By Jennifer Nachbur Article published October 17, 2007
The practice of Chinese herbal medicine focuses on restoring a balance of energy, body and spirit using intricate mixtures of hundreds of herbs, minerals and plant extracts. A number of research studies indicate that some individual herbs or extracts may play a role in the prevention and treatment of cancer and other diseases when combined with conventional treatment.
But are all those combinations safe?
Not necessarily. Christina Melvin, clinical assistant professor of nursing, saw an educational opportunity in the problem. “Some patients ask about the safety of combining herbs and supplements with pharmaceuticals, but many don’t ask and are combining these with no idea of the dangers,” explains Melvin.
She enlisted the help of Felicia Foster, adjunct assistant professor of nursing and an integrative medicine consultant at South Burlington-based Healthy Living, to create service-learning opportunities in this area for junior and senior nursing students in her “Health Promotion across the Lifespan” and “Community/Public Health Nursing” courses.
The issue is important. Americans have embraced the use of complementary and alternative medicine. A July 2000 study in the Journal of Clinical Oncology found that 69 percent of 453 cancer patients had used at least one complementary or alternative medicine therapy as part of their cancer treatment. Overall herbal product use jumped 50 percent from 1997 to 2002, according to a 2005 Harvard study.
The popularity magnifies the complications. Like traditional medications, supplements can have side-effects or interact with other medications and herbs. And then there's choosing a remedy in the first place: figuring out which herb or supplement to take for which ailment still stumps people. Melvin and her students are working to provide reliable, accessible information to begin addressing both problems.
Facing complexity
During a Wednesday afternoon session with Foster, junior nursing students Melissa Weinberger and Janna Trombley checked out the herb and supplement shelves at Healthy Living for the first time. They plan to conduct surveys about alternative remedies with cardiac patients in the near future.
“I wanted to allow students to get involved in medication integration issues before they got to the bedside, so that when they’re practicing, they’re looking for this” explains Melvin. “When they work with Felicia, they learn first-hand about the complexities of educating the general public about prescription and over-the-counter medication and the integration of these medications with herbs and supplements.”
The students who participate in the Healthy Living program self-select to focus on alternative and complementary medicine. “They could do flu shot clinics instead,” said Melvin, “but they do this because they have a specific interest.”
Senior nursing student Yen Tai participated in a related service-learning project in fall 2006. “I love herbal remedies,” she admits. “A lot of people don’t consider them drugs. People undergoing surgery don’t know about some of the possible adverse effects, like risk of increased bleeding.”
Yen and fellow student Sara Clafferty worked with a charge nurse at Fletcher Allen, auditing dozens of pre-operative patient charts to identify whether people were taking one or more of five commonly used herbal remedies and supplements. “It’s important for patients to know that herbs and supplements are drugs that can interact with pharmaceuticals and really make a difference in the outcomes of drug actions,” says Clafferty. “Often, patient use of these therapies is not noted in charts.”
Since the program’s launch in 2004, more than 20 students have participated in this collaborative service-learning program, conducting client and patient surveys and participating in sessions in the outpatient oncology clinic, surgical pre-operative services and the Children’s Specialty Clinic at Vermont Children’s Hospital at Fletcher Allen Health Care.
“The students have helped develop brochures for pediatrics, pre-op, general use, oncology and most recently, Chinese medicine,” Melvin reports. In spring 2007, students surveyed Healthy Living customers about their use of pharmaceuticals, herbs and vitamins. Mingruo Guo, associate professor of nutrition and food sciences, served as a consultant on Chinese medicine and assisted with the student-produced educational guide on Chinese herbs. Foster has also worked with Dr. Patricia O’Brien, clinical assistant professor of medicine and rehabilitation and movement sciences, about the integration of body care products, which can cause interactions for patients going through chemotherapy and radiation treatment.
“Certain supplements get popular — like Q10 for example — and people say, ‘I should take that,’ but they don’t think about the complications,” remarks Clafferty. “That’s why we need to keep updating this information.”
Foster works closely with physicians and nurses at Fletcher Allen Health Care on safe integration of herbs, supplements and medication and the brochures produced through the UVM collaboration are distributed to providers through the hospital's human resources office, hematology/oncology clinic and the community resource center. Healthy Living, which has an active community outreach program, fully supports Foster’s continued role as an educator of students and providers in the area.
“Some of the nursing students I worked with are now working at Fletcher Allen,” says Foster, a former cardiac nurse, who is thrilled that the program has come full circle to benefit hospital patients. “The goal is to give information to the whole community, to help people stay safe by communicating and collaborating,” she adds.
Melvin echoes the sentiment: “This model is a great example of what service-learning is supposed to do — educate the student and provide a service to the community.”
