A paradigm shift is occurring within our society wherein a growing number of people are adopting an expanded view of health which embraces a holistic perspective rather than a purely allopathic one (Northcott, 1994). As a result, many are seeking and using a variety of complementary and alternative healing modalities (Montbriand, 1989). Eisenberg and colleagues' 1993 survey indicated that 1 in 3 health care consumers had chosen at least one alternative healing modality within the year of the survey. Many of these modalities will always remain "alternative" (Helman,1994; Pietroni, 1988). Others may undergo the validation necessary to eventually deem them mainstream practice (Pietroni, 1992).

The Registered Psychiatric Nurses Association of Saskatchewan (RPNAS) has a professional responsibility to develop clear guidelines as to what constitutes appropriate psychiatric nursing practice in relation to these modalities. Therefore, the Registered Psychiatric Nurse (RPN) has a professional responsibility to practice in a manner which appropriately recognizes alternative and complementary modalities. In an effort to promote primary health care the World Health Organization (WHO) recommended in 1978 that traditional (alternative) medicine be promoted, developed and integrated wherever possible with modern, scientific (allopathic) medicine, stressing the necessity "to ensure respect, recognition and collaboration among the practitioners of the various systems concerned" (Helman, 1994).

The RPNAS believes that the Registered Psychiatric Nurse has a professional responsibility to promote safe and appropriate client use of complementary healing modalities. In order to do so, the RPN needs to be prepared to appropriately dialogue with the client regarding health care choices to help facilitate informed consent and client safety.

Therefore, the RPNAS encourages inquiry during the psychiatric nursing assessment process regarding use of complementary and alternative healing modalities. The RPNAS also supports ongoing education for the RPN in relation to complementary and alternative health care, remaining cognizant that such education does not place the RPN in a position to advise clients regarding complementary and alternative health care choices or to make referrals to alternative health care practitioners at this time. Nor does it necessarily credential the RPN as an alternative health care practitioner. Rather, such education enables the RPN to fulfil a key role as facilitator of informed consent. In fulfilling this role the RPN has a responsibility to convey regard for the client's right to make personal health care choices and to share with clients the RPN's own level of understanding. The RPN needs to be aware of personal and/or professional biases. The RPN has a professional responsibility to provide client education that will assist the client to locate suitable resources and help protect the client from unscrupulous practices in the currently unregulated alternative health care market. The client should be encouraged to choose practitioners who:

• can provide documentation regarding their credentials, educational preparation and experience that demonstrates they have the necessary qualifications to practice the modality professionally
• can identify whether or not their modality is regulated by a professional organization. If so. they provide documentation of membership in that organization and practice in accordance with its code of ethics and standards of practice and/or other appropriate guidelines
• facilitate informed consent by outlining the potential risks, benefits and limitations of the modality.
• support a multi-disciplinary approach

The RPN also has a responsibility to inform clients about the importance of seeking the guidance of a qualified practitioner when using complementary or alternative self-care measures e.g.: herbs, selfhypnosis. In addition, the RPN has a responsibility to inform appropriate members of the health care team of any health care practice that the RPN is aware may compromise the safety of the client e.g.: herbs in combination with medication.

Congruent with guidelines governing the RPN's professional practice, the RPN does not administer substances such as herbal preparations or aromatherapy without a physician's order. Agency policies regarding client self-administration of these substances must be adhered to.

The RPNAS recognizes that the RPN may wish to incorporate some complementary healing modalities into the RPN's own practice. The RPNAS acknowledges the value of many timehonoured healing practices which have lost credibility since the allopathic paradigm has become dominant (Achterberg, 1990). The RPNAS also recognizes the necessity of engaging in a careful process of re-validating those modalities that may become a part of, or be compatible with, psychiatric nursing practice. Thus, the RPNAS supports the responsible development of an expanded role for the RPN in this area, while honouring the importance of maintaining a researchbased practice which ensures protection of the public. To achieve this balance, the RPNAS endorses a practice whereby the RPN wishing to practice in an expanded role in this area is screened on a caseby-case basis, using review processes and criteria developed for use by the Registration and Membership Committee.

The RPNAS recognizes the necessity of maintaining current and progressive regulations relevant to the paradigm shifts which are taking place within our cultural context (Leininger, 1995). Therefore, the RPNAS has adopted a position and a set of guidelines which will help expand the number of health care options available to the client while continuing to fulfil its key mandate of public protection. It is implicit, then, that the RPNAS requires the RPN to adhere to all RPNAS standards, guides, and codes in all dimensions of professional practice, including that which relates to alternative and complementary healing modalities.

Approved by Council
September 1997