Response From NH-PAI to White House Commission on COMPLEMENTARY AND ALTERNATIVE MEDICINE POLICY
by Rebecca Good, Coordinator Nurse Healers-Professional Associates, International, Inc., The Official Organization of Therapeutic Touch

This article appeared in the NH-PAI publication, the "Co-operative Connection".

It is printed with the intent of making the questions and responses available as a worldwide reference for Therapeutic Touch practitioners and teachers.

The Commission on CAM is made up of individuals appointed by the President with the mandate of addressing:

1) coordinated research on complementary and alternative (CAM) practices and products 2) appropriate education and training of CAM and conventional heath care practitioners 3) dissemination of reliable information on CAM to health care providers and the general public 4) delivery and public access to CAM services Additional information on this Commission can be obtained at its web site at: http://www.whccamp.hhs.gov.

The Commission has had town meetings in several states and has asked NH-PAI and other organizations to answer questions regarding education and training of health care practitioners, quality of care, and accountability specific to each organization. The questions and responses follows.

Therapeutic Touch was developed in the early 1970? by Dr. Dolores Krieger, then a professor of nursing at New York University, and Dora Van Gelder Kunz, a natural healer.

Nurse Healers-Professional Associates International (NH-PAI) was formed in 1976 by Dr. Krieger and a group of professionals who felt there was a need to have an organized body to share information and to develop standards of practice and policy and procedure for this well researched and effective healing therapy. Dolores Krieger, presently Professor Emerita, taught the first class in any college or university on a complementary therapy, at New York University in the late 1970's. This course on Therapeutic Touch is still being taught there today. In addition, TT is taught in numerous colleges and universities throughout the United States and in over 80 countries throughout the world.

TT has the strongest research base of any CAM therapy and includes multiple doctoral and master theses, predominately in nursing.

"Energy field disturbance" is a nursing diagnosis according to the North American Nursing Diagnosis Association (NANDA). Although TT is primarily practiced by nurses, Dr Krieger and Dora Kunz realized that healing is a natural potential and so it is appropriate that other healthcare professionals as well as lay people are also learning and using TT to help others.

The interesting, and in some cases, challenging questions that were developed to guide the Commission's deliberations are addressed.

1. Are there national educational standards for Therapeutic Touch undergraduate, postgraduate, and continuing education? Should those national educational standards include exposure to CAM other than Therapeutic Touch?

Yes, there are national educational standards for Therapeutic Touch education, which are set by Nurse Healers-Professional Associates International, the official organization for Therapeutic Touch. There are courses taught at the undergraduate, post graduate and continuing education level.

While NH-PAI does not set standards for other CAM therapies, it supports and includes other CAM therapies in its conferences. Although many of our practitioners practice other CAM therapies and have taken classes from qualified teachers of such therapies, they do not teach other CAM therapies in a TT class. Students in a TT class often ask questions while they are trying to compare TT with other modalities. TT teachers need to be familiar with a variety CAM therapy, but it is unrealistic for anyone to be current with all of the alternatives. Further, it is not the function of a TT class to go into depth on any modality other than TT. It would be confusing to the student to intermingle therapies. TT is only one option among many; this would be the perspective of any teacher or practitioner.

2. Should there be national standards or certification to provide CAM practices and products? If so, how and by whom should national standards or certification be established, to whom should they apply, and how should they be implemented?

Yes, there should be national standards of for CAM practices and products. Standards, certification and/or credentialing would be done by the official organization that has a full understanding of that specific CAM therapy.

National standards and certification should apply to all individuals who practice or teach the modality, especially in a hospital, healthcare facility, and private practice or for compensation. The application would be directed to, and credentialing implemented by, the appropriate organization for each CAM therapy.

3. Should the numerous energy healer organizations come together to form "a community"? If so, how and by whom should that "community" be formed?

No, the energy healer organizations should not form a "community." It is not possible to lump different energy modalities together. Each is separate and distinct. IT MUST BE UNDERSTOOD THAT ALL ENERGY HEALING IS NOT IDENTICAL.

If this were done, the result will be to muddy the waters for the consumer and in the education of the health care professionals and the general public. Each form of energy healing needs to stand on its own research and not on already proven and established healing modalities that are unrelated in their approaches, programs or processes. In addition, there is already sharing through professional journals and the many conferences held throughout the United States.

4. Should there be condition-specific or modality-specific practice guidelines and why or why not? If so, how and by whom should these guidelines be developed, to whom should they apply, and how should they be implemented?

There should be modality specific guidelines and standards of practice set by the professional organizations of each modality. The modality specific organization is best equipped to do so. It contains the experts in the modality; they are familiar with the history, education, practice and research.

As for condition specific guidelines, one cannot do that with TT as it is based on and individualized assessment. While two people may have the same physical "condition", energetically their treatments might look quite different. Such guidelines would take away from being client-focused. Healing is about treating the whole person; and we are each different and unique. As one practices TT for a period of time and attends the advanced workshops, information is shared on what different practitioners have found helpful in certain clinical situations, but it may not be the primary focus each client needs.

5. Are your members concerned about malpractice liability associated with providing CAM practices and products?

Each modality has to be considered individually. This is a difficult question for NH-PAI as TT is a non-invasive technique. The TT therapist works primarily in the client/patient's energy field and sometimes does gentle hands-on work. There have been no problems of malpractice with TT in the 30 years it has been in existence.

However, some of our members feel the need for malpractice insurance in this litigious society; others do not. There is a double-edged sword to malpractice insurance for CAM therapies. If there is no insurance, then there is no money to be sought after. If malpractice insurance comes to be, then it is feeding into the possibility of dramatically increased lawsuits which has occurred in the past twenty years in conventional Western medicine. Question 6 will continue NH-PAI's response to this question.

6. Are there any risks associated with CAM that may be of concern to your members? If so, can you suggest ways to minimize those risks?

As stated above, TT has little, if any risk when it is the only CAM therapy used and the individual is well educated in using the intervention. There are possible risks to CAM. There is a lack of credentialing in many modalities combined with a proliferation of practitioners who say they practice a modality, but are not qualified to do so.

In general, energy modalities have been lumped together, and this is a particular problem because the practice of one often violates the conceptual basis of another. The uninformed clients/patients may not actually be receiving what they think they are.

There is need for more research and increased funding. Each CAM must be clearly defined with its own research. CAM modalities are developed from a variety of theoretical frameworks. There have been instances of a modality other than Therapeutic Touch citing TT research as supporting its own outcomes. Such a practice can mislead the uninformed which is often the medical community. It is essential for each CAM to have integrity regarding the research of its own discipline.

Another risk is that the CAM practitioner demonstrates a negative attitude toward allopathic medicine. It is important that the CAM practitioner is part of the medical team. The patient is empowered to use Dr Krieger's 'optional medicine' approach in which they choose from among the options of treatment.

7. Should there be a mechanism to address consumer concerns or grievances about the quality of CAM practices or products? If so, what should that mechanism be?

Yes. The mechanism would be the same as that for allopathic medicine. This has not been addressed by healing organizations yet, but is an area, which deserves exploration and clarification.

8. What information should a conventional health care provider communicate to a CAM practitioner? What information should a CAM practitioner communicate to a conventional provider either with a referral or without a referral as when a consumer self-refers?

Full disclosure with the consent of the client/patient is most helpful and appropriate on the part of both practitioners. A common problem lies in the fact that the patients/clients do not tell their conventional medicine provider that they are seeing or seeking a CAM provider out of fear that their doctor may react negatively.

The conventional medicine practitioner should communicate the same information that s/he would to a conventional medicine practitioner. BOTH are professionals in their area of expertise, and all information relevant to the patient/client's wellbeing should be shared.

The problem lies in the lack of respect some allopathic practitioners have for CAM. There needs to be massive education. Appropriate CAM awareness should begin at the college, nursing and medical school levels. Clients/ patients need to be part of the team and not feel they need to discontinue one course of treatment over the another.

9. What policy recommendations would you like to make to assure the quality of CAM practices and products whether they are provided by a practitioner or used as self-care?

* Only CAM practitioners who meet the credentialing criteria of the official organization or accrediting body *Practice in hospitals, and private practice or for remuneration * Policy and procedure for the practice of each CAM where it is practiced * The practitioner's credentialing information should be available for the client. * Proper labeling of products * Better education of the healthcare providers and public about CAM * More cooperation and referrals by allopathic practitioners to CAM practitioners * Many CAM practitioners will give their allopathic colleagues a free consult to experience the technique or process. * More research in CAM * Increased access to CAM therapies by reimbursement from insurance companies, Medicaid and Medicare * Increased role by government in educating the public in the advantages, of self-responsibility, alternative/complementary modalities and choice.

Thank you again for inviting NH-PAI to participate in these hearings.

From the Cooperative Connection, the newsletter of the NH-PAI, Vol. XXII, No. 2, Spring 2001 Reprinted with permission of the Nurse Healers-Professional Associates International. Inc. Permission to copy granted from In Touch and the TTNO.

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