Controversies in Holistic Nursing
By Karilee Halo Shames, PhD, RN, HNC
Exploring Our Relationship with Acupuncture
A nurse is bending over a hospitalized patient. she encourages the patient to relax, inhale, exhale, and to imagine energy flowing through the entire body. She appears to be administering a form of touch therapy, but upon closer examination, we see that she is inserting needles into the patient. She is not giving a shot; rather, she is using acupuncture. Nurse-administered acupuncture is not yet common. But the increasing availability of and demand for acupuncture raises questions about the nurse's role in this modality. Are nurses uniquely qualified to learn acupuncture or is Oriental medicine simply too far removed from Western medicine? The answer is complex.
Should Acupuncture Be Incorporated by Nurses into Holistic Patient Care?
Acupuncture has been used effectively in the Orient for thousands of years. Oriental medical practitioners spend years learning their art form, using the meridian systems of energy flow to stimulate the "qi," or energy of the body. This modality has been practiced in our country for the past few decades. In America, practitioners of Oriental medicine most often learn the modality during an extensive three- to four-year program.
Nurses who study acupuncture may be able to exempt some of the beginning courses, but many acupuncturists do not endorse this practice. Reasons vary from economic and political considerations to the overriding concern that there is little translation between Western and Oriental medicine. Some even believe Western preparation could be a liability.
While working with Isabel Reza, a Doctor of Oriental (DOM) Medicine in Sausalito, CA, I had the opportunity to experience acupuncture. In addition to inserting needles, Reza remained with me during the treatment, feeling for various pulses, examining my tongue, and asking for my feedback. She used special oils, aromas, and creams, and all the skills and tools holistic nurses use: deep breathing, relaxation, imagery, affirmations, nutrition counseling, and exercise regimens.
Another acupuncturist, Diane Monteil, L.Ac., of Mill Valley, CA, expressed that acupuncture is based on diagnostic techniques and ways of perception that are totally different from Western medicine. She believes nurses do have skills that would enable us to walk "between the worlds," especially in preparing patients for surgery, assisting in the post-operative phase to decrease anxiety and pain, relax muscles, and decrease fluid retention.
Yet acupuncture relies heavily on many forms of information gathering, and cannot easily be done as a "technique," thus accounting for the arduous training period. Many experienced acupuncturists explained that they are just beginning to grasp the complexity of their art. In addition to multi-pulse taking and tongue diagnosis, one must understand the use of special herbs, nutrition, exercise, and Oriental philosophy. Their descriptions helped me envision a model whereby Western doctors provide diagnosis and treatment, and nurses intervene for health promotion, education, and relaxation. As research continues to demonstrate the efficacy of acupuncture for pain relief, this option might be viewed as an extension of the nursing role.
William Prensky, DOM and Chief of Service for Acupuncture and Oriental Medicine at Sound Shore Medical Center of Westchester, NY, directs students and faculty at the Graduate Program in Acupuncture and Oriental Medicine at Mercy College in Dobbs Ferry, NY. Prensky found nurses trained in acupuncture are not necessarily better prepared. While familiar with pathophysiology for example, most nurses have not had the experience with a cadaver that this program provides. And although science courses may be easy for nurses, most do not place out of these when tested. Nurses are more knowledgeable about core terminology, but this accounts for only 2 of 141 credits in their program.
Yet Prensky believes there will be a role for nurses as acupuncture is increasingly integrated into mainstream care. As more hospitals and clinics utilize acupuncture, Prensky believes it will be important for nurses to know what patients are experiencing. This information could be imparted through courses in Oriental medicine theory and practice, focusing on implications for patient comfort rather than preparing nurses as practitioners.
Because we could benefit from the results and most readily see the changes in our patients, nurses could be the strongest advocates for the application of acupuncture in traditional settings. For the future, there may be possibilities for nursing externships in Oriental Medicine, or combined OM/NP degree possibilities. There may be opportunities for nurses to become acupuncture technicians, under supervision, as the field of acupuncture continues to expand.