1. Eschiti, Valerie S. RN, MSN CHTP, AHN-BC Reviewer, DCCN Assistant Professor

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In order to achieve higher levels of wellness and a sense of control, patients in critical settings are using complementary and alternative modalities (CAM) with increasing frequency. This is a reflection of the increased use by the general public.1,2 It behooves critical care nurses to learn more about CAM. What are the benefits? What are the risks? What modalities might critical care nurses be able to provide? When are referrals for CAM appropriate?


For instance, a patient may be admitted to the coronary care unit who has been taking garlic capsules at home. This patient is scheduled for an emergency coronary artery bypass graft. Does a red flag go up for the nurse? Does she realize that use of garlic may increase bleeding time? Does she notify the physician?3,4


After returning to the unit after surgery, this patient may have difficulty resting, and requests to have a Therapeutic Touch (TT) treatment to promote relaxation and pain reduction. Does the nurse have any education regarding TT? If not, is she knowledgeable of a nurse in the hospital who is? Is she able to provide a referral for this patient, so that the highest quality of care is delivered and the patient's needs are met?5


The National Health Center for Complementary and Alternative Medicine (NCCAM) defines integrative therapies as those modalities for which there is some scientific basis for usage. Closely related terms are "alternative" and "complementary" therapies. Alternative therapies are those that are used instead of mainstream medical therapies. Complementary therapies are those that are used in conjunction with mainstream treatments. Both alternative and complementary therapies do not have adequate, high-quality scientific evidence for usage.6


CAM is divided into 5 major categories: alternative medical systems, mind-body interventions, biologically based therapies, manipulative and body-based methods, and energy therapies.6 Rather than discuss details of each category, I refer readers to the reference list below to learn more about CAM.


Fascinating research has been conducted by Tracy and Lindquist7 in the use of CAM by critical care patients. They note that nurses may serve as barriers or facilitators to CAM usage, depending on factors such as nurses' attitudes and knowledge regarding CAM. Their proposed model of nursing's role in the use of CAM by patients points to potential outcomes of improved patient and family satisfaction, improved staff satisfaction, enhanced patient safety, as well as positive physical and psychosocial outcomes.


In order to provide holistic, safe, quality care, the critical care nurse needs to become knowledgeable about CAM. However, it is not expected that she become an expert in all modalities. Rather, she needs to be cognizant of major CAM categories, where to locate information regarding specific modalities, and how to make referrals as needed.


Unit policies and procedures may need to be developed. CAM resources may need to be made available on the unit, such as handbooks and Internet resources. It is wise for the critical care nurse to keep an open mind with CAM. Because like it or not, the public continues to increase their demand for CAM in conjunction with Western biomedicine.


This provides challenges to nursing, but also rewards. As Tracy and Lindquist's model indicates, numerous positive outcomes may be achieved by the nurse acting as a facilitator to CAM use.7 These outcomes benefit not only critically ill patients, but also the nurses who care for them.


Valerie S. Eschiti, RN, MSN,CHTP, AHN-BC


Reviewer, DCCN


Assistant Professor, Midwestern


State University, Wilson School


of Nursing, Wichita Falls, TX




1. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997. JAMA. 1998;280(18):1569-1575. [Context Link]


2. Barnes P, Powell-Grinner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. DHHS Publication No. 2004-1250-04-0342. Hyattsville, MD: U.S. Department of Health and Human Services; 2004. [Context Link]


3. Agency for Healthcare Research and Quality. Garlic: effects on cardiovascular risks and disease, protective effects against cancer, and clinical adverse effects. Evidence Report/Technology Assessment: Number 20. Rockville, MD: Author. Available at: [Context Link]


4. Lu Y. Herb use in critical care: what to watch for. Crit Care Nurs Clin North Am. 2003;15:313-319. [Context Link]


5. Richards K, Nagel C, Markie M, Elwell J, Barone C. Use of complementary and alternative therapies to promote sleep in critically ill patients. Crit Care Nurs Clin North Am. 2003;15:329-340. [Context Link]


6. National Center for Complementary and Alternative Medicine. What is complementary and alternative medicine? 2002. Available at: [Context Link]


7. Tracy MF, Lindquist R. Nursing's role in complementary and alternative therapy use in critical care. Crit Care Nurs Clin North Am. 2003;15:289-294. [Context Link]