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Discussion

How important is integrative practice to you?

Hello Advanced Practice Nurses!

I'm curious how many of you would consider your practice to be integrative? By that, I mean that you include not only basic health instruction/counsel to your patients regarding diet and exercise but that you are also comfortable discussing/prescribing herbs, medical foods (FDA regulated) or perhaps other complementary modalities?

I know I will have TONS to learn in my FNP program, not to mention the continuing learning that awaits on the other side of the degree and throughout my practice. I am wondering how realistic it is that I will be able to keep up with "allopathic medicine" changes/practice while at the same time gaining some literacy in alternative practices. To be clear, I am not interested in becoming a practitioner known for alternative practices. But the fact is in this age of information, patients have access to a great deal of health counsel (good and bad) and many providers are not literate in alternative practices, thus forcing their patients to choose between alternative (and sometimes dangerous) and conventional providers. There are certainly some beneficial herbs and supplements available and I want to be the kind of practitioner that can help my patients navigate that world. Years ago I was suffering from headaches and other problems. Along with appropriate testing and treating of sinuses, etc. my doc at the time recommended yoga. Yoga! She even told me what book to get. So simple (and maybe it seems obvious even, but it wasn't to a 20 something me), and it made a big difference in my health then and my health now. That's obviously a tiny example of what I'm talking about -- as it doesn't take much research to recommend increasing endurance and flexibility.

So how do you gain literacy in things that are beneficial but could be considered alternative practice? And if you don't, no judgement, but why not?

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    Hmm...I work in nephrology so no herbals as their actions can be prolonged if you don't have good renal clearance.

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    I work in an ICU so in terms of medical management, we stick to therapies that are backed up by strong evidence in medical research. However, we are also open to other complementary therapies that will not cause harm and have the potential to help.

    For instance, because of the multicultural nature of our population, we allow expressions of healing through spirituality especially in some Southeast Asian and Latin cultures and welcome the playing of religious music/chants and adornments in the room.

    We also have an active animal therapy program and in fact there's a youtube video that has garnered many hits showcasing our therapy cat making his rounds in the ICU. We don't allow herbs (such as those in TCM or Traditional Chinese Medicine that is very common in the area) as well as other non-FDA approved agents.

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    I work in a practice that is looking towards integrating more functional medicine into our scope. I'll be taking some courses on the basics of functional medicine. My medical director is interested in the effect of diet on food sensitivities and other allergies. If he decides to go forward with this, he'll look into having one of the providers become certified as a functional medicine practitioner.

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    A true functional/integrative practice includes both allopathic and complementary approaches depending on the patient's needs. When looking at health, the functional practitioner is looking for clues BEFORE the person becomes "diagnosed" (patient sways to the left but compensates during Rhomberg...this will be a fail / touches tip of nose with any part of the finger rather than the tip of the finger...this will be a fail / Vitamin D level of 35...not good). There is a LOT of teaching and coaching to improve the patient's lifestyle choices. An increased look at genetic defects and how the environment can influence a bad gene to "turn on"...the list goes on and on. Understanding the various supplements, herbs, and homeopathics patients will try, or get, to treat "symptoms" just like drugs without determining what these symptoms can indicate. To me, it makes sense and my practice continues to grow with this approach through word of mouth.

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