Robert is a home care nurse caring for Jim, a client who has colon cancer. Jim has just finished his last cycle of chemotherapy. For the past few weeks, Robert noticed that Jim has had difficulty managing his pain and is feeling anxious about the uncertainty of his prognosis. During their conversations, Jim is more frequently discussing and asking questions about complementary and alternative health care (CAHC) and natural health products (NHPs) as options for managing his pain.
Robert recognizes that clients have the right to make their own decisions and choices with respect to health care. As a registered nurse, he is responsible and accountable to help clients make informed decisions by providing information, to the extent possible, in an open, accurate and transparent manner. Due to Robert’s limited knowledge around CAHC and NHPs, he decides to participate in a webinar on this topic. He learns that many clients who use CAHC or NHPs do not typically discuss their use with their primary care provider. During his next visit, Robert decides to further explore CAHC and NHPs with Jim and discovers that he has been using some herbal remedies for pain management and is considering increasing the use of these herbal remedies in the near future.
In addressing these new findings, Robert decides to visit the College and Association of Registered Nurses of Alberta’s (CARNA) website to look for some guidance. During his search, he finds two particularly relevant documents including the Ethical Decision-Making for Registered Nurses in Alberta: Guidelines and Recommendations (2010) document and the Complementary and Alternative Health Care and Natural Health Products Standards (2018) document. He learns about his responsibility as a nurse when caring for a client who is considering or using CAHC and/or NHPs, and what is expected of him in order to provide safe, competent and ethical care.
Upon reviewing the documents, Robert has more questions. He decides to contact a Policy and Practice Consultant at CARNA to discuss these questions. In addition to supporting Robert in exploring his questions, the Policy and Practice Consultant also encourages Robert to seek out employer policy and to contact the Canadian Nurses Protective Society (CNPS) for additional support. Robert follows up with his employer and CNPS, and reflects on his discussion with the Policy and Practice Consultant to prepare for his visit with Jim next week.
During this visit, Robert uses what he has learned to start a discussion with Jim. He begins by assessing the client’s knowledge around the particular NHPs and other treatment options that he is using or is considering using for pain management. He encourages Jim to inform his primary care provider and pharmacist that he is using NHPs and to discuss the effects and interactions between the conventional medications and the NHPs. Robert also discusses with Jim other evidence-informed CAHC therapies that have been approved for use in home care including guided imagery, therapeutic massage and therapeutic touch, all of which could be useful for pain management.
Upon receiving this information, Jim thanks Robert for providing him with information to better support his decision around the use of herbal remedies and other options. Robert uses what he has learned about CAHC and NHPs and shares his new findings with his home care team and manager.