Allied Health and Nursing Academic Programs at New Jersey county colleges: Holistic Health and Complementary and Alternative Medicine Content

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1 Allied Health and Nursing Academic Programs at New Jersey county colleges: Holistic Health and Complementary and Alternative Medicine Content Elsa Bruguier, MLS Complementary Health Practice Review Volume 13 Number 3 October # 2008 SAGE Publications / hosted at Rising public interest in and use of holistic health (HH) practices and complementary and alternative medicine (CAM) has created a need for health care providers to become knowledgeable in these areas. HH/CAM content is increasingly included in curricula of professional health education, a trend less clear in associate, certificate, and diploma programs of 2-year colleges. A survey of directors and coordinators of allied health and nursing programs at New Jersey county colleges was conducted to determine curricular presence of HH/CAM and program constituency awareness of institutionally accessible HH/CAM information resources. Results indicated: rising interest in HH/CAM instruction; multiple forces influencing HH/CAM inclusion; HH/CAM strengthening programs; and uncertainty regarding knowledge of and perceived use of library HH/CAM resources. By including HH/CAM, New Jersey s allied health and nursing programs are progressively aligned with consumer use, and trends of professional health schools. Keywords: allied health; CAM; education; holistic; information; library; nursing An Institute of Medicine report (2005) revealed that more than 33% of American adults use complementary and alternative medicine (CAM) modalities. Consultations with complementary and alternative health care providers have surpassed those to primary care physicians, though Barrett (2003) qualified this finding. The shift in the US public attitudes toward holistic health (HH) and CAM has been well documented during the last decade (Barnes, Powell-Griner, McFann, & Nahin, 2004; Barrett, 2003; Burke, Peper, Burrows, & Kline, 2004; Eisenberg et al., 1993; Eisenberg et al., 2001; Tindle, Davis, Phillips, & Eisenberg, 2005). Accelerated growth of consumer interest in HH and CAM has enlarged the US public s health care behaviors, fostering a need for conventional (allopathic) health care providers to become knowledgeable in these areas (Burke et al., 2004) and positioned to guide care seekers (Kreitzer, Mann, & Lumpkin, 2008). From the Union County College, Plainfield, New Jersey. Address correspondence to: Elsa Bruguier, MLS, Librarian, Union County College, 232 East Second Street, Plainfield, NJ 07734; bruguiere@ucc.edu. 155

2 156 Complementary Health Practice Review Although the professional health schools are broadening curricula to include HH principles and CAM (Kreitzer, Mitten, Harris, & Shandeling, 2002), this trend in US health education is not as clearly defined at the 2-year college level (associate, certificate, diploma programs). A survey was undertaken to determine the following: The degree to which allied health and nursing academic programs at New Jersey county colleges provided HH/CAM content or courses; and knowledge and perceived use of an institution s library HH and/or CAM resources (including librarians). LITERATURE REVIEW There is a substantive and expanding literature that documents the integration of HH and/or CAM into professional schools of health education curricula. The mind-body-spirit orientation of a holistic healing model has been a core component of the nursing profession, curriculum, and standards of practice since its beginnings (Fenton & Morris, 2003; Halco n, Leonard, Snyder, Garwick, & Kreitzer, 2001). Burke et al. (2004, p. 1118) identified a difference in the perceived meanings between HH and CAM stating, This difference...may reflect the clinical/medical versus educational nature of the two words, CAM being more related to clinical/medical issues than Holistic Health. However, there is an overlap in the use of these terms both in understanding and perception among non-hh or CAM practitioners. Thus, within this document, HH/CAM will be used together. Until recently, biomedical education had not considered HH/CAM, although as its integration within allopathic education increases, this is less frequently the case (Barzansky & Etzel, 2003; Baugniet, Boon, & Ostbye, 2000; Lie & Boker, 2006; Patterson & Graf, 2000). Fenton and Morris (2003) documented a similar transition in CAM curricular offerings in baccalaureate and advanced nursing programs. Kreitzer et al. (2008) and Pearson and Chesney (2007) highlighted the R-25 project, an initiative begun in 2000 through the National Center for Complementary and Alternative Medicine (National Center for Complementary and Alternative Medicine [NCCAM], 2007), awarding competitive grants to health professional schools committed to curricular integration of CAM. The growing body of research reflecting inclusion of HH/CAM in baccalaureate, graduate, and medical education is not mirrored in a literature on HH/CAM in allied health and nursing programs in 2-year colleges. Database searches for articles on integration of HH/CAM in allied health and nursing education at US 2-year colleges were unproductive. Literature searches were conducted using database and Web sources: Academic Search Premier, Alt HealthWatch, Biomedical Reference- Comprehensive, Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text, Cochrane Library, Education Resources Information Center (ERIC), Health & Wellness, Health Reference Center, Medline, Nursing and Allied Health Comprehensive, ScienceDirect, Scirus, and Wiley InterScience. By contrast, popular World Wide Web search engines retrieved academic institution homepages, which revealed a modest but more nuanced glimpse of HH/CAM content in allied health and

3 Bruguier / HH/CAM Use: NJ Allied Health and Nursing Programs 157 Table 1 Operational Definitions for HH and CAM Used in Survey HH: The American Holistic Medical Association defines HH principles as those concerned with the interrelationship of the body mind spirit as they represent function and balance between the physical, environmental, mental, emotional, and social aspects of human experience (American Holistic Medical Association, 2004). HH perspective: The American Holistic Nurses Association encourages responsibility for self-care, an awareness of the interconnectedness of body, mind, and spirit, and a belief system in which holism and related therapies offer options in health and healing (American Holistic Nurses Association, 2004). CAM: The NCCAM differentiates between complementary and alternative medicine: Complementary medicine is medicine used together with conventional medicine (e.g., using aromatherapy postoperatively to lessen discomfort). Alternative medicine is medicine used in place of conventional [e.g., using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor (p.1)]. The NCCAM further delineates CAM into five major domains, recognizing that there can be overlap: Whole medical systems, mind body interventions, biologically based therapies, manipulative and body-based methods, energy therapies (NCCAM, 2007). NOTES: CAM ¼ complementary and alternative medicine; HH ¼ holistic health; NCCAM ¼ National Center for Complementary and Alternative Medicine. nursing programs at 2-year colleges. In 2004, in his work on HH and CAM at the baccalaureate level, Burke et al. experienced a similar information retrieval phenomenon. METHOD In 2007, on receiving Georgian Court University Institutional Research Review Board approval, 64 program directors and coordinators from New Jersey county college allied health and nursing programs were sent invitations to participate in an HH/ CAM survey. Participants were sent an that contained the recruitment letter, implicit consent, assurance of anonymity and confidentiality, the survey s operational definitions for HH/CAM (Table 1), and a link to the survey itself. The principal researcher developed and distributed all materials using a commercial online survey vendor. Contact to nonrespondents was attempted with follow-up 1 week after the original invitation was distributed. Participant self-reported responses were received in the principal researcher s secure commercial survey account. Data were collected using a cross-sectional, nonexperimental, qualitative survey questionnaire composed of 19 multiple-choice questions (see appendix for list of questions). Every question provided the respondent with the opportunity to comment. Survey questions corresponded to 3 areas: (a) curriculum (HH/CAM content, stand-alone courses, required/elective; personnel teaching HH/CAM; rationale for including/ excluding HH/CAM); (b) access and use of authoritative/institutional HH/CAM information resources; and (c) program type (allied health or nursing). Data analysis

4 158 Complementary Health Practice Review Table 2 Curriculum Revision as Specific HH/CAM Courses or Additions to Existing Course Content: HH/CAM Instruction in Allied Health and Nursing Programs at New Jersey s 2-Year County Colleges Curriculum Has Been Revised N Yes No Do Not Know Specific courses offered in HH/ 20 25% 75% N/A CAM Course content includes HH/ CAM 21 48% 52% N/A Curriculum revision occurred Within 1 4 years (66%) Within 5 10 years (11%) No need to revise; always had it (11%) Do not know (11%) NOTES: CAM ¼ complementary and alternative medicine; HH ¼ holistic health; N/A ¼ Not Applicable. Percentages may not equal 100% because of rounding. was conducted by tabulating responses in frequency tables where theme development was based on overall results and participant comments. RESULTS Of the 64 surveys sent to program directors and coordinators of New Jersey County College allied health and nursing programs, 57 were deliverable. The response rate was 39%, with a participation rate of 33% and 1 respondent opting out. Of those who participated, 67% were from allied health programs and 33% were from nursing programs. Curriculum For the 48% of respondents (Table 2) who indicated course content revision to include HH/CAM, a follow-up question was posed to determine when course content had been revised. Sixty-seven percent indicated content had been changed during the last 1 4 years, 11% within 5 10 years, and 11% responded that HH/CAM was always included in course content. Eleven percent did not know when revision had occurred and commented: Whenever the textbooks covered this information, so did we. Motivation for Including HH/CAM in the Curriculum Respondents were queried regarding the motivating factors for including HH/CAM courses and/or content in program curricula. More than one answer to this question was allowed. A majority, 52%, indicated faculty interest was a prime factor; 48% indicated inclusion was to better prepare program graduates because of likely exposure to care seekers who use HH/CAM; 38% indicated inclusion was because program graduates were likely to be asked questions about HH/CAM; 24% included content

5 Bruguier / HH/CAM Use: NJ Allied Health and Nursing Programs 159 Table 3 New Jersey County College Administrator Perceptions: Confidence Levels of Faculty Teaching HH/CAM in Stand-Alone and Regular Courses N Always Confident Sometimes Confident Do Not know Specific HH/CAM courses 18 17% 33% 50% Non-HH/CAM courses 19 21% 37% 42% NOTES: CAM ¼ complementary and alternative medicine; HH ¼ holistic health. because of student interest; 13% included content because the program s traditions included HH/CAM modalities; and 5% included content because of an accreditation requirement. Thirty-eight percent indicated that their program did not include courses in HH/CAM. Administrators whose programs offered no HH/CAM courses were asked their perception of curricula strengthening with the addition of such courses. Forty-four percent of respondents stated that inclusion of HH/CAM courses could strengthen the curriculum. Thirty-three percent indicated inclusion would not strengthen the current curriculum and 22% stated they did not know. Of those who indicated that adding a specific HH/CAM course could strengthen the curriculum, a question was asked regarding the type of course (elective/required) that could achieve this goal. Results were split evenly between elective and required courses. Two questions were asked as to who provided HH/CAM instruction. Multiple responses were allowed for both questions. For programs with specific HH/CAM course offerings, 100% used a guest practitioner with HH/CAM credentials to teach course content, 50% used faculty, and 25% used faculty with HH/CAM knowledge. For programs in which HH/CAM content was included in regular courses, 47% indicated faculty members taught course content, 47% stated faculty with HH/CAM knowledge taught course content, 5% used a guest practitioner with HH/CAM credentials, and 26% did not know. A majority of respondents indicated they were not aware of faculty s confidence in educating students on HH/CAM (Table 4). Access to and Use of Information Services Participants were asked how important it was for the academic program of study to have access to quality HH/CAM library resources. Thirty-eight percent of respondents felt it was very important, 38% felt it was somewhat important, 19% felt it was not too important, and 5% felt it was not important. In addition, a question was posed to determine the frequency of program constituents use of HH/CAM library resources, including librarians. Five percent of respondents indicated constituents always used these resources and 29% indicated these resources were sometimes used. One third of the respondents indicated these resources were rarely or never used; 19% stated these resources were rarely used; while 9% acknowledged they were never used. Thirty-eight percent were unsure of the degree to which these resources were used.

6 160 Complementary Health Practice Review Table 4 HH/CAM Inclusion: Incorporation Into Course Content and as Stand-Alone Course in Allied Health and Nursing Programs at New Jersey s 2-Year County Colleges HH/CAM Inclusion N Frequently Sometimes Rarely Never In course content (not specifically HH/CAM course) 21 19% 47% 10% 24% As elective or required course 21 10% 5% 5% 81% NOTES: CAM ¼ complementary and alternative medicine; HH ¼ holistic health. Percentages may not equal 100% because of rounding. DISCUSSION This study is the only known investigation of HH/CAM in allied health and nursing at the US 2-year county college level. Data analysis revealed four prominent themes: There is a rising interest in HH/CAM within allied health and nursing programs at New Jersey county colleges; multiple forces from within and outside of the programs themselves drive HH/CAM courses or content; programs that include HH/CAM content are strengthened by this inclusion; perceived importance of access to authoritative HH/CAM library resources (including librarians) vis-a` -vis degree of use is uncertain. Themes Theme One. There is a rising interest in HH/CAM within allied health and nursing programs at New Jersey county colleges. Two thirds of respondents indicated that HH/CAM content was frequently or sometimes included in course content (Table 3). Interestingly, the majority of respondents, 67%, indicated that HH/CAM content or courses had been added during the last 1 4 years. This is in keeping with the findings of Barzansky and Etzel (2003), Fenton and Morris (2003), and Lie and Boker (2006) regarding the increased inclusion of HH/CAM in health practitioners curricula. Opportunity exists to further expand curricula, as many respondents indicated HH/CAM was more likely to be included in courses not specifically HH/CAM focused (see Table 2). Theme Two. Multiple forces from within and outside of the programs themselves drive HH/CAM courses or content. A majority indicated it was faculty interest that led to the inclusion of HH/CAM courses or content. Said 1 respondent: The courses and curriculum are continually revised yearly this topic is included. This may reflect the latitude that accompanies syllabi development whereby individual faculty members are able to cover content by including material of professional interest. Likewise, respondents indicated course changes were made when textbook content was revised to include HH/CAM. Other areas that were influential in creating curricular

7 Bruguier / HH/CAM Use: NJ Allied Health and Nursing Programs 161 reform included the likelihood that program graduates would be asked questions about, or would encounter clients who use HH/CAM. Thus, market forces are key factors in programmatic revision. There are also forces that work against HH/CAM inclusion. Many more respondents (Table 2) indicated that HH/CAM was included in current course content rather than specific courses. One commented: Our curriculum already contains this content and our accrediting institution would not permit additional courses. Where HH/ CAM content was not covered, regulatory body requirements were cited as the rationale. For example, one participant commented: It is not a board of nursing requirement. This is a mistaken belief since the 2007 NCLEX-RN blueprint specifically mentions CAM as a content area in the test (National Council of State Boards of Nursing [NCSBN], 2007). This misconception could reflect the delay that occurs between changes to the NCLEX blueprint and curricula revision. Theme Three. Programs that include HH/CAM instruction are strengthened by this inclusion. Two thirds of respondents indicated program strengthening with HH/CAM courses. It is thus viewed as worthwhile to change curriculum as well as develop courses and course content to include HH/CAM, as the end result is a stronger academic base for the program itself. Theme Four. Program administrator knowledge regarding use of HH/CAM library resources is largely lacking. Seventy-six percent of respondents indicated access to library resources was either very or somewhat important. However, in the follow-up question which asked the degree to which academic program constituents use the library resources, only slightly more than one-third stated always or sometimes. Thirty-eight percent did not know constituents use of library resources and one-third indicated that the faculty, students, and staff either rarely or never used these resources. There are two parts to this theme. First, a majority of program administrators are not knowledgeable regarding the resources used by the faculty, students, and staff of their programs; this may affect use and lead to decreased referrals by program administrators to use library resources. Second, there is a lack of awareness regarding how collaboration with academic librarians can enrich program content through improved use of and access to HH/CAM resources. Pearson and Chesney s (2007) article that reviewed the NCCAM CAM Education Program indicated that knowing how to obtain reliable information about the safety and efficacy of CAM or integrative medical practices (p. 925) is a primary goal in CAM curriculum development for conventional health care providers in an integrative medicine environment. The results suggest academic librarians are underutilized as a resource when seeking quality HH/ CAM information. Collaborating with librarians will enable faculty and researchers to greatly enhance their understanding of where and how to retrieve authoritative HH/ CAM information. This theme points to an opportunity that exists for improved collaboration among librarians, program directors, faculty, and students.

8 162 Complementary Health Practice Review CONCLUSION This research sought to fill the knowledge gap that existed regarding HH/CAM content or courses included in allied health and nursing programs at New Jersey s 2-year county colleges. To date, research has largely ignored this population. This research revealed several positive themes regarding HH/CAM education. Among these were the rapidly changing landscape regarding HH/CAM inclusion in health education; the need for greater collaboration among faculty and library professionals; that most programs used HH/CAM professionals to teach this content, important for retaining the integrity of the material; and the key role that market forces play in stimulating HH/CAM inclusion in formal health education programs. The paradigm of Western biomedicine is changing because of public demand and use of HH/CAM. Simultaneously, there is a growing need for incorporation of HH/ CAM knowledge and philosophies into allied health, medical, and nursing models of care and education at all levels. Global changes all point to the need for further incorporation of HH/CAM within allopathic health education. Such changes include the following: Worldwide availability of Western biomedicine. Increased hybridization of conventional medical practice with other medical traditions (such as Ayurvedic, Chinese, or herbal medicine [Kleinman, 2002]). High demand for holistic and complementary and alternative healing protocols. Interest at the legislative policy level regarding public protection. The creation of and access to quality information. Areas for Future Research This research has highlighted several areas in which further study is suggested. Because this study revealed faculty interest as a factor for HH/CAM inclusion in programs, a county college faculty development project funded by NCCAM may be warranted. Because this study did not explore the degree to which other US county college allied health and nursing programs may be integrating HH/CAM, it may be useful for allied health and nursing accrediting agencies to conduct annual surveys to document this trend. This study revealed that one reason for including HH/CAM material in the curriculum is the likelihood of program graduates encountering care seekers using/inquiring about HH/CAM. To ensure that program graduates are best able to provide care of and information for those seeking HH/CAM, further exploration as to what type of educational content creates the best health care competencies is warranted. The data revealed a mixed message on use and awareness of an institution s HH/CAM library resources (including the librarian). As such, greater interdependencies between instructional and library faculty must be cultivated so as to increase usage of the library and other authoritative HH/CAM information resources.

9 Bruguier / HH/CAM Use: NJ Allied Health and Nursing Programs 163 Although not explored in this research, it may be useful to determine the degree to which program administrators perceptions of HH/CAM efficacy influence inclusion in their programs, and whether faculty beliefs regarding the efficacy of HH/CAM positively or negatively influence inclusion of HH/CAM content within specific courses. Practical Recommendations Recruitment of current allied health and nursing faculty into postgraduate HH/ CAM programs may lead to increased inclusion of HH/CAM in the courses they teach. By integrating HH/CAM into allopathic medicine, a more whole person centered Western medical professional may emerge. Academic faculty who do not have HH/CAM expertise should consider collaborating with knowledgeable HH/CAM practitioners to provide the best learning outcomes for their students. Support for HH/CAM by accrediting bodies will help in acknowledging its legitimacy, permit more seamless incorporation of HH/CAM into standard care, create more inclusive curricula, and may positively influence health outcomes of people seeking care. Textbook authors and publishers must acknowledge the exponential growth of and interest in HH/CAM by including quality information on these topics within allied health and nursing resources. Faculty should supplement current texts with reliable HH/CAM information in varied formats (e.g., literature, guest practitioners, listservs, wikis, blogs, podcasts). Although this research was limited to allied health and nursing programs within 2-year county colleges in the State of New Jersey, its conclusions mirror trends of HH/CAM integration within professional medical, nursing, and allied health curricula. Future research efforts should examine other states allied health and nursing programs at 2-year colleges to determine whether the results from this study can be replicated.

10 Appendix HOLISTIC HEALTH/COMPLEMENTARY AND ALTERNATIVE MEDICINE SURVEY QUESTIONNAIRE 1. Does your Allied Health or Nursing academic program of study cover holistic health, and/or complementary and alternative medical topics in any classes whose topical area is not specifically holistic health or complementary and alternative medicine? Always Frequently Sometimes Rarely Never 2. Does your Allied Health or Nursing academic program of study offer courses on holistic health and/or complementary and alternative medicine topics? (Check all that apply.) Yes: required elective No Sometimes 3. Does your Allied Health or Nursing academic program of study encourage faculty or students to pursue holistic health or complementary and alternative medicine educational offerings outside your institution? (Check all that apply.) Yes No Sometimes 4. Has your Allied Health or Nursing academic program of study revised its curriculum to include courses on holistic health and/or complementary and alternative medical topics? Yes No

11 Bruguier / HH/CAM Use: NJ Allied Health and Nursing Programs Has your Allied Health or Nursing academic program of study revised its existing course content to include holistic health and/or complementary and alternative medical topics? Yes No 6. If your Allied Health or Nursing academic program of study revised the curriculum or individual course content to include holistic health and/or complementary and alternative medicine, when did this happen? Within the last 1 4 years Within the last 5 10 years No need to revise; always had it Other 7. Will your Allied Health or Nursing academic program of study revise its curriculum or individual course content to include holistic health, and/or complementary and alternative medicine? Yes: curriculum revision individual course revision No Maybe 8. If you answered No to Question 7, please go to Question 9. If you answered Yes to Question 7, please continue here. Indicate when your Allied Health or Nursing academic program of study plans to revise its curriculum or individual course content to include holistic health and/or complementary and alternative medicine. 1 2 years 2 4 years 5 or more years Don t plan to revise curriculum or content of existing courses

12 166 Complementary Health Practice Review 9. Who teaches the holistic health and/or complementary and alternative courses in your Allied Health or Nursing academic program of study? (Check all that apply.) Faculty member Faculty member with holistic/complementary/alternative medical knowledge Faculty member with holistic/complementary/alternative medical credential Guest practitioner with holistic/complementary/alternative medical knowledge Guest practitioner with complementary/alternative medical credential Other Program doesn t offer courses in holistic health or complementary and alternative medicine 10. Who teaches the holistic and/or complementary and alternative medical content discussed in regular courses (courses whose content is not specifically holistic and/or complementary and alternative medical)? (Check all that apply.) Faculty member Faculty member with holistic/complementary/alternative knowledge Faculty member with holistic/complementary/alternative credential Guest practitioner with holistic/complementary/alternative medical knowledge Guest practitioner with holistic/complementary/alternative medical credential Other 11. Do you perceive regular faculty (nonholistic/cam specialist) who teach holistic and complementary/alternative medical courses to be confident in their preparation to do so? Always Sometimes Rarely Never 12. Do you perceive regular faculty (nonholistic/cam specialist) who teach holistic or complementary/alternative content in regular courses to be confident in their preparation to do so? Always Sometimes Rarely Never

13 Bruguier / HH/CAM Use: NJ Allied Health and Nursing Programs If your Allied Health or Nursing academic program of study contains no holistic health, and/or complementary and alternative medicine courses, could the curriculum be strengthened by offering such classes? Yes No 14. If you answered No to Question 13, please go to Question 15. If you answered Yes to Question 13, please continue here. Could the curriculum be strengthened by offering required or elective classes on these topics? Yes: required elective No 15. If your Allied Health or Nursing academic program of study does contain required or elective holistic health and or complementary courses, do these courses strengthen the program? (Check all that apply.) A great deal Some Not at all Program doesn t contain holistic health and/or complementary and alternative medicine courses 16. To what degree is it important for your Allied Health or Nursing academic program of study to have access to quality library resources for holistic health and/ or complementary and alternative medical information? Very important Somewhat important Not too important Not important

14 168 Complementary Health Practice Review 17. To what degree do your Allied Health or Nursing academic program of study constituencies use your institution s holistic and/or complementary and alternative medical library resources (including the librarian)? Always Sometimes Rarely Never 18. Why does your Allied Health or Nursing academic program of study program offer holistic and/or complementary/alternative medical courses/content to its students? (Check all that apply.) Program graduates in clinical settings likely to be exposed to people seeking care who use holistic health and/or complementary and alternative therapies People seeking care likely to ask program graduates questions about holistic health and/or complementary/alternative medicine Student interest Faculty interest Certification requirement Accreditation requirement Licensure requirement Program s tradition includes these principles or modalities Profession s tradition None of the above Program doesn t offer holistic health and/or complementary and alternative medicine courses 19. What is your academic program of study? Allied Health (please specify type) Nursing (please specify: LPN; RN) References American Holistic Medical Association. (2004). The principles of holistic medicine. Retrieved May 4, 2008, from American Holistic Nurses Association. (2004). What is holistic nursing. Retrieved May 4, 2008, from Barnes, P. M., Powell-Griner, E., McFann, K., & Nahin, R. L. (2004). Complementary and alternative medicine use among adults: United States, (CDC Advance Data Report No. 343). Retrieved November 12, 2006, from

15 Bruguier / HH/CAM Use: NJ Allied Health and Nursing Programs 169 Barrett, B. (2003). Alternate, complementary, conventional: Is integration upon us? Journal of Complementary and Alternative Medicine, 9, Retrieved November 12, 2006, from Alt HealthWatch database ( ). Barzansky, B., & Etzel, S. (2003). Educational programs in US medical schools, Journal of the American Medical Association, 290, Baugniet, J., Boon, H., & Ostbye, T. (2000). Complementary/alternative medicine: Comparing the view of medical students with students in other health care professions. Family Medicine, 32 (3), Board on Health Promotion and Disease Prevention, Institute of Medicine. (2005). Complementary and alternative medicine in the United States. Washington, DC: The National Academic Press. Retrieved October 31, 2006, from Burke, A., Peper, E., Burrows, K., & Kline, B. (2004). Developing the complementary and alternative medicine infrastructure: Baccalaureate programs in the United States. Journal of Alternative and Complementary Medicine, 10, Retrieved September 10, 2006, from Alt HealthWatch database ( ). Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R., Delbanco, T. (1993). Unconventional medicine in the United States. Prevalence, costs, and patterns of use. The New England Journal of Medicine, 328, Eisenberg, D. M., Kessler, R. C., Van Rompay, M. I., Kaptchuk, T. J., Wilkey, S. A, Appel, S., et al. (2001). Perceptions about complementary therapies relative to conventional therapies among adults who use both: Results from a national survey. Annals of Internal Medicine, 135, Retrieved November 12, 2006, from Academic Search Premier database ( ). Fenton, M. V. & Morris, D. L. (2003). The integration of holistic nursing practices and complementary and alternative modalities into curricula of schools of nursing. Alternative Therapies in Health and Medicine, 9, Retrieved October 11, 2006, from CINAHL with Full Text database ( ). Halco n, L., Chlan, L., Kreitzer, M., & Leonard, B. (2003). Complementary therapies and healing practices: Faculty/student beliefs and attitudes and the implications for nursing education. Journal of Professional Nursing, 19, Retrieved March 27, 2008, from CINAHL database. Kleinman, A. (2002). The Global transformation of health care: Cultural and ethical challenges to medicine [Videocast]. Retrieved October 30, 2006, from Kreitzer, M., Mann, D., & Lumpkin, M. (2008). CAM competencies for the health professions. Complementary Health Practice Review, 13, Kreitzer, M. J., Mitten, D., Harris, I., Shandeling, J. (2002). Attitudes toward CAM among medical, nursing, and pharmacy faculty and students: A comparative analysis. Alternative Therapies in Health and Medicine, 8, Retrieved September 10, 2006, from Alt HealthWatch database (AN ). Lie, D. & Boker, J. (2006). Comparative survey of complementary and alternative medicine (CAM) attitudes, use, and information-seeking behaviour among medical students, residents, and faculty. BMC Medical Education, 6, 1-6. Retrieved October 30, 2007, from /6/58. National Center for Complementary and Alternative Medicine. (2007). What is CAM? Retrieved October 25, 2007, from National Council of State Boards of Nursing. (2005). NCLEX-PN examination: Test plan for licensed practical/vocational nurses. Retrieved November 10, 2007 from _NCLEX_PN_Detailed_Test_Plan.pdf. National Council of State Boards of Nursing. (2007). NCLEX-RN examination: Test plan for the national council licensure exam for registered nurses. Retrieved November 10, 2007 from Pearson, N., & Chesney, M. (2007). The CAM Education Program of the National Center for Complementary and Alternative Medicine: an overview. Academic Medicine, 82, Tindle, H., Davis, R., Phillips, R., & Eisenberg, D. (2005). Trends in use of complementary and alternative medicine by adults: Alternative Therapies in Health and Medicine, 11, Retrieved October 8, 2006, from Alt HealthWatch database (AN ).

16 170 Complementary Health Practice Review Wetzel, M., Eisenberg, D., & Kaptchuk, T. (1998). Courses involving complementary and alternative medicine at US medical schools. Journal of the American Medical Association, 280, Elsa Bruguier, MLS, MA, is an academic librarian and a tenured member of the faculty at Union County College in New Jersey. She is the manager of the Plainfield Campus library, providing bibliographic instruction, reference assistance, collection development, and service on college committees including the Physical Therapist Assistant and Practical Nursing advisory boards. This article details research conducted in partial fulfillment of the degree requirements for the MA in Holistic Health Studies at Georgian Court University (Lakewood, New Jersey).