PROFESSIONAL DEVELOPMENT Learner’s Name Capella University Health Promotion and Disease Prevention in Vulnerable and Diverse Populations May, 2017

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CAM and Spirituality for Health Care Workers

Organizational education plan on Complementary and Alternative Medicines (CAM) and spirituality.

An Overview of CAM and Spiritual Care

What is spiritual care?

Spiritual care is defined as meeting patients’ spiritual needs by identifying and recognizing the importance of spirituality to the patients (Baldachinno, 2015).

An Overview of CAM and Spiritual Care

Complementary and Alternative Medicine

CAM is medical and health care practices and systems that are not included in conventional, western medicine. (Pérez & Luquis, 2013, p.90).

The Importance of Understanding CAM and Spirituality for Health Care Workers

This session focuses on an organizational education plan on Complementary and Alternative Medicines (CAM) and spirituality. It will elaborate on the following points:

Identifying the topics to be covered in the educational plan.

Providing a list of resources used to further the understanding of CAM.

Explaining the importance of health care professionals to develop an understanding of CAM, traditional medicine, holistic health, and spirituality/spiritual care.

Examination of any ethical, legal, and economic principles related to CAM, traditional medicine, holistic health, and spirituality.

Analyses of how the pros and cons of CAM, traditional medicine, spirituality, and holistic health can affect a plan of action for individuals and populations.

Includes

Importance of understanding CAM, traditional medicine, holistic health, and spirituality/spiritual care.

Ethical, legal, and economic principles.

Analyses of the pros and cons of a plan for individuals and populations.

List of resources.

CAM is currently used by 38.3% of the adult population and 12% of the children population in the United States.

What is spiritual care?

Spiritual care is defined as meeting patients’ spiritual needs by identifying and recognizing the importance of spirituality to the patients (Baldachinno, 2015). The organizational educational plan for spiritual care should include two primary topics:

Important topics on spiritual care

Understanding concepts such as spiritual well-being and spiritual distress.

The importance of spirituality in end-of-life-care (Paal, Helo, & Frick, 2015).

Important topics on CAM

Nurses with a high level of spiritual well-being and distress have a positive attitude toward spiritual care. They are also able to use the spirituality in their care plan for the patients, thus providing them with holistic health care (Azarsa, Davoodi, Markani, Gahramanian, & Vargaeei, 2015).

In case of terminally ill patients, health care workers must have a holistic outlook toward patients. They should sensitive to all aspects of the patient’s experience, including the spiritual and existential. However, they should be careful to operate within their own professional limits and avoid taking on the role of a religious leader (Broeckaert, 2011).

Considered from a holistic perspective, critical care is not only about the body. The holistic triad of body-mind-spirit is extremely important. This means that if nurses and physicians do not take care of the patient’s spirit, they will not be able to cure the mind and body fully. (Pérez & Luquis, 2013).

If workers are to truly care for the holistic treatment of the patient—body, mind, and spirit—then they must step outside their comfort zone. Health care workers must remind themselves that nourishing their own spiritual needs will only allow them to serve their patients’ spiritual needs better. Doing so will help us see further and do more when the patients and their families need them the most (Pérez & Luquis, 2013)

Ami B (AB) – The speaker notes look very good and they are formatted so that they are easy to read!

Ethical and Legal Principles of CAM

The ethical principles of various alternative treatments in health care.

Patient autonomy

Consent

Beneficence, non-maleficence, autonomy, and paternalism

The legal principles of various alternative treatments in health care.

Direct government-administered regulation.

Government-sanctioned self-regulation.

Independent self-regulation.(Complementary and Alternative Medicine for Doctors [CAMDOC] Alliance, n.d.).

Ethical and Legal Principles of CAM, Traditional Medicine, Holistic Health, and Spiritual Care

The ethical principles of various alternative treatments in health care are:

Patient autonomy. Doctors need to respects their patients’ decisions about their treatment.

Doctors must discuss patients’ treatment and care with them. They must respect patients’ views about their health. Regard for patients’ autonomy and right to self-determination may therefore require that they be knowledgeable about CAM treatments if that is what the patients prefer.

Consent. Obtaining consent from patients to undergo treatment requires equipping them with sufficient information about the likely effects of a proposed treatment.

Issues around consent may raise separate problems in cases involving children, particularly in situations where a parent requests a CAM treatment for a child. Parents or others making decisions about medical treatment on behalf of children must do so in their best interests. In case of the practitioner, the incomplete information about the effects of CAM therapies it may be difficult for them to make a well-informed decision about whether a CAM treatment would be clinically appropriate or not.

Beneficence, non-maleficence, autonomy, and paternalism. The principle of beneficence requires practitioners to act in a way that benefits their patients (Wilkinson, 2013).

The principles of beneficence and autonomy conflict when a patient autonomously chooses, and consents to, a treatment which the practitioner believes would not be beneficial to them. Those who believe that the principle of beneficence may override patient autonomy in certain cases are sometimes said to be committing medical paternalism.

The legal principles of various alternative treatments in health care are:

Direct government-administered regulation.

This implies that the government, through the appropriate authorities, decides to what extent the use of CAM by licensed health professionals can be designated as ‘responsible professional conduct.’

In many countries the law assigns the process of authorisation, registration and supervision of health professionals to national medical associations. This means that the national medical associations decide to what extent the use of CAM by licensed health professionals can be called ‘responsible professional conduct.’

Government-sanctioned self-regulation.

Independent self-regulation.(Complementary and Alternative Medicine for Doctors [CAMDOC] Alliance, n.d.). In some countries, self-regulation is necessary for an association to be approved by the government. A ‘registered’ CAM professional must have membership in a government-approved providers’ federation (CAMDOC Alliance, n.d.).

In some countries, self-regulation is necessary for an association to be approved by the government. A ‘registered’ CAM professional must have membership in a government-approved providers’ federation (CAMDOC Alliance, n.d.).

Ami B (AB) – This area may have too many speaker notes. General rule- if you have to keep scrolling in the speaker notes, there are too many. Keep in mind that it is not supposed to be a paper, just brief notes to elaborate on the ideas in the slides.

Economic Principles of CAM

Economic evaluation of CAM are the same as those used for conventional medicine.

Perspective of the Patients

Availability of Data on the Effectiveness of Therapies

Evaluating CAM Costs (Herman, 2013)

The principles described here for the economic evaluation of CAM are the same as those used for conventional medicine. Key aspects of economic evaluation salient to CAM are:

Perspective of the Patients;

As much of CAM is accessed directly through the patient’s sole choice and paid without insurance, it is important for the benefits of the care to exceed the cost of the care. Thus, the treatments and results valued by the patient become important in CAM. This is ignored in the economic evaluation of conventional medicine.

Availability of Data on the Effectiveness of Therapies

Economic evaluation requires data on both the health benefits and costs of the therapies under consideration.

Evaluating CAM Costs (Herman, 2013).

There are many integral issues specific to CAM when calculating costs. Since much of CAM is not covered by insurance, claims data are not readily available for analysis. There is not much public information on the cost of individual CAM services. As CAM can have broad health impacts, it is important to consider whether to capture all health care costs or only those related to the most relevant case at a certain point in time (Herman, 2013).

Global Impact of Ethical, Legal, and Economic Principles of CAM

Demand for CAM with traditional medicine implies a global acceptance of both traditional and alternative medicines.

Globally, CAM has increased in acceptance by the health consumers and broader health services.

CAM modalities are following differing ways toward or away from professionalization and integration in different countries.

More research needs to be done for CAM.

The demand for an increased integration of CAM with traditional medicine implies a global acceptance and compatibility of both traditional and alternative medicines.

This increase in status is evidenced by both statutory registration legislation, for example, the inclusion of the Chinese medicine profession in the National Registration and Accreditation Scheme for Health Professions in 2012, and regulations surrounding education – including the emergence of degrees for integrative health care (IHC) practitioners, increased governmental funding for research as well as private insurance coverage for some treatments.

Globally, CAM has increased in status by the health consumer and broader health services.

CAM modalities are following differing ways toward or away from professionalization and integration in different countries.

Where there is a prevalence of traditional medicine, CAM practitioners feel they have a lot to gain by legitimising their knowledge in clinical trials– especially in those trials that are involved in the professionalization process. They feel that this will lead to an increased market penetration and a belief that they can be a force for good.

A proper analytic framework and appropriate tools are required to discover the complexities of CAM (Possamai-Inesedy & Cochrane, 2013).

Proper research needs to be carried out for CAM, it can only be speculated on what the potential health benefits might be, and how it may contribute to the increase of health literacy (Possamai-Inesedy & Cochrane, 2013).

Analyses of how Traditional Medicine, CAM, Spiritual, and Holistic Care Affects the Action Plan for Individuals

Pros of TM and CAM for individuals

Cons of TM and CAM for individuals

Pros of Spiritual and Holistic Care for Individuals

Cons of Spiritual and Holistic Care for Individuals

Pros of TM and CAM for individuals:

More trustworthy as TM and CAM therapies are supported by empirical evidence on safety and effectiveness.

TM and CAM therapies may have fewer adverse effects than conventional therapies such as treatment with conventional medicines.

The evidence regarding the trustworthiness of TM and CAM is usually based on sources such as old scriptures and clinical experience collected over hundreds of years. An increasing number of scientific studies now support the use of certain TM/CAM therapies. The effectiveness of acupuncture, for example, a popular treatment for pain relief, has been demonstrated both through numerous clinical trials and laboratory experiments.

For example, a National Institutes of Health (NIH) panel released a statement on acupuncture stating that the occurrence of adverse effects from acupuncture are much lower than for conventional treatments.

Its widespread acceptance in low- and middle-income countries, its comparatively low cost, and the relatively low level of technological input make it an ideal treatment for the Hispanic population as a majority of them come from a low socio-economic background and do not have the insurance for traditional health care.

Cons of TM and CAM for individuals:

Studies show that many individuals, who use TM and CAM therapies simultaneously with conventional medicine, often do so without informing their health care provider. This can be fatal.

TM/CAM medication therapies are commonly self-administrated. However, TM/CAM products are unregulated in many countries, and therefore many of the concerns about the risks for consumers relate to the safety and quality of TM/CAM medicinal products. Reported problems include sales of incorrect plant species and the contamination and adulteration of TM/CAM medication therapies. Heavy metals, fumigation agents, and pharmaceutical substances have been found in toxic concentrations in TM/CAM medication therapies

Pros of Spiritual and Holistic Care for Individuals are:

Joining a spiritual group changes one’s life for the better.

Spiritual strength helps one cope with hardships better.

Spiritual people are healthier.

Spirituality leads to a long life-span.

One’s overall general health sees a significant improvement. (University of Minnesota [UoM], n.d.). Spiritual fellowship, such as attending church or a meditation group, can be sources of social support which may provide a sense of belonging, security, and community.

Some people overcome trauma—such as abduction, war, and imprisonment—by seeking comfort in spirituality or religion. Having a strong spiritual outlook may help one find meaning in life’s difficult circumstances.

Adhering to a particular spiritual tradition may bring an indirect health benefit because many traditions have rules about treating the body with kindness and avoiding unhealthy behaviors. Research shows that perhaps because of these tenets, people who practice a religion or faith tradition are less likely to smoke or drink, commit a crime, or become involved in violent activity.

There is a positive relationship between religious and spiritual practices and better health outcomes (UoM, n.d.).

Cons of Spiritual and Holistic Care for Individuals:

Can delay proper treatment for some health conditions, such as cancer which should be treated as early as possible.

Lack of evidence-based research, which leads individuals to self-administer therapies and medicines. This can be harmful (Billings, 2014). As many alternative treatments have not received corroboration of the scientific community, many insurance companies refuse to pay for them. In many cases, a patient is stuck with a high medical bill with no hope of insurance reimbursement (Symptomfind, 2016).

If an individual has a serious medical ailment, especially one that requires immediate attention such as an aggressive cancer, delays spent on seeking alternative treatment can allow the disease to become much worse, even to the point of being untreatable by any medicine. Holistic supplements aren’t always required to reveal all their ingredients, so one can end up taking something that interacts badly with other medication or that is actually very dangerous in and of itself (Symptomfind, 2016).

How Traditional Medicine, CAM, Spiritual and Holistic Care Affects the Action Plan for Hispanics

Around 11.8% Hispanics use biologically-based therapies, 10.6% Hispanics use mind-body therapies, and 6.7% Hispanics use manipulative and body-based practices (Pérez & Luquis, 2013).

The CAM educational plan should focus on the three primary modules that are best tailored for Hispanics:

Natural Products

Mind and body medicine

Manipulative and body-based practices

Hispanics believe that diseases are caused by an imbalance of the body’s main humors: hot and cold. Therefore, cold diseases like asthma are treated with hot remedies such as herbal products and massages. Hot diseases like hypertension are treated with cold remedies like aloe vera juice (Pérez & Luquis, 2013). Herbal medicines fall under the category of ‘natural products,’ while massages are a part of ‘manipulative and body-based practices.’ In order to administer the right type and quantity of herbal medicine, and carry out a proper massage, it is important for health care workers to learn these topics.

Spirituality leads to better mental health as it enables Hispanic patients to cope better. It also adds meaning to negative effects like death as prayers are often carried out at the person’s death-bed and the family spends time with the body before sending it to the morgue (Koening, 2012; HCCN, 2013).

Hispanics have a notion about the hot and cold source of illnesses. Due to this belief they are most comfortable using ‘natural products’ and ‘manipulative and body-based practices’ for treatment (Pérez & Luquis, 2013).

Awareness of spiritual well-being and spiritual distress leads to better mental health. Among Hispanics, using spirituality for end-of-life care makes the patient feel that his life has meaning (Koenig, 2012; HealthCare Chaplaincy Network [HCCN], 2013).

Analyses of how Traditional Medicine, CAM, Spiritual, and Holistic Care Affects the Action Plan for Hispanics

Pros of TM/CAM for Hispanics

Cons of TM and CAM for Hispanics

Pros of Spiritual & Holistic Care for Hispanics

Cons of Spiritual and Holistic Care for Hispanics

Pros of TM/CAM for Hispanics:

As Hispanics come from a low socio-economic background, TM and CAM’s availability and affordability makes it more usable. It is comparatively low cost; and requires relatively low level of technological input.

CAM is widely used by the Hispanic population in the U.S., as it is cheaper and does not require insurance. It is also becoming more popular globally, as it has effective and immediate results. This growing popularity requires health care professionals be extremely well-informed about CAM and spiritual care.

Cons of TM and CAM for Hispanics:

Concerns about quality. (Essential Medicines and Health Products Information Portal [EMHPIP], n.d.).

Hispanic convenience stores are not the most reliable. Concerns include accurate product identity, freshness, contamination with heavy metals and pesticides, and interactions with medications (Consumer Reports [CR], 2012).

Pros of Spiritual & Holistic Care for Hispanics:

Costs are lower than traditional health care treatments.

Better understanding of the need for a well-balanced lifestyle.

Improvement of overall general health (Perry, 2017).

Cons of Spiritual and Holistic Care for Hispanics:

Lack of insurance acceptance.

Unreliability (Symptomfind, 2016).

Some educational resources and programs that may provide better understanding of CAM.

A general internal medicine residency program at the Rhode Island Hospital and Brown University School of Medicine (Brown Alpert Medical School, n.d.).

Courses about herbal medicine and nutritional supplements at the College of Pharmacy. (College of Pharmacy, 2014).

The National Center for Complementary and Alternative Medicine (NCCAM) that provides resources for and supports scientific research initiatives in CAM (Perez & Luquis, 2013).

Another excellent resource is a book titled ‘Evidence-Based Practice in Complementary and Alternative Medicine’ (Rastogi, Chiappelli, Ramchandani, & Singh, 2012).

Educational resources for spiritual care are provided by the HealthCare Chaplaincy Network, which has developed two programs: the Professional Continuing Education (PCE) and Clinical Pastoral Education (CPE). (HealthCare Chaplaincy Network [HCCN], 2017).

Resources for Educational Plan on CAM and Spiritual Care

The program at the Brown Alpert Medical School includes instructive sessions in acupuncture, chiropractic, and massage therapy, along with an optional clinical experience (Brown Alpert Medical School, n.d.).

This course uses both didactic lectures in mandatory courses, and an integrative care cycle in which students participate in natural products compounding (College of Pharmacy, 2014).

The NCCAM sponsors centers of excellence for research on CAM, and carries out clinical investigations on topics such as herbs and dietary supplements (Pérez & Luquis, 2013).

This book focuses on how evidence-based research is influencing complementary and alternative medicine in general and Ayurveda and allied health practices in particular (Rastogi, Chiappelli, Ramchandani, & Singh, 2012).

Professional Continuing Education is a current professional development course for chaplains and other spiritual care providers that helps them improve their knowledge, skills, and research abilities on spiritual care and healthcare. The HealthCare Chaplaincy Network’s educational resources include downloadable publications, videos of past events, registration access for events, and courses, and spiritual tools, cards and related merchandise (HCCN, 2017).

Clinical Pastoral Education is a form of chaplain practice or internship whereby student chaplains are taught to observe, listen, communicate, and more effectively respond and attend to patient spiritual needs. Anyone who wishes to become a Clinical Pastoral Educator is required to become a Board Certified Chaplain (HCCN, 2017).

Each of these resources is extremely relevant as they provide a comprehensive understanding of the topics proposed for the educational plan on CAM and spiritual care.

Conclusion

Along with the growing incorporation of CAM and conventional medicine in health care organizations and private practices, the quantity of health care education programs that teach CAM is also growing. Both traditional medicine practitioners and CAM practitioners have educational challenges ahead. However, meeting those challenges will contribute to the knowledge base and the capability to offer inclusive care.

References

Azarsa, T., Davoodi, A., Khorami Markani, A., Gahramanian, A., & Vargaeei, A. (2015). Spiritual wellbeing, attitude toward spiritual care and its relationship with spiritual care competence among critical care nurses. Journal of Caring Sciences, 4(4), 309-320. https://doi.org/10.15171/jcs.2015.031

Baldacchino, D. (2015). Spiritual care education of health care professionals. Religions, 6, 594-613. https://doi.org/10.3390/rel6020594

Billings, S. (2014, October 7). Alternative medicine: Scope, examples, and advantages and disadvantages [Web log post]. Retrieved from http://naturalnewsblogs.com/alternative-medicine-scope-examples-advantages-disadvantages/

Broeckaert, B. (2011). Spirituality and palliative care. Indian Journal of Palliative Care, 17(4), 39. https://doi.org/10.4103/0973-1075.76241

Brown Alpert Medical School. (n.d.). Internal medicine residency program memorial hospital of Rhode Island. Retrieved from https://brown.edu/academics/medical/about/departments/medicine/residencies/internal-medicine-mhri/

College of Pharmacy. (2014). Herbal medicines. Retrieved from http://file.cop.ufl.edu/studaff/syllabi/PHA%205352%20Syllabus.pdf

Complementary and Alternative Medicine Alliance. (n.d.). The regulatory status of complementary and alternative medicine for medical doctors in Europe. Retrieved from http://camdoc.eu/Pdf/CAMDOCRegulatoryStatus8_10.pdf

Consumer Reports. (2012). Latino use of alternative medicine and botanicas. Retrieved from http://consumerreports.org/cro/2012/02/is-it-safe-to-buy-herbs-from-botanicas/index.htm

Essential Medicines and Health Products Information Portal. (n.d.). Guidelines on developing consumer information on proper use of traditional, complementary and alternative medicine. Retrieved from http://apps.who.int/medicinedocs/en/d/Js5525e/5.1.html

HealthCare Chaplaincy Network. (2017). Education. Retrieved from https://healthcarechaplaincy.org/education.html

Herman, P. M. (2013). Evaluating the economics of complementary and integrative medicine. Global Advances in Health and Academics, 2(2), 56-63. https://doi.org/10.7453/gahmj.2013.002

Koenig, H. G. (2012). Religion, Spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry, 2012, 1- 33. https://doi.org/10.5402/2012/278730

Paal, P., Helo, Y., & Frick, E. (2015). Spiritual Care Training Provided to Healthcare Professionals: A Systematic Review. Journal of Pastoral Care & Counseling: Advancing theory and professional practice through scholarly and reflective publications, 69(1), 19-30. https://doi.org/10.1177/1542305015572955

Perry, M. (n.d.). The benefits of holistic treatments. HealthGuidance for Better Health. Retrieved from http://healthguidance.org/entry/11858/1/The-Benefits-of-Holistic-Treatments.html

Pérez, M. A., & Luquis, R. R. (2013). Cultural Competence in Health Education and Health Promotion. New York, NY: John Wiley & Sons.

Possamai-Inesedy, A., & Cochrane, S. (2013). The consequences of integrating complementary and alternative medicine: An analysis of impacts on practice. Health Sociology Review, 2048-2064. https://doi.org/10.5172/hesr.2013.2048

Rastogi, S., Chiappelli, F., Ramchandani, M. H., & Singh, R. H. (2012). Evidence-based practice in complementary and alternative medicine: Perspectives, protocols, problems and potential in ayurveda. Berlin: Springer.

Symptonfind. (2016, May 7). Pros and cons of holistic medicine. Retrieved from https://symptomfind.com/procedures-tests/pros-and-cons-of-holistic-medicine/

University of Minnesota. (n.d.). Why is spirituality important? | Taking charge of your health and wellbeing. Retrieved from https://takingcharge.csh.umn.edu/enhance-your-wellbeing/purpose/spirituality/why- spirituality-important

Wilkinson, A. (2014). Complementary Medicine: ethics. Nuffield Council on Bioethics. Retrieved from http://nuffieldbioethics.org/wp-content/uploads/Complementary_medicine_FINAL_FL_paper-1.pdf

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