Nursing Regulation for Holistic Therapies

Laws and regulations aiming to facilitate responsible health care practices involving alternative therapies are popping up everywhere, including in the nursing profession.

Here are the regs from Maryland, appropriately entitled "COMPLEMENTARY/ALTERNATIVE/HOLISTIC/INTEGRATED THERAPIES," from the Maryland Board of Nursing website. Notice the long list of disclosures required for informed consent. Even though the field has significantly changed in just a few years (with the IOM Report and new research data), these do not appear to have been revised since the paleolithic age (1999).

COMPLEMENTARY/ALTERNATIVE/HOLISTIC/INTEGRATED THERAPIES
There has been a proliferation of complementary, alternative, holistic and/or integrated therapies (therapies) that effect the health and well being of clients. These therapies are those which licensed nurses (both RN and LPN) may employ to increase comfort or relaxation, improve or restore health, improve coping mechanisms, reduce stress, relieve pain and/or increase the client's sense of well being. Currently, many of the therapies are not subject to State of Maryland regulations. Licensed nurses, in ever increasing numbers, are examining these therapies and incorporating one or more of these therapies into their practice.
Utilization of any complementary therapy requires that the licensed nurse have documented knowledge, judgement, skill and competency in the application of the therapy. When a licensed nurse, functioning within an organized health system, elects to utilize a therapy to augment his/her practice, the therapy must be approved by and be consistent with the organization's policies and procedures. The therapy must also be consistent with the mutually established client goals and the overall treatment plan.
Prior to implementing the therapy the licensed nurse shall: complete a health history of the individual client; provide the client with information about the procedure/therapy; support the client to become an informed consumer; and, obtain the client's written permission to utilize the specific complementary therapy.
When a licensed nurse independently practices as a provider of complementary therapy, the licensed nurse shall disclose to the client: the nurse's status as a licensed nurse; and, the educational preparation, experiences and credentials as a therapist/practitioner of this therapy. In addition, the licensed nurse must inform the client whether this therapy is regulated by a state regulatory agency and whether uniform educational standards or requirements have been adopted by that agency.
In all cases, the licensed nurse has an accountability to practice in accord with generally accepted standards of nursing practice; and, the statutes and regulations governing the practice of nursing. In addition, when a licensed nurse employs the use of any therapy which is regulated by any other State of Maryland health related Agency, Board or Commission, the nurse must at all times adhere to those statutes and regulations pertaining to the therapy.
SUPPORTING THE CLIENT TO BECOME AN INFORMED CONSUMER
The client is the primary health care decision maker and may choose to whom, under what circumstances, and for what purpose he/she seeks health care. A licensed nurse, while providing care to a client, may be asked by the client, or discover inadvertently, that the client is either seeking to utilize, or currently utilizing, over-the-counter products or alternative/ complementary/holistic/integrated therapies to supplement or to replace prescriptive medications, treatments and/or therapies. In this instance, the licensed nurse would encourage the client to: inform their primary health care provider of the client's actions or intended actions; and, encourage the client to acquire accurate information about the over-the-counter products such as:
1. Possible consequences of discontinuing the prescription medication(s);
2. Description and components of this therapy;
3. Safety factors/issues related to this therapy;
4. Potential goals/benefits of this therapy;
5. The potential for this therapy to interact in a non-therapeutic way with the treatment regime established by the primary health care provider;
6. Expected frequency of therapy over what course of time;
7. Expected course of therapy and its total cost; and,
8. Third party reimbursement.
The licensed nurse would educate the consumer that health care decision-making begins with the client obtaining a complete medical evaluation including current health practices in order to: develop a therapeutic treatment plan which enhances the client's health promotion and maintenance; reduces opportunity for untoward side effects or contraindications; and safeguard the client's health.

Approved by the Board February 23, 1999