- Email: [email protected]
The development of a diploma in complementary medicine
The development of a diploma in complementary medicine Denise Rankin-Box ...forum for increased decision making between clients and nurses regarding the provision and delivery of care.
This paper describes the rationale for the development of a Diploma in Complementary Medicine, validated by the University of London and offered by The Centre for Complementary Medicine North West, School of Nursing and Health Studies, Stockport College of Higher and Further Education. The Diploma in Complementary Medicine is in part a considered response to the recent BMA (I 993) report evaluating the current status of complementary medicine in the UK and recommendations for training proposed by the RCN (RCN CTINSIG 1993, 1994). The course team perceived and identified a need for a common theoretical framework, validated at University level, to set precedent for the development of educational standards in the field of complementary therapies. It is suggested that in order to facilitate the development of competent clinical practitioners it is necessary to establish a common educational foundation from which to develop practice skills.
INTRODUCTION
Denise F. Rankin-Box Senior Lecturer in Nursing and Health Studies, Director, Centre for Complementary Medicine North West, Stockport College of Further and Higher Education, Wellington Road South, Stockport SKI 3UQ, UK
The World Health Organisation ( W H O ) has defined alternative medicine as all forms of health care provision which 'usually lie outside the official health care sector' (Bannermann 1984). This broad description embraces traditional systems of medicine such as acupuncture, healing, biofeedback, chiropractic, homeopathy, osteopathy and hypnotherapy. It has been suggested that there may be up to 160 therapies
ComplementaryTherapiesin Nursing& Midwifery(I 995) I, 8- I0 9 1995PearsonProfessionalLtd
practiced in the U K (Skelmersdale 1987 cited by BMA 1993). Complementary therapies are generally those practices which provide a supportive role in the treatment of a disorder and may be used in conjunction with some form of conventional treatment. Pietroni (1990) suggests a taxonomy of classification to distinguish between differing facets of complementary medicine. These are: 9 Complete systems of h e a l i n g - such as acupuncture, herbal medicine, osteopathy and homeopathy 9 Diagnostic methods - kinesiology, iridology, hair analysis and aura diagnosis 9 Therapeutic modalities - massage, reflexology, aromatherapy, spiritual healing, and hydrotherapy 9 Self-help measures - breathing and relaxation techniques, meditation, visualisation, yoga.
RATIONALE UNDERPINNING THE DIPLOMAIN COMPLEMENTARY MEDICINE Increasingly, health professionals are exploring the potential of alternate or supportive approaches to the treatment of health problems (tkankin-Box 1991). Changes witlfin the structure of nursing, demographics and economics suggest that a number of complementary therapies are gaining increasing acceptance within orthodox health care. A restructuring of nursing practice away from task orientated care towards primary nursing and the case approach, espoused by medicine, is facilitating an increase in nursing autonomy and in the provision of individualistic client care. This is providing a forum for increased decision making between clients and nurses regarding the provision and delivery of care. More recently the revised U K C C document 'Scope of Professional Practice' (1993) provides individual nurses with greater autonomy and accountability than previously recognised. It would appear that a proportion of nurses are keen to develop the parameters of their skill to develop their therapeutic role. In this respect there is an increasing demand to undertake training in a complementary therapy, with the view to integrating it within orthodox nursing practice. It is notable that similar developments are also occuring in medical practice (BMA 1993). A number of indicators suggest that generally there is an increase in the use of complementary therapies over recent years ( W h i c h 1992, Eisenberg 1993: BMA 1993). Whilst it is inappropriate to generalise upon these survey
The development of a diploma in complementary medicine
...a recognition of an increase in the number of individuals wishing to practice some form of therapeutic treatment.
findings, it is notable that results suggest that utilisation of the services of complementary therapy practitioners in this country has increased from one in eight people in 1986 to one in four individuals in 1992 (Which 1992). This is not a phenomenon unique to the UK. Eisenberg (1993) reported upon survey findings in the USA suggesting one in three adults had used some form o f non-conventional therapy in 1990. Various explanations have been suggested for this growth ranging from general dissatisfaction and increased critical appraisal of reductionist forms of health care (Sharma 1992; BMA 1993, Rankin-Box 1993) to sociological accounts focusing upon medicalisation-demedicalisation with reference to holistic care (Lowenberg & Davis 1994). In conjunction with increased demand for non-conventional health care services is a recognition of an increase in the number of individuals wishing to practice some form of therapeutic treatment. Whilst it is not the place o f the nursing or medical profession to prescribe consumer activities, health care professionals have a duty to
APPROACHES T O COMPLEMENTARY MEDICINE Provides the opportunity for students to explore and critically appraise different perspectives and approaches to health care. The influence and impact of allopathic medicine and emergent naturopathic perspectives of health care will be explored in relation to sociocultural influences. PSYCHOLOGICAL ASPECTS OF HEALTH Explores how psychology has contributed to our understanding of health and illness. By studying key concepts and theories attributed to psychological research students develop an understanding of the impact of this perspective upon perceptions of health and illness. COUNSELLING SKILLS IN HF.ALTH CARE Examines the repertoire of skills necessary for effective communication practice. A range of techniques and philosophies drawn from counselling are examined in relation to health care practice. The therapeutic process will be addressed with reference to complementary therapies. The skills covered in this module encompass techniques drawn from psychology, communication studies and counselling. RESEARCH M E T H O D S IN HEALTH CARE (DOUBLE MODULE) Explores the role of research methodologies typically adopted by a variety of disciplines. An understanding of research design and data collection methods is utilised in the review of research selected by the student. This module will enable the student to select and critically appraise research studies addressing selected complementary therapies. PROFESSIONAL LEADERSHIP A N D M A N A G E M E N T OF C H A N G E Change is inevitable in the provision of health care. This issue is particularly pertinent when exploring the emergent issuesassociated with the current interest shown in complementary medicine. This module prepares the student to be a successful change expert. Theories underlying the process of change provides the student with the necessary skills to plan, manage and evaluate successfully. PHARMACOLOGY AND TOXICOLOGY The use of specific oils, herbs and medicines in the field of complementary medicine necessitates an awareness of o~hodox pharmacological processes, interactions.
9
safeguard individuals and uphold public health (BMA 1993). In line with the BMA (1993) report, it is recognised that it is important to protect health care consumers from unskilled or unscrupulous practitioners o f health care (BMA 1993). In this respect it is pertinent to address educational issues in this field. The rapid and widespread interest by nurses and doctors in the use o f non-conventional therapies should not be taken to imply that these individuals are competent to train in a therapy o f their choice, and the issue o f competent educational programmes for medical, paramedical and lay people is currently under debate. To date, only osteopathy has statutory recognition in Parliament. The decision to develop a Diploma course for all health professionals rather than orientated towards discrete disciplines such as nursing, pharmacy or medicine was grounded in the belief that innovative health care developments can be enhanced where there is a shared educational experience. This facilitates insight into differing professional perspectives and fosters professional collaboration, communication and understanding. It is suggested that pursuance of traditionalistic approaches to health care education in this field may be divisive promoting the professions rather than the clients interest.
DIPLOMA
OUTLINE
The development of a c o m m o n educational foundation for subsequent training in a therapy is applicable across the field of health care. In this respect the modules offered seek to develop a sound theoretical knowledge base, addressing principles underlying complementary medicine (Trevelyan 1994). The following modules were selected in order to provide an in depth appraisal o f theoretical perspectives o f health care and the nature o f their delivery within the health care context. Core modules focus upon the development o f an holistic perspective o f health care, addressing social, cultural and physiological aspects of health care. Additionally, the social and differing philosophical constructions of complementary medicine are explored along with ethical and legislative considerations. Tables 1 and 2 illustrate some o f the modules presented. The core modules also address research issues underpinning the development o f substantiated knowledge. Issues associated with the successful integration o f therapies and the management of change within orthodox health care are also explored. Additionally students are
I0
Complementary Therapies in Nursing & Midwifery
As consumer demand increases or shifts, so the needs of practitioners will alter.
expected to select two modules from 8 options offered. T w o of these options are experiential skills based modules focusing on an introduction to one therapy. In addition to this approach a second experientially based course is offered in a specific therapy. Thus students wishing to develop an academic foundation to complementary medicine may, if they wish train in a practical therapy. All modules are presented as stand alone units. Students may be exempted from a module upon satisfactory demonstration of a competent knowledge base in that subject.
PSYCHOLOGICAL ASPECTS OF HEALTH This module examines physiological aspects of health and the implication of wider aspects of the environment upon health and well being. Students will explore key issues and physiological processes influencing health and illness. SOCIOLOGICAL ASPECTS OF HEALTH This module examines the social construction of complementary medicine and the influence of sociological theory in relation to health care. Students will explore how sociological concepts and theories can be related to naturopathic allopathic systems of health care. REGULATION A N D PRACTICE IN C O M P L E M E N T A R Y MEDICINE This module provides students with the opportunity to become acquainted with current British and European Ilegislation in relation to the practice and utilisation of a range of complementary therapies. In addition the module will encourage students to examine the nature of health care practice with reference to ethical and moral considerations. HEALING Explores concepts and practices associated with healing procedures. A range of techniques will be explored and exam ined with reference to the use of healing in clinical practice. A theoretical and experiential approach will be used throughout the module. HOM EOPATHY The principles and practice underlying homeopathic medicine will be addressed and the process of diagnosis and treatment explored. The current status of homeopathy and its place within health care will be discussed along with research on homeopathy. Theoretical and experiential approach will be used throughout the module. O T H E R MODULES INCLUDE 9 9 9 9 9
Stress management Therapies in health care Women's health Decision making in health care settings Hea~th promotion and education
CONCLUSION Undoubtedly the next few years will witness the development of a range of University validated courses in complementary medicine. As consumer demand increases or shifts, so the needs of practitioners will alter. Nevertheless it is suggested that the value of a c o m m o n core programme providing an academic foundation for subsequent studies in complementary medicine should not be underestimated. W e believe this course sets educational precedent by promoting cross-disciplinary education and enhancing professional excellence in the field of complementary medicine. For further details and application forms for the Diploma in Complementary Medicine please contact: The Course Secretary Centre for Complementary Medicine North West, School of Nursing and Health Studies, Stockport College of Further and Higher Education, Wellington Road South, Stockport SK1 3 U Q , UK.
REFERENCES
Bannermanet al 1983 Traditionalmedicineand health care coverage. W.H.O. Geneva British MedicalAssociation1993 Complementary medicine:new approaches to good practice. Oxford UniversityPress, Oxford Eisenberget al 1993 Unconventionalmedicinein the United States: prevalence,costs and patterns of use. New EnglandJournal of Medicine328:246-252 LowenbergJ S, Davis F 1994Beyond medicalisation-demedicahsation:the case for holistic health. Sociologyof Health and Illness16 (5): 570-599 Pietroni P 1990 The greeningof medicine.Victor Gollancz,London Rankin-BoxD F 1991 Proceedwith caution.Nursing Times 87 (45): 34-36 Rankin-BoxD F 1993 Innovationin practice: complementarytherapies in nursing.Complementary Therapies in Medicine 1:30-33 Sharma U 1992 Complementarymedicinetoday. Routledge, New York TrevelyanJ 1994 Courses of action. NursingTimes90 (7): 21 Which 1992 Alternativemedicine.Which (Nov) 45-49
This paper describes the rationale for the development of a Diploma in Complementary Medicine, validated by the University of London and offered by The Centre for Complementary Medicine North West, School of Nursing and Health Studies, Stockport College of Higher and Further Education. The Diploma in Complementary Medicine is in part a considered response to the recent BMA (I 993) report evaluating the current status of complementary medicine in the UK and recommendations for training proposed by the RCN (RCN CTINSIG 1993, 1994). The course team perceived and identified a need for a common theoretical framework, validated at University level, to set precedent for the development of educational standards in the field of complementary therapies. It is suggested that in order to facilitate the development of competent clinical practitioners it is necessary to establish a common educational foundation from which to develop practice skills.
INTRODUCTION
Denise F. Rankin-Box Senior Lecturer in Nursing and Health Studies, Director, Centre for Complementary Medicine North West, Stockport College of Further and Higher Education, Wellington Road South, Stockport SKI 3UQ, UK
The World Health Organisation ( W H O ) has defined alternative medicine as all forms of health care provision which 'usually lie outside the official health care sector' (Bannermann 1984). This broad description embraces traditional systems of medicine such as acupuncture, healing, biofeedback, chiropractic, homeopathy, osteopathy and hypnotherapy. It has been suggested that there may be up to 160 therapies
ComplementaryTherapiesin Nursing& Midwifery(I 995) I, 8- I0 9 1995PearsonProfessionalLtd
practiced in the U K (Skelmersdale 1987 cited by BMA 1993). Complementary therapies are generally those practices which provide a supportive role in the treatment of a disorder and may be used in conjunction with some form of conventional treatment. Pietroni (1990) suggests a taxonomy of classification to distinguish between differing facets of complementary medicine. These are: 9 Complete systems of h e a l i n g - such as acupuncture, herbal medicine, osteopathy and homeopathy 9 Diagnostic methods - kinesiology, iridology, hair analysis and aura diagnosis 9 Therapeutic modalities - massage, reflexology, aromatherapy, spiritual healing, and hydrotherapy 9 Self-help measures - breathing and relaxation techniques, meditation, visualisation, yoga.
RATIONALE UNDERPINNING THE DIPLOMAIN COMPLEMENTARY MEDICINE Increasingly, health professionals are exploring the potential of alternate or supportive approaches to the treatment of health problems (tkankin-Box 1991). Changes witlfin the structure of nursing, demographics and economics suggest that a number of complementary therapies are gaining increasing acceptance within orthodox health care. A restructuring of nursing practice away from task orientated care towards primary nursing and the case approach, espoused by medicine, is facilitating an increase in nursing autonomy and in the provision of individualistic client care. This is providing a forum for increased decision making between clients and nurses regarding the provision and delivery of care. More recently the revised U K C C document 'Scope of Professional Practice' (1993) provides individual nurses with greater autonomy and accountability than previously recognised. It would appear that a proportion of nurses are keen to develop the parameters of their skill to develop their therapeutic role. In this respect there is an increasing demand to undertake training in a complementary therapy, with the view to integrating it within orthodox nursing practice. It is notable that similar developments are also occuring in medical practice (BMA 1993). A number of indicators suggest that generally there is an increase in the use of complementary therapies over recent years ( W h i c h 1992, Eisenberg 1993: BMA 1993). Whilst it is inappropriate to generalise upon these survey
The development of a diploma in complementary medicine
...a recognition of an increase in the number of individuals wishing to practice some form of therapeutic treatment.
findings, it is notable that results suggest that utilisation of the services of complementary therapy practitioners in this country has increased from one in eight people in 1986 to one in four individuals in 1992 (Which 1992). This is not a phenomenon unique to the UK. Eisenberg (1993) reported upon survey findings in the USA suggesting one in three adults had used some form o f non-conventional therapy in 1990. Various explanations have been suggested for this growth ranging from general dissatisfaction and increased critical appraisal of reductionist forms of health care (Sharma 1992; BMA 1993, Rankin-Box 1993) to sociological accounts focusing upon medicalisation-demedicalisation with reference to holistic care (Lowenberg & Davis 1994). In conjunction with increased demand for non-conventional health care services is a recognition of an increase in the number of individuals wishing to practice some form of therapeutic treatment. Whilst it is not the place o f the nursing or medical profession to prescribe consumer activities, health care professionals have a duty to
APPROACHES T O COMPLEMENTARY MEDICINE Provides the opportunity for students to explore and critically appraise different perspectives and approaches to health care. The influence and impact of allopathic medicine and emergent naturopathic perspectives of health care will be explored in relation to sociocultural influences. PSYCHOLOGICAL ASPECTS OF HEALTH Explores how psychology has contributed to our understanding of health and illness. By studying key concepts and theories attributed to psychological research students develop an understanding of the impact of this perspective upon perceptions of health and illness. COUNSELLING SKILLS IN HF.ALTH CARE Examines the repertoire of skills necessary for effective communication practice. A range of techniques and philosophies drawn from counselling are examined in relation to health care practice. The therapeutic process will be addressed with reference to complementary therapies. The skills covered in this module encompass techniques drawn from psychology, communication studies and counselling. RESEARCH M E T H O D S IN HEALTH CARE (DOUBLE MODULE) Explores the role of research methodologies typically adopted by a variety of disciplines. An understanding of research design and data collection methods is utilised in the review of research selected by the student. This module will enable the student to select and critically appraise research studies addressing selected complementary therapies. PROFESSIONAL LEADERSHIP A N D M A N A G E M E N T OF C H A N G E Change is inevitable in the provision of health care. This issue is particularly pertinent when exploring the emergent issuesassociated with the current interest shown in complementary medicine. This module prepares the student to be a successful change expert. Theories underlying the process of change provides the student with the necessary skills to plan, manage and evaluate successfully. PHARMACOLOGY AND TOXICOLOGY The use of specific oils, herbs and medicines in the field of complementary medicine necessitates an awareness of o~hodox pharmacological processes, interactions.
9
safeguard individuals and uphold public health (BMA 1993). In line with the BMA (1993) report, it is recognised that it is important to protect health care consumers from unskilled or unscrupulous practitioners o f health care (BMA 1993). In this respect it is pertinent to address educational issues in this field. The rapid and widespread interest by nurses and doctors in the use o f non-conventional therapies should not be taken to imply that these individuals are competent to train in a therapy o f their choice, and the issue o f competent educational programmes for medical, paramedical and lay people is currently under debate. To date, only osteopathy has statutory recognition in Parliament. The decision to develop a Diploma course for all health professionals rather than orientated towards discrete disciplines such as nursing, pharmacy or medicine was grounded in the belief that innovative health care developments can be enhanced where there is a shared educational experience. This facilitates insight into differing professional perspectives and fosters professional collaboration, communication and understanding. It is suggested that pursuance of traditionalistic approaches to health care education in this field may be divisive promoting the professions rather than the clients interest.
DIPLOMA
OUTLINE
The development of a c o m m o n educational foundation for subsequent training in a therapy is applicable across the field of health care. In this respect the modules offered seek to develop a sound theoretical knowledge base, addressing principles underlying complementary medicine (Trevelyan 1994). The following modules were selected in order to provide an in depth appraisal o f theoretical perspectives o f health care and the nature o f their delivery within the health care context. Core modules focus upon the development o f an holistic perspective o f health care, addressing social, cultural and physiological aspects of health care. Additionally, the social and differing philosophical constructions of complementary medicine are explored along with ethical and legislative considerations. Tables 1 and 2 illustrate some o f the modules presented. The core modules also address research issues underpinning the development o f substantiated knowledge. Issues associated with the successful integration o f therapies and the management of change within orthodox health care are also explored. Additionally students are
I0
Complementary Therapies in Nursing & Midwifery
As consumer demand increases or shifts, so the needs of practitioners will alter.
expected to select two modules from 8 options offered. T w o of these options are experiential skills based modules focusing on an introduction to one therapy. In addition to this approach a second experientially based course is offered in a specific therapy. Thus students wishing to develop an academic foundation to complementary medicine may, if they wish train in a practical therapy. All modules are presented as stand alone units. Students may be exempted from a module upon satisfactory demonstration of a competent knowledge base in that subject.
PSYCHOLOGICAL ASPECTS OF HEALTH This module examines physiological aspects of health and the implication of wider aspects of the environment upon health and well being. Students will explore key issues and physiological processes influencing health and illness. SOCIOLOGICAL ASPECTS OF HEALTH This module examines the social construction of complementary medicine and the influence of sociological theory in relation to health care. Students will explore how sociological concepts and theories can be related to naturopathic allopathic systems of health care. REGULATION A N D PRACTICE IN C O M P L E M E N T A R Y MEDICINE This module provides students with the opportunity to become acquainted with current British and European Ilegislation in relation to the practice and utilisation of a range of complementary therapies. In addition the module will encourage students to examine the nature of health care practice with reference to ethical and moral considerations. HEALING Explores concepts and practices associated with healing procedures. A range of techniques will be explored and exam ined with reference to the use of healing in clinical practice. A theoretical and experiential approach will be used throughout the module. HOM EOPATHY The principles and practice underlying homeopathic medicine will be addressed and the process of diagnosis and treatment explored. The current status of homeopathy and its place within health care will be discussed along with research on homeopathy. Theoretical and experiential approach will be used throughout the module. O T H E R MODULES INCLUDE 9 9 9 9 9
Stress management Therapies in health care Women's health Decision making in health care settings Hea~th promotion and education
CONCLUSION Undoubtedly the next few years will witness the development of a range of University validated courses in complementary medicine. As consumer demand increases or shifts, so the needs of practitioners will alter. Nevertheless it is suggested that the value of a c o m m o n core programme providing an academic foundation for subsequent studies in complementary medicine should not be underestimated. W e believe this course sets educational precedent by promoting cross-disciplinary education and enhancing professional excellence in the field of complementary medicine. For further details and application forms for the Diploma in Complementary Medicine please contact: The Course Secretary Centre for Complementary Medicine North West, School of Nursing and Health Studies, Stockport College of Further and Higher Education, Wellington Road South, Stockport SK1 3 U Q , UK.
REFERENCES
Bannermanet al 1983 Traditionalmedicineand health care coverage. W.H.O. Geneva British MedicalAssociation1993 Complementary medicine:new approaches to good practice. Oxford UniversityPress, Oxford Eisenberget al 1993 Unconventionalmedicinein the United States: prevalence,costs and patterns of use. New EnglandJournal of Medicine328:246-252 LowenbergJ S, Davis F 1994Beyond medicalisation-demedicahsation:the case for holistic health. Sociologyof Health and Illness16 (5): 570-599 Pietroni P 1990 The greeningof medicine.Victor Gollancz,London Rankin-BoxD F 1991 Proceedwith caution.Nursing Times 87 (45): 34-36 Rankin-BoxD F 1993 Innovationin practice: complementarytherapies in nursing.Complementary Therapies in Medicine 1:30-33 Sharma U 1992 Complementarymedicinetoday. Routledge, New York TrevelyanJ 1994 Courses of action. NursingTimes90 (7): 21 Which 1992 Alternativemedicine.Which (Nov) 45-49