Running head: THE NURSE IN COMPLEMENTARY AND ALTERNATIVE MEDICINE
The Nurse in Complementary and Alternative Medicine
Richardia Gibbs-Hook
Ferris State University
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Abstract
This paper explores the definition of Complementary and Alternative Medicine and how its use
impacts conventional medicine. Information about lack of communication concerning use of
herbal products by patients as well as the fact that patients are not routinely asked about use will
be provided. The nurse is profiled as the member of the healthcare team who is in a position to
enhance communication concerning a patient’s use of herbal supplements and thusly prevent
adverse reactions from occurring.
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The Nurse in Complementary and Alternative Medicine
As Complementary and Alternative Medicine (CAM) is being utilized by more Americans,
the implications for conventional medicine are many. Patients may be unwilling to volunteer
herbal product use with physicians or nurses unless asked. The role of the nurse as patient
advocate and the member of the healthcare team who has the most frequent and combined time
with the patient puts the nurse in a position to obtain the most accurate information about herbal
supplement use. As there are potential adverse reactions from combining herbal and
conventional medicine, the nurse has an ethical responsibility to obtain herbal supplement usage
information from the patient.
Complementary and Alternative Medicine: Defined
According to the United Sates National Center for Complementary and Alternative Medicine,
CAM can be defined as “a group of diverse medical and healthcare systems, practices and
products that are not presently considered to be part of conventional medicine” (2011, Zhang &
Fong & Changli). This includes but is not limited to such products and practices as herbal
supplements, vitamins, guided imagery, acupuncture, yoga, meditation, tai-chi, healing
ceremonies and prayer (2011, Egede & Bais).
Prevalence of Use
According to Zhang herbal product use is on the rise “is used by more than 38.2 million
people in the United States with thousands of products available world-wide” (2011). Ventola
attributes the increase in use to dissatisfaction with conventional medicine, frustration with an
impersonal medical system and for some consumers a feeling of control of illness or health
promotion (2011). Also, the prevalence of mass media coverage of adverse reactions and side
effects of conventional medications and treatments may drive a health care consumer to seek
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alternative or complementary therapies (Ventola, 2011). The internet is a tool that is used by
many consumers and a vast amount of information is available about herbal remedies on any
search engine.
Risks
Herbal supplements are not regulated in the same way that conventional medicine is with
double blind studies and approval as medicine by the Food and Drug Administration. Many
herbal supplements are either “unintentionally mixed with contaminants or intentionally mixed
with pharmacological agents such as “warfarin, estrogen, corticoids” and other substances (2011,
Zhang). Many consumers purchase herbal supplements because they have been led to believe
that herbal is “all natural” and hence safe. Because the herbal industry is not regulated
worldwide, it is for health practitioners to assess for accuracy in treatment of their patients take
herbal supplements along with conventional medicine. Many drugs have adverse reactions when
taken concurrently with popular herbal remedies. According to Zhang, there are documented
safety concerns with “thirty-four drugs, including anticoagulants, anti-depressants,
cardiovascular drugs and anticancer drugs” (2011).
Lack of Communication
Many patients are hesitant to share with their primary care provider (pcp) that they use herbal
supplements. These patients may fear that the pcp will disapprove of the use and thus do not
disclose the information or they are never asked in the first place. In a study of Hispanic women,
60% reported never being asked about supplement use and 40% never volunteered the
information with another survey indicating that 72% of all patients did not report supplement use
with two thirds of those having chronic illness requiring conventional medicine (Ventola, 2011).
This is troubling because those with chronic illnesses are more likely to take multiple
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conventional medicines leading one to infer that those who take herbal medicine and
conventional medicine are at a greater risk of supplement and drug interactions. If patients are
not willing to volunteer information about herbal medicine out of fear of disapproval or a belief
that herbal is synonymous with natural and natural is synonymous with safe, the health care
industry has an ethical duty to ask every patient about herbal supplement use in an effort to keep
patients safe.
The Role of the Nurse
As a patient advocate and the member of the health care team who may have the initial and
most frequent contact with the patient, the nurse has the greatest opportunity to ascertain
information about herbal supplement use and hence can be involved in educating the patient
about potential adverse reactions. Optimally this would be done during a patient admission
assessment in a hospital setting, but could also occur in the physician’s office or public health
department. While in the hospital there are other opportunities to inquire about supplement use
during routine medication administration and at discharge. A patient being sent home on
Coumadin for the first time may have neglected to share herbal supplement use upon admission
and if not asked about the use may go home and return to taking the herbal supplements along
with the Coumadin. to the ethical principal of Nonmaleficence can be defined as “the duty to do
no harm” (Chitty & Black, 2011, p. 109). Failing to obtain a full medication list including herbal
supplements could bring harm to the patient and thus is an ethical responsibility of the nurse.
Cultural Considerations
Nurses encounter patients from multiple cultural backgrounds. From Native Americans to
first generation immigrants, America is a multi-cultural country with populations that may use
herbal remedies as traditional medicine because that is what has always been done in a native
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culture (Ventola, 2011). In the same manner that nurses must be sensitive to transcultural
differences in patients, special consideration may need to be given to different ethnic groups who
that traditional herbal medicine from a particular culture. When language may already be a
barrier in these instances, the nurse must make a thorough assessment of medication and herbal
supplement use in order to avoid adverse supplement and drug interactions during hospitalization
and in the patient’s home.
Acceptance of Use
According to Ventola, orthodox medicine practitioners have historically denounced the use of
alternative and complementary therapies despite the fact that many current conventional
medications are derived from plants. For example Quinine, which is the only treatment for
malaria was derived from unconventional treatments (2011). “With support from the federal
government, medical and nursing schools are incorporating lessons about CAM and dietary
supplements into the education and training of physicians and nurses” (2011, Ventola).
Code of Ethics
In reference to the Code of Ethics for nurses (ANA, 2001), the nurse assists healthcare
consumers in informed decision making. Obtaining information concerning herbal supplement
use is the ethical responsibility of the nurse in order to educate the patient and the patient’s
family about what may be unsafe practice for the patient. While alternative medicine has not
made its way completely into acceptance on the part of conventional medicine, the health care
consumers are clearly using herbal medicines as evidenced by yearly expenditures of 14.8 billion
dollars (Ventola, 2011). While it may take time for physicians and nurses to become completely
educated about herbal medicines, the nurse can assist patients and keep them informed of
potential interactions simply by asking “Do you use any herbal supplements?” Clearly this
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information is not being asked and utilized on a routine basis, and healthcare practitioners owe it
to their patients to inform them of risks. The risk of adverse reactions is much greater if the topic
is not broached.
Conclusion
Alternative and Complementary medicine use is on the rise. Patients may not share the fact
that they consume herbal medicines with their primary care provider for a variety of reasons.
Regardless of the reasons, there are still risks associated with the concurrent use of herbal
medicines with conventional medicines. If patients are not willing to share the information
voluntarily, they need to be asked about the use of herbal supplements. As a patient advocate,
the nurse is in an optimal position to inquire about herbal supplement use during their multiple
interactions with families. Patients who may mistakenly believe that herbal is the same as
natural and therefore harmless need to be educated about the use of these products. The nurse
identifies learning needs based on nursing knowledge, the various roles the nurse may assume,
and the changing needs of the population (ANA, 2010). As herbal product use is on the rise, so
are the educational needs of the patient population and nursing on this topic.
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References
ANA, (2010). Nursing: Scope and Standards of Practice (2nd ed.). Silver Spring, Maryland:
Author
Chitty, K.K., & Black, B.P. (2011). Professional nursing: concepts and challenges (6th ed.).
Maryland Heights Missouri: Saunders Elsevier
Egede, L.E., & Bais, S.S. (2011). BMC Complementary Alternative Medicine Dec 30 11(18).
Department of Medicine, Medical University of South Carolina, Charlotte, South
Carolina. Retrieved from PubMed
Pender, N., Parsons, M., & Murdaugh, C. (2011). Health promotion in nursing practice (6th ed.).
Upper Saddle River, New Jersey
Ventola, C.L., (2010). Current Issues Regarding Complementary and Alternative Medicine in the
United States. Pharmacy and Therapeutics P.T. 35 (8), 461-468. Retrieved from Cinhal
Zhang, A.L., Fong, H.H.S., & Changli, X.C. (2011). Integration of herbal medicine into evidence
based clinical practice: Current status and issues. Herbal Medicine: Biomolecular &
Clinical Aspects (2nd ed.). Boca Raton, Florida: CRC Press