Essentials of Complementary and Alternative Medicine (June 1999)

ORGANIZATION
Training
The education of the naturopathic physician is extensive and incorporates the diversity that typifies the natural health care movement. The training program is similar 
to conventional medical education, but the primary differences are in the therapeutic sciences. To be eligible to enroll, prospective students must first successfully 
complete a conventional premedicine program, which typically requires a college degree in a biological science.
The naturopathic curriculum is a four-year program. The first two years concentrate on the human biological sciences, basic diagnostic sciences, and introduction to 
the various treatment modalities. The conventional basic medical sciences include anatomy, human dissection, histology, physiology, biochemistry, pathology, 
microbiology, public health, pharmacology, biostatistics, and so on. The development of diagnostic skills is initiated with courses in physical diagnosis, laboratory 
diagnosis, and clinical assessment. Finally, introductory natural medicine subjects, such as environmental health, pharmacognosy (pharmacology of herbal 
medicines), naturopathic philosophy, Chinese medicine, Ayurvedic medicine, homeopathy, counseling, spinal manipulation, nutrition, and hydrotherapy, are covered.
The last 2 years are oriented towards the clinical sciences of diagnosis and treatment. Not only are the standard diagnostic techniques of physical, laboratory, and 
radiological examination taught, but there is a special emphasis on preventive diagnosis, such as diet analysis, recognition of the early physical signs of nutritional 
deficiencies, laboratory methods for assessing physiological dysfunction before it progresses to cellular pathology and end-stage disease, and methods of assessing 
toxic load and liver detoxification efficacy. The natural therapies, such as nutrition, botanical medicines, homeopathy, acupuncture, natural childbirth, hydrotherapy, 
fasting, physical therapy, exercise therapy, counseling, and lifestyle modification, are also studied extensively.
During the last 2 years, students also work in clinical settings seeing patients, first as observers and later as primary care providers under the supervision of licensed 
NDs. Unlike MD and DO schools, most naturopaths do not go on to internship or residency training, although a limited number of optional residencies are available. 
Naturopaths do not do inpatient training or care; therefore, they generally do not deal with seriously ill patients who require hospitalization. These patients are referred 
for conventional treatment.
Professional Organizations
Three national organizations define and ensure the standards of naturopathic medicine: the Council on Naturopathic Medical Education (CNME), American 
Association of Naturopathic Physicians (AANP), and the Naturopathic Physicians Licensing Examination (NPLEx). The CNME is recognized by the United States 
Department of Education as the accrediting agency for schools and programs of naturopathic medicine. The AANP is the national professional association and counts 
the majority of licensed NDs in the United States as members of the associations. NPLEx provides nationally recognized standardized tests for licensing.
Licensing
Naturopathic physicians (NDs or NMDs) are currently licensed as primary health care providers in Alaska, Arizona, Connecticut, Hawaii, Maine, Montana, New 
Hampshire, Oregon, Puerto Rico, Utah, Vermont, and Washington. Legal provisions allow the practice of naturopathic medicine in several other states. There are 
currently efforts to gain licensure in other states. Naturopathic physicians are also recognized in most of the provinces in Canada. Naturopaths also practice in other 
states without government approval; however, without licensing standards, individuals with little or no formal education can proclaim themselves naturopaths.
All states and provinces with licensure laws require a resident course of at least 4 years and at least 4,100 hours of study from a college or university recognized by 
the State Examining Board. To qualify for a license, the applicant must satisfactorily pass the Naturopathic Physicians Licensing Exam, which includes basic sciences, 
diagnostic and therapeutic subjects, and clinical sciences. An applicant must satisfy all licensing requirements for the individual state or province to which he or she 
has applied as well. This requirement in most states licensing naturopathic physicians is a comprehensive written state board exam divided into main areas of focus 
and given over a 2- to 3-day period.
Unlicensed, self-proclaimed naturopaths are a serious problem for both the public and the naturopathic profession. With either no education or only correspondence 
school study, their health care credentials are, at best, problematic. In unlicensed states, the best criteria to determine if a naturopathic physician is legitimate is if he 
or she is a graduate from one of the three schools listed previously or a member of the AANP.
Reimbursement Status
Similar to licensure, insurance reimbursement differs from state to state. Insurance reimbursement ranges from government-mandated reimbursement, as occurs in 
Connecticut and Washington, to no reimbursement. Reimbursement standards for naturopathic physicians are of growing interest for insurance groups in many 
states.
Relations with Conventional Medicine
Because naturopathic physicians are primary care providers, it is essential they interact with conventional medical doctors. Naturopathic physicians, out of necessity 
for good patient care, develop a good working relationship with the various medical specialists to whom their patients must be referred when needed. Referral is 
required when more interventionist therapy or hospitalization is required. Examples of cases in which referrals are appropriate include life- threatening situations (e.g., 
acute myocardial infarction, stroke, sepsis, appendicitis, ruptured spleen), conditions in which the disease process has become advanced to a stage that is organ-or 
life-threatening (e.g., severe angina, very high blood pressure, advanced osteoporosis, nephrotic syndrome, brittle diabetes), and any condition outside the scope of 

practice for the individual naturopathic physician (e.g., broken bones, traumatic injuries requiring surgery).
The difficulty many naturopathic physicians experience in attempting to interact with conventional medical doctors stems from misconceptions the medical doctor may 
have about naturopathic medicine or from fraudulent naturopathic practitioners. These issues are usually displaced when conventional medical doctors interact with a 
well-trained modern naturopathic physician.
PROSPECTS FOR THE FUTURE
To some, naturopathic medicine, as well as the entire concept of natural medicine, appears to be a fad that will soon pass away. However, naturopathic physicians 
believe they are at the forefront of a better health care system.
One of the myths about naturopathic medicine is that there is no firm scientific evidence for the use of the natural therapies. However, numerous research studies and 
observations have not only backed the validity of diet, nutritional supplements, herbal medicines, detoxification, and physical medicine, but also have lent some 
support to more esoteric natural healing treatments, such as acupuncture, biofeedback, meditation, and homeopathy. In some cases, the scientific investigation has 
not only validated the natural measure, but also led to greater understanding of the pathophysiology and healing processes of the practices. In the past 30 years, 
there have been advances in understanding about how many natural therapies and compounds work to promote health or treat disease. Research has not lent 
support to all naturopathic practices. For example, recent studies on the effect of several naturopathic on the progress of HIV disease have shown no benefit from 
such practices. Undoubtedly, other established naturopathic practices will be shown to be ineffective or possibly even harmful as more and better research is 
conducted. The naturopathic organizations are committed to conducting those studies and improving naturopathic practices as resources for such research become 
available.
Scientific tools exist to assess and evaluate the fundamental principles and therapies of naturopathic medicine. It is becoming more common for conventional 
medicine to adopt and endorse a number of age-old naturopathic techniques, such as lifestyle modification, stress reduction, exercise, consuming a whole foods diet, 
supplemental nutrients, toxin reduction, and others.
There is a paradigm shift occurring in medicine. What was once scoffed at is now becoming generally accepted as effective. In many cases of common illnesses, the 
naturopathic alternative offers significant benefit over standard medical practices. In the future, it is likely that many of the concepts, philosophies, and practices of 
naturopathy will be demonstrated.
The naturopathic profession is growing rapidly. The therapeutic and diagnostic skills of practitioners are becoming more sophisticated; licensing is being established 
in new states; and public interest is strong. Key to the profession's future is becoming an integral part of the health care system.
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HAPTER
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CHAPTER 18. H
OLISTIC
 N
URSING
Essentials of Complementary and Alternative Medicine
CHAPTER 18. H
OLISTIC
 N
URSING
Barbara Dossey
Background
 
Definition and Description
 
History and Development
 
Principal Concepts of the Philosophy and Model of Holistic Nursing
Provider-Patient/Client Interactions
 
Patient Assessment Procedures
Therapy and Outcomes
 
Treatment Options
 
Description of Treatment Interventions and Evaluation
Use of the System for Treatment
 
Meanings of Health and Illness
 
Doing and Being Therapies
 
Ritual
Organization
 
Training
 
Quality Assurance
 
Reimbursement Status and Relations with Conventional Medicine
Prospects for the Future
Resources
Chapter References
BACKGROUND
Definition and Description
Holistic nursing is a philosophy and a model that integrates concepts of presence, healing, and holism. Although holistic nursing is not a system of nursing practice, it 
is recognized as an important way to conceptualize and practice professional nursing. The American Holistic Nurses Association (AHNA) defines and describes 
holistic nursing as follows (
1
):
Holistic nursing embraces all nursing practice which has healing the whole person as its goal. Holistic nursing recognized that there are two views regarding 
holism: that holism involves studying and understanding the interrelationships of the bio-psycho-social-spiritual dimensions of the person, recognizing that 
the whole is greater than the sum of its parts; and that holism involves understanding the individual as an integrated whole interacting with and being acted 
upon by both internal and external environments. Holistic nursing accepts both views, believing that the goals of nursing can be achieved within either 
framework.
Holistic practice draws on nursing knowledge, theories, expertise, and intuition to guide nurses in becoming therapeutic partners with clients in 
strengthening the clients' responses to facilitate the healing process and achieve wholeness.
Practicing holistic nursing requires nurses to integrate self-care in their own lives. Self-responsibility leads the nurse to a greater awareness of the 
interconnectedness of all individuals and the relationships to the human and global community, and permits nurses to use this awareness to facilitate 
healing.
The AHNA Standards of Holistic Nursing Practice defines and establishes the scope of holistic practice (
2
). These standards are based on the philosophy that nursing 
is an art and a science whose primary purpose is to provide services that strengthen individuals so they can achieve the wholeness inherent within them. The 
concepts of holistic nursing are based on broad and eclectic academic principles. Holistic concepts incorporate a sensitive balance between art and science, analytic 
and intuitive skills, and the ability and interconnectedness of body, mind, and spirit. 
Table 18.1
 lists the two major parts and nine core values addressed in the  AHNA 
Standards of Holistic Nursing Practice.