East meets West - Traditional and alternative health practices merge to provide patients with the best care

Toni Fitzgerald, NurseWeek March 19, 2001
Used with permission

Acupuncture, massage and guided imagery are turning up more often in tandem with traditional medicine. Hospitals have begun to offer alternative therapies alongside Western medicine.

Kathy Wanderer, RN, doesn’t consider her use of alternative medicine within the walls of a bastion of Western medicine as contrary to allopathic medicine.  Not long ago, the use of alternative therapy techniques such as acupuncture, massage and guided imagery to help patients cope with the presurgery stress of cardio bypass surgery and to ease postop pain would have been unthinkable within a hospital.  So strong was the mistrust and opposition to alternative methods that any traditional health care provider who delved into such "quackery" was met with a firing squad of disdain.

When one highly regarded physician in Abilene, Texas, embraced the study of Reiki, the art of natural healing, his colleagues asked him to retire.  Immediately. They begged reporters not to mention his dalliance with something so unscientific, so as not to sully his reputation.  Although Reiki may not be one of the alternative therapies going mainstream, acupuncture, massage and guided imagery are turning up more often in tandem with traditional medicine.

Hospitals across the United States, such as Cedars-Sinai Medical Center in Los Angeles, have begun to offer alternative therapies alongside Western medicine.  Alternative medicine can help cure anything from back pain to insomnia, Wanderer said. It’s no surprise that nurses, who are always looking for better ways to serve their patients, are taking notice.

At Cedars-Sinai, the combined use of traditional and alternative therapy still is in a growth stage.  The hospital offers three forms of alternative medicine—acupuncture, massage and guided imagery.

Guided Imagery
A patient worried about surgery may relax by listening to a guided imagery tape, which walks listeners through the preop and postop procedures.  A patient who suffers from postsurgery insomnia could try acupuncture or massage. When patients hear what is available, they take advantage. "The nurses are the link here. They’re in closest contact with the patient, and many references we get, we get from nurses," Wanderer said.

Alternative methods are becoming so mainstream that "alternative" may soon become passé in favor of the current lingo—integrative or complementary. These words describe treatments that nurses at Cedars-Sinai say no longer are outside the expected realm.
"Actually, the patients like to have them offered," said Saisunee Vong, RN, of Cedars-Sinai’s intensive care open-heart surgery unit. "They feel that they may soothe their pain and calm them down."

Alleviating pain, patient care, dispelling anxiety—aren’t these the traditional duties of the nurse?  "I see it as the strength of one—the integrative medicine—supporting the weakness of the other, the traditional medicine," said Wanderer, coordinator of the cardiothoracic surgery department’s integrative therapies at Cedars-Sinai. "It goes both ways."

"Since the early ’90s, more people are [looking into alternative medicine]," said Jon Seskevich, RN, a nurse clinician who focuses on stress and pain management education at Duke University Medical Center in Durham, N.C. Seskevich has treated 18,000 patients since 1990.  "They used to be afraid that they would be judged negatively, but now people are speaking up more as [alternative therapies] are becoming more mainstream."
With more patients hearing about alternative medicine through newspaper and magazine articles and on television, the interest grows.  "When people see the patient benefits, the referrals pour in," Seskevich said.  That’s something Western medicine can’t always offer.

The idea is for both forms of medicine to complement one another, Wanderer said.
While no one is suggesting choosing acupuncture over a cast for a broken arm, one method can help the other. "I think probably it gives the patient a sense of having more choices to help them get through whatever they need to get through," said Walter Lemankiewicz, RN, a Cedars-Sinai liaison to cardiac surgery. "They feel more in control."
Wanderer estimates that a few hundred patients have taken advantage of the pilot program since Cedars-Sinai started it more than a year ago in the cardiothoracic surgery unit.

That’s a good number, considering patients must pay out-of-pocket for any complementary treatment they receive. Integrative medicine has spread to another, separate outpatient program and continued success may persuade the hospital to keep expanding, Wanderer said.

Nurses are often the link to treatments. If a patient complains to the nurse about postop pain that isn’t dulled by painkillers, the nurse can discuss complementary options.
While only physicians can order treatments (Wanderer has an acupuncturist and masseuse on staff), nurses say doctors listen to their referrals.

Positive Impact
"Nurses and doctors traditionally kind of shunned these treatments, downplayed them," Lemankiewicz said. "But now there’s a view that some of them made the patients more comfortable, and that has a positive impact on their outcome."

Lessening their patients’ pain is the No.1 concern for nurses in Vong’s department. She said those with a lower threshold for pain frequently request integrative therapy.
"The pain is just terrible. Most people say the [postop] pain is like a 10-out-of-10 on the scale," Vong said. "Especially for the young people, their pain tolerance is often lower. We have to support them. We have to get [the pain] lower with [integrative] medicine."
Combination is the key word. A common misconception is that patients must get one or the other, traditional or alternative therapies.

Somewhere in the middle usually works out just fine for doctors, patients and especially nurses, Wanderer said.

Better Communication
"In nursing sometimes there is a lot of distance from the patient," she said. "But these models don’t distance us. This allows nurses to get more involved."

Lemankiewicz agreed. He said personal experience with acupuncture and meditation allows him to communicate better with his patients when discussing their alternative therapy options.  "Because of my past history, I’m the voice of experience," Lemankiewicz said. "[Patients] are more ready to listen."

Of course, for all the positives at Cedars-Sinai, complementary medicine remains far from mainstream. It’s not always covered by insurance, and the nurses said some older patients aren’t interested in such "new" techniques. Acceptance is growing, but is not full-blown. Wanderer wants to change that.

"I think it’s important for nurses to know that [Eastern and Western approaches] work beautifully together, and we can better serve our patients this way," Wanderer said.