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Simple distraction is an amazingly effective complementary therapy, especially with children. “Kids say the needles are the worst,” Guzzetta said, “but if you’re really engaged in one task, you have little mental capacity to think about another, and kids are easily distracted.”

Research has shown that handheld video games and virtual reality glasses are effective with older children, and techniques are as simple as Where’s Waldo books and blowing bubbles with younger ones.

Guzzetta recently was involved in a study published in the American Journal of Critical Care and the Journal of Emergency Nursing that showed multiple benefits from family presence during cardiopulmonary resuscitation and invasive procedures.

Many health care providers are resistant to family presence, but that may be changing. Studies show that most consumers think it should be allowed, and the American Heart Association CPR guidelines recommend offering family members the option of remaining with a patient. The Emergency Nurses Association adopted a resolution supporting that option. It also has an educational program and guidelines for implementing the practice, although 95% of institutions do not have written policies.

“We recommended that nurses work closely with physicians, health care administrators, and professional organizations to adopt policies supporting family access,” Guzzetta said. Without written policies, it is a hit-or-miss approach that varies according to prevailing attitudes or even the persistence of the family.

Graham used research to implement a pet visitation program at UC San Diego, a program that rotates artwork through the ICU, and a relaxation channel broadcast to televisions in patients’ rooms.

Proof in the pudding

One of the major obstacles to nurses introducing complementary care into the critical care setting is that many methods and procedures have little conventional research behind them, according to critics as well as advocates of complementary care. The National Center for Complementary and Alternative Medicine, which operates as one of the 27 independent National Institutes of Health centers, began funding research grants for clinical studies only in 1999. With an estimated budget of $121 million in 2005, the center is scientifically investigating a range of complementary care and procedures, such as acupuncture and homeopathy.

A good source of information on existing research is the center’s website search engine, CAM on PubMed [www.nccam.nih.gov/research or www.nlm.nih.gov/nccam/camonpubmed.html], which automatically limits searches to the CAM subset.

Using complementary care procedures in critical care is a matter of weighing risks and benefits, Kreitzer said. Nurses in critical care environments need to look at what is in the profession’s literature, ask whether a therapy has been used to manage a problem, and whether it is safe, effective, and appropriate for this particular patient. Other considerations are the qualifications needed to implement the therapy and whether it falls into the scope of nursing.

Without sufficient research, there are concerns that the time spent applying CAM techniques takes away from other nursing care. “The drawback is wasting a lot of time that could be spent on nursing care that helps,” said Vern Bullough, RN, PhD, a medical historian, sexologist, and emeritus professor at State University of New York. Bullough also has been a contributing editor to the Scientific Review of Alternative Medicine.

“These things need to be tested. We need to find out what kind of patients respond to them. A nurse’s duty is to try therapies that work,” Bullough said. “Critical care nurses have their hands full.”