Abstract
This study acknowledges the increasing use of complementary and alternative medicine (CAM) within the Iranian population and it highlights a corresponding need for nurses to be better informed about CAM if they are to support patients in this respect. I concur with the authors’ assertion that nurses tend to have a relatively low knowledge base in relation to CAM and I share their enthusiasm for the inclusion of CAM in nursing curricula. Although I was struck by the similarities between this study and comparable Western observations, with which I am more familiar, it is undoubtedly difficult to meaningfully translate research findings from one cultural community to another. The study therefore has the potential to inform future practice and policy development in nursing, specific to the context of Iranian health care.
A questionnaire approach is applied to determine levels of knowledge and attitude to CAM amongst nurses working in Iranian hospitals. Although this approach can prove useful in terms of raising awareness and encouraging an atmosphere of curiosity, I would encourage the authors to now consider how qualitative approaches, thoughtfully selected, might clarify and elaborate on their initial findings.
It is my experience, for example, that CAM is very slow to infiltrate nursing curricula and that progress in this respect is dependent on collaboration and consensus between educators, practitioners and, wherever possible, by embracing the patient perspective in curricula design. This can be achieved by drawing on qualitative approaches that: facilitate engagement between groups as a means for exposing and debating difference; provide insight into meanings that underpin health care behaviour; and permeate professional barriers that hinder collaborative practice. In the context of this particular study, such approaches would enable a shared understanding about CAM to emerge, from a range of personal, professional and patient perspectives.
One concern that I have with this study is the suggestion that nurses ‘have an important role in advising and directing patients towards effective therapy methods’ and that they require ‘sufficient knowledge about CAM treatments and the influence and side effects of different methods’. Quite rightly, the authors identify that ‘CAM’ subsumes a vast range of therapies. These therapies, however, do not share a common underpinning, a fact that demands caution in determining the role of nurses in supporting patients in their use of CAM. Whereas it would be beyond the realms of possibility to account for the methods, risks and benefits unique to each of these therapies, a broad-based programme of education that enables nurses to guide patients towards sources of reliable information about CAM would be both achievable and beneficial to the cause. Designated CAM ambassador(s) within the health care setting can also provide a useful centre point for concentrating information-gathering efforts. In other words, it is preferable to be well informed about broad principles than to be poorly informed about detail.
Overall, I am heartened by the authors’ endeavours to highlight the need for conventional health care to ‘catch up’ with trends in patients’ health care behaviours and to situate this in the context of contemporary nurse education. The potential for nurses to play a pivotal role in supporting patients in their use of CAM is evident but is clearly dependent on the provision of education that enables them to do so confidently and responsibly. The challenge here is to mould practice, educational and/or policy developments in such a way that strikes a balance between preserving the patient’s right to choose while promoting safe healthcare behaviours. I would encourage the authors to further their studies in pursuit of this goal.