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Complementary and Alternative Therapy

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”

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Complementary and Alternative Therapy

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  1. Complementary and Alternative Therapy C. Matthews MSN, RN Marilee Elias, MSN, RN Spring 2012 Please make phones silent & visible

  2. 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. C. Matthews RN, MSN M. Elias RN, MSN

  3. 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. C. Matthews RN, MSN M.Elias RN, MSN SP10

  4. 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. C. Matthews RN, MSN M.Elias RN, MSN SP11

  5. 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 C. Matthews RN, MSN M.Elias RN, MSN SP11

  6. CONTENT FOR ALTERNATIVE THERAPIES • IV. Biologic Based Therapies • A. Aromatherapy • B. Herbal preparations • V. Energy Therapies • Healing touch • Therapeutic touch • Reiki C. Matthews RN, MSN M.Elias RN, MSN SP10

  7. History of Western Medicine C. Matthews RN, MSN M.Elias RN, MSN SP11

  8. Ancients -- Myths & Religion – Basis For Medical Practice C. Matthews RN, MSN M.Elias RN, MSN SP11

  9. History of Western Medicine:Ancient Greece & Rome • Hippocrates • Galen C. Matthews RN, MSN M.Elias RN, MSN SP11

  10. History of Western Medicine • Early Christian era ushers in hospitals and health care similar to established Arab Medicine C. Matthews RN, MSN M.Elias RN, MSN SP11

  11. History of Western Medicine • Middle Ages • Midwives • Witches • Physicians C. Matthews RN, MSN M.Elias RN, MSN SP11

  12. History of Western Medicine • Renaissance C. Matthews RN, MSN M.Elias RN, MSN SP11

  13. History of Western Medicine • Lister • Nightingale C. Matthews RN, MSN M. Elias RN, MSN SP11

  14. History of Western Medicine • 20th and 21st Centuries C. Matthews RN, MSN M. Elias RN, MSN SP11

  15. 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? C. Matthews RN, MSN M. Elias RN, MSN SP11

  16. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  17. 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/ C. Matthews RN, MSN M. Elias RN, MSN SP11

  18. 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) C. Matthews RN, MSN M. Elias RN, MSN SP11

  19. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  20. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  21. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  22. NCCAM Domains of C.A.M.Ignataviciuspg 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  23. 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) C. Matthews RN, MSN M. Elias RN, MSN SP11

  24. 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 muscle relaxation (PMR) (Wilkinson p. 807) • Promoting sleep • Can be taught in home setting • Nurses can use for reduction of pain & stress. C. Matthews RN, MSN M. Elias RN, MSN SP11

  25. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  26. Mind - Body • Biofeedback (see Wilkinson text p. 1027) • Journaling • Provides a vehicle for expressing feelings • Hypnosis • Advanced training is NECESSARY • Humor • Biochemical Responses? • Physiologic Responses? C. Matthews RN, MSN M. Elias RN, MSN SP11

  27. Spiritual • Life force beliefs found in most cultures. (Wilkinson, p 1020) • Faith healing (Wilkinson page 260) C. Matthews RN, MSN M. Elias RN, MSN SP11

  28. Spiritual • spiritual beliefs – how they affect health • Longer life span • Predictors of health outcomes • Effects on specific diseases • Page 249 Wilkinson C. Matthews RN, MSN M. Elias RN, MSN SP11

  29. Prayer • Most Widely Used CAM in U.S. (NCCAM, 2004) • C.A.M. interventions (Wilkinson page 257) • Prayer • For Self • For Others • Healing Prayer Services • Prayer Groups C. Matthews RN, MSN M. Elias RN, MSN SP11

  30. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  31. 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. C. Matthews RN, MSN M. Elias RN, MSN SP11

  32. Manipulative and body-based methods • Movement & exercise • Strengthens circulatory & respiratory function • Endorphins • Helps regulate metabolism • Enhances Immune system C. Matthews RN, MSN M. Elias RN, MSN SP11

  33. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  34. Other Movement Therapies • Dance Therapy C. Matthews RN, MSN M. Elias RN, MSN SP11

  35. Chiropractic and Osteopathy • Chiropractic • Relationship between Body Structure and Function • Subluxation & Adjustment • Osteopaths D.O. vs. M.D. • Includes Osteopathic Manipulation C. Matthews RN, MSN M. Elias RN, MSN SP11

  36. Massage • Muscles & Soft Tissues • Benefits of Massage • Contraindications for Massage • Can we (nurses) do Massage? C. Matthews RN, MSN M.Elias RN, MSN SP10

  37. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  38. Energy – Based Therapies • Energy fields http://images.google.com/images?hl=en&q=layers+of+body+energy+field&btnG=Search+Images&gbv=2 • Layers • Chakras • Reflexology ‘zones’ http://images.google.com/images?gbv=2&hl=en&q=reflexology+zones&btnG=Search+Images • Traditional Chinese Medicine – 12 Meridians (Ignatavicius, 6th ed., page 9) • Acupressure ‘meridians’ (Wilkinson figure 40-3 page 1024) • Acupuncture chi/blockages www.windsofchange.eu.com/chakra.html CC. Matthews RN, MSN M. Elias RN, MSN SP11

  39. Energy – Based Therapies • Therapeutic massage • Precaution – Wilkinson p. 1033 • Therapeutic touch • Caution for touch – Ignatavicius 6th ed., page 13 • Healing touch • Reiki • Acupressure • Reflexology C. Matthews RN, MSN M. Elias RN, MSN SP11

  40. Energy – Based Therapies • TT (Therapeutic Touch) • Integral to assessment • Bonding • Communication • Soothing, calming, comfort • orientation • Contraindications • When NOT to touch – Ignatavicius pg. 13 C. Matthews RN, MSN M. Elias RN, MSN SP11

  41. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  42. Reflexology/Acupressure • Reflexology • Ancient Egypt • Energy Zones Top to Bottom • Pressure Points • What conditions benefit from it? • Acupressure • Meridians & Pressure Points C. Matthews RN, MSN M. Elias RN, MSN SP11

  43. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  44. Acupuncture – uses for Migraine headache – Ignatavicius, p. 953 Pain and Anesthesia – Ignatavicius p. 57 C. Matthews RN, MSN M.Elias RN, MSN SP10

  45. The dreaded nausea and vomiting which commonly occurs insome 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 multi-drug 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 M.Elias RN, MSN SP10

  46. Biologically Based Therapies • Dietary Therapies • Herbs • Vitamins • Aromatherapy C. Matthews RN, MSN M. Elias RN, MSN SP11

  47. 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, beta-carotene, vitamin E C. Matthews RN, MSN M. Elias RN, MSN SP11

  48. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  49. 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 C. Matthews RN, MSN M. Elias RN, MSN SP11

  50. Aromatherapy • Can be used for sense of smell, but also as compresses, baths or topical C. Matthews RN, MSN M. Elias RN, MSN SP11

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