Illustration by
Christina Sponselli/PhotoDisc

By Valerie Nelson
October 26, 1998

Nurses are ideally positioned to help patients who prefer to use alternative therapies, say healthcare experts. That’s because nurses can get them talking about a spectrum of care that includes patients’ alternative interests.

By displaying an openness to alternatives, nurses can glean medically important information that the patient might have otherwise withheld, experts say.

The need for nurses and other care providers to be sensitive to alternative therapies—which include acupuncture, herbal treatments, and homeopathic therapies, as well as traditions such as Chinese medicine—is increasing, say experts. The therapies are "popping up like weeds," said Jack Raso, MS, a registered dietitian and director of publications for the American Council on Health and Science.

Forty percent of Americans have used alternative therapies in the past year, according to a study reported in the May 20 issue of The Journal of the American Medical Association. In addition, a 1993 survey published in the New England Journal of Medicine showed that 72 percent of patients who used alternative treatments do not tell their primary care provider about alternative treatments they had used or planned to try.

Health practitioners should question patients about modes of self-treatment they are using or considering, but they must walk a fine line, Raso said. "You don’t want to risk alienating a client toward biomedicine. You also don’t want to give the appearance of approval for a method or putative remedy for which supportive evidence is lacking or absent."

Dangers of secrecy

Patients often feel uncomfortable about expressing their views on alternative therapies, and healthcare providers need to keep an open mind, said Karilee Shames, PhD, RN, director at large and California coordinator for the American Holistic Nurses Association.

"As nurses, a lot of our work is to be patient advocates and allies, to support the patient’s own decision-making process by supplying data and giving the person support to reflect upon their own belief," Shames said. "It’s important to work with patients, to ask them, ‘What do you believe?’ "

"You have to remember, and this is difficult, that not everyone starts where we start. We are looking at it from a different perspective," said Georgia Decker, MS, RN, a nurse practitioner whose year-old practice, Integrative Care, is in Albany, N.Y.

Many patients Decker sees take far more nutritional supplements than they need, and the supplements end up canceling each other out, Decker said. Their beliefs often are partly based on advice from friends, and Decker doesn’t miss the chance to point out that it’s a mistake to base health care on hearsay.

"When I speak to them, I ask what the patients think, what the patients know, and what they think they know. That provides different kinds of information," Decker said. And it helps her impart sound advice without appearing judgmental.

Decker responds to her patients by saying something like, "I don’t know that what you have said is true, but in general, you shouldn’t mix medicinal herbs with herbs, or you shouldn’t take really high doses of vitamins the day before chemotherapy." Decker will couch her advice with, "Just to play it safe, let’s come up with something that’s acceptable," and suggest the patient quit taking vitamins three days before chemotherapy, for instance.

Rewards of an open mind

When talking about alternative medicine with a patient, Decker advises avoiding confrontation. Instead of saying, "Are you practicing alternative medicine?" ask, "What activities are you doing for yourself to promote wellness?"

Many of Decker’s patients argue that their alternative therapies could be an enhancement, and she always makes sure she acknowledges, to a point, that they could, be right. She is careful to point out what has been scientifically proven about the alternative treatment they are using.

Although many alternative therapies haven’t gone through rigorous tests to examine their effectiveness. Some forms of treatment are gaining mainstream credibility. A National Institutes of Health panel concluded last year that there is solid evidence that acupuncture is a useful treatment for several conditions, including nausea, addiction, headache, muscle pain, and carpal tunnel syndrome.

In addition to being "reflective, nonjudgmental, and open-minded," healthcare providers should encourage patients to do research on their own, experts say. Healthcare professionals can connect patients with journals, books, Web sites, and other resources that can help them gain knowledge.

Care providers who make it look like a "war" between traditional Western medicine and alternative therapies don’t understand there is room for all treatments, Shames said. "The best health care involves the broadest possible range of treatments to choose from," she added.

"Western medicine has given 27-letter words to everything. People can’t pronounce them, let alone understand them. That’s when nurses can come in uniquely and handily, to talk to patients about how the medications work.

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