In a profession steeped in science, holistic measures gain acceptance
Complementary therapies make inroads into the ICU
Amid the tubes and lines and high-tech medical devices in ICUs across the country, a quiet revolution is spreading, accompanied by the soothing sounds of music synthesizers and the gentle touch of nurses trained in contemporary versions of the ancient art of laying on of hands.
And if it all sounds too "touchy-feely" and of no scientific value in treating critically ill patients, then check with other hospitals in your area; chances are at least one or two are integrating alternative or complementary medical therapies with conventional treatments to help relieve pain and promote healing - a movement spurred mainly by patient demand.
Complementary therapies, in general, range from acupuncture, acupressure, aromatherapy, and massage to therapeutic touch (see story p. 99), healing touch (see story p. 100), music therapy (see story, p. 100), and guided imagery. While all such techniques might not be appropriate for every ICU patient, several therapies are being used regularly in many units. All are subsets of holistic medicine, which emphasizes a mind/body/spirit approach to health. (See description of therapies, p. 101.)
Holistic medical practitioners focus mainly on chronic conditions rather than acute care, but complementary therapies definitely have a place in critical and intensive care settings, says Robert Anderson, MD, founder and past president of the McLean, VA-based American Holistic Medical Association. Anderson, who has practiced holistic medicine for nearly 30 years, supports the use of a variety of complementary modalities for critical care patients, including positive suggestion audiotapes, touch therapy, nutritional therapy, and music therapy.
Physicians who practice holistic medicine don't look upon touch therapies and other complementary modalities as alternatives. "They're just additions to the standard armamentarium of options," Anderson says. "We don't turn our backs on high-tech medicine, which is the essence of acute care. However, even in the ICU, these softer kinds of approaches are helpful as ancillary therapies. They reduce complications, they shorten hospital stays, and they improve survival."
In addition, health care today is consumer-driven, and complementary therapies are what consumers want.
"One force that is fueling change is that people are asking for this," he says. "This is the age of the consumer, and ultimately, when consumers say to their health care providers, 'I want this. Why aren't you doing it?' it fuels the change process. Acceptance of these therapies is accelerating."
Nurses' organizations tend to be less guarded in their approach to the possibilities of complementary therapies. A recent conference of the Washington, DC-based American Nurses Association featured presentations on relaxation and music for postoperative pain, outcomes of therapeutic massage for hospitalized cancer patients, and the effect of relaxation therapy on postoperative pain, among its more conventional offerings. "Whatever can be clinically proven to work should be implemented," says spokesman Michael Stewart.
The American Association of Critical Care Nurses in Aliso Viejo, CA, is associated with the Journal of Alternative Therapies, which publishes articles on a broad spectrum of complementary approaches. Some of the organization's members incorporate independent nursing intervention such as relaxation or guided imagery "to produce psychophysiologic effects" beneficial to patients.1
Adding to the quality of care
The American Holistic Nurses Association (AHNA) in Flagstaff, AZ, supports the use of "researched complementary approaches that enhance the spectrum of care for the patient," says executive director Maggie McKivergin, RN, BSN, MS, CNS, HNC. Those include aromatherapy, music therapy, chiropractic, massage, therapeutic touch, and healing touch, among others.
"Basically, they work," she says. "There's only so far that medical approaches can serve to enhance a person's health and well-being, so people are finding that these complementary approaches are adding to the quality of care they're receiving. We look at a patient's right to receive the best care possible, and should they choose to bring in these modalities, we should honor their right to do so."
Most hospital ICUs that incorporate complementary therapies do so for their contribution to reducing patients' pain and anxiety.
Barbara Dossey, RN, MS, FAAN, editor of the Study Guide for AHNA Core Curriculum for Holistic Nursing (Gaithersburg, MD: Aspen; 1997), also is director of Holistic Nursing Consultants in Santa Fe, NM, and consults with hospitals on how to integrate complementary therapies with traditional technologies. She says modalities such as touch therapy, music tapes, and even simple positive suggestion help ICU patients relax and heal.
"People in critical care units have an enormous amount of anxiety; they have a lot of pain and uncertainty, and they feel helpless and hopeless. What nurses and physicians can do is use themselves as instruments of healing and guide the person in relaxation exercises. Frequently, nurses get caught up in the technology, and they will [speak] impatiently to patients [and expect them to] relax [even when the patients are fearful and worried]. It takes a shift in a nurse's consciousness to see himself or herself as an instrument of healing. But the way they touch, the way they talk - just spending maybe three to five minutes extra - can change the rest of the 24 hours for the patient," says Dossey, author of Holistic Nursing: A Handbook for Practice (Gaithersburg, MD: Aspen; 1995), Rituals of Healing (New York City: Bantam; 1994), and The Art of Caring (Gaithersburg, MD: Aspen; 1996).
Dossey notes that changes in consciousness come from within the organization, as well as the individual: "Administrators have to own it and say this is what they want to be doing."
Reference
1. Tiernan PJ. Independent nursing interventions: Relaxation and guided imagery in critical care. Crit Care Nurse 1994; 14:47-51.
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