Supplements, Oils

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  • #42805
    Robyn Janloo
    Participant

    Hi Camp Nurses,

    I am new to the camp environment, so I am still trying to figure out what should be considered a medication. I don’t believe my camp has an opinion on whether essential oils or supplements are medications. I’m curious how these are classified at your camps. Also, for things like melatonin or herbal/homeopathic remedies, do you get MD approval? They are technically OTC, but for minors…? Would you allow your campers to keep essential oils with them (we had a camper come with a roller ball of essential oil).

    Thanks four your feedback!

    Robyn

    #42806
    Mary Marugg
    Member

    Robyn,

    Good questions! From Erceg and Gaslin’s Camp Nursing: The Basics and Beyond book there is a good explanation of medication:
    “From a camp perspective “medication” often refers to substances that people use either routinely or as needed to maintain their health and/or to promote recovery from injury or illness events.Such a definition brings alternative and complimentary remedies, vitamins and food supplements under the camp’s “medication” umbrella.”

    Check your state regulations regarding medications at camps, some states do specifically include herbal and homeopathic remedies, and require MD approval for their use at camp.

    ACN’s practice guideline also addresses this umbrella of “medication” https://s3.amazonaws.com/amo_hub_content/Association1124/files/Medication%20Management%20PG%20Dec%202013.pdf

    CBD oil also is included in this realm, here is a link to additional information about CBD oil: https://www.acacamps.org/resource-library/campline/challenges-considerations-cbd-oil-camp

    This may be a great time for you to help your camp develop some policies for herbal and homeopathic substances, taking in to consideration state regulations.

    -Mary

    #42934
    Stacy Dorian
    Participant

    I do have a question and have been looking at ACN and online…we have a policy about NOT accepting homeopathic remedies but my boss keeps trying to force me to accept and administer them..which I have refused. One essential oil capsule clearly stated on the manufacturers website not to give to anyone under the age of 18 years…..I said case closed…it keeps getting thrown in my face and I have had it.
    Now they want me to give some COVID homeopathic stuff (Covid Nosode) and I flat out said no…..

    So, does ACN have a position statement on the use of unregulated substances (I will not call them medications) such as homeopathic granules, tinctures etc. My boss is telling me that ACN fully supports giving such medications which I do not believe to be the case based on your presentations on CBD and other unregulated substances.

    Can you please give me some advice on how to proceed at this point? I am working with someone who has zero medical experience and does not understand the concept of having a license.

    #42935
    Stacy Dorian
    Participant

    This is the response I sent out…to the parent pushing me to give COVID homeopathic remedies….

    I am sorry but it is the policy of Camp XXXXX to not accept homeopathic/naturopathic remedies.
    The Association of Camp Nurses (part of the American Camp Association) supports this policy.

    In addition, giving remedies to people may have implications under a camp’s insurance policy. Frequently, policies include language excluding coverage for willful, intentional, or criminal acts and under the Nurse Practice Act dispensing a remedy falls under the discretion of the person administering the substance. Evidence based care is the standard in nursing practice and any deviation from this can be construed as a willful and intentional act if there are any detrimental outcomes. The nursing literature is very specific about the responsibility a nurse assumes when giving medication to a client and the nurse is then held responsible for the administration of any substance (medication or otherwise.)

    The nurse is held accountable for his or her actions. Some nurses may accept that responsibility; others may not. Note that the nurse is the one who must accept the responsibility, thus the accountability. A camp may be implicated, but each nurse retains accountability for his or her professional behaviors.

    Anecdotal evidence as to the safety and efficacy of homeopathic/naturopathic/CBD products do not rise to the level of safe practice..see framework below which comes directly from the Association of Camp Nurses:

    I cannot get the Nursing Practices Decision Framework to copy here, but it is in the article from ACA Publication in 2017 entitled Can My Camp Nurse Do That?

    #42936

    Hello Everyone:

    It looks like there is some great conversation here. I hope more will see the robust interaction of this forum and realize the value to their practice.

    Please allow me to respond with the knowledge and experience that ACN (Association of Camp Nursing) has from years of working in this space. Medication management is one of the most common activities performed at camp and licensed nurses are the only healthcare provider with the training, education, and background in this complex area of practice.

    What do we know:
    1. Every nurse has to follow their state nurse practice act. I encourage everyone to know their practice act, especially if you are working in a state different than your home state.
    2. There is a standard of care that we all must consider. The standard of care is “what any reasonable and prudent person with similar training and experience would do”. Therefore the standard of care is different depending on nursing educational level, years of experience, and comfort in providing a service. Stacy is correct in that the nurse, as a licensed healthcare provider, is accountable for their actions. Example: If a nurse receives a medication order and the nurse recognizes that the dose prescribed is 5x the normal limit, is he/she supposed to administer? No, the nurse is accountable to verify that dose, confirm the rationale for the high dose, or help get the dosing corrected through communicating with prescriber. We would expect the same thoughtful consideration for anything being given at camp.
    3. All medications have to be given per a prescriber order – prescription medications and OTC medications. Most camps do this by having medical standing orders that are signed by a licensed prescriber in that state. If you don’t give a tylenol in the hospital without an order, then the same rules apply at camp. Just because the setting is different (camp and not hospital) the same state regulations apply. Nurses should not give medications or other products under the direction of a parent. In many cases, that would be practicing outside your scope and could be grounds for losing a license.

    This is where the challenge comes with homeopathics, herbals, vitamins, and other rememdies that a parent wants their child to take. A camp nurse who has been a camp nurse for 20+ years may have developed some comfort in giving these agents, while the new nurse most likely will not be comfortable. Remember, the comfort comes from education and experience so practice patterns between nurses will vary for this reason. We all still have to follow state law and that too can vary some from state to state.

    So, in response to the question about giving homeopathics, here are some considerations:
    1. Ask a prescriber (MD, NP, PA) for a prescription for the agent outlining the five things a nurse needs for med administration (right person, right drug, right dose, right route, right time). This will at least meet the standard of most state laws.
    2. Talk to the parent about the need for the agent as a life-sustaining or life-saving product. Some parents will be willing to just restart that product when the camper returns home.
    3. Decide about your standard of care. What is your experience with a product? What is your comfort level? It is OK to remind parents and camp leadership that your job is to set campers (and staff) up for success and one of the best ways to do that is to make sure all the medications being administered are within your area of expertise.

    Keep up the good conversation. For camp leadership, this can become somewhat of a “turf war” so try and approach the situation focused on caring for staff and campers to the best of your ability.

    Take care
    Tracey Gaslin

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