The pancreas in Room 201. A postop in 620. The cath scheduled for 7 a.m. Modern medicine has a way of reducing people to less than the sum of their parts. That kind of thinking, viewing people as diseases or procedures, said Mary Jo Krietzer, Ph.D., RN, director of the Center for Spirituality and Healing at the University of Minnesota, is the root of much dissatisfaction and stress in nursing.

But that is changing, thanks to a resurgence in modalities-holistic (with or without a "w"), integrative, complementary or alternative-that many say were part of nursing in the beginning. Alternative therapies focus on looking at the entire person-mind, body and spirit.

"Nursing started out to be holistic," said Karen Rader, MSN, RN, a certified healing touch practitioner in Indiana. "Holistic techniques don't take away from medicine, but complement it." People who are ill tend to experience a lot of stress, for example, and holistic medicine offers many therapies designed to deal with stress.

"Florence Nightingale herself was extremely holistic," said Marsha Walker, MSN, RN, a registered massage therapist and certified holistic nurse in Austin, Texas. "She advocated that nurses were to tend not only to a person's body, but their environment, food, air, their spirit."

The broad range of holistic healing approaches may not be common in mainstream, Western medicine, but most techniques have been around for centuries, if not millennia. Many were routinely taught in nursing schools before medicine's technological boom in the 1970s and '80s.

Traditional Chinese medicine, including acupuncture, herbal therapies, hypnosis, therapeutic massage, imagery, aromatherapy, meditation and other modalities are used as alternatives to conventional therapies, or in addition to them (thus the term complementary or integrative). But nurses say the holistic approach isn't so much about the technique as it is about attitude.

"A lot of nurses don't see any difference between what they've always been doing and this 'new' holistic thing," particularly those who were trained before the 1970s, Walker said. "A person can be practicing this way without ever taking a single class. There are a lot of nurses who naturally take into account the total person, without ever hearing of holistic nursing."

There is ample anecdotal evidence of the effectiveness of integrative practices, and a growing body of scientific evidence.

A study conducted by the National Center for Complementary and Alternative Medicine (NCCAM) at the University of Maryland in Baltimore found that patients treated with acupuncture after dental surgery had less intense pain than patients who received a placebo.

Another study found that older people with osteoarthritis experienced significantly more pain relief after using conventional drugs and acupuncture together than those who used conventional therapy alone.

Researchers at the Minneapolis Medical Research Foundation now are studying the use of acupuncture to treat alcoholism and other addictions. The Kessler Institute for Rehabilitation in New Jersey is studying acupuncture to treat a stroke-related swallowing disorder and the pain associated with spinal cord injuries.

The NCCAM is spearheading additional research into clinical outcomes, effectiveness, safety and benefits of a variety of alternative practices. The World Health Organization considers acupuncture an effective treatment for a comprehensive list of diseases, said Patricia Faust of the Austin Academy of Oriental Medicine.

At any rate, the movement is speeding on without necessarily waiting for scientific proof.

Americans spent $3.24 billion on herbal supplements in 1997. According to the NCCAM, more than 42 percent used an alternative therapy in 1997, most likely herbal medicines, massage, megavitamins, self-help groups, folk remedies, energy healing or homeopathy. The more than $27 billion spent on these therapies in 1997 exceeded out-of-pocket spending for all U.S. hospitalizations.

Brian Berman, MD, director of the Complementary Medicine Program at the University of Maryland School of Medicine, recently reported that of the 125 U.S. medical schools, 66 percent include complementary medicine information in core curriculum and half offer electives courses in complementary medicine. Nursing schools increasingly are including it again as well.

Whether they actually employ these techniques, nurses need to know enough about alternative therapies to intelligently discuss them with patients who are increasingly more likely to expect such options. "The times they are 'a-changing.' Patients are demanding more person-centered treatment," said Jon Suskevitch, RN, a nurse clinician at Duke University Medical Center. "They want the health care team to recognize them as a whole person."

Healthier healers
Nurses also can benefit from the study and application of these approaches. "Many people who practice integrative medicine recognize the effect it has on the healer," Krietzer said. "It encourages you to value your own health and develop good self-care practices. Becoming a healer in the true sense of the word is more than facts or procedures. There is a whole inner life that needs to be attended to. That is incredibly fulfilling."

"While nurses are natural caregivers, there is a lot of stress and frustration, especially in a hospital setting," said Tim Shurr, president of the International Association of Wholistic Medicine. "It affects how the nurse is feeling, and that affects how the patient is feeling."

Massachusetts-based Seeds & Bridges, a holistic nursing continuing education program, found that participants in its training reported increased job satisfaction, increased productivity, decreased sick time and workers comp use, and overall better patient outcomes.

"The real power of transformation in this field is not in just substituting an herb for a drug," Krietzer said. "It is looking at patients in a more comprehensive way.

"Is it more work? I don't think so. To the extent you can help a patient relax in the ICU, for example, and get them off a ventilator sooner, have them require fewer meds, that's not more work. This isn't doing what we always do and then layering the integrative medicine on top of it. It is a different way of everything we do."