Online Companion: Fundamentals of Nursing Standards and Practice 2E

Frequently Asked Questions

How and when are alternative and complementary treatment modalities (CAM) introduced to the care of the client?

The client frequently initiates the use of CAM. The client may be using an herbal preparation to treat a symptom such as difficulty sleeping. The nurse includes questions about the use of herbs during the assessment step and makes the client comfortable with sharing this information. The client's presenting symptoms may be related to the herbal preparation or interaction may occur between the herb and a prescribed medication. During the assessment step, the nurse asks about the client's use of other CAM with a question such as, "What have you tried at home to help yourself with this problem?"
The nurse may recommend the use of a type of CAM. For instance, when the client's pain is not sufficiently managed by the use of analgesics, the nurse may offer to assist the client to use relaxation techniques as an adjunct therapy. As with any nursing intervention, the client's responses is assessed and monitored and documented.
The client's physician may prescribe the use of a CAM. In this situation, the nurse must know by research and experience, the indications, methods, and effects of the prescribed CAM just as is done for any other treatment or medication the client is receiving.

What are the legal implications for the nurse who is using alternative/complementary treatment modalities (CAM)?

The nurse must be aware of the scope of practice as defined by the state where the nurse is licensed to practice. Some states have guidelines for the use of a CAM such as hypnosis. Chiropractic therapy requires specialized education and training and is not within the scope of nursing practice. The nurse must have a knowledge base about any CAM that is offered to the client. The nurse should have supervised training in the skills needed to implement the CAM. There may be established standards for use of a type of CAM and these should be used by the nurse. The appropriate indications for and methods of use must be clearly understood by the nurse and explained to the client. The client should indicate consent to use or participate in the modality. The client's response to the treatment modality must be observed and documented. The members of the health team should be informed of the use and rationale for the treatment modality.

What are the barriers to nurses' using alternative/complementary treatment modalities (CAM) in the care of clients?

The health care delivery system in the USA is strongly oriented to the Western allopathic tradition of curative medicine. The use of alternative modalities is beginning to gain acceptance. The use of CAM typically takes more time for beneficial results to be evident in the client. The nurse's daily schedule is usually very busy and time is a limited resource in clinical settings. In most situations, the use of CAM is not reimbursed by third-party payers. The nurse who plans to use CAM in practice needs to feel empowered about positive effects of alternative modalities and work to overcome the identified barriers.