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By Nicole Griffis, RN, MS, APRN-BC, HNP
Are you a nurse or nurse practitioner who regularly sees patients? What do you say to patients who share with you that they are using herbal medicine for symptoms of stress, anxiety, tension or insomnia? Do you have a prepared response like “That's not something I know much about, but if it's working for you then that is great.” Or maybe, “Cool! Where did you get it and how do I get some?”
Chances are you are in the first camp, though you could be in the second. Many nurses are aware of herbal remedies and view them in a favorable light, but when it comes to interacting with patients, their lack of comfort with the subject prevents them from exploring the many possibilities offered by herbal medicine. Many of these patients could greatly benefit from herbal remedies for an array of stress-related symptoms that are most often treated with pharmaceuticals (many of which come with side effects and the risk of habit-forming use).
A 2019 article in the Journal of Holistic Nursing published the results of an online survey of nurses working in a large medical center. Of the 218 nurses surveyed, 85% supported use of complementary and alternative medicine (CAM) but only 32% reported recommending CAM use with patients, indicating an attitude of apprehension to broaching the subject with patients. One reason this may be is a lack of knowledge on the subject. After all, each and every CAM modality has a lengthy history, shelves and shelves of books about it, and practitioners who have studied long and hard to master it. It is understandable why busy nurses with plenty of Western medical information to stay current on every day would be intimidated by the vast and ancient field of herbal medicine.
Rest assured, you do not have to be an expert highly trained in phytochemistry, botany, and humoral energetics to be able to safely recommend simple, common herbs that can effectively treat symptoms of tension, anxiety, depression, and insomnia that are so often associated with chronic stress. A 2016 article in the journal Cancer studied 175 oncology nurses and nurse practitioners, those who reported some sort of CAM education and comfort with CAM, in general, were more likely to talk to their patients about CAM as part of their treatment. So it seems that enough knowledge to make you conversationally comfortable can open many doors for your patients.
Take for instance a patient that comes to see her favorite nurse practitioner for a bout of insomnia accompanied by heart palpitations in the night related to a recent increase in work-related stress. Once the responsible NP rules out any inherent disease process causing the symptoms, she can recommend the pillars of stress reduction: deep-breathing relaxation, exercise, healthy diet, sleep hygiene, and connection to nature and loved ones. These are all wonderful recommendations and will prove to have long-term benefits, but they will not help the patient get to sleep that night. For more immediate results while the patient is implementing stress reduction techniques, the NP may recommend a safe and gentle herb or herbal combination to ease the sleep process.
In this case, the NP may recommend a remedy such as lemon balm for it’s calming properties. This calming herb is also known to reduce benign heart palpitations. The informed NP will use this herb with caution if the patient has any thyroid conditions. If this is the case, she knows there are other useful herbs that help promote peaceful sleep and lower the heart rate. Among these are passion flower, valerian root, hops, and chamomile. This NP has done some research into herbal brands that are of high quality and easily accessible. She may be able to relate stories of how these herbs have helped her get some rest in times of stress or of other patients that have had positive experiences with them. The NP can assure the patient that these herbs are safe to use over several weeks without side effects or risk of dependency. Ideally, the patient will be able to weather this period of increased stress and insomnia with the aid of calming herbs and by employing stress-reducing techniques that will equip her for handling future stress and sleep disturbance.
As Western medicine becomes more integrated with complementary and alternative modalities, it is the responsibility of nurses to their patients to offer holistic treatment plans. Herbal medicine is an elegant modality that gives nurses and patients a safe, gentle alternative to using pharmaceuticals. There are many resources available for nurses to build a tool kit of common, useful herbal allies to offer patients suffering from symptoms of chronic stress. Nurses can seek evidence-based continuing education opportunities on this subject that can only benefit themselves and their patients. For patients amenable to the idea of plant medicine, they will be grateful they found a nurse ready and willing to talk to them about their options.
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