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Delmar's Integrative Herb Guide for Nurses
Delmar's Integrative Herb Guide for Nurses

Integrative Herb Guide for Nurses, by Martha Libster, MS, RN. Delmar Press, 2002. 931 pp., $29.95. ISBN 0-7668-2710-0. Soft cover with full-color botanical illustrations insert.

Delmar's Integrative Herb Guide for Nurses CD-ROM. ISBN 0-7668-2711-9. $49.95.

Finally, here is a herb book written by a nurse, for nurses. Professional nursing is a holistic practice that has always considered all aspects of an individual when providing care. Thus, nursing has much in common with traditional herbalist approaches to the individual. Unlike other reference books aimed at the nurse, this book educates the nurse about herbalism while using the paradigms and language of nursing practice. It provides counseling skills needed with the many patients who use herbs, and addresses the concerns of the nurse who seeks to use herbal therapies at work.

The introductory chapters ground the nurse in the world of herbs while teaching how to integrate both traditional and biomedical knowledge into the nursing paradigm. Reading about the history of herbs in the nursing profession will be of special interest to nurses. The vitalist viewpoint and extensive herbal practices of Florence Nightingale may come as a pleasant surprise to nurses and herbalists alike. One chapter is devoted to the preparation of basic herbal applications: teas, foods, external preparations, and environmental therapies. The CD-ROM features 17 videos that demonstrate their preparation and application for patient use; reason enough to consider buying the CD-ROM.

The next two-thirds of the book, more than 600 pages, is devoted to detailed profiles of 58 plants commonly used for healing. The author groups these plant profiles into health patterns along the lines of nursing diagnostic categories. Most categories are easily recognized by nurses: skin care, sleep and rest, comfort and pain relief. This organization focuses attention on herbal therapies that address a patient's pattern of response to an illness rather than the disease process, as a medical diagnosis reflects. The introduction to the profiles discusses how to use the information in the profiles. The traditional evidence section is introduced with a sketch of the healing paradigms of twelve different cultures, including Hispanic, African, Russian/Baltic, Middle Eastern, and European cultures. Details of use by these cultures are provided in the profiles. Modern herbal use (i.e., Western herbalism) is described separately. This cultural information alone makes the book a worthy resource, especially for those working in ethnically diverse settings.

Biomedical evidence is then reviewed, a serviceable introduction to the scientific literature. The reliability of information in the pregnancy and lactation sections is highly variable. Herbal use during labor and delivery is given in some detail; at last, the use of herbal allies for the laboring woman is discussed in a book for nurses! The profiles do not discuss pregnancy and lactation separately, although the pharmacological considerations for each are very different. Statements of herb "contraindication" during lactation (such as the author lets stand with coffee) always irritate me, as they do not always reflect modern standards of lactation information or counseling considerations. For one thing, the individuality of every mother-baby pair renders such blanket contraindication statements clinically useless. Further, there is also no discussion of the key safety considerations for lactation needed to assist interpretation of such statements to mothers. In all fairness to the author, these deficiencies are the norm for professional herbal literature to date. Some of the lactation-related information is hidden in other profile sections; having it all in one place would have been preferable, especially when using the CD-ROM.

The pediatric information section is most welcome, as there is a great need for the pediatric nurse to be herbally competent to counsel parents. This book will be a great help, as many (most) herbals for healthcare professionals do not even mention pediatric use of herbs, let alone show a willingness to discuss specifics of use (the "just say no" strategy). The herb profiles also consider cautions, nursing evidence (historic and potential uses, integrative insights), therapeutic applications (types of preparations, dose ranges), potential nursing applications, and patient interaction.

The information for patients section has permission from the author for copying and may be printed from the CD-ROM for use as a handout. Nurturing the nurse-plant relationship section has wonderfully creative activities inspired by the author's own relationship with each plant.

The final chapters of the book discuss further learning opportunities, research, and the law. The discussion on the law will, I am sure, be read carefully by all practitioners, as this is one hot topic. Even mentioning possible herbal therapies to patients has brought physician accusations of the nurse being a "kook" or of giving medical advice. Many nurses have heard of such incidents, or endured them. While this section is a little short on providing the specifics for bringing herbs into Western hospital practice (e.g., how to deal with infection control concerns), it is a great discussion of current legal and ethical challenges and opportunities. More success stories would have been encouraging reading (there are never enough of these!).

Nursing regulations pertinent to herb care vary by country and in the United States by state. It is heartening to read that the Canadian Nursing Association considers the use of complementary therapies such as herbs, as falling within the scope of nursing practice if such practice takes place within the nursing process, with evidence of the nursing process being used. Clearly, the profession of nursing in the United States still needs to define how herb care will be integrated into nursing practice. Currently, many state regulatory boards are officially "studying" the issue (i.e., not taking action). This inaction has potential for both good and bad. Taking note of the historically independent nature of herbal care by nurses, the author warns against nursing regulations that would limit nursing practice to that covered by a physician's order. She rightly perceives that such regulations would result in overkill, similar to regulations that would make all herbal medicines prescription drugs.

The last section features a summary of effective ways to communicate with patients about herbs, providing guidelines on how, when, and to whom to refer patients; required reading for all nurses. References are listed by chapter in the back of the book. The CD-ROM provides rapid alphabetical referral to each herb profile; one can find the herb using the numerous common names provided or the botanical name – your choice.

Overall, this book and the accompanying CD-ROM will greatly assist nurses. Even for the nurse who cannot yet imagine using herbs with patients, the book is an excellent counseling resource. Both the book and the CD-ROM would be excellent tools for teaching. There is enough information here to get a nurse started on becoming herbally educated, while suggesting that there is plenty more to learn. An inspiring book at a bargain price.

– Sheila Humphrey, BSc, RN International Board Certified Lactation Consultant Marine on St. Croix, Minnesota