PETER, a Registered Nurse, had recently joined the staff of a Christian Nursing Home. His caring manner and cheerful attitude had already made him popular with the residents. One day the Director of Nursing happened to walk into a room where Peter was attending to a resident and found him lighting some incense sticks which were in a jar on the locker. At the same time she noticed a crystal hanging from the light above the bed. Later as she spoke with Peter about this, she discovered he was keen to incorporate a number of alternative therapies into his nursing care. Many of these proposed interventions and the philosophies behind them, were incompatible with the Christian ethos of the Nursing Home and the beliefs of the majority of staff and residents.

AN APPEALING OPTION...

Peter is just one of a growing number of nurses who are eager to incorporporate alternative therapies and techniques into their nursing practice. Wide exposure through magazines, books and television programs, has resulted in a growing acceptance by lay people and health professionals, of what was once considered to be fringe medicine. There is no doubt that alternative medicine with its focus on prevention, wholeness and healing for the total person, is steadily gaining in popular appeal within our society.

While alternative therapies are being integrated into orthodox medicine by a growing number of registered Medical Practitioners, many in the nursing profession have begun to practise what they now term 'complementary therapies'. These therapies have considerable appeal to nurses, because they fit in well with prevailing nursing philosophy and offer an extra dimension of care. After all, nursing has long recognised that a person is more than just a body, and therefore good nursing practice needs to take into account all dimensions of our being - physical, psycho-social and spiritual. The holistic approach to health and healing is not new, but has in fact been the traditional focus of nursing.

BUT JUST A MOMENT...

Attractive as complementary therapies might appear, it is appropriate to ask some searching questions before hastening to integrate them into our nursing practice or attempting to influence others to do so. We need first to objectively evaluate complementary therapies as a nursing intervention. Some questions we need to ask...

Are there sound reasons for believing that some or all are beneficial for health and wholeness? What are their underlying principles and philosophies? What are the intentions of those who promote and practice them?

A POSITIVE APPROACH...

We all look forward to a time when as much emphasis is given to the healing process as to the disease process. It would be naive to consider that our current technologies, wonder drugs, and collective store of (Western) medical wisdom holds all the answers for our health needs and well being. Some complementary therapies may prove to be a valuable means to stimulate and support the healing response. We cannot afford to "throw out the baby with the bath water" as the old saying goes. but should rather approach new therapies (and for some societies they will be ancient ones ) positively and objectively. In the discussion paper, "Complementary Therapies in Relation to Nursing Practice in Australia" circulated by the Royal College of Nursing Australia in 1996, it was encouraging to note that the authors' first recommendation was, "that the act of nursing itself be identified as therapeutic in recognition of the need to document in everyday nursing care plans the importance of the human presence in nursing care."

SOME SERIOUS CONCERNS...

However the RCNA discussion paper made little attempt to evaluate complementary therapies as a nursing intervention, or more importantly, their underlying philosophies. Many alternative therapies have ancient origins, and share a common philosophy based on the concept of ENERGY - said to be a controlling force which governs the whole body and enables the body systems to operate. This energy is said to flow through invisible channels called meridians and is known by many names. The ancient Chinese called it Ch'i, or Q'i. Hindus call it prana. It is believed that ill health occurs when this energy is interrupted or becomes unbalanced. Therapies which work on the premise of energy or life force. include, reflexology, acupuncture, acupressure, therapeutic touch, meridian massage, chiropractic and homeopathy

Not all practitioners of these therapies subscribe to the universal energy philosophy, but may simply assert that here is a therapy which works, even though science may not yet be able to explain how it works. Nonetheless in many cases this idea is either central and overt, or hidden beneath the surface in the theory which underlies the practice. Indeed the authors of the RCNA discussion paper stated, "the notion of people open to and continuous with, the environment in a dynamic interchange, by virtue of the human energy field, is central to understanding holistic nursing and nursing interventions that operate on the assumption that interactions within and between all living systems are fundamental energy exchanges."

In the light of this, the questions posed earlier become most necessary. For me it raises at least three areas of concern

1) Nursing ethics require a respect for the beliefs of our patients/clients, requiring that there be no undue intrusion of the nurse's own religious or philosophical beliefs. This value would surely be violated by therapies practiced with an underlying religious meaning to which the patient/client may not subscribe.

2) The energy field theory is a speculative assumption which has not yet been scientifically validated, despite a considerable amount of research. The authors of the discussion paper appear to subscribe to the view that scientific proof is of no great importance in regard to complementary therapies. Yet the credibility of the nursing profession and its standing in the health field will not be served well by rushing to adopt such (as yet) unfounded theory. The uncritical adoption of any theory or practice, is surely not in the best interests of the profession or indeed the people we serve - our patients and clients.

3) Biblical truth and principle is at odds with the Eastern mysticism, philosophies and religious beliefs which underlie some popular therapies. One notable example, "Therapuetic Touch",1 is becoming increasingly popular in Australia and is now taught in some nursing courses.

Therapuetic Touch' is a practice which has become a concern to Christian nurses worldwide as it is based on an ancient mystical belief system called TAOISM which focuses on the metaphysical. The healer is presumed to be a channel of universal energy, which flows through the body of the patient. The general consensus is that the healing method and the religious message are inseparable. Last year a proponent of Therapuetic Touch was invited by a Christian education group to conduct a course in Australia. Yet it is hard to see how this therapy with its underlying principles and philosophy, can be equated with Christian healing. While some practitioners may attempt to equate the 'energy' said to be involved, with the Holy Spirit, it is worth noting that the Bible teaches that "The relationship between believers and the Spirit of Christ is personal and moral. The Holy Spirit is not an impersonal energy to be directed and modulated by us." (A. Miller 1987)

A NEED FOR DISCERNMENT...

The authors of the RCNA discussion paper give every indication of enthusiasm for the incorporation of complementary therapies in nursing practice. New Age philosophies and ideas are supported, and in many of the arguments put forward, there is a correlation between the 'energy field' models of nursing and complementary therapies. This is a serious concern. However, as many alternative therapies can be neutral, there is need to somehow discriminate between the theory or philosophy adopted to explain them, and the benefits which could be derived. As we look more closely into the various therapies we soon discover that there is a great deal of variation in the nature, value and scientific basis for individual therapies. There is also a great deal of difference in the meaning placed on the therapies by those who practice them.

At a time of change and growth for nursing, it is important that we should be open to new ways, and even new roles, in order that we may improve and enhance the care we provide. Yet it is necessary that we subject all new trends, practices or theories, to a careful analysis and evaluation. In the case of complementary therapies, we would be remiss if we do not sound a note of warning amidst the enthusiasm and eagerness to introduce this new dimension into nursing practice. Nurses are looking for new ways to make them more independent, and so practices which enable this, will be readily adopted. By looking at both sides of the question and encouraging more critical analysis, nursing Bodies such as the RCNA can help to ensure that nurses will not enter hastily into major new spheres of practice, without careful consideration of the relevant social, ethical and practice issues. Christian nurses also need to have a voice in the profession on this issue. That will mean evaluating and responding to new trends and practices in the light of Christian values and principles, and being prepared to respond appropriately within our sphere of influence.

(c) Margaret G. Hutchison, 1997

1 A technique developed by Delores Krieger, RN, PhD, and expounded in her book, "The Therapeutic Touch" USA: Prentice Hall, 1979.

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