Postmodern nursing

Public Interest, Summer, 2000 by Sarah Glazer

IN the late 1980s, Linda A. Rosa, a registered nurse working in Denver, Colorado, was deluged with brochures promoting courses for nurses in crystal healing, color therapy, and a technique called "therapeutic touch," derived from the laying-on of hands. All the courses fulfilled the continuing education credits then required for state relicensure of nurses in Colorado, but none appeared to have any scientific basis. Aghast at this antiscientific trend in nursing, Rosa began to investigate the research and claims behind therapeutic touch.

Therapeutic touch is a technique with roots in Eastern mysticism. Its practitioners claim to heal people without actually touching them by "smoothing out" energy fields, which they contend extend a few inches out from the body. There is no evidence that such a phenomenon exists, and experts consider it implausible. Rosa's crusade to expose what she has described as "silly nursing" culminated in a widely publicized article in 1998 in the Journal of the American Medical Association (JAMA). After reviewing hundreds of reports on the technique, Rosa and her coauthors concluded, "No well-designed study demonstrates any health benefit from therapeutic touch."

The article also reported the results of her daughter Emily's fourth-grade science project, which tested whether practitioners of the technique could actually sense a "human energy field," as they claim. Emily asked 21 therapeutic-touch practitioners to guess whether she was holding her hand above their right or left hand. A screen hid Emily's hand from the healer's view to provide blinded conditions. The healers' ability to guess the correct hand (44 percent of the time) was slightly worse than random chance. The article concluded that therapeutic-touch claims "are groundless and that further use of Therapeutic Touch by health professionals is unjustified."

Yet therapeutic touch continues to be an entrenched technique in nursing, endorsed at the highest levels of the profession. Nursing journals continue to publish articles claiming positive health effects for therapeutic touch and enthusiastically encouraging its use with patients. The American Nurses' Association (ANA), the main professional organization, responded to Rosa's JAMA article by publishing a lead editorial defending therapeutic touch, written by the nurse who introduced the technique into the profession in the early 1970s. Dolores Krieger, professor emerita of nursing at New York University, denounced the study as a "parlor game" and said therapeutic touch had been the target of "reactionary forces whose viewpoints are embedded in materialistic and reductionist philosophies." The same issue of the ANA's official journal ran an enthusiastic article on "healing touch," a variation of therapeutic touch, with this come-on headline: "Take a closer look at one of the 'energetic' therapies. It might just recharge your practice."

Therapeutic touch is taught at more than 100 colleges and universities around the world. It is used by nurses in at least 80 hospitals in North America. Proponents claim that at least 43,000 health-care professionals have been trained in the technique. The National League for Nursing, the agency that accredits nursing schools in the United States, has promoted the technique through books and videotapes. A past president, Jean Watson, is a prominent advocate. The North American Nursing Diagnosis Association names therapeutic touch as the only appropriate treatment for a diagnosis it dubs "energy field disturbance," It defines energy field disturbance as "a disruption of the flow of energy surrounding a person's being which results in disharmony of the body, mind, and/or spirit."

Therapeutic touch is not the only holistic healing technique adopted by nurses, but it is probably the most widely recognized and used. A nurse casting about for a way to fulfill the continuing education requirements in the state of Michigan in 1996 could attend workshops that promised to teach her how to "sense angelic presence," understand "the human aura," and "contact people who have passed over." Workshops in these techniques carry the approval of the National League for Nursing.

Scientific mysticism

How have techniques steeped in mysticism gained such a foothold in the nursing profession? Ironically, their acceptance has coincided with another movement within the profession toward enhancing the scientific foundation and orientation of nursing practice. In the early 1990s, organizations like the ANA were lobbying federal legislators to treat their most highly trained nurses on an equal level with doctors for reimbursement from federal and private health insurers. Their lobbying effort focused on an elite group of "advanced practice nurses"--nurses who hold master's degrees or specialty certification permitting them to practice as nurse practitioners, certified nurse midwives, or certified nurse anesthetists, among other specialties. At the time, nursing association leaders pointed proudly to advanced practice nurses who operated in solo practices in rural areas and impoverished inner-city neighborhoods. Much like doctors, they conducted examinations and doled out prescriptions--with a distant doctor's te lephone authorization. Unlike doctors, they put a premium on spending time with patients, listening to them, and providing more patient education. Nurses with Ph.D.s in academia were also calling attention to their research that used scientific methods to come up with innovative recommendations for nursing care distinct from traditional medical studies.