NRSG 3225 Nursing Inquiry

CAM refers to a diverse group of health-related therapies and disciplines which are not considered to be part of mainstream medical care (12). Individuals may pursue unconventional therapies both to seek relief from chronic cancer-related pain, and to effect a sense of control and assist them in developing coping skills to learn deal with the disease and its symptoms. An individual�s perception of the amount of control they have over their pain may influence the level of pain experienced (13). Clients with a strong internal locus of control usually want to participate actively in treatment decisions, while a lack of sense of control can exacerbate such clients' pain and limit compliance with recommended treatments (14).

CAM therapies for management of cancer-related pain often involve cognitive behavioural relaxation techniques, which may include biofeedback, progressive muscle relaxation, redirecting thinking, slow, rhythmic breathing, aromatherapy, or guided imagery as common components of multi-modal chronic pain management programs (15). Using touch and massage are conventional nursing methods of helping clients relax, and traditionally, therapeutic effleurage and petrissage massage techniques have been used to provide relief from pain, improve sleep quality, promote relaxation, and decrease anxiety in hospitalized clients. Massage may be a valuable nursing intervention for clients with cancer-related pain and pain symptom distress, as it evokes the relaxation response and promotes a more natural sleep (16).

With the popularity of CAM on the rise, collaboration between health care professionals and client/family is necessary to prevent adverse interactions between prescribed treatment and some forms of CAM. Greater than 40% of clients use CAM in conjunction with traditional pharmacological treatment to decrease pain and analgesic use, but not all clients share this information with their healthcare team (17). Reasons why clients may not inform health care professionals they are using CAM include: disappointment in medical care and placing hope in other possibilities; personal choice; belief that health care professionals would be cynical and unsupportive; fear of how the topic will be received; and physician unawareness of therapies serving as a barrier(18). �When the conspiracy of silence exists, it just feeds the anxiety and the loneliness of the cancer experience� (19). As a result, to protect the physical and emotional health and safety of the client it remains imperative that information regarding alternative treatment is shared between client and caregiver.

Using CAM in a Professional Capacity

Reasons nurses give for using CAM therapies in practice including �role expansion, increased scope of practice, independence of judgement, decision making, and action (20). However, approval of nursing regulatory bodies, informed policy and procedure from agencies, as well as having adequate knowledge and training would need to be obtained before a practitioner qualified to practice particular CAM therapies could offer that therapy to clients as part of their care.

Barriers to general implementation of defined standards for CAM practice include a lack of hospital policy and lethargic management (21). Consequently, nurses have a key role in facilitating this multidisciplinary approach to care, as they are often the front line contact with the client. Nurses have the greatest responsibility of understanding the client�s attitude toward CAM use within the context of coping with the illness (22).

There is insufficient or unclear evidence that simple relaxation techniques learned by nurses who then teach the skills to clients, may instead have an effect on coping rather than a specific effect on pain. Relaxation strategies may not have a direct effect on pain, but may be useful in the management of other aspects of chronic pain such as coping and anxiety, which may have a direct impact on patients� overall well-being and quality of life (23). Although there is strong evidence to support the use of behavioural interventions in chronic pain, [the literature] do not provide the evidence on which they base these conclusions (24). These findings call into question the validity of the studies and biases of the researchers.