Sep 01, 2012
By Kate Jaimet
Energy at work
Some nurses believe that using therapeutic touch and other energy-based modalities can improve patients’ health by balancing their energy fields
As Susan Morris begins a session of therapeutic touch, her fingers hover close to the body of her client. She sweeps with her hands over her client from head to toe — never making physical contact — and tunes into sensations of warmth, cold, tingling or heaviness in her fingers.
“You do an assessment of the energy field by feeling it. Then you do things to balance the field,” says Morris, an RN and president of the Canadian Holistic Nurses Association (CHNA). “If an area felt still to me, and sluggish, I would visualize something that showed gentle movement to encourage balance in the flow of energy in that area of the person’s body.”
At the end of a session, Morris performs a final sweep around the client’s body, feeling for differences in sensation. “You would see whether that sluggishness or congestion had changed or not,” she says. “You smooth the field again and you ground the person. You want to make sure they’re well connected to the Earth.”
Therapeutic touch is one of several practices known as energy-based modalities. These modalities, which fall under the broad umbrella of holistic practices, rest on the belief that humans possess an energy field, with physical, mental, emotional and spiritual aspects, and that the energy practitioner can promote health by balancing the client’s energy field and helping it to connect to a higher power.
“You’re connecting with the universe,” says Morris, who plans to open a private practice in the Red Deer, Alta., area that will be focused on energy-based modalities. “The holistic nurse is really a conduit for energy.”
But most of Canada’s RN regulatory bodies take the position that energy-based modalities do not constitute nursing practice. The existence of a human energy field with material and spiritual dimensions has not been scientifically proven. And the evidence from clinical studies examining whether treatments with energy-based modalities are more effective than placebo treatments is inconclusive.
Linda Rosa, a Colorado RN who co-founded the non-profit think-tank Institute for Science in Medicine, is skeptical. “I’m sure that many nurses feel down to their bones that what they’re doing is helpful to their patients. And they have the best of intentions. But without science to guide us, we can fool ourselves into thinking things are helpful, and they really aren’t,” says Rosa, who challenged the Colorado Board of Nursing in the 1980s over accreditation of continuing education courses in practices such as crystal healing and therapeutic touch.
In its broadest sense, the term holistic nursing means considering not only patients’ diagnosed illnesses but also their overall wellness and life circumstances. By this definition, holistic nursing is widely accepted within the profession.
However — somewhat confusingly — the term holistic is also applied to an array of “complementary and alternative” therapies. These may include practices such as art therapy, music therapy, aromatherapy, prayer, meditation and yoga, along with energy-based modalities such as reiki, therapeutic touch and healing touch.
The beliefs underlying energy-based modalities are embraced by CHNA, whose standards of practice document states: “We believe that each person is a whole, unitary human being and a unitary human essence field in continuous mutual process with the environmental essence field.” Similarly, the Complementary Therapies Nurses’ Interest Group of the Registered Nurses’ Association of Ontario (RNAO), which has more than 200 RN and some 500 student members, identifies the statement that “all reality consists of energy fields” as one of its “basic assumptions.”
Although the concept of a vital human energy has millennia-old roots in various religious, mystic and medicinal traditions, the U.S. government’s National Center for Complementary and Alternative Medicine (NCCAM) notes that the existence of vital human energy fields has not been proven by modern science.
“Putative energy fields (also called biofields) have defied measurement to date by reproducible methods,” states NCCAM’s 2007 backgrounder on energy medicine. “Nonetheless, therapists claim that they can work with this subtle energy, see it with their own eyes, and use it to effect changes in the physical body and influence health.”
Martha Rogers and Dolores Krieger are two nurses who played pioneering roles in applying the idea of energy fields to promoting healing.
Rogers worked as a public health nurse before becoming a professor in, and later head of, the division of nursing at New York University, where she worked from 1954 to 1975. She developed what she called the science of unitary human beings, postulating that every human being is an individual who cannot be reduced to the sum of his or her parts — and whose health therefore cannot be restored by treating an isolated organ or ailment. She further postulated that humans consist essentially of energy fields, which interact with environmental energy fields.
The idea of energy fields also underlies the beliefs of Krieger, an RN with a PhD in nursing, who created therapeutic touch in the 1970s with Dora Kunz. Kunz was a mystic who said she had clairvoyant powers and could view the subtle energies surrounding people. While studying the work of Hungarian faith healer Oskar Estebany — who believed he was channelling the spirit of Jesus when he laid his hands upon patients — Krieger and Kunz developed a system of hand motions by which, they believed, trained practitioners could improve patients’ health.
Energy practitioners at work
Barbara Dobbie was a nursing professor at the University of Calgary in 1977 when she attended a therapeutic touch workshop given by Dolores Krieger. It immediately sparked her interest: “Here was a whole other way of working with people. I learned that people are energy beings and that I could bring comfort and relaxation to them, simply by moving the energy around them. It was astounding.”
Dobbie went on to learn therapeutic touch and reiki, eventually becoming a holistic nurse in independent practice. Her work hours are recognized by the College and Association of Registered Nurses of Alberta, which means that she is able to keep her RN designation.
Dobbie has used energy-based modalities to help victims of sexual abuse and women struggling with life transitions during menopause, she says. She also works with preoperative and postoperative patients and says that energy work can help to alleviate pain in some patients. Many energy practitioners work with clients experiencing pain or stress, and some have clients who are dealing with existential issues and hoping to find greater meaning in life. Some practitioners treat cancer patients who believe the treatments will boost their immune system and increase the effectiveness of radiation or chemotherapy or who need help coming to terms with the disease itself and their own mortality. Some practitioners also use energy-based modalities to treat drug addicts.
By inducing a feeling of calm and relaxation, energy sessions help clients examine their lives and make positive changes, Dobbie says. “In my PhD project, I worked with women who were struggling with their mid-life transition. They were exploring all sorts of things in their lives that were no longer working and they were trying to figure out why. It seemed like working with them energetically gave them a sense of peace and calmness that helped them to take a different view of the world, to see that maybe something was changing for the better. And maybe they could risk doing something different. Some of them had life-changing spiritual experiences.”
Dobbie, who has permission to enter hospital wards to treat her clients, views her work as being complementary to mainstream medicine and says she will not take on clients who do not have a regular physician.
Nurse and reiki practitioner Laurie Marshall also regards energy work as being complementary to conventional medicine — a way of managing symptoms like pain, stress and anxiety — but not as a replacement for it.
In her work as a home care nurse employed by a private company, Marshall always looks at her patients holistically: the circumstances of their lives surround her every time she walks into their homes. “I have some clients who experience nausea for no reason. But when I talk to them, I realize that it’s because their welfare cheque hasn’t come in, and they’re so anxious, they actually physically begin to shut down,” she says.
Much of Marshall’s job involves talking to clients, encouraging them to see their lives differently or make changes to their lifestyle, and connecting them to community resources. Although holistic nursing of this sort is, of course, practised by a wide variety of nurses and is encouraged by her employer, Marshall is not permitted to use energy-based modalities on the job. “I have a lot of chemo and end-of-life cancer patients. So many times I’d like to say: ‘Can I hold your hand and send you a little reiki?’ But I’m not allowed to do that. What if one of them were to call my employer and say: ‘We had a nurse practising voodoo’?” she says. “Unfortunately, there’s a lack of knowledge and acceptance.”
Marshall stays in practice by performing reiki on friends and colleagues. One of those is fellow nurse Karen McBurney, who for the past three years has experienced chronic, stress-related pain in her shoulder. She says the pain went down after she started reiki sessions a few months ago, though she adds that seeing a chiropractor and taking a vacation to Mexico probably helped, too.
McBurney believes the reiki sessions have helped her feel calmer and more able to deal with issues in her life. “At one point, Laurie placed one hand on each of my ears, and I could feel an energy going back and forth between the two hands. It was like a pulse from one hand to the other,” says McBurney. “One day after the session, I was driving along and all of a sudden I burst into tears. There was no other trigger. I felt like a sandbag was being lifted off of me. I spoke to Laurie about it, and she said, ‘It’s letting you purge. Sometimes it’s a delayed reaction.’”
Understanding energy-based modalities
Participants in CHNA’s Specialization Program in Holistic Nursing explore the use of these modalities in their work with clients:
Meditation: A mind-body practice by which a person learns to focus attention, resulting in a state of greater calmness and physical relaxation
Guided imagery: A series of relaxation techniques followed by the visualization of calm and peaceful images
Progressive muscle relaxation: A technique used to relieve tension and stress by systematically tensing and relaxing successive muscle groups
Therapeutic touch: A modality in which the practitioner uses hand motions, but not direct physical contact, in an effort to balance and modulate the energy flow through and around the body of the client
Reiki: A Japanese technique in which the practitioner places his hands on or near the person receiving treatment, with the intent to transmit ki, believed to be life-force energy
Healing touch: A modality that uses gentle touch in an effort to balance a client’s physical, mental, emotional and spiritual well-being; practitioners believe it enhances the body’s natural healing ability
Light/colour: A modality that rests on the belief that the seven colours of the rainbow resonate with the seven chakras, or energy centres, of the human body, and thus can be used to balance a person’s energy and promote well-being
Sound/music: The use of music and musical elements in an effort to promote, maintain and restore mental, physical, emotional and spiritual health
Therapy or placebo?
In 2010, Holistic Nursing Practice published a literature review of studies conducted between 1980 and 2008 on the effect of energy-based modalities on pain. The results were mixed. In some studies, patients who received energy treatment reported experiencing a greater decrease in pain than subjects in a placebo group. However, other studies found no difference in pain between those in the treatment group and the placebo group.
Another literature review, published by the Cochrane Collaboration in 2008, examined 24 controlled studies involving 1,153 participants and concluded “touch therapies may have a modest effect in pain relief.” However, the Cochrane Collaboration also commented that “as a result of inadequate data, the effects of touch therapies cannot be clearly declared.”
In its 2007 backgrounder on energy medicine, NCCAM summed up the state of research into therapeutic touch and similar treatments as follows: “Overall, these therapies have impressive anecdotal evidence [concerning their effectiveness in treating a variety of conditions], but none has been proven scientifically to be effective.”
For Rosa, the reports of patients feeling less pain or anxiety after energy treatment indicate nothing more than a placebo effect. “If they feel better, well, studies have already shown that patients just feel better when a nurse is in the room,” she says. “They’re comforted by knowing the nurse is present, is concerned and is listening.”
Kim Watson, an emergency department nurse at the Hôtel-Dieu Grace Hospital in Windsor, an energy therapy practitioner and the chair of RNAO’s Complementary Therapies Nurses’ Interest Group, feels that randomized controlled trials aren’t the only way to measure the value of holistic practices. “If I put people in a study, maybe the results will show that energy therapy is not really that effective. Yet I can take a hundred people and they’re all saying, ‘Are you kidding? I feel a hundred times better!’” Watson says. “Maybe you can’t find a scientific tool to measure it, but something’s working.”
Looking for acceptance
Energy-based modalities have not gained widespread official recognition within the nursing profession in Canada. Of the RN regulatory bodies, only those in Ontario, B.C., Alberta and P.E.I. recognize some of the hours worked by nurses using energy-based modalities, says Morris.
CHNA itself counts about 80 members; Morris attributes this low number, in part, to the lack of recognition by regulatory bodies. “In some jurisdictions, holistic nurses are simply allowing their RN registration to lapse, because what we do isn’t recognized,” she says. “Certainly, one of our goals is to encourage regulatory bodies across the country to accept the work we do.”
Pat Miles recently found herself at odds with the College of Registered Nurses of Manitoba over this very issue, after she completed a certificate in integrative energy healing at B.C.’s Langara College in 2007. “I chose to come out of the closet as a holistic, integrative energy healing nurse practitioner, and I put in my hours as such on my registration renewal form,” she says. “CRNM denied that my practice was nursing practice, so I am no longer an RN.”
Miles says she thinks the college should accept holistic healing practices because they give patients more choice: “Healing is the goal of holistic health care, and it is the true heart of nursing.”
But Suzanne Wowchuk, CRNM’s director of regulatory services, says the college made the decision on the basis of the province’s Registered Nurses Act and the college’s Standards of Practice for Registered Nurses. “That practice is not grounded in the practice of registered nursing and it’s not an extension of the competencies gained through an entry-level registered nursing education program,” she says.
The lack of recognition for energy-based modalities extends beyond regulatory bodies. The modalities are not taught at Canadian nursing schools, and no Canadian hospitals employ nurses or other practitioners to practise them (some hospitals do allow their nurses to perform these modalities at a patient’s request or permit volunteers to offer the therapies). CNA does not offer certification in holistic nursing.
Most nurses who use energy-based modalities have their own independent practices, and clients are often referred through word of mouth. In jurisdictions where the regulatory bodies do not recognize these therapies, nurses sometimes offer them as a sideline, while continuing to hold down full-time nursing employment in a hospital or clinic.
Undaunted by the skeptics, Watson says she has a vision that one day, CNA will offer a certification exam in complementary therapies, and Canadian hospitals will hire holistic nurses to provide complementary treatments to patients.
Morris acknowledges there is a long way to go: “Having holistic practices accepted into mainstream health care is one of CHNA’s dreams. Meanwhile, we’ll continue to advocate for holistic nursing to help us achieve that dream.”