The increased use of complementary and alternative therapies by the American public is well documented, with out-of-pocket expenditures for professional provision of such therapies exceeding out-of-pocket expenditures for hospitalizations. Eisenberg and colleagues 1 found that by 1997, 42% of Americans had used such a therapy during the previous year. Rates of use were more common among women, people on the West coast, and people with college educations; and less common among African Americans than other racial groups.

That nurses have been active users and practitioners of complementary and alternative therapies is not surprising. Nightingale wrote not only of the importance of fresh food and air, cleanliness, ventilation, and light, but also of the effects of specific aromas on the bedridden patient. 2 Patients would benefit from having fresh flowers in their rooms, with the exception of lilies, the smell of which was thought to depress the nervous system. Regardless of the merit of the specifics of that idea, this consideration of the effect of aroma can be considered a foreshadowing of the use of aromatherapy for specific effects. Nurses have long recognized the importance of touch and comfort in caring for patients, and that "it takes more than dispensing medications or following doctor's orders to restore patients to their pre-illness selves." 3

Nurses practice with reference to at least two ways of thinking: the medical model and a personal or theoretical model of what it means to facilitate growth or healing in the individual. Thus the integration of specific techniques such as therapeutic touch, acupressure or Reiki to augment or guide the use of touch is not such a big step for nurses. Even the integration of a therapy based in a radically different conceptual framework such as Traditional Chinese Medicine may present less of a challenge to professionals who are already used to thinking about patient care from both a medical and a nursing framework.

In this issue of Holistic Nursing Practice a dozen writers present information on the traditional background and present day use of interventions now used in complementary and alternative health care. This collection begins with two articles on Therapeutic Touch (TT). The first is an overview by Straneva, who describes the origin of TT in the laying on of hands, and its development as a nursing intervention. This is followed by a research report by Hagemaster on the use of TT in a program for treatment of people with substance use. Reiki, another touch therapy of modern origins and Asian roots, is presented in an article by Nield-Anderson and Ameling.

Following these three articles on touch therapy, DeMarco-Sinatra provides an overview of relaxation techniques used in a broad range of circumstances to decrease anxiety, tension, and pain, and to moderate symptoms. Ameling has written about prayer as an ancient healing practice. Although professionals generally do not consider prayer to be part of our health care system, many Americans would like to see spirituality integrated into health care. Ameling cites a poll reporting that a sizable percentage of patients would like their doctors to pray with them. Cohen, Rousseau, and Robinson provide an introduction to herbology, presenting a framework for nurses to learn about herbs and providing specific information on five herbs used commonly in the United States today. Hayes and Alexander address the use of alternative and complementary therapies by advanced practice nurses. In the final article in this issue, Beal presents the origins and modern uses of acupuncture and the related therapies of moxibustion and body work such as shiatsu and acupressure. Both the traditional and the modern biomedical frameworks are presented, with implications for nursing practice.

This issue provides an overview of several specific therapies and their use in nursing practice. Touch and relaxation therapies may be particularly suitable for implementation in mainstream settings; others therapies, such as the use of herbs, are probably more likely to be implemented by nurses in independent or advanced practice roles. The extent to which the use of these and other complementary therapies will ultimately contribute to mainstream nursing practice remains to be seen, as does how complementary therapies do and do not contribute to holistic nursing practice and improved patient outcomes.

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