spiritual support

Spiritual Well-Being

Spiritual growth facilitation

to support growth/reflection reexamination of values

Anxiety or Fear

Guided imagery, relaxation therapy, biofeedback, calming techniques

to reduce sense of anxiety

Art therapy

to facilitate expression

Impaired Communication

to facilitate a sense of inner peace

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