The interpretation of research in health care is essential to decision making. By understanding research, health care providers can identify risk factors, trends, outcomes for treatment, health care c

However, increasing numbers of people are using private CAM therapists to address their health needs. This has consequences in terms of cost to the patient, of using CAM instead of traditional health care, and for policy makers and educators raises questions of competency, regulation and research to validate its eflScacy. This article provides a personal account of a nurse educator's discovery of homeopathy as a complementary therapy, its impact upon health status, training undertaken and action taken as a result. It outlines the potential use of CAM as a holistic approach that embraces the interprofessional framework and suggests CAM practitioner inclusion within mainstream healthcare provision. The article emphasizes the need for further quantitative and qualitative research of CAM treatment.

Key words: Reflection • Education • Research • Interprofessionalism I nterprofessional working across service sectors to meet client needs, is outlined in 'The NHS Plan' (Department of Health (DH), 2000), and in the National Service Frameworks for mental health (DH, 1999), older people (DH, 2001b) and children (DH, 2005a).

According to the House of Lords Select Committee on Science and Technology (HLSCST) 'Report on Complementary and Alternative Medicine (CAM)' (2000), the strategy paper 'Building on the Best: Choice, Responsiveness and Equity in the NHS' (DH, 2003) and National Institute for Clinical Excellence guidelines (NICE, 2004a,b), CAMs are becoming more relevant. This is also refiected in the estimated ;£130 million a year spent on CAM and this expenditure continues to rise (Prince of Wales Foundation for Integrated Health, 2003).

There is evidence to suggest that CAM has physical, psychological, emotional and spiritual benefits (HLSCST, 2000; Washburn, 2000; Lewith et al, 2002; Bechtel, 2004).

Mary Laurenson is Lecturer in Health and Social Care, University of Hull Accepted for publication:

March 2006 However, it is arguable that people with long-term health conditions have difficulty accessing CAM because of lack of knowledge and attitudes towards CAM, and because of the financial costs (DH, 2003, 2004, 2005b). It is necessary to overcome these issues if CAM is to become integrated into mainstream healthcare provision.

As a consequence of the changing healthcare environment the provision of CAM over a range of practice areas needs to be explored. This exploration will enable healthcare professionals to embrace different frameworks and to refiect, examine and critically analyse their own practice and the practice of others.

Reflections: scepticism, reveiation, indoctrination and deiiverance Before entering teaching in 1990 I had been a nurse practitioner since the 1960s and was open to all the biomedical and nursing models of caring.

My belief in the conventional system was unquestionable as I had witnessed the extraordinary results over years of evidence- based practice. I was sceptical of any other approach, but using the biomedical model for my rheumatoid arthritic condition had not eased the symptoms and repeat prescriptions of medication only masked the pain for short periods.

The revelation about a different way forward came when a friend suggested a visit to a homeopath. My first reaction was 'stuff and nonsense, this cannot help', but in desperation for pain relief I booked an appointment. The homeopath listened to my complete history and at the end of the lengthy consultation said that she would send me a remedy through the post. I remember driving home thinking'well there goes j{^50'.

I consoled myself that she had given her time and had listened to my life history, but wondered why all that information was necessary. Three days later the remedy arrived and I was shocked to see one extremely small soft tablet. The thought of this one tablet doing what all my normal medication could not do seemed impossible and I very nearly threw the tablet away. I guess the truth is that having spent ^50 I thought I might as well take it, after all what harm could it do?

What happened next changed my whole outlook on life because as the tablet melted on my tongue the pain dripped quickly downwards out of my body.

It was instantaneous and unbelievable as I was without pain for the first time in years.

Then my questioning mind though this cannot be permanent and the pain would return as soon as the effects ofthe remedy wore off and then I'd be onto a more expensive form of treatment. I was wrong, the pain never returned and 6 years on I am still pain free and have not had to take any further medication for my condition. In fact, after further blood tests my rheumatoid factor is now normal.

I was baffled and thought no one would believe me and so began my quest to find out more about homeopathy. My initiation into homeopathy began with reading and culminated in a 4-year training course.

This taught me about Hahnemann and his rediscovery of modern homeopathy (its origins began in ancient Greece) and about the minimal dose, the Law of Cure (symptoms moving downwards and outwards, inward to outward) and numerous other aspects of a holistic way of helping people to heal themselves.

356 British Journal of Nursing, 2006, Vol 15, No 7 COMPLEMENTARY THERAPY I still believe in the biomedical and nursing models of care, but also believe in CAM and wanted to share this knowledge with others and so deliverance came in the form of introducing a post-registration module on CAM into the nursing curriculum.

CAM integration The newly introduced CAM module helped to raise practitioners' awareness and knowledge, to enable them to provide patients with a choice in service provision, as oudined in the DH paper 'Building on the Best:

Choice, Responsiveness and Equity in the NHS' (DH, 2003). The learning outcomes enabled students to develop a critical aw^areness of CAM issues; raise awareness of and promote new and innovative ways of practice in health and social care; consohdate and build on previous knowledge, skills and attitudes; recognize and understand change in service provision; acknowledge diversity and personal identity; and critically challenge and evaluate professional evidence-based practice.

If CAM was integrated more fully into higher education it would also present a flirther opportunity for interprofessional collaboration and lead to research on competency and regulation. The HLSCST 'Report on Complementary and Alternative Medicine' (2000) and the DH paper Better Regulation of Complementary Healthcare (2004) both made recommendations about the requirement for regulation, education and research to expand practitioners' knowledge and to address the need for an overarching regulatory body.

Nurses' knowledge of CAM does not enable them to help patients make informed choices so curricular change if needed to address this. Nursing research is needed to provide scientific evidence of efficacy of the different CAM therapies. While the general public are increasingly using CAM, it remains controversial within mainstream health care.

To counteract this is it necessary for professionals to understand CAM and to contextuahze it in terms of its historical, political and ethical frameworks, so that they can critically analyse whether these should be included in mainstream provision.

This means examining published research and assessing their attitudes to CAM.

Westwood (1991) states, that many therapies, such as aromatherapy, have historical usage and are centuries old.The Cochrane Collaboration (1999) defined CAM as, '...a domain of healing resources for all health systems, modalities.

practices, theories and beliefs other than the politically dominant health system of a particular society or culture at a given period in history'.

Ernst (1995) and Ernst and Cassileth (1998) suggest complementary therapies can be used to aid diagnosis, treatment or disease prevention and act as an adjunct to mainstream conventional medicine, while alternative medicine is a direct substitute for orthodox medicine. The HLSCST Report (2000) stated that five professions in group 1 — osteopathy, chiropractic, acupuncture, herbalism and homeopathy — had scientific credibility, were safe to use, were effective, and had professional accountability. They also stated that homeopathy carried the fewest inherent risks in its practice.

Evidence-based practice, education and researcii The problems facing homeopathy being accepted into mainstream care centres on its inability to provide a scientific explanation of how its remedies work. But is this because it follows a different methodological approach to the one conventionally used by traditional medicine and should this bar it from further investigation? If patients positively acknowledge the benefits, then it may be time for the scientific community to assess the accuracy of these benefits by reviewing the evidence for efficacy and safety.

Information on CAM therapies needs to be integrated into education courses for health practitioners so that practitioners working in health and social care can assess the benefits and contraindications using an evidence-based practice approach. Evidence of CAM efficacy using an empirical approach is inconclusive, even though some studies have met the Cochrane criteria (1999).

In terms of proving CAM efficacy, both quantitative and qualitative methodological approaches should be used, as incorporation into the nursing curriculum means it is necessary to justify its inclusion in terms of patient outcomes.

The main barrier to incorporation of CAM into mainstream heath care is the lack of evidence, but this barrier is also a way of ensuring that further research is undertaken.

There is a need to widen practice through interprofessional and interagency working to open education opportunities to incorporate CAM therapies (Corner et al, 1995). At the same time, ethical, legal and accountability issues have to be addressed (Ernst et al.

2004).

The problem is that adding to the curriculum by trying to integrate change into estabhshed practice brings resistance (Curtis and White, 2002).

The Nursing and Midwifery Council Code of Professional Conduct (NMC, 2004) points out that any employer giving consent for nurses to practice complementary therapies must ensure practice is within the scope of professional practice and that professional body registration is obtained along with the patients' informed consent. This is a major issue as nurses are notorious for working beyond their boundaries and embracing new opportunities (Burton, 2000; Cook, 2000; English National Board, 2001). It also brings in the need for CAM practitioners to embrace regulation if they wish to be included within mainstream provision.

Conclusion The general population, as well as health professionals, are increasingly accepting the value of complementary therapies alongside conventional medicine. Michael Fox, Chief Executive of The Prince of Wales Foundation for Integrated Health, stated:

'Complementary and conventional medicine can work safely alongside each other as long as there is effective communication bet^veen all practitioners as ^vell as between patients and practitioners.

For patients to receive the best treatment, it is essential to make sure that complementary practitioners are aware of any conventional treatment they are having and that other health professionals are aware of any concurrent complementary treatments' (Prince of Wales Foundation for Integrated Health, 2003 p2).

This is one practitioner's account of her discovery of CAM and the measures taken as a response to this.

There is a place for CAM in mainstream healthcare provision, but there is also the need for further research. If nurses are to offer information about choice to patients then they themselves need an understanding of the choices available. One way of overcoming these concerns and increasing nurses' knowledge and application of CAM is to include it in their professional education and training at both pre- and post-registration. liU3 British Journal of Nursing, 2006, Vol 15, No 7 357 Bechtel R (2004) Complcineiit.iry therapies in rehabilitation:

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Amberwood Publishing, Kent KEY POINTS I Healthcare professionals require an understanding of complementary and alternative medicine (CAM) to enable them to provide informed choice to patients.

I The mainstream healthcare curriculum needs to adapt to include CAM into its provision.

I CAM professional bodies need regulation to meet nationally recognized heaithcare standards.

I Integrating CAM into mainstream healthcare provision requires further research to assess its efficacy.

znternurse With over 9000 peer-reviewed clinical and professional articles, and more than half a million downloads in the last 12 months, /nternurse.com is the largest online nursing archive in the UK Log on and see what you're missing illl MA Healthcare Ltd, Jesses Farm, Snow Hill, Dinton, Nr Salisbury, Wiltshire SP3 5HN tel 01722 716997 fax 01722 716926 MA HEAITHCARE UMIItD 358 British Journal of Nursing, 2006, Vol 15, No 7