Someone once said: It’s not what the facts are that matters – it is what people believe. I think the same can be said about complementary and alternative medicine (CAM) and its use in nursing.
There are numerous government documents emphasising the importance of basing practice upon evidence. Government policy on health care is what provides the ideology in which Clinical Governance is framed. It provides the policies, procedures and practices of our employing organisations; and, on the other hand, evidence can provide the ammunition to question accepted practices and to bring about effective practice.
CAM however is a disturbing exception to this principle. It seems to have slipped under the Clinical Governance radar and is gradually becoming accepted practice in health care. There is little physical ‘hard’ scientific evidence to confirm the efficacy of CAM; however there is evidence that people who have used CAM say they have benefited from the intervention. It seems that this anecdotal evidence is what justifies the expansion of CAM in health care, and its increasingly adopted use in the repertoire of nursing interventions. In an era of health care where patients are encouraged to be self-managing and ‘expert’ it is likely that they will resort to more and more of these harmful substances that not only have a detrimental physical affect used alone but also in interaction with prescribed medication. Nurses have a responsibility to work not only according to Clinical Governance as employees of health care organisations, but also as registered practitioners with a Code of Professional Conduct.
In nursing, someone’s ‘lived experience’ of their own health is increasingly taking precedence over more traditional approaches towards health: that is to say, if it works for the patient then they are supported in doing it. However what does a nurse do if an empowered and self-managing patient is determined to follow a course of treatment which the nurse knows is an inappropriate course?
I doubt whether a government regularly terrified by screaming news headlines would make much of an effort to redress the balance of evidence-based practice in favour of hard science. It is arguable that recent attempts to regulate CAM have been engineered by a powerful pharmaceutical industry resolute to maintain chemicals as the main intervention in health care. On the other hand it is argued that some of the substances used in CAM are actually physically harmful. Whilst working in a profession that trumpets itself as uniquely humanistic and holistic, nurses will practice those techniques and methods that patients ask for because those patients believe they will benefit from them. A nurse using CAM in the course of his or her practice must be covered by insurance and they will need to be a registered practitioner of the particular CAM intervention in order to practice safely.
The issue was neatly summed up for me by a colleague who described CAM as like taking a placebo tablet. There are worrying implications for nursing practice that encourages the placebo effect whatever the motive.
