Week 13 Complementary and Alternative Therapies PDF

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Complementary and Alternative Therapies Most people in the US use complementary alternative therapies (CAT) to promote health and assist healing from illness or injury Allopathic, biomedicine and traditional medicine (western medicine) have been around for hundreds of years - These include: surgical interventions, pharmaceutical approaches, and diagnostic tools - This is typical treatment with physical ailments then preventing disease or managing chronic illness Complementary and Alternative Therapies - CAM – an array of health care approaches with a history of use or origins outside of mainstream medicine o CAM – complementary and alternative medicine o Now CAT are used to treat or answer problems due to chronic illness -

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Complementary therapies – used in addition to conventional treatment (aka integrative therapies) o Complement conventional treatments o Many of them, such as therapeutic touch, contain diagnostic and therapeutic methods that require special training o Others, such as guided imagery and breath work, are easily learned and applied o Also relaxation, exercise, massage, prayer, biofeedback, hypnotherapy, creative therapies including music, art and dance, meditation, chiropractic and herb supplements Alternative therapies – therapies that replace allopathic medical care o May include the same interventions as complementary therapies but they become the primary treatment, replacing allopathic medical care o Several therapies are always considered alternative because they are based on completely different philosophies and life systems than those used by allopathic medicine – these are identified as whole medical systems

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Because of increased interest in complementary therapies, many health care programs, including medical and nursing schools, have integrated conventional “biomedical” education with programs that incorporate complementary and alternative therapy content

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Integrative healthcare – emphasizes the importance of the whole relationship between practitioner and patient o Focuses on the whole person o Is informed by evidence o Makes appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health

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Holistic nursing – approaches look at more natural approaches to obtaining or maintaining health o Holistic nursing treats the mind-body-spirit of patients, using interventions such as relaxation therapy, music therapy, touch therapies, and guided imagery o The American Holistic Nurses Association maintains Standards of Holistic Nursing Practice, which defines and establishes the scope of holistic practice and describes the level of care expected from a holistic nurse o Nurses have historically practiced in an integrative fashion o A review of nursing theory reveals the values of holism, relational care, and informed practice o Until recently nursing identified its practice as holistic rather than integrated

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Integrative nursing – defined as a way of being-knowing-doing that advances health and well-being of people, families, and communities through caring-healing relationships o Integrative nurses use evidence to inform traditional and emerging interventions that support “whole person/whole systems healing” o Although the body of evidence about CAM is growing, limited data make it difficult to establish the specific benefits of complementary therapies

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Weigh the risks and benefits of each intervention when recommending complementary therapies and consider the following when recommending therapies  The history of each therapy  History and experience of nursing with a particular therapy  Outcomes and safety data, including case study and qualitative research  Cultural influences and context for certain patient populations

NURSING-ACCESSABLE TECHNIQUES - Some CAM therapies and techniques are general in nature and use natural processes (breathing, thinking and concentration, presence, movement, etc.) to help people feel better and cope with both acute and chronic conditions - They are easily learned by healthcare professionals

Relaxation Therapy - The relaxation response – is the state of generalized decreased cognitive, physiological and/or behavioral arousal o The process of relaxation elongates the muscle fibers, reduces the neural impulses sent to the brain, and thus decreases the activity of brain and other body systems o Decreased heart and respiratory rates, blood pressure, and oxygen consumption and increased alpha brain activity and peripheral skin temperature characterizes the relaxation response o Relaxation helps individuals develop cognitive skills to reduce the negative ways in which they respond to situations within their environment

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Progressive relaxation – training teaches an individual how to effectively rest and reduce tension in the body o The person learns to detect subtle localized muscle tension sequentially, one muscle group at a time o An example of active progressive relaxation techniques involves the use of slow, deep abdominal breathing while tightening and relaxing an ordered succession of muscle groups, focusing on the associated bodily sensations while letting go of extraneous thoughts The goal of passive relaxation is to still the mind and body intentionally without the need to tighten and relax any particular body part o One effective passive relaxation technique incorporates slow, abdominal breathing exercises while imagining warmth and relaxation flowing through specific body parts such as the lungs or hands o Passive relaxation is useful for persons whom the effort and energy expenditure of active muscle contracting leads to discomfort or exhaustion An important consideration when choosing a relaxation technique is the physiological and psychological status of the individual o Active progressive relaxation requires energy and is not recommended for weak patients

Meditation and Breathing - Meditation – any activity that limits stimulus input by directing attention to a single unchanging or repetitive stimulus so the person is able to become more aware of self o A wide range of practices that involve relaxing the body and stilling the mind o Works well with worry and stress o Four components of meditation:  A quiet space  A comfortable position  A receptive attitude  A focus of attention o Meditation is different from relaxation – its purpose is to become “mindful,” increasing our ability to live freely and escae destructive patterns of negativity -

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Most meditation techniques involve slow, relaxed, deep, abdominal breathing that evokes a restful state, lowers oxygen consumption, reduces respiratory and heart rates, and reduces anxiety Meditation reduces overall systolic and diastolic blood pressures and significantly reduces hypertensive risk It also successfully reduces relapses in alcohol treatment programs Patients with cancer who use mindfulness-based cognitive therapies often experience less depression, anxiety, and distress and report an improved quality of life Patients suffering from PTSD and chronic pain also benefit from mindfulness meditation In addition, meditation increases productivity, improves mood, increases sense of identity, and lowers irritability

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Considerations for the appropriateness of meditation include: o A person’s degree of self-discipline, it requires ongoing practice to achieve lasting results o Most meditation activities are easy to learn and do not require memorization or particular procedures o Meditation in contraindicated from some people – a person who has a strong fear of losing control will possible perceive it as a form of mind controlling and thus will be resistant to learning the technique o Some individuals become hypertensive during meditation and require a much shorter session than the average 15 – 20 minute session o Meditation may enhance the effects of certain drugs, therefore monitor individuals learning meditation closely for physiological changes with respect to their medication o Prolonged practice of meditation techniques sometimes reduces the need for antihypertensive, thyroid-regulating, and psychotropic medications (such as antidepressants or antianxiety medications) – in these cases adjustment of the medications may be necessary

Imagery - Imagery or visualization – is a mind-body therapy that uses the conscious mind to create mental images to stimulate physical changes n the body, improve perceived well-being, and/or enhance self-awareness o Frequently, imagery combined with some form of relaxation training facilitates the effect of the relaxation technique o Imagery may be self-directed, in which individuals create their mental image, or guided, during which a practitioner leads an individual through a particular scenario o When guiding an imagery exercise: 1. Direct a patient to begin slow abdominal breathing while focusing on the rhythm of breathing 2. Then direct the patient to visualize a specific image such as ocean waves coming to shore with each inspiration and receding with each exhalation 3. Next instruct the patient to take notice of the smells, sounds, and temperatures that he or she is experiencing 4. As the imagery session progresses, instruct the patient to visualize warmth entering the body during inspiration and tension leaving the body during exhalation -

Individualize imagery scenarios for each patient to ensure that the image does not evoke negative memories or feelings Creative visualization – is self-directed imagery based on the principle of mind-body connectivity o People typically respond to their environment according to the ways they perceive it and by their own visualizations and expectancies – it is important to individualize it

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Imagery helps control or relieve pain, decrease nightmares, improve sleep It also aids in the treatment of chronic conditions such as:  Asthma  Cancer  Sickle cell anemia  Migraines  Autoimmune disorders  Atrial fibrillation  Functional urinary disorders  Menstrual and premenstrual syndromes  Gastrointestinal disorders, such as IBS and ulcerative colitis  Rheumatoid arthritis

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Imagery has relatively few side effects, yet increased anxiety and fear sometimes occur when it is used to treat PTSD and social anxiety disorders Some patients with COPD and asthma experience increased airway constriction when using guided imagery Thus you need to monitor patients closely when beginning this therapy

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*Autogenic training is a technique to program the mind to override the stress response* TRAINING-SPECIFIC THERAPIES - Treatments that nurses administer only after completing a specific course of study and training - These therapies require postgraduate certificates or degrees indicating completion of additional education and training, national certification, or additional licensure beyond the registered nurse to practice and administer them - Several training-specific therapies (biofeedback and acupuncture, etc.) are very effective and often recommended by western health care practitioners - Although many of these complementary therapies elicit positive effects, all therapies carry some risk, particularly when used in conjunction with conventional medical therapies - You need advanced knowledge to talk about them effectively with patients and provide education about their safe use

Training-Specific Therapies include: 1. Biofeedback 2. Acupuncture 3. Therapeutic touch 4. Chiropractic therapy 5. Traditional Chinese medicine 6. Natural products and herbal therapies

Biofeedback - Biofeedback – is a mind-body technique that uses instruments to teach self-regulation and voluntary self-control over specific physiological responses o Electronic or electromechanical instruments measure, process, and provide information to patients about their muscle tension, cardiac activity, respiratory rates, brain-wave patterns, and autonomic nervous system activity o Immediate feedback is given in physical, physiological, auditory and/or visual feedback signals that increase a person’s awareness of internal processes that are linked to illness and distress -

Biofeedback therapies can change thinking, emptions, and behaviors which in turn support beneficial physiological changes, resulting in improved health and well-being Biofeedback provides immediate feedback about which stress relaxation behaviors work most effectively

Traditional Chinese Medicine (TCM) - Traditional Chinese medicine – is a whole system that began approximately 3600 years ago o Chinese medicine views health as “life in balance,” which manifests as lustrous hair, a radiant complexion, engaged interactions, a body that functions without limitations, and emotional balance - Yin and yang – represent opposing yet complementary phenomena that exist in a state of dynamic equilibrium o Yin represents shade, cold, and inhibition o The inner part of the body, specifically the viscera, liver, heart, spleen, lung, and kidney o Yang represents fire, light, and excitement o The outer part, specifically the bowels, stomach, and bladder - Harmony and balance in every aspect of life are the keys to health, including the yin/yang balance - Imbalance ultimately leads to disruption of vital energy, qi, which compromises the bodymind-spirit of the person, causing disease

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TCM practitioners use four methods to evaluate a patient’s condition  Observing  Hearing/smelling  Asking/interviewing  Touching/palpating

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Therapeutic modalities include acupuncture, Chinese herbs, tu nai massage, moxibustion, cupping (placing a heated cup on the skin to create a slight suction), tai chi, qi gong, lifestyle modifications, and dietary changes

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Evidence about its effectiveness is limited o Some evidence shows that TCM is helpful in treating fibromyalgia and addressing symptoms with menopause o There is some concern about the safety of Chinese herbal treatments that are used in teas, remedies, and supplements o These herbs can be very powerful, interacting with drugs and causing serious complications – this is important when you are assessing a patient using TCM o You need to ask your patient about the therapies he or she receives including types of herbs they are using o Some patients consider these as teas or dietary additives, powders, or supplements and not as over-the-counter medications

Acupuncture - Acupuncture – a key component of TCM, is one of the oldest practices in the world o When used outside of TCM, it is viewed as a mind-body therapy and is called medical acupuncture o In the US, medical acupuncture is often provided by specially trained health care providers o Acupuncture regulates or realigns the vital energy which flows like a river through the body in channels that form a system of 20 pathways called meridians o An obstruction in these channels block energy flow in other parts of the body o Acupuncturists insert needles into the skin in specific areas along the channels called acupoints, through which the qi can be influenced and flow reestablished -

Current evidence shows that acupuncture modifies the response of the body to pain and how pain is processed by central neural pathways and cerebral function

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Acupuncture is effective for a variety of health problems o it is a safe therapy when the practitioner has the appropriate training and uses sterilized needles o although needle complications occur (infection, fainting), they are rare if the practitioner takes appropriate precautions o in addition, caution patients about the use of acupuncture in cases of pregnancy, history of seizures, and immunosuppression o Treatment is contraindicated in people who have bleeding disorders and skin infections

Therapeutic Touch - Therapeutic touch – affects the energy fields with that are surrounded and penetrate the human body with the conscious intent to help or heal o A natural human potential that consist of placing the practitioners hand on or close to the body of a person o A nurse developed this therapy o Practitioner attempts to redirect energy to bring the person back to an energy balance similar to that of the practitioner

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Therapeutic touch consists of several phases 1. Centering – to begin the practitioner centers physically and psychologically, becoming fully present in the moment and quieting outside distractions 2. Assessing – the practitioner scans the body of the patient with the palms, roughly 5 – 15 cm (2 – 6 in) from head to toe 3. Unruffling – while assessing the patient’s energetic biofield, the practitioner focuses on the quality of the qi and areas of energy obstructions, redirecting the energy to harmonize and move 4. Treating – using long, downward strokes over the energy fields of the body, the practitioner touches the body or maintains the hands in a position a few inches away from the body 5. Evaluating

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Although the use of therapeutic touch causes very few complications or side effects, it is contraindicated in certain situations when patients are sensitive to human interaction and touch Reiki is a form of therapeutic touch that uses hands on client to transfer energy to the client Therapeutic touch and reiki are examples of energy field therapies

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Natural Products and Herbal Therapies - As the oldest form of medicine, archaeological evidence supports that herbal remedies have been used for more than 60,000 year - Herbal medicines – the prominent part of healthcare among indigenous populations worldwide - A natural product – is a chemical compound or substance produced by a living organism and includes herbal medications (also known as botanicals), dietary supplements, vitamins, minerals, mycotherapies (fungi-based products), essential oils (aromatherapy), and probiotics o The most frequently used products are garlic, Echinacea, saw palmetto, ginko biloba, cranberry, soy, ginseg, black cohosh, St. John’s wort, glucosamine, peppermint, fish/oil omega 3, and milk thistle o Many are sold as foods or food supplements -

The Dietary Supplement Health and Education Act of 1994 allows companies to sell herbs as dietary supplements as long as their labels do not contain health claims A number of herbs are safe and effective for a variety of conditions o Simply because a product is “natural” does not make it “safe” o Because they are not regulated, concentrations of the active ingredients vary considerably o Contamination with other herbs or chemicals, including pesticides and heavy metals, is also problematic o Not all companies follow strict quality control and manufacturing guidelines that set standards for acceptable levels of pesticides, residual solvents, bacterial levels, and heavy metals

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o Teach patients to purchase herbal medicines only from reputable manufacturers Labels on herbal products need to contain the scientific name of the botanical, the name and address of the actual manufacturer, a batch or lot number, the date of manufacture, and the expiration date Using natural products that have been verified by the U.S. Pharmacopeia (USP) is another way to ensure product safety, quality, and purity Some herbs also contain toxic products that have been linked to cancer As with any other medication, examine herbs for interaction and compatibility with other prescribed or over-the-counter substances that are being used simultaneously

THE INTEGRATIVE NURSING ROLE - Need to encourage dialogue about the use of CAM o Most people using and seeking information about CAM are well-educated and have a strong desire to actively participate in decision making about their health o Allopathic physicians have increasing concerns that current conventional medicine is not meeting the need of their patients - Responsibility to understand the benefits of therapies that encourage active patient par...