Massachusetts Board of Registration in Nursing
Advisory Ruling on Nursing Practice
Title: Holistic Nursing and Complementary Integrative Health Approaches
(Previous title: Holistic Nursing and Complementary/Alternative Modalities)
Advisory Ruling Number: 9801
Authority:
The Massachusetts Board of Registration in Nursing (Board) is created and authorized by Massachusetts General Laws (M.G.L.) c. 13, §§ 13, 14, 14A, 15 and 15D, and G.L. c. 112, §§ 74 through 81C to protect the health, safety, and welfare of the citizens of the Commonwealth through the regulation of nursing practice and education. In addition, M.G.L. c.30A, § 8 authorizes the Board to make advisory rulings with respect to the applicability to any person, property or state of facts of any statute or regulation enforced or administered by the Board. Each nurse is required to practice in accordance with accepted standards of practice and is responsible and accountable for his or her nursing judgments, actions, and competency. The Board’s regulation at 244 CMR 9.03(6) requires all nurses to comply with any other law and regulation related to licensure and practice.
Date Issued: September 10, 1997
Date Revised: September 25, 2002; September 12, 2012, September 9, 2015
Scope of Practice: Registered Nurse and Licensed Practical Nurse
Purpose:
To guide the practice of registered nurses and licensed practical nurses who, within their practice, incorporate complementary integrative health approaches (CHA) to meet such nursing and client goals including, but not limited to, increased comfort, relief of pain, relaxation, improved coping mechanisms, reduction of stress, an increased sense of well-being comprehensive health promotion and health risk reduction.
Acupuncture or body manipulative methods such as chiropractic or craniosacral therapy are not within the scope of nursing practice. Nurses who integrate homeopathy, herbal medicines and/or dietary supplements (a vitamin, a mineral, an herb or other botanical, an amino acid, a dietary substance for use by humans to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract, or combinations of these ingredients[1]) into their practice require a prescription(s) from duly authorized prescribers identifying the minimum required elements[2] of a prescription prior to incorporation in the overall plan of care.
Advisory:
A model of holistic nursing incorporates a philosophy of nursing practice that involves recognizing the individual as an integrated whole interacting with and being acted upon by both internal and external environments. Holistic nursing emphasizes self-care, intentionality, presence, mindfulness, and therapeutic use of self as central to facilitating healing and patterning wellness in others. It involves studying and appreciating the interrelationships of the bio-psycho-social-spiritual dimensions of the person.
Nurses who practice holistic nursing integrate CHA into clinical practice as a nursing intervention to treat individual’s physiological, psychological, and spiritual needs as part of an overall plan of care. Examples of CHA include, but are not limited to:
- Mind-body interventions
- Meditation, relaxation, imagery, hypnosis, yoga, t’ai chi, prayer, art, music and dance therapies, cognitive-behavioral therapy, biofeedback, therapeutic counseling, stress management
- Energy therapies
- Therapeutic touch, Reiki, qi gong, acupressure, healing touch, magnet therapy
- Other modalities
- Relaxation massage
- Reflexology
- Shiatsu
- Aromatherapy
- Guided imagery
- Animal-assisted therapy
- Use of essential oils
Patient Consent Required
When nurses employ CHA patients must grant informed consent in writing or orally, with substantiating documentation by the nurse. In obtaining informed consent for a CHA nursing intervention, the nurse will provide the client with information about the modality, including its intended benefits and potential risks, as well as conventional treatments or procedures that are available.
Competency
Employing CHA requires that the nurse have documented knowledge, skills and competency in using each modality. Education programs which have as their objective the preparation of nurses in the use of CHA must be guided by the minimum requirements for nursing continuing education at 244 CMR 5.00. When such education programs include a clinical component, a licensed nurse must provide supervision.
Standards of nursing practice for a nurse competent to employ CHA, includes, but is not limited to:
- performing medication reconciliation that includes a query of herb, vitamin, mineral, homeopathy, herbal medicines and/or dietary supplement use
- documenting patient consent, assessment information, plan of care, interventions, and evaluation of response to treatment
- collaborating and consulting with appropriate members of the health care team
Relaxation Massage
Nurses may incorporate relaxation massage into their practice as part of a nursing plan of care. Unless currently licensed as a massage therapist by the Board of Registration of Massage Therapy (pursuant to M.G.L. c.112), a licensed nurse may not hold him/herself out to others as a massage therapist or practice massage independent from an organized healthcare business and/or independent from a nursing plan of care.
Nurse in a Management Role
The nurse in a management role must ensure the availability of sufficient resources to provide for safe implementation of CHA, including, but not limited to organizational evidence-based policies and procedures consistent with current nursing standards that provide for:
- protocols for assessing, validating and documenting CHA competency acquisition and maintenance for each activity
- nursing care responsibilities, including, but not limited to patient assessment, monitoring, medication practices, response to potential complications and/or emergency situations, and documentation criteria
References:
American Holistic Nurses Association (AHNA), & American Nurses Association (ANA). (2013). Holistic Nursing: Scope and Standards of Practice (2nd ed.) Silver Springs, MD: NurseBooks.org
American Holistic Nurses Association. (2012). Position on the Role of Nurses in the Practice of Complementary and Alternative Therapies. Accessed 5/15/15 at http://www.ahna.org/Resources/Publications/Position-Statements
National Center for Complementary and Integrative Health. Accessed 5/15/15 at http://nccam.nih.gov/
Institute of Medicine. (2005). Complementary and Alternative Medicine in the United States. Accessed at http://www.nap.edu/openbook.php?record_id=11182&page=1 5/15/15
U. S. Food and Drug Administration accessed 5/15/15 at http://www.fda.gov/AboutFDA/Transparency/Basics/ucm194357.htm (Page Last Updated: 01/26/2015)
[1]http://www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/SignificantAmendmentstotheFDCAct/ucm148003.htm accessed 5/26/15
[2] Name of ultimate user, name of the medication/substance, dose and route of the medication/substance, frequency of the medication/substance administration, a valid medication/substance order date, specific directions for administration, signature of the duly authorized prescriber, signature of the individual accepting/verifying the order.
