Transcript COMPLEMENTARY AND ALTERNATIVE THERAPIES

Complementary and
Alternative Therapy
C. Matthews MSN, RN
Marilee Elias, MSN, RN
Spring 2012
Please make phones silent & visible
Reading

Required:
– Wilkinson-Ch. 40
– Ignatavicius – Ch. 2

Suggested Additional reading:
– Lilley – Ch. 8 “Over the counter drugs and
Herbal products”
Some references in this presentation will be
from pages in your textbooks other than
required chapters – highly recommended
reading.
7/16/2015
C. Matthews RN, MSN
M. Elias RN, MSN
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Course Outcomes
1. Identify the roles of the nurse in a variety of
community settings to maintain optimal level of
wellness.
2. Client - centered teaching.
3. Apply the nursing process to meet the
physiological and psychosocial needs of clients
and their families at the end of life.
4. Standards of safe medication administration.
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M.Elias RN, MSN SP10
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UNIT OUTCOMES
1. Integrate complementary therapies into health promotion
activities for the well client.
2. Assess client need for Complementary or Alternative
therapy.
3. Identify use of Complementary or Alternative therapy.
4. Evaluate outcomes of Complementary or Alternative
therapy practices.
5. Provide non-pharmacological measures for pain relief.
6. Identify quackery or unscrupulous practitioners.
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M.Elias RN, MSN SP11
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CONTENT FOR ALTERNATIVE THERAPIES

I. Systems of Health Care
– Traditional Chinese Medicine
– Native American medicine
– Homeopathy

II. Mind-Body Therapies
– A. Journaling
– B. Imagery
– C. Meditation

III. Manipulative Therapies
– D. Massage
– E. Tai Chi
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CONTENT FOR ALTERNATIVE THERAPIES

IV. Biologic Based Therapies
– A. Aromatherapy
– B. Herbal preparations

V. Energy Therapies
– Healing touch
– Therapeutic touch
– Reiki
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M.Elias RN, MSN SP10
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History of Western Medicine
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M.Elias RN, MSN SP11
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Ancients -- Myths & Religion –
Basis For Medical Practice
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M.Elias RN, MSN SP11
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History of Western Medicine:
Ancient Greece & Rome
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
Hippocrates

Galen
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M.Elias RN, MSN SP11
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History of Western Medicine

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Early Christian era
ushers in hospitals
and health care
similar to
established Arab
Medicine
C. Matthews RN, MSN
M.Elias RN, MSN SP11
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History of Western Medicine

Middle Ages
– Midwives
– Witches
– Physicians
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M.Elias RN, MSN SP11
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History of Western Medicine

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Renaissance
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M.Elias RN, MSN SP11
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History of Western Medicine
– Lister
– Nightingale
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M. Elias RN, MSN SP11
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History of Western Medicine

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20th and 21st
Centuries
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M. Elias RN, MSN SP11
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Integrative Health Care is
A Concept of Coordinated Health Care that
Includes ALL the Treatments
(Conventional and CAMs) and Health
Practices that Your Patient uses in their
Life.
How do We get our Patients to Tell us about
the CAMs they use?
Course outcome #1
Unit outcome #1
C. Matthews RN, MSN
M. Elias RN, MSN SP11
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What is Holism?
Concept focused on Relationships among
all living things.
 Therapeutic Encounters include:

– Enhancing Resistance to Illness
– Reducing aggravating behaviors
– Stress Management
– Goal is Optimal state of Wellness for each
unique person
Course outcome #1
Unit outcome #1
C. Matthews RN, MSN
M. Elias RN, MSN SP11
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RNs must be familiar with C. A. M.
“The 2007 National Health Interview
Survey (NHIS), which included a
comprehensive survey of CAM use by
Americans, showed that approximately
38 percent of adults use CAM.” NCCAM
retrieved 3/16/11 from http://nccam.nih.gov/health/whatiscam/
Course outcome #1
Unit outcome #1
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M. Elias RN, MSN SP11
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What is CAM?
 Complementary
modalities
(therapies): used in conjunction with
conventional medical practice.
(Wilkinson, p. 1019)
 Alternative
Modalities(therapies):
used instead of traditional care.
(Wilkinson, p.1019)
Unit outcome #3
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M. Elias RN, MSN SP11
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RN must:
1.Be non-judgmental despite personal opinions
2. Build rapport by showing client respect – if
not, he may be afraid to tell about CAM use
3. Understand that C.A.M. can be beneficial,
when used correctly
4. Be aware that C.A.M. can be dangerous if it
interacts or interferes with conventional
treatment
Course outcome #1
Unit outcome #1
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M. Elias RN, MSN SP11
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RN must:
5. Be willing to teach the public about the
positive and negative information
regarding C.A.M.
6. Be aware that use of C.A.M. is popular
and increasing and must be included in
the history & physical
7. Know that Herbals, in particular, can
have significant effect on prescription
drugs and body function
Course outcome #1,2
Unit outcome #1
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M. Elias RN, MSN SP11
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National Center for Complementary
and Alternative Medicine
National Institutes of Health established
NCCAM.
 Purposes:

– Fund studies evaluating effectiveness of
C.A.M.
– Advance health professional knowledge re:
C.A.M.
– Serve as a clearinghouse for information
about these therapies
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M. Elias RN, MSN SP11
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NCCAM Domains of C.A.M.
Ignatavicius pg 8; Wilkinson p. 1020

National Center for Complementary and
Alternative Medicine – 5 categories
– Systems of Health Care
– Mind-body therapies
– Manipulative and body-based therapies
– Biologically based therapies
– Energy therapies
Unit outcome #3
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M. Elias RN, MSN SP11
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Mind-Body

Meditation
– Stress relief/ reduce anxiety
– Relaxation
– Reduced levels of lactic acid
– Decreased oxygen consumption
– Slowed heart rate
– Decreased blood pressure
– Improved function of immune system
– Reduce pain
– Relieve symptoms of psoriasis
– Improve health
 (References: Ignativicius; Wilkinson)
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Relaxation
 Used post-operatively (Ignatavicius, p. 299)
 Relaxation techniques (Ignatavicius, p. 56-57)
– To reduce anxiety, tension & emotional
tension which can exacerbate pain
 Relaxation (Wilkinson Vol 2, p. 967; Vol 1, pg 806-807)
 Progressive
(Wilkinson p. 807)
muscle relaxation (PMR)
 Promoting sleep
 Can be taught in home setting
 Nurses can use for reduction of pain & stress.
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Guided Imagery
– Distraction when confronting pain, discomfort
or fear
– Making decisions and altering behavior
– Caution: not recommended for emotionally
unstable or cognitively impaired client
– Helps reduce pain.
– Reduction of nausea & vomiting.
– Decreasing anxiety
– Promoting comfort during cancer treatment
– Ignatavicius, 6th ed. p. 9
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Mind - Body
Biofeedback
 Journaling

(see Wilkinson text p. 1027)
– Provides a vehicle for expressing feelings

Hypnosis
– Advanced training is NECESSARY

Humor
– Biochemical Responses?
– Physiologic Responses?
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Spiritual

Life force beliefs found in most cultures.
(Wilkinson, p 1020)

Faith healing
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(Wilkinson page 260)
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M. Elias RN, MSN SP11
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Spiritual
 spiritual
beliefs – how they affect health
 Longer life span
 Predictors of health outcomes
 Effects on specific diseases
– Page 249 Wilkinson
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Prayer

Most Widely Used CAM in U.S.
(NCCAM, 2004)
C.A.M. interventions
 Prayer

(Wilkinson page 257)
– For Self
– For Others
– Healing Prayer Services
– Prayer Groups
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M. Elias RN, MSN SP11
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Spiritual
 Intercessory
prayer
– An organized and regular form of prayer in
which someone communicates with his or
her higher power on behalf of another who
is in need.
 Healing
prayer
– Studies showing evidence of improvement
 Wilkinson, p 259-260
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Spiritual

Nurses should expect to work in
collaboration with others, particularly
ministers, pastors and chaplains, to meet
the complex spiritual needs of all patients.

Potential problem: the nurse and patient
have different views of spirituality
– Respect patient’s wishes
– If patient asks for spiritual intervention that is
inconsistent with the nurse’s beliefs, seek
assistance from another nurse or chaplain.
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Manipulative and body-based methods
 Movement
& exercise
– Strengthens circulatory & respiratory
function
– Endorphins
– Helps regulate metabolism
– Enhances Immune system
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Manipulative and Body-based Therapies

Yoga
– “life forces in correct balance and flow
– Concentration, strength, flexibility, symbolic
movements
– Breathing, movement & posture

Tai Chi
– Promotes the flow of qi or energy throughout the
body
– Ignatavicius, p. 11
– Reduces sx. of fibromyalgia
– Used in cardiac rehab programs, can lower BP
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Other Movement Therapies

Dance Therapy
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Chiropractic and Osteopathy

Chiropractic
– Relationship between Body Structure and
Function
– Subluxation & Adjustment

Osteopaths D.O. vs. M.D.
– Includes Osteopathic Manipulation
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M. Elias RN, MSN SP11
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Massage
– Muscles & Soft Tissues
– Benefits of Massage
– Contraindications for Massage
– Can we (nurses) do Massage?
Unit outcomes #1-5
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M.Elias RN, MSN SP10
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Energy – Based Therapies

“A group of techniques
that work with the
body’s energy field by
the use of the hands to
direct or redirect the
energy to enhance
balance within the field.”
(see Wilkinson page 1033-34)
alternativecancer.us/aura.jpg
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M. Elias RN, MSN SP11
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Energy – Based Therapies

Energy fields
www.windsofchange.eu.com/chakra.
html
http://images.google.com/images?hl=en&q=layers+of+body+energy+field&btnG=Se
arch+Images&gbv=2
– Layers
– Chakras
– Reflexology ‘zones’
http://images.google.com/images?gbv=2&hl=en&q=reflexology+zones&btnG=S
earch+Images
– Traditional Chinese Medicine – 12 Meridians
(Ignatavicius, 6th ed., page 9)
– Acupressure ‘meridians’ (Wilkinson figure 40-3 page 1024)
– Acupuncture chi/blockages
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Energy – Based Therapies

Therapeutic massage
– Precaution –

Wilkinson p. 1033
Therapeutic touch
– Caution for touch –
Ignatavicius 6th ed., page 13
Healing touch
 Reiki
 Acupressure
 Reflexology

Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Energy – Based Therapies

TT (Therapeutic Touch)
– Integral to assessment
– Bonding
– Communication
– Soothing, calming, comfort
– orientation

Contraindications
– When NOT to touch –
Unit outcomes #1-5
Ignatavicius pg. 13
C. Matthews RN, MSN
M. Elias RN, MSN SP11
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Reiki
Create Energy Balance
 Patient draws Energy
 Reiki Masters & Training

“Reiki is a Japanese technique for stress
reduction and relaxation that also
promotes healing. It is administered by
"laying on hands" and is based on the idea
that an unseen "life force energy" flows
through us and is what causes us to be
alive.”
http://www.centurylink.net/search/index.php?q=google&context=www.centurylink.net
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Reflexology/Acupressure

Reflexology
– Ancient Egypt
– Energy Zones Top to Bottom
– Pressure Points
– What conditions benefit from it?

Acupressure
– Meridians & Pressure Points
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Acupuncture
Derived from traditional Chinese medicine
and other countries and alternative
systems
 Qi (chi) Energy travels through 72
Meridians in the body
 Needles are applied to Acupoints on the
Meridians to restore the flow of qi

Unit outcomes #1-5
C. Matthews RN, MSN
M. Elias RN, MSN SP11
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Acupuncture – uses for
Migraine headache – Ignatavicius, p. 953
Pain and Anesthesia – Ignatavicius p. 57
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M.Elias RN, MSN SP10
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
The dreaded nausea and vomiting which commonly
occurs in some patients undergoing chemotherapy
and inevitably, with the use of certain classes of
agents, can often be worse than the disease itself.
Most oncologists have experienced the patients
who start vomiting at the thought of their next clinic
visit. At the University of Los Angeles (UCLA)
School of Medicine, a well-controlled study
completed over two Years ago, the authors of the
published paper reported significant reduction of
nausea and vomiting when pre-treated with. It is
now routinely administered before, after and in
between chemotherapy treatment sessions for
control or nausea and emesis. Such treatments are
relatively simple and easily executed in an
outpatient setting. Its effectiveness helps in
minimizing the use of standard, expensive multidrug anti-nausea regimens with their attendant side
effects, given along with the chemotherapeutic
agents.

Acupuncture in Cancer Treatment by Eugene Mak, MD@
http://www.medicalacupuncture.org/acu_info/articles/cancertreatment.html
C. Matthews RN, MSN
7/16/2015
M.Elias RN, MSN
SP10
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Biologically Based Therapies
Dietary Therapies
 Herbs
 Vitamins
 Aromatherapy

Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Dietary Therapies
Nutraceuticals and phytonutrients
 Protective or healing agents found in plant
and animal foods.
 Free radicals: unstable molecules that alter
genetic codes and trigger the development of
cancer growth in cells.
 Antioxidants: react with free radicals,
preventing their damaging effects

– Sources of antioxidants: vitamin C, betacarotene, vitamin E
Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Dietary Therapies

Macrobiotic Diets
– Yin/ yang of foods
– Balanced foods
– Foods to avoid: processed and treated foods,
red meat, sugar, dairy products, eggs,
caffeine
– Caution: children and pregnant women may
have deficiency in Vitamins D and B12
Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Aromatherapy –
Wilkinson page 1030
Essences from oils extracted from plants &
flowers.
 Conditions responsive to aromatherapy:

– Stress and anxiety
– Muscular and rheumatic pains
– Digestive disorders
– Skin conditions
Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Aromatherapy

Can be used for sense of smell, but also
as compresses, baths or topical
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M. Elias RN, MSN SP11
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Aromatherapy
(Ignativicius, p.12)
Lavender – promotes relaxation & sleep
 Peppermint – stimulation, concentration
 Sandalwood – ease depression
 Tea tree – treating MRSA?
 Chamomile – relaxation
 Lemon – promotes sleep/ tx for insomnia
and/or digestive disorders

Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Herbals
Cherokee story
 “…humans were without diseases until the
animals created them in retribution for the
lack of respect humans had shown them.
The plants, however, felt that the animals
were much too harsh and volunteered
themselves to provide a cure for every
disease the animals had created.”
 Cavendar, p. 55
Course outcome # 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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HERBALS – what RN needs to know

Major drawback: May delay important diagnosis
and treatment.

Nursing Intervention: Make certain MD or ARNP
is aware of client’s use of herbals.
 Nursing action: What to assess & instruct preop client regarding herbal therapy.
Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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HERBALS – what RN needs to know

FDA categorized herbals as food and nutritional
supplements not as drugs

The Dietary Supplement Health & Education Act
(DSHEA) of 1994 allowed herbs to be sold as
dietary supplements as long as there are no
health claims written on labels

DSHEA requires no proof of safety or efficacy
and sets no standards for products labeled as
supplements, i.e. no guarantee the herb is
properly prepared
Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Commonly used Herbals
Ignatavicius page 12 – table 2-3
Know intended uses for each
 Know Caution & adverse effects of each

– Gingko bilboa
– Garlic
– Echinacea
– Ginseng
– St. John’s Wort
Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Ginko Biloba
Reduce Memory Problems, Dementia,
Peripheral Vascular Disease
 Antioxidant & Vasodilatory Properties
 BUT can cause BLEEDING when used
with Anticoagulants
 Avoid before surgery
 Also cause Headache, GI Upset

Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Garlic
Lowers Cholesterol, Lowers BP, Natural
Antibiotic,
 Natural Anti-platelet Agent
 BUT Causes BLEEDING with other Antiplatelet Drugs
 Potentiates Anti-diabetic Drugs
 Avoid before Surgery

Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Echinacea
Builds Immunity, Helps Wound Healing
 Use > 8 Weeks & Possible Immune
Function Suppression
 NOT Recommended for People with
Immune Diseases

Course outcome #2, 3 & 4
Unit outcomes #1-5
C. Matthews RN, MSN
M. Elias RN, MSN SP11
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Ginseng
Asian Ginseng- Diabetes, Erectile
Dysfunction, “Unclear” Thinking
 American Ginseng- Diabetes,
Prevention of Colds & Flu
 Siberian Ginseng- Prevent Colds & Flu,
reduce Severity of Herpes Simplex type 2
Infections
 BUT, BUT, BUT, BUT…

Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Ginseng and the Big Buts
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M. Elias RN, MSN SP11
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Ginseng & The BIG BUTS
Insomnia, Headache, Agitation, GI Upset,
Unusual Menstrual Bleeding, Breast Pain,
Dizziness, Increase or Decrease BP,
Hypoglycemia,
Fast/Pounding/Irregular Heartbeat;
Severe Allergic Reaction
 Not with Immune System Disorders,
Schizophrenia, Endometriosis, Fibroids
 NOT FOR Long-term Use

Course outcome # 2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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St. John’s Wort
Ease Mild to Moderate Depression
 BUT causes Photosensitivity
 DO NOT use in Major Depression
 DO NOT use with Other Antidepressants

Course outcome #2, 3 & 4
Unit outcomes #1-5
C. Matthews RN, MSN
M. Elias RN, MSN SP11
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Herbals
Alert: “Natural” does not always mean
harmless.
 Plants used improperly can be poisonous.
 Chemicals within herbs can strengthen the
immune system, alter blood chemistry, or
protect specific organs against disease
 Caution: some individuals may have
allergies

Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Herbals

Special precaution with pregnant or
lactating women and children – should not
use without physician’s knowledge
Rationale:
Unpredictable biologic effects
Possible allergies
Side effects
Herbs have chemical composition
Little or no regulation of production/ quality
Possible herb/drug or herb/herb interaction
Possible delay of treatment is dangerous
Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Herbals & the RN
 Teach
about signs of allergic
reactions
 Teach
that herbs can be dangerous
even if they are not Rx and are
“natural”
Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Herbals & the RN

Always ask about use of herbals when
getting medication history

“What is the story of why the patient is
using the plant medicine or therapy?”
– Libster, p. 809

Teach clients to look for products labeled
‘standardized’ – these more likely to have
accurate amounts of herb and less likely
to have contamination
Course outcome #2, 3 & 4
Unit outcomes #1-5
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Frankincense and Myrrh* medicinal use

Have had spiritual significance since ancient
times and they also were adopted as medicines
for physical ailments.

In modern Chinese Materia Medica, these two
resins are classified as herbs for vitalizing
circulation of blood and are utilized for treating
traumatic injury, painful swellings, masses, and
other disorders related to stasis syndromes.
–
MYRRH AND FRANKINCENSE by Subhuti Dharmananda, Ph.D., May 2003 @
http://www.itmonline.org/arts/myrrh.htm
Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
*Will not be on the test!
67

Pain in the epigastrum, abdomen, hypochondria, and/or
heart due to qi and blood stasis, and stagnation in the
viscera and bowels or the channels (jing) and network
vessels (luo).

Amenorrhea, dysmenorrhea, or postpartum abdominal
pain due to blood stasis.
Rheumatic complaints due to wind damp causing qi and
blood stagnation and stasis in the network vessels.
Wounds, scars, and skin inflammation with blood stasis
and necrotic tissue.



Traumatic injuries with pain, swelling, and redness due
to qi stagnation and blood stasis.
–
7/16/2015
MYRRH AND FRANKINCENSE by Subhuti Dharmananda, Ph.D., May 2003 @
http://www.itmonline.org/arts/myrrh.htm
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M. Elias RN, MSN SP11
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Folk Medicine
(Ignatavicius, 6th ed., page 32-33)
Learned from experience
 Passed from generation to generation
 Preservation of heritage/ culture
 Some have been scientifically proven (ex.
Garlic)
 Plants/herbs
 Hot/cold


“Evil Eye” (Mal de Ojo)
Course outcome #2, 3 & 4
Unit outcomes #1-5
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M. Elias RN, MSN SP11
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Folk Medicine

Own terminology: (Feel free to ask the meaning)
–
–
–
–
–
–
–
“high blood”
“low blood”
“Thick blood”
conjure
“fall out”
gimpy
risin’
sugar
Weeded breasts
“snuffing the mother”
“the itch”
“thin blood”
water
dropsy
cut pain
– Cavendar, 2003
Course outcome #2, 3 & 4
Unit outcomes #1-5
C. Matthews RN, MSN
M. Elias RN, MSN SP11
71
Course outcome #2
Unit outcome #6
C. Matthews RN, MSN
M. Elias RN, MSN SP11
72
What is Quackery?
A pretender
 Questionable products & services
 Overpromotion vs fraud
 Misinformation
 Useful for some purposes, not others

Course outcome #2
Unit outcome #6
C. Matthews RN, MSN
M. Elias RN, MSN SP11
73
How to spot Quackery











Tell only part of the story
Overpromotes nutritional insurance
Play on fears about chemicals
‘Everyone needs supplements’
Promise quick, dramatic, miraculous results
Anecdotes & testimonials
Questionable credentials
Claim persecution
Promote distrust
Take claims directly to the media, not peers
Resist peer review
Course outcome #2
Unit outcome #6
C. Matthews RN, MSN
M. Elias RN, MSN SP11
74
Nurses Educate the Public
Teach signals of fraudulent practice
 Avoid ‘healers’ who:

– Promise immediate relief or success
– State that their way is the only sure therapy
– Refuse to work with other health care
providers
– Claim to have all the answers
– Use testimonials that claim amazing results
Course outcome #2
Unit outcome #6
C. Matthews RN, MSN
M. Elias RN, MSN SP11
75
One Minute Paper
Now is the time to write short answers
to:
1. What is something you heard today that
is new to you?
2. How do you plan to approach your
clients about CAM?
3. List one thing that surprised you.
4. List one thing that reinforced something
you already believed.
7/16/2015
C. Matthews RN, MSN
M. Elias RN, MSN SP11
76
References
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Cavender, A.(2003) Folk Medicine in Southern
Appalachia. The University of North Carolina Press,
Chapel Hill, N.C.
Ignatavicius, D.D. & Workman, M.L. (2010) MedicalSurgical Nursing. 6th ed. Elsevier Saunders, St. Louis,
Missouri.
Libster, M.L. (2002) Delmar’s Integrative Herb Guide for
Nurses. Delmar Thomson Learning. United States.
Wilkinson, J.M. & Treas, L.S. (2011) Fundamentals of
nursing, 2nd ed. FA Davis Company, Philadelphia, PA.
7/16/2015
C. Matthews RN, MSN
M. Elias RN, MSN SP11
77