Framework, scope and trends in nursing practice

 DEFINITION OF ADVANCED NURSING PRACTICE:-

Advance nursing practice is an umbrella term describing an advance level of clinical practice
that maximizes the use of graduate educational preparation, in depth nursing knowledge and
expertise in meeting the health needs of the individual, families, group, communities and
population. It involves:
 Analyzing and synthesizing knowledge.
 Understanding, interpreting and applying nursing theory and research.
 Developing and advancing nursing knowledge and the profession as the whole.
ADVANCED REGISTERED NURSE PRACTITIONER:
ARNPs are those who not only acquire basic nursing education and licensure, but also Master’s
degree in the same field. They provide direct care to the patients. There are various types of
APRNs. The specialty areas of nursing practice for the ARNP are Certified Clinical Nurse
Specialist, Certified Nurse Midwife, Certified Nurse practitioner and Certified Registered Nurse
Anesthetist.
CHARACTERSTICS OF NURSING PRACTICE:
In advance nursing practice, nurses consistently display the following feature and
characteristics:-
 Provision of effective and efficient care, delivered with a high degree of autonomy.
Demonstrate of leadership and initiation of change to improve client, organization and system
outcomes.
 Deliberate, purposeful and integrated use of in-depth nursing knowledge, research and clinical
expertise.
 Depth and breadth of knowledge that draws on a wide range of strategies to meet the needs of
client and to improve access to and quality of care.
 Ability to apply and explain the theoretical, empirical, ethical and experiential foundation of
nursing practice.
Demonstration of advanced judgment and decision making skills.
 Critical analysis and influence on healthy policy.

FRAMEWORK OF NURSING PRACTICE:

A framework is a real or conceptual structure intended to serve as a support or guide for the
building of something that expands the structure into something useful.
One of the first priorities of vice president and chief nursing officer of Calgary Health region
was to develop a vision for nursing in the region .Through the development of vision it was
apparent that a mission for nursing was also essential as this work progresses, an evident need
emerged to establish a definition of professional practice or a guide line or frame work that the
nurses could utilize on a daily basis to achieve vision and mission of nursing. After several

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months of consultations, discussions and revisions, the final draft of professional practice frame
work was approved by nursing council and distributed during nurse’s week 2003.
The Professional Nursing Practice and Framework Development was created to provide
structure for nurses that describes various evidence- based concepts that are necessary to support
and develop professional nursing practice and promote excellent patient care experiences.
Banner Health defines Nursing based on American Nurses Association (ANA) ”the
protection, promotion, and optimization of health and abilities, prevention of illness and injury,
alleviation of suffering through the diagnosis and treatment of human response, and advocacy in
the care of individuals, families, communities and population.”
Banner Health in-coperates the ANA standards in framewok. The ANA is the overarching
professional organization for all RNs regardless of practice and maintains the code of ethics for
nurses, as well as a definition of nursing. The final version of the framework is called the
Professional Nursing Practice and Development Framework (PNPDF).

Figure: Framework for professional nursing practice and development

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The framework consists of three concentric circles around the patient. Hash marks (not solid
lines) make up the boundaries of each circle to demonstrate the fluidity of all the concepts. A
patient-centric focus is emphasized in nursing framework. The patient is placed in the center,”the
nurse’s primary commitment is the patient, whether an individual, family, group, or community,
making a difference in the people’s lives through excellent patient care.” These 3 circles were
named as- Contribution to the Patient, Contribution to the Profession, and Contribution to
Society.

Contribution to the Patient:

Closest to the patient core are the ANA Standards of Practice, which demonstrate the critical
thinking model known as the nursing process, for effective patient care which includes
assessment, diagnosis, outcome identification, implementation,and evaluation The nursing
process is how the nurse should be organizing and thinking about the daily care of the patient.
‘‘The nursing process encompasses all significant actions taken by registered nurses and forms
the foundation of the nurse’s decision-making.’’ This is the nurse’s direct contribution to the
patient.

Contribution to the Profession:

The middle circle represents the ANA Standards of Professional Performance that represent our
investment in professional development. This development is an expectation of both the
organization and the individual nurse and includes a “significant emphasis on orientation,
inservice
education, continuing education, formal education, and career development as well as personal
and professional growth and development.”

Contribution to Society:
The 6 dimensions of quality care that are imperative for all includes--- safe, timely, efficient,
effective, equitable, and patient-centered care. The impact made by nurses on the dimensions of
quality demonstrates nurse’s integral role in our healthcare system. These dimensions of quality
are noted in the outermost circle. Although nursing focuses on the outcomes of the patient in the
center of the framework, but our responsibility to quality and safety extends to the entire
community.

SCOPE OF NURSING PRACTICE:

The term “scope of practice” is used to define the actions or procedures that are permitted by law
for a specific profession. It outlines restrictions to what the law permits, based on specific
experience and educational qualification.

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 The scope of nursing practice is the range of roles, functions, responsibilities and activities
which a registered nurse is educated, competent and has the authority to perform.. Nursing
profession is accountable for ensuring that its member act in the public interest and provide the
unique service that has been designated to them by society. This process is called professional
regulation. The profession of nursing regulates itself through defining practices, establishing and
developing the public standard of practice and a code of ethics. In turn, the state through statues,
attests to the public that registered nurses meet minimal standards for practice and prohibits
unlicensed individual from practicing as registered nurse.
The legal boundaries of the scope of practice are determined by the definition of nursing
found in the Nurse Practice Act(NPA).Since each state has legal authority for the regulation of
nursing, the definition and therefore the scope of nursing practice may vary from state to state.
However, the purpose of law remain consistent to protect the public.

THE NURSING PRACTICE ACT:

The nurse practice act was enacted by the legislature to regulate the practice of nursing and to
define the parameters of nursing practice for the purpose of protecting the public. The NPA
defines the scope of practice specific to a registered nurse, a licensed practical nurse, an
advanced nurse practitioner and a nurse anesthetist. The act is designed to protect the public
from harm through incompetent nursing as well as lay down the rules and regulations for the
specific level of a nurse’s educational and licensure requirements, but does not protect nurses
from discriminatory or questionable employment practice.

PRINCIPLES •:
The following are the basis for making decision with regards to the scope of practice for an
individual nurse:-
The primary motivation for expansion of practice must be the best interest of patient/clients
and the promotion and maintenance for the best quality health services for the population.
Expansion of the practice must be made in the context of the definition of nursing and the
values that underpin nursing practice.
The principles include:
Expansion of practice must only be made with due consideration to legislation National policy,
local policy and guidelines.
 In determining of his or her scope of practice the nurse/midwife must make a judgment as to
whether he/she is competent to carry out the role function.
The nurse/midwife must take measures to develop and maintain the competence,
communications and evaluations.
Expansion of the practice must be based on appropriate assessment, planning, communication
and evaluation.

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 The individual nurse is accountable for his/her practice this means that he/she is accountable
for decision he/she makes in determining his/her scope of practice that included decision to
expand or not to expand his/her practice.
In making decision about an individual nurse’s scope of practice, the best interest of the
patient/client and the importance of promoting and maintaining the highest standards of quality
in the health services should be foremost. Nursing care should be delivered in a way that respects
the uniqueness and dignity of each patient/clients regardless of culture and religion.

NURSING PRACTICE IN DIFFERENT SETTING:

INDIVIDUAL RNS :
The registered nurse is responsible and accountable, professionally and legally for determining
his/her professional scope of nursing practice.
The role and consequently the scope of nursing practice, is ever changing and increasing in
complexity. It is important that the nurse makes decision regarding his/her own scope of practice.
 THE NURSE MANAGER AND NURSE EXECUTIVE:
The nurse executive, in a changing and complex health delivery system is knowledgeable
regarding change in rules and regulation, accreditation standards and standards of care and
practice, in addition to evaluation of boundaries specified in nurse practice act.
The nurse executive and/or the nurse manager facilitates changes to assure quality patient care
outcomes and develop mechanism that will promote the same.
MOBILE NURSING PRACTICE :
 The need was seen in 1984, for local resident to offer more extensive care at home to reduce
the cost and remain in their home for a longer period of time.
 Organization known as Mobile health care limited and later changed into Mobile nursing
services limited.
 Provides care during day and night but previously it was given only during business hours.
 MILITARY NURSING SERVICES:
 First World War:-The military nursing services has its origin from the Army Nursing Service
formed in 1881 part of Royal army. After the war on 1 October 1926 the nursing services was
granted permanent status in Indian Army.
Second World War:- With the outbreak of second world war, nurses once again found
themselves serving all over the world. During the mid of the war in1943 Indian Army Nursing
services separated from Indian Military nursing service ordinance and redesigned as Military
Nursing Service (MNS).
The Military Nursing Service stands out as one of the oldest services where women have
contributed directly to the nation’s war effort by providing care to the sick and wounded soldiers.
The army nurses have made a permanent place in every Nation’s heart by nursing million of sick
and wounded soldiers back to health.
TELE NURSING:

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  Refers to the use of telecommunication and information technology for providing nursing
services in health care whenever a large physical distance exists between patient and nurse, or
between any numbers of nurses.

THE NURSING ROBOTS:

The development of nursing robot system included the development of a mobile robot system
to help physically handicapped people.
Completed in 1986, the nursing Robot was one of the first fully functioning mobile robots
equipped with a manipulators arm, also integrated with seven different sensor systems.
NURSING IN OCCUPATIONAL HEALTH:
OHNs are registered nurses who independently observe and assess the worker’s health status
with respect to job tasks and hazards, using their specialized experience and education, these
registered nurse recognize and prevent health effects from hazardous exposure and treat workers
injuries/illness.
SCHOOL HEALTH NURSING:
School nurses are primary care nurses for school children. They work with individual children,
young people and families, schools and communities to improve the health and tackle inequality.
SPACE NURSING SOCIETY:
It is an international space advocacy organization devoted to space nursing and the contribution
to space exploration by Registered Nurses. SNS is an affiliated, non –profit special interest group
associated with the National Space Society.

TRENDS IN NURSING PRACTICE

Trends in nursing are closely tied to what is happening to health care in general. Trends are
fascinating phenomena, but they do not existing in vacuums. Most of them are interrelated; one
trend often spawns another. These are the changes or development in a particular direction.
When we look back on trends, however, some will have permanent changes, but other might
have temporary.
Different aspects of trends in nursing practice:
BROADENING FOCUS :
 Presently the nursing profession has grown tremendously in comparison to earlier stages .The
nursing profession has developed as full-fledged stream which would take care of ailing
humanity in the urban and rural area of state /country with latest and modern techniques. The
profession has developed to MSc and PhD levels keeping in view the need of evidence based
practice, research oriented and problem solving approaches.
 The focus of nursing has broadened from the care of the ill person to the care of the people in
illness and from care of only the patient to care of the clients, the family, and in some instance
the community.

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 In the past, nursing like medicine was oriented towards disease and illness but today there is
increasing recognition of people needs for health care as distinct from illness care and of the
nurse’s independent functions in this area.
 Another aspect of the broader nursing focus is the movement of nursing practice into the
community. In a sense there is a return to the beginning of nursing that is before it becomes a
recognized occupation. Throughout most of this century however nurse worked only in
institution, increasingly nursing services are provided in community often in homes and clinics.
 The nursing activity not only assists those who are ill but also helps those who are healthy to
maintain or continue their health.
SCIENTIFIC BASIS :
In the past, nursing largely was either intuitive or relied on experience or observation rather
than on research. Through trial and error the individual nurses discovered the measures that
would assist the client and many nurses become highly skilled in providing care through
experience. Presently every action of nursing is based on scientific principles.
TECHNOLOGY:
Technology or mechanization is being applied in the health field extensively. Certain areas of a
hospital are more technologic than others. Nurses find themselves in the midst of rapidly
changing, increasingly technologic environment in hospital and in client’s homes.
Indication of Increasing Technology:
The proliferation of the technologic equipment used in case of client in hospitals and homes.
The increasing home and self care equipment.
Use of computers in many areas of health care.
Many nurses feel they need more education to obtain the knowledge and skills necessary
to use the new technology. High technology has enabled nurse to gather client assessment data
through non-invasive techniques (eg:- pulse oxymetry), rather than the costly invasive procedure.
EXPANSION OF EMPLOYMENT OPPORTUNITIES:
Nursing practice trends include a growing variety of employment setting in which nurses have
greater independence, autonomy and respect as member of the health care team. Nursing role
continue to expand and develop, broadening the focus of nursing care and providing a more
holistic and encompassing all domain. Nursing therapies are not only drawn from traditional
nursing and medicine, spiritual and emotional realms, but also expanding into alternative
therapies such as healing touch, massage therapy and use of natural herbs and vitamins.
NURSING’S PUBLIC PERCEPTION:
Earlier there was a perception that nurses cannot provide good care but now this perception has
been changed. Any member of society who has been ill, hospitalized or visited an emergency
department noted that everybody needs a nurse. The Johnson Foundation has developed
compelling, attention getting media campaign on nursing profession. This media clips show
nursing practice, and the nurses featured in the advertisement and described their satisfaction in
the profession. Nursing is a pivotal health care profession, as frontline health care providers,
nurses, practice in all health care setting and constitute the largest number of professionals.

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Nurses are essential to provide skilled, specialized, knowledgeable care, to improve the health
status of the public and to ensure safe effective quality care. In addition, the American Public
rated nurses high in honesty and ethics in their professional role.

CARE ACCORDING TO NURSING PROCESS:

Earlier there used to be no nursing process but nowadays nursing care is provided in accordance
with nursing process. The nursing process consists of five steps – assessment , diagnosis,
planning, implementation and evaluation. Each step of a nursing process leads to next one, which
makes it a continuing cyclic process.
EXPANDED NURSING ROLES:
Nurse assumes expanded roles by virtue of education and experience. The nurse who assumes an
expanded role has increased responsibility and, usually greater autonomy. Nurses are assuming
expanded roles in both hospitals and community settings like nurse Practitioner , nurse Clinician.
EVIDENCE BASED PRACTICE :-
Nurses conducted published research in 1950. Importance of using scientific evidence was to
develop guidelines for nursing care.Nurses steadily develop further guide lines for clinical
practice useful nationally and internationally
COMMUNITY BASED NURSING:
Health care is increasingly provided in community i.e clinics outpatient settings and home .
Implementation of a system of managed care to control, monitor health care services to minimize
cost.
NURSING IMPACT ON POLITICS AND HEALTH POLICY:
The ability to influence or persuade an individual holding a government office to exert the
power of that office to affect a desired outcome is known as Political power or influence. Nurse
involvement in politics is receiving greater emphasis in nursing curricular, professional
organization and health care setting. Professional nursing organizations have employed lobbyists
to urge state legislature and the US congress to improve the quality of health care.

CHANGING TRENDS IN NURSING:

Nursing has originated from the word “nurturing” which means nourishing, helping in growth
and development of a human being, in the past nursing was family based work. Modern nursing
began in the 19th century under the leadership of Florence Nightingale.
 The aim of nursing was only to promote the recovery of patients. Even now, the central
concern of nursing is nurturing the human beings.
 The present day nurse provides care for the people in health and illness. Nursing is one of
the health services, which contribute to wellbeing of an individual, family and
community. Therefore, nursing is defined as a humanistic science dedicated to maintain
and promote health, preventing illness, care for and rehabilitation of the sick and disabled
person.

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  Nursing process includes doing, thinking and interaction component. It is mainly and
basically a problem solving approach of nursing cares. The nursing process consists of
five steps: Assessment, Nursing Diagnosis, planning, Implementation and evaluation.
Each step of nursing process leads to the next one, making it a continuing cyclic process.

MORDEN TRENDS IN NURSING PRACTICE:

A Rekindled interest in Eastern Religion, lifestyle and medicine has fueled the development of
complementary holistic, alternative complementary modalities. Client are seeking out
alternative/complementary therapies because most such therapies are non-invasive, holistic and
in many instance less expensive than going to a physician.
In 1993 a landmark survey found 1/3 of the US population had used some nontraditional
alternative method of treatment in addition to the standard medical treatment. In 1993 the US
Government established an Office of Alternative Medicine (OMA) at the National Institute of
Health.
A few therapies investigated by the OAMs -1995:-
 Biofeedback to control pain
Acupuncture to relieve depression
Imagery to control Asthma
Ayurvedic medicine to treatment to treat parkinson’s disease
Music therapy to treat brain injured client
Shark cartilage to treat cancer.

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BIBLIOGRAPHY:
 Shabeer P. Basheer, “A Concise Book of Advanced Nursing Practice” 1st edition, 2012,
Emmss medical publishers, page no. 648-675.
 Kozier, “Fundamental Of Nursing” 5th Edition, page no. 18-21, 40-41.
 Lois While “ Fudamental of Nursing” Mosby Publication, Page No.85, 224.
 Patricia A. Potter, “fundamental Of Nursing” 3rd edition, Mosby Publication, Page no.-
29-31 Potter and Perry, “fundamental Of Nursing”, 5th edition Mosby publication.
 Internet:- www.wikepedia.com www.ncbi.com www.pubmed.com www.scribd.com
www.slideshre.com www.sparknotes.com www.ACN.org.com

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ALTERNATIVE MODALITIES OF CARE, ALTERNATIVE SYSTEM OF
HEALTH AND COMPLIMENTARY THERAPIES
Introduction:

Alternative & complimentary medicine is any practice that is put forward as having the
healing effect of medicine , but is not based on evidence gathered using scientific validation &
their effectiveness is either unproven or disproved. It includes the therapies that generally
replaces or substitutes a traditional or orthodox treatment. It emphasizes on prevention,
practicing principles of healthy life style & developing the mental & spiritual healing power in
body’s system. Consumers are becoming increasingly educated & are actively moving towards
holistic approach of health care. The role of physician & hospitals are shifted from doing things
for people to helping the people to do things for themselves.

A diverse group of therapies and practices used together with conventional medicine for the
purpose of increasing comfort or relaxation, maintaining, improving or restoring health and
harmony of the body, mind, and/or spirit, improving coping mechanisms, reducing stress,
relieving pain and/or increasing the client’s sense of wellbeing. Alternative and complementary
therapies can be the same, depending on whether the therapy is a primary treatment or treatment
in addition to the western medicine treatment. Integrative medical programs utilize a
multidisciplinary (both allopathic and complementary) treatment approach providing holistic
care to clients.

Nursing, however, is a holistic approach at its essence. Likely, it is because nursing is a holistic
discipline that nurses have demonstrated great enthusiasm for the techniques and modalities
associated with the field of complementary and alternative care as these techniques assist nurses
to address the physical, mental, emotional, and spiritual dimensions of care.

CAM is the abbreviation used for Complementary and alternative medicine. 

Complementary and alternative medicine (CAM) is the term for medical products and
practices that are not part of standard care. Standard care is what medical doctors, doctors of
osteopathy, and allied health professionals, such as nurses and physical therapists, practice.
It is a group of diverse medical and health care system, practices, therapies and
procedures that are not presently considered to be part of conventional medicine. The phrases
complementary therapy and alternative therapy are often used as if they mean the same thing.
They may also be combined into one phrase – complementary and alternative therapies (CAMs).
It is not always easy to decide whether something is a complementary or an alternative therapy.
But there is an important difference. 

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A complementary therapy means you can use it alongside your conventional medical
treatment. It may help you to feel better and cope better with your treatment. It is important to
discuss with your doctor any complementary therapy that you are thinking of using.

An alternative therapy is generally used instead of conventional medical treatment. All

conventional treatments have to go through rigorous testing by law in order to prove that they
work. Most alternative therapies have not been through such testing and there is no scientific
evidence that they work. Some types of alternative therapy may not be completely safe and could
cause harmful side effects. Then, ‘alternative’ medicine means practices and healing techniques
that are not generally taught in medical schools, thus alternating with prevailing view. The
technique that replaces the allopathic medical care. 

DEFINITION:

 Definition of the alternative & complimentary medicine devised by US National center

for complimentary &alternative medicine(NCCAM) of the national institute of health
(NIH), states that it is a group of diverse medical and health care systems, practices,&
products that are not generally considered part of conventional medicine.
 Alternative/Complementary modalities have been defined as treatment techniques whose
goals are to evoke healing, taking into account the body-mind-spirit connection of every
individual (Dossey, 1995).

Many of the alternative & complimentary therapies are based on accepted theories of

 Gate control theory of reducing pain.(it asserts that non pain full inputs closes the “gate
“of painful inputs, which prevents pain sensation from reaching to central nervous system
) Given by Ronald Melzeck (Canadian researcher) in 1965 along with Patrick.
 The fact that natural endorphins control pain & can be stimulated by drugs or alternative
means.

TYPES OF COMPLIMENTARY AND ALTERNATIVE THERAPIES

According to the National Center for Complementary and Alternative Medicine (NCCAM),
complementary and alternative medicine therapies can be classified into five broad categories:

1) Alternative Medical Systems

Alternative medical systems are built upon complete systems of theory and practice. Often, these
systems have evolved apart from an earlier than the conventional medical approach used in the
United States. Examples of alternative medical systems include:

(a)Acupuncture: Acupuncture is a technique in which practitioners stimulate specific points on

the body known as meridians or dermatosomes—most often by inserting thin needles through the

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skin. It is one of the practices used in traditional Chinese medicine. Results from a number of
studies suggest that acupuncture may help ease types of pain that are often chronic such as low-
back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of
tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a
reasonable option for people with chronic pain to consider. However, clinical practice guidelines
are inconsistent in recommendations about acupuncture. It may trigger the release of natural pain
killing substances within the body called endorphins thus blunting the perception of pain. It may
also alter the body’s output of neurotransmitters such as serotonin and nor epinephrine. The
effects of acupuncture on the brain and body and how best to measure them are only beginning
to be understood. Current evidence suggests that many factors—like expectation and belief—that
are unrelated to acupuncture needling may play important roles in the beneficial effects of
acupuncture on pain.

(b)Ayurveda: Ayurvedic medicine is a traditional medicine of India. It includes a belief that

health can be influenced by use of traditional herbs, and by achieving the spiritual balance of the
religions of Hinduism and Buddhism. Ayurveda stresses the use of plant-based medicines and
treatments, with some animal products, and added minerals, including sulfur, arsenic,
lead, copper sulfate. Andrew Weil, an American promoter of alternative medicine, wrote that in
Ayurvedic medicine, "being 'healthy' is more than the absence of disease - it is a radiant state of
vigor and energy, which is achieved by balance, or moderation, in food intake, sleep, sexual
intercourse and other activities of daily life, complemented by various treatments including a
wide variety of plant-based medicines".
Safety concerns have been raised about Ayurveda, with two U.S. studies finding about 20
percent of Ayurvedic Indian-manufactured patent medicines contained toxic levels of heavy
metals such as lead, mercury and arsenic. Other concerns include the use of herbs containing
toxic compounds and the lack of quality control in Ayurvedic facilities. Incidents of heavy metal
poisoning have been attributed to the use of these compounds in the United States.
Terminals arjuna :- useful in alleviating pain of angina pectoris, treating heart failure &
coronary artery diseases ,& hypercholesterolemia

Black pepper & long pepper:-combined with ginger to form mixture which increases appetite ,
promotes secretion of digestive juices, cures gastric disorders like Achlorhydria &
Hypochlorhydria.

(c)Homeopathy: The alternative medical system of homeopathy was developed in Germany at

the end of the 18th century. Supporters of homeopathy point to two unconventional theories:
“like cures like”—the notion that a disease can be cured by a substance that produces similar
symptoms in healthy people; and “law of minimum dose”—the notion that the lower the dose of
the medication, the greater its effectiveness. Many homeopathic remedies are so diluted that no
molecules of the original substance remain.
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Homeopathic remedies are derived from substances that come from plants, minerals, or animals,
such as red onion, arnica (mountain herb), crushed whole bees, white arsenic, poison ivy,
belladonna (deadly nightshade), and stinging nettle. Homeopathic remedies are often formulated
as sugar pellets to be placed under the tongue; they may also be in other forms, such as
ointments, gels, drops, creams, and tablets. Treatments are “individualized” or tailored to each
person—it is not uncommon for different people with the same condition to receive
different treatments. Homeopathic remedy examples like Arsenicum album, Natrium muriaticum
& Thyroidinum are used for treating patients.

(d)Native American healing practices: Like other ancient healing systems, Native American
medicine focuses on a holistic approach to medicine that emphasizes the treatment of the entire
person, including physical, mental, emotional, and spiritual aspects. Native American healers,
often referred to as "medicine men," "medicine women," or "shamans," believe that individual
health is intertwined with the natural and spiritual world and thus incorporate symbolic healing
rituals, ceremonies, and the extensive use of herbal remedies. Native American medical
interventions, such as medical herbs and healing plants, have had a significant impact on modern
society. In fact, 7 out of the 10 top-selling herbal remedies in the U.S. today were originally used
by Native American tribes

(e)Naturopathic medicine: Naturopathic medicine is based on a belief that the body heals itself
using a supernatural vital energy that guides bodily processes, a view in conflict with the
paradigm of evidence-based medicine. Many naturopaths have opposed vaccination, and
"scientific evidence does not support claims that naturopathic medicine can cure cancer or any
other disease".

(f)Tibetan medicine Tibetan Medicine provides a comprehensive system for maintaining health

and preventing disease through diet and lifestyle choices individually designed for your unique
attributes. It is important to make sure the Tibetan doctor you consult takes the time to explain
basic theory and how to apply it to your diet and lifestyle choices.
(g)Traditional Chinese medicine: In a different fashion, Traditional Chinese Medicine (TCM)
has restored harmony to those with illness for close to 23 centuries. By enhancing recuperative
power and immunity through several mechanisms including herbs, acupuncture, diet, massage,
and exercises such as qigong and tai chi, TCM is used today throughout the world. TCM is based
on a belief in yin and yang-defined as opposing energies such as earth and heaven, winter and
summer, and happiness and sadness. When yin and yang are in balance, patients feel relaxed and
energized, experiencing only occasional highs and lows. Out of balance yin and yang, however,
can negatively affect the health of a patient. In addition, TCM professionals believe that there is
a life force or energy in all people, known as qi. In order for yin and yang to be balanced and for

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the body to be healthy, qi must be balanced and flowing freely. When there is too little or too
much qi in one of the body's energy pathways (called meridians), or when the flow of qi is
blocked, illness may result.

2) Mind-Body Interventions
Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to
affect bodily function and symptoms. Some techniques that were considered alternative in the
past have become main stream (for example, patient support groups and cognitive-behavioral
therapy).

Other mind-body techniques are still considered alternative, including:

(a)Aroma therapy: It is the use of fragrant compounds or essential oils (volatile) extracted from
plants. They are used to improve & overall health. They can be inhaled or applied during
massage. Some of the popular compounds include chamomile, eucalyptus, jasmine, lavender,
Peppermint. It can improve one’s quality of life despite weather it has other benefits.

(b)Art therapy: The use of art to promote healing and manage physical and emotional problems
has been around for a few centuries, but “art therapy” as a science has become especially popular
during the last 30-40 years or so. This is thanks in part to the formation of the American Art
Therapy Association and the offering of college degree programs in art therapy. Art therapy is
now known to be extremely valuable to those battling difficult cancers like mesothelioma. Art
therapy is most often used to help patients come to grips with or express concerns about their
disease, especially in the case of terminal patients.

(c)Biofeedback: Often referred to as mind-body therapy, biofeedback has been around for
several generations. Offering another way to treat pain and a viable alternative to taking more
pain medication, biofeedback has been used for decades to treat not only chronic pain associated
with diseases like mesothelioma cancer, but also to treat addictions, depression, anxiety,
attention deficit disorder, and more. It has also been used successfully with many mesothelioma
Navy veterans at VA centers throughout the country. It is a technique that allows individual to
gain control over specific physiological reactions that are ordinarily subconscious. Malfunction
in these automatic responses contribute to severe medical problems. The practitioner involved in
the use of biofeedback attempts to teach the patient how to establish a connection between the
processes of the mind and body. There are several ways to do this and, hence, are several
different biofeedback techniques offered by proponents of this complementary treatment.

(d)Dance therapy: Dance therapy uses movement to allow patients to express what is going on
in their bodies and how they feel about it, all in a non-verbal way. Most dance therapists will
note that their goal is to promote the idea that mind and body work together. Therefore, when
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patients can bring their emotions to the surface through dance, the body will be relieved or
experience a lessening of certain problems like stress and pain .Dance therapy has long been
used with individuals who have emotional problems including victims of abuse, those with
depression or anxiety, and people who have difficulty verbalizing their issues. It has had limited
use with cancer patients and there is no recorded scientific evidence that it can reduce the pain
experienced by or other forms of the disease though many patients report feeling better after a
session. In a dance therapy session, which can be done privately or in a group, participants are
generally encouraged to move their body in a certain way or respond to a certain type of music or
prose. Dance therapists can help guide the movement and may encourage those participating in
group therapy to interact with one another.

(e)Guided imagery: Guided imagery is a powerful technique centered on the imagination of the
participant. Utilizing a program of thoughts and images, a guided imagery therapist guides the
imagination of the participant towards a relaxed and focused state of mind. Those involved in
care are now beginning to recognize the impact of imagery on the health of patients. While many
conceive guided imagery as a purely mental technique, properly conducted sessions are whole
body sensory experiences that can have a powerful impact.As a meditative technique for patients
undergoing care, guided imagery often involves the patient imagining inside their body shrinking
and dissolving, as they visualize the effects and benefits of the treatment they may be receiving.
There are no risks associated with guided imagery, but patients should alert their doctors before
beginning any alternative or complementary therapies.

(f)Humor therapy: Humor therapy (sometimes called therapeutic humor) uses the power of
smiles and laughter to aid healing. Humor therapy helps you find ways to make yourself (or
others) smile and laugh more. When you think of humor therapy, picture clowns in the children's
ward of a hospital cheering up sick children. Some hospitals now have humor carts that provide
funny materials for people of any age. Many nurses have learned the value of providing a good
laugh to those they care for. Scientists have been researching the relation between the mind and
the body, especially in connection with the body's ability to heal (a field called psycho neuro
immunology). Laughter appears to change brain chemistry and may boost the immune system.
Anyone can use humor therapy, either preventively or as part of treatment for any disease.
People commonly use it in the treatment of long-term (chronic) diseases, especially those that are
made worse by stress (such as heart disease and asthma). Chronic diseases have a negative effect
on mood and attitude, which can make the disease worse. Humor therapy helps reduce the
negative effects of feeling unhealthy, out of control, afraid, or helpless, which are common
problems for those with cancer or chronic diseases. Humor therapy is also valuable as a
preventive measure for the caregivers of people with chronic diseases. Caregivers are at high risk
of becoming sick themselves, and humor therapy can help release the stress that comes from
being a caregiver. Caregivers and those they care for can practice humor therapy together, and
they both are likely to have better health as a result

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(g)Hypnotherapy: Hypnosis is often described as an altered state of consciousness, somewhat
like day dreaming, similar to that which one experiences when they are beginning to fall asleep
or are just waking up. During this trance-like state, which is induced by the hypnotherapist, the
patient is offered suggestions that will enter the subconscious mind without being intercepted by
the conscious mind. What is said during the trance is actually more important than the actual
state of being in a trance, professional’s note. Once a person participates in several guided
hypnosis sessions with the therapist, they can often achieve self-hypnosis when the need arises.
This means it isn't necessary to visit the hypnotherapist every time one needs to be in a state of
hypnosis. That makes hypnotherapy a very affordable form of treatment. Some scientists
speculate that it prompts the brain to release chemicals Encephalin & Endorphins, which are
natural mood altering substances that can change the way we perceive pain & other physical
symptoms like Phobias , Certain pain syndromes , Smoking cessation , Headaches , Asthma,
Skin disorders , HTN , Nausea & vomiting by chemotherapy, Anxiety & diminished quality of
life in people who have cancer.

(H)Meditation: Meditation is a method of relaxation and mental restoration that is implemented

by many individuals. It has long been proven to instill a sense of peacefulness and balance within
the body and mind. By definition, meditation is a "discipline in which the mind is focused on an
object of thought or awareness." Those who practice meditation may rely on the repetition of
certain phrases or words, also known as mantras, paired with deep-breathing exercises, or they
may envision various calming scenarios or situations in an effort to increase the wellbeing of
their body and soul.

(i)Music therapy: Music therapy can be performed in a variety of different settings and in
various ways. It may be administered by a degreed professional who has been certified in music
therapy, by another medical professional, or may even be self-administered at home. Certified
music therapists, however, have the most knowledge of this form of alternative treatment and
have been trained to work specifically in healthcare settings. Some may be part of the multi-
disciplinary teams of professionals often assigned to cancer patients, especially at large cancer
facilities where alternative and complementary therapies are part of the care plan. It is used with
individuals of all ages & with a variety of conditions like psychiatric disorders , medical
problems , physical handicaps , sensory impairment , substance abuse , communication disorders
& aging. Many patients may mistakenly believe that they need to be “musical” to take advantage
of this type of therapy when, in fact, no musical experience is necessary. While many
experienced musicians do find making music to be therapeutic, music therapy as a science
requires only an open mind and a willingness to try something that may help relieve the
symptoms.Many forms of music therapy simply involve listening to the music of the patient’s

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choice, but may also include playing simple instruments, singing, writing songs that express
one’s feelings, or discussing lyrics of existing songs. Hence, therapy of this type can be active or
passive, allowing it to be used even with patients who are deemed “too sick” to participate.

(j)Prayer therapy: Prayer Therapy is the practice of using prayer therapeutically in a clinical,
intensive treatment and learning session for the purpose of emotional and mental healing and
wholeness. Prayer Therapy engages the person’s SOUL (mind, will, and emotions) in a
conscience process of TRANSFORMATION; rather than just praying for them to be healed.
Prayer Therapy is NOT deliverance in the common usage of the word, although deliverance
(freedom from demonic oppression and affliction will occur). It is our observation that
‘deliverance’ is relatively easy; but if the affliction is not healed and the mind renewed, the
condition will often re-occur, in a relatively short time.

(k)Yoga: It is a set of exercises that offer a variety of proven health benefits. The practice
originated in India but is very different than the practices we see today in fitness centers and
other health centers. In today's practice, the ultimate emphasis is placed upon certain body
positions or postures, known as asanas and is usually regarded as a form of exercise. In its most
literal of terms the word Yoga means "union," which suggests a oneness or unity of mind, soul,
and body. Through careful rejection of distractions and posturing of the body, it is believed that
this can be attained. In today's culture, these beliefs are accepted with different levels of
participation. However, very few will not agree that Yoga has many complementary clinical
benefits. It includes the three benefits

1) Breathing exercises 2) Body posture 3) Meditation. Advice about nutrition may also be given
.sessions begins with warm up exercises. Yoga emphasizes a great deal of self reflection and
fitness. Maintaining a healthy body and mind is essential for battling any disease, but is
particularly important for cancer patients, whose body is debilitated by chemotherapy and other
types of treatment. Among Yoga's more important benefits is its ability to induce relaxation,
which is essential for patients battling anxiety and stress. Used to treating depression , deep
breathing controls Premature ventricular complexes , improves blood sugar level in diabetic
patients , increases hand grip strength in rheumatoid patients , useful for treating asthma, back
pain etc.

3) Biologically-Based Therapies
Biologically based therapies in complementary and alternative medicine use substances found in
nature, such as herbs, foods, and vitamins. Some examples include:

(a)Diet or Medical nutrition therapy (MNT) is a therapeutic approach to treating medical

conditions and their associated symptoms via the use of a specifically tailored diet devised and
monitored by a registered dietitian or professional nutritionist. The diet is based upon the

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patient's medical and psychosocial history, physical examination, functional examination and
dietary history. It is a system of healing based on belief that food, as nature intended. Provides
the medicines we need to obtain & maintain a state of health: our food is our medicine & our
medicine is our food.
The role of MNT when administered by a dietitian or professional nutritionist is to reduce the
risk of developing complications in pre-existing conditions such as diabetes as well as ameliorate
the effects any existing conditions such as high cholesterol.
A nutritional therapy practitioner or clinical nutritionist combines the bio-chemical individuality
of each client with a nutrient dense, properly prepared whole food diet and nutritional
supplementation in order to return the client to a state of optimal health. They strive to treat the
body as a whole - addressing the causes of problems, not just the symptoms .Many medical
conditions either develop or are made worse by an improper or unhealthy diet .An example is
Intradialytic Parenteral Nutrition (IDPN) Therapy, a nutritional support therapy for people
on hem dialysis who have a difficult time maintaining adequate nutrition.
(b)Dietary supplements: Nutrients, herbs, and other supplements can be powerful
medicine.
While eating a wholesome, varied diet is crucial to fighting cancer, it’s hard to get all the
nutrients your body needs through diet alone — especially during treatment. Certain herbs and
nutritional supplements can help provide what you’re missing. Some substances go even further,
easing side effects, reinforcing your conventional treatment, and slowing cancer on a cellular
level. For example, herbs like rosemary and garlic help your body process and eliminate toxins,
making your body a less cancer-friendly environment. And foods and supplements
with antioxidants seek out and destroy free radicals, which are naturally occurring substances
that damage healthy cells and leave them vulnerable to cancer.More than 20000 herbs & dietary
supplements are sold in the United States.

(c)Herbal products: Herbalism ("herbology" or "herbal medicine") is use of plants for

medicinal purposes, and the study of such use. Plants have been the basis for medical treatments
through much of human history, and such traditional medicine is still widely practiced today.
Modern medicine recognizes herbalism as a form of alternative medicine, as the practice of
herbalism is not strictly based on evidence gathered using the scientific method. Modern
medicine, does, however, make use of many plant-derived compounds as the basis for evidence-
testedpharmaceutical drugs, and phytotherapy works to apply modern standards of effectiveness
testing to herbs and medicines that are derived from natural sources. The scope of herbal
medicine is sometimes extended to include fungal and bee products, as well
as minerals, shells and certain animal parts.
 St John Wart (Hypercom perforatum) is safe & effective treatment for mild to
moderate depression
 Ginkgo Bilbao; relieves symptoms of dementia

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  Ginger effective remedy for nausea & vomiting
 Tea tree oil effective against fungal infections
 Vegetables (onion & garlic) may protect against certain cancers
The World Health Organization (WHO) estimates that 80 percent of the population of some
Asian and African countries presently use herbal medicine for some aspect of primary health
care. Pharmaceuticals are prohibitively expensive for most of the world's population, half of
which lived on less than $2 U.S. per day in 2002. In comparison, herbal medicines can be grown
from seed or gathered from nature for little or no cost.

(d)Megavitamins: Megavitamin therapy is the use of large doses of vitamins, often many times
greater than the recommended dietary allowance (RDA) in the attempt to prevent or
treat diseases. It is typically used in complementary and alternative medicine by practitioners
who call their approach "orthomolecular medicine", but also used in mainstream medicine for
"exceedingly rare" genetic conditions that respond to mega doses of vitamins. In 2002, a review
of these conditions identified about 50 that respond to "high-dose vitamin therapy "Further
understanding of these conditions is expected to play a part in the emerging field
of nutrigenomics.
Nutrients may be useful in preventing and treating some illnesses, but the conclusions of medical
research are that the broad claims of disease treatment by advocates of megavitamin therapy are
unsubstantiated by the available evidence. It is generally accepted that doses of any vitamin
greatly in excess of nutritional requirements, will result either in toxicity or in the excess simply
being metabolized - evidence in favor of vitamin supplementation supports only doses in the
normal range. Critics have described some aspects of orthomolecular medicine as food
faddism or even quackery. Research on nutrient supplementation in general suggests that some
nutritional supplements might be beneficial, and that others might be harmful; several specific
nutritional therapies are associated with an increased likelihood of the condition they are meant
to prevent.

4) Manipulative and Body-Based Methods

Manipulative and body-based methods in complementary and alternative medicine are based on
manipulation and/or movement of one or more parts of the body. Some examples include:

(a)Acupressure The term “acupressure” describes a family of procedures involving the

stimulation of points on the body using a variety of techniques. It is pressing of the single point
or specific points to relieve pain and stress in a particular area of the body.

Concept: it is based on the same concept as that of the acupuncture but unlike acupuncture,
acupressure does not involve the use of needles to stimulate energy points along the meridians,

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but employs pressure from the fingers and hands for the same purpose. In stimulating the energy
points in this way, acupressure aims to remove energy blocks which produce health problems.
It is used as an adjunct therapy to either acupuncture or massage.
It promotes relaxation and comfort.
Caution: should not be applied near areas of fractures, broken bones or near blood clots, wounds,
sore and bruises.
(b) Alexander Technique: The Alexander technique deals with bad habits of posture and
movement. Bad posture can lead to head, neck and back pain, muscle aches, bursitis and
repetitive strain injuries. The Alexander technique teaches awareness of movement and thought.
The Alexander technique addresses these bad habits by helping us to develop an even
distribution of muscle tone, neither sloppily relaxed nor over tense. The philosophy of ‘good use’
means using and moving the body lightly, with a minimum of interference in the
interrelationship of neck, head and back. The Alexander technique is a process of re-education,
not a ‘quick fix’ solution. Over time, you will find that you function better in almost every way

(c)Chiropractic: is a form of alternative medicine that emphasizes diagnosis, treatment and

prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the
belief that these disorders affect general health via the nervous system. Many chiropractors reject
being characterized as complementary and alternative medicine (CAM). It is a healthcare
profession, and although chiropractors have many similarities to primary care providers, they are
more similar to a medical specialty like dentistry or podiatry. The main chiropractic treatment
technique involves manual therapy, especially manipulation of the spine, other joints, and soft
tissues; treatment may also include exercises and health and lifestyle counseling. Traditional
chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the
body's function and its innate intelligence. A large number of chiropractors want to separate
themselves from the traditional vitalistic concept of innate intelligence.
(d) Feldenkrais Method: The Feldenkrais Method, often referred to simply as "Feldenkrais",
is a somatic educational system designed by Moshé Feldenkrais(1904–1984). Feldenkrais aims
to reduce pain or limitations in movement, to improve physical function, and to promote general
wellbeing by increasing students' awareness of themselves and by expanding students' movement
repertoire. Feldenkrais taught that increasing a person's kinesthetic and proprioceptive self-
awareness of functional movement could lead to increased function, reduced pain, and greater
ease and pleasure of movement. The Feldenkrais Method is therefore a movement pedagogy,
similar to the Alexander Technique in being educational and not a form of manipulative therapy.
The Method is experiential, providing tools for self-observation through movement enquiry.
The practitioner directs attention to habitual movement patterns which are inefficient or strained,
and teaches new patterns using gentle, slow, repeated movements. Slow repetition is believed to
be necessary to impart a new habit and allow it to begin to feel normal. These movements may
be passive (performed by the practitioner on the recipient's body) or active (performed by the
recipient). The recipient is fully clothed.

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Feldenkrais is used to improve movement patterns rather than to treat specific injuries or
illnesses. However, because habitual and repetitive movement patterns can contribute towards
and in some cases cause injury, pain, and physical dysfunction, the method is often regarded as
being within the field of integrative medicine or complementary medicine.

(e)Massage therapy: Massage is the manipulation of superficial and deeper layers of muscle
and connective tissue using various techniques, to enhance function, aid in the healing process,
decrease muscle reflex activity, inhibit motor-neuron excitability, promote relaxation and well-
being, and as a recreational activity.
The word comes from the French massage "friction of kneading", or
from Arabic massa meaning "to touch, feel or handle" or fromLatin massa meaning "mass,
dough", cf. Greek verb μάσσω (massō) "to handle, touch, to work with the hands, to knead
dough". In distinction the ancient Greek word for massage was anatripsis, and the Latin
was frictio.
Massage involves working and acting on the body with pressure – structured, unstructured,
stationary, or moving – tension, motion, or vibration, done manually or with mechanical aids.
Target tissues may include muscles, tendons, ligaments, fascia, skin, joints, or other connective
tissue, as well as lymphatic vessels, or organs of the gastrointestinal system. Massage can be
applied with thehands, fingers, elbows, knees, forearm, feet, or a massage device.
In professional settings massage involves the client being treated while lying on a massage table,
sitting in a massage chair, or lying on a mat on the floor, while in amateur settings a general
purpose surface like a bed or floor is more common. The massage subject may be fully or
partially clothed or unclothed.

(f)Osteopathy: it is a way of detecting, treating and preventing health problems by moving,
stretching and massaging a person's muscles and joints. Osteopathy is based on the principle
that the wellbeing of an individual depends on their bones, muscles, ligaments and connective
tissue functioning smoothly together. They use a range of techniques but do not use drugs or
surgery.
Most people who see an osteopath do so for help with back pain, neck pain, shoulder pain or
other problems related to muscles and joints. Some osteopaths also claim to treat a wide range of
health conditions, including asthma, digestive problems and period pain.

(g)Reflexology is an alternative medicine involving application of pressure to the feet and hands

with specific thumb, finger, and hand techniques without the use of oil or lotion. It is based on a
system of zones and reflex areas that reflect an image of the body on the feet and hands, with the
premise that such work affects a physical change to the body.

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A 2009 systematic review of randomised controlled trials concludes: "The best evidence
available to date does not demonstrate convincingly that reflexology is an effective treatment for
any medical condition."
There is no consensus among reflexologists on how reflexology is supposed to work; a unifying
theme is the idea that areas on the foot correspond to areas of the body, and that by manipulating
these one can improve health through one's qi. Reflexologists divide the body into ten equal
vertical zones, five on the right and five on the left. Concerns have been raised by medical
professionals that treating potentially serious illnesses with reflexology, which has no proven
efficacy, could delay the seeking of appropriate medical treatment.

(h)Rolfing: Rolfing is an alternative medical treatment marketed by the Rolf Institute of

Structural Integration (RISI). The Institute states that Rolfing is a "holistic system of soft tissue
manipulation and movement education that organize(s) the whole body in gravity". Rolfing is
essentially identical to Structural Integration. There is no evidence Rolfing is effective for the
treatment of any health condition Rolfing is typically performed in a progression of 10 sessions,
sometimes called "the recipe", which is claimed to provide a systematic approach to address
goals for the theorized alignment and movement of various body areas. The purpose is to educate
the body to have better alignment within gravity. Rolfers manipulate the fascia until they believe
it is operating in conjunction with the muscles in a more optimal relationship In addition to
physical manipulation of tissue, Rolfing uses a combination of active and passive movement
retraining.

(i)Therapeutic Touch: Therapeutic touch (commonly shortened to "TT"), known by some

as non-contact therapeutic touch (NCTT), is an energy therapywhich practitioners claim
promotes healing and reduces pain and anxiety. Therapeutic Touch is a registered trademark in
Canada for the "[s]tructured and standardized healing practice performed by practitioners trained
to be sensitive to the receiver's energy field that surrounds the body;...no touching is required."
Practitioners of therapeutic touch state that by placing their hands on, or near, a patient, they are
able to detect and manipulate the patient's energy field. One highly cited study, designed by a
then-nine-year-old Emily Rosa and published in the Journal of the American Medical
Association found that practitioners of therapeutic touch could not detect the presence or absence
of a hand placed a few inches above theirs when their vision was obstructed. Simon
Singh and Edzard Ernst concluded in their 2008 book Trick or Treatment that "the energy field
was probably nothing more than a figment in the imaginations of the healers." The American
Cancer Society has noted, "Available scientific evidence does not support any claims that TT can
cure cancer or other diseases." A 2014 Cochrane review found no good evidence that it helped
with wound healing.

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(j)Trager Approach:  is a form of movement education and mind/body integration. Proponents
claim the Trager Approach helps release deep-seated physical and mental patterns and facilitates
deep relaxation, increased physical mobility, and mental clarity The founder, Milton Trager,
called his work Psychophysical Integration. He was an athlete, dancer, and bodybuilder. He
began doing bodywork with no training and later worked under a variety of practitioner licenses.
Late in life, at Esalen Institute, he was encouraged to begin teaching, which he did for the last 22
years of his life.At the beginning of a session, the practitioner enters into a state of awareness
that Milton Trager termed "hook-up," a state similar to meditation From this state of mind, the
practitioner uses gentle touch and a combination of passive and active movement to teach the
body how to move with less effort. 

5) Energy Therapies
Energy therapies involve the use of energy fields. They are of two types:

(1)Bio field therapies are intended to affect energy fields that purportedly surround and penetrate
the human body. The existence of such fields has not yet been scientifically proven. Some forms
of energy therapy manipulate bio fields by applying pressure and/or manipulating the body by
placing the hands in, or through, these fields. Examples include:

(a 1)Qi gong: Qigong practice typically involves moving meditation, coordinating slow flowing
movement, deep rhythmic breathing, and calm meditative state of mind. Qigong is now practiced
throughout China and worldwide for recreation, exercise and relaxation, preventive
medicine and self-healing, complementary and alternative medicine, meditation and self-
cultivation, and training for martial arts.

(b1)Reiki: Reiki   is a spiritual practice developed in 1922 by Japanese Buddhist Mikao Usui,

which has since been adapted by various teachers of varying traditions. It uses a technique
commonly called palm healing or hands-on-healing as a form of alternative medicine and is
sometimes classified as oriental medicine by some professional medical bodies. Through the use
of this technique, practitioners believe that they are transferring universal energy (i.e., reiki) in
the form of qi (Japanese: ki) through the palms, which they believe allows for self-healing and a
state of equilibrium.
There are two main branches of Reiki, commonly referred to as Traditional Japanese
Reiki and Western Reiki. Though differences can be wide and varied between both branches and
traditions, the primary difference is that the Westernised forms use systematised hand-
placements rather than relying on an intuitive sense of hand-positions , which is commonly used
by Japanese Reiki branches. Both branches commonly have a three-tiered hierarchy of degrees,
usually referred to as the First, Second, and Master/Teacher level, all of which are associated
with different skills and techniques.

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Reiki is based on a ki – a supposed life force which is purely hypothetical. Used as a medical
treatment, reiki confers no benefit: theAmerican Cancer Society, Cancer Research UK, and
the National Center for Complementary and Alternative Medicine have found no clinical or
scientific evidence supporting claims that Reiki is effective in the treatment of any illness.

(c1)Therapeutic Touch (discussed above)

(2)Bio electromagnetic-based therapies involve the unconventional use of electromagnetic fields,

such as:

(a2)Pulsed fields: Pulsed electromagnetic field therapy (PEMFT), also called pulsed

magnetic therapy, pulse magneto therapy, or PEMF, is a reparative technique most
commonly used in the field of orthopedics for the treatment of non-union fractures, failed
fusions, congenital pseudoarthrities and depression. In the case of bone healing, PEMF uses
directed pulsed magnetic fields through injured tissue. This is believed to stimulate cellular
repair. The FDA has approved several such stimulation devices. These devices provide a
complementary solution that may aid in bone repair.

(b2)Magnetic fields: Magnet therapy, magnetic therapy, or magno therapy is

a pseudoscientific alternative medicine practice involving the use of static magnetic fields.
Practitioners claim that subjecting certain parts of the body to magneto static fields produced by
permanent magnets has beneficial health effects. These physical and biological claims are
unproven and no effects on health or healing have been established. Although hemoglobin, the
blood protein that carries oxygen, is weakly diamagnetic (when oxygenated)
or paramagnetic (when deoxygenated) the magnets used in magnetic therapy are many orders of
magnitude too weak to have any measurable effect on blood flow. Magnet therapy is the
application of the magnetic field of electromagnetic devices or permanent static magnets to the
body for purported health benefits. Some believers assign different effects based on the
orientation of the magnet; under the laws of physics, magnetic poles are symmetric.
Products include magnetic bracelets and jewelry; magnetic straps for wrists, ankles, knees, and
back; shoe insoles; mattresses; magnetic blankets (blankets with magnets woven into the
material); magnetic creams; magnetic supplements; plasters/patches and water that has been
"magnetized". Application is usually performed by the patient.

(c2)Alternating-current or direct-current fields: it is the use of electrical energy as a medical

treatment In medicine, the term electrotherapy can apply to a variety of treatments, including the
use of electrical devices such as deep brain stimulators for neurological disease. The term has

26
also been applied specifically to the use of electric current to speed wound healing. Additionally,
the term "electrotherapy" or "electromagnetic therapy" has also been applied to a range
of alternative medical devices and treatments. It has not been found to be effective in increasing
bone healing. It  is primarily used in physical therapy for relaxation of muscle spasms,
prevention and retardation of disuse atrophy, increase of local blood circulation, muscle
rehabilitation and re-education electrical muscle stimulation, maintaining and increasing range of
motion, management of chronic and intractable pain, post-traumatic acute pain, post surgical
acute pain, immediate post-surgical stimulation of muscles to prevent venous thrombosis, wound
healing and drug delivery.
Some of the treatment effectiveness mechanisms are little understood, with effectiveness and
best practices for their use still anecdotal.
Electrotherapy devices have been studied in the treatment of chronic wounds and pressure ulcers.
A 1999 meta-analysis of published trials found some evidence that electrotherapy could speed
the healing of such wounds, though it was unclear which devices were most effective and which
types of wounds were most likely to benefit. However, a more detailed review by the Cochrane
Library found no evidence that electromagnetic therapy, a subset of electrotherapy, was effective
in healing pressure ulcers or venous stasis ulcers.

NURSING AND ALTERNATIVE MODALITIES OF CARE:

Nurses are in an excellent position to adopt complementary/alternative modalities into practice
that addresses assessed client needs and to use these techniques to achieve the goals of nursing.

Use of theory and nursing classification systems help nurses and provide a context to use these
complementary/alternative modalities professionally.

Nursing theory providing context

Alternative/complementary modalities performed from within a context of a nursing
theory/model take on meaning from within the theory.
E.g. Roy adaptation model, deals with the concept of focal, contextual and residual stimuli.

Nurse working within the context of this, assesses the stimuli and takes action to promote the
client’s adaptation in physiologic needs, self-concept, role function, and relations of
interdependence nursing health and illness.

With regard to contextual stimuli, she uses Music therapy to change the environment and
promote the client’s adaptation to stressful situation.

Nursing taxonomy providing the context

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Provide frameworks for naming and documenting the phenomena of concern of professional
nursing.
Use of CAM, this action becomes an identified nursing intervention planned to address/remedy a
nursing problem or concern.
E.g. fear related to undergoing medical diagnostic procedures (concern), and use of guided
imagery becomes a useful nursing intervention.

Nursing Nursing
Rationale
Diagnosis/concern Intervention(s)
Acupressure,
Impaired Comfort to decrease perceived pain
TT
Disturbed Sleep
Massage to promote relaxation, rest
Pattern
Impaired
Art therapy to facilitate expression
Communication
to facilitate appreciation of that which is funny, to relieve
Impaired Coping Humor
tensions
Spiritual
spiritual Distress to facilitate a sense of inner peace
support

Nurses documenting practice using these systems are accomplishing three important things:
- Appropriate documentation of care,
- Identification of work as within the scope of professional nursing, and
- Building a body of knowledge for nurses on the use of specific interventions.
Thus, documentation of care from a nursing framework provides for practice which is
recognizable as nursing, and legally defensible as within nursing’s scope of practice.
Nursing Education in Homoeopathy
Homoeopathy is a recognized system of medicines by Government of India
Most of the Homoeopathic medical colleges have its own teaching hospitals
There is a great need to have a system of nursing personnel duly trained in Homoeopathic skill of
patient care with the background of Homoeopathic subjects

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REFERENCES

 Basheer .P.Shabeer khan Yaseen; A Concise Text Book of Advanced Nursing Practice
(2013), 1st edition, EMMESS Medical publishers, pp 660 -675.
 Myles Text Book for Midwives, 5th edition, Elsevier publications, pp 959-974.
 Elizebth Marie Text Book of midwifery for nurses,2nd edition,Elsevier publications,pp
449-459.
 National Center for Complimentary and Alternative Medicine.”what is Complimentary
and Alternative Medicine?”2002 NCCAM 3 Agust 2006.
(updated December 01,2014)
 Black and Hawks:Medical surgical nursing ;vol 1:7th edition,Elsevier publications,pp109-
118.
 Miller. M.(1999).A brief history of CAMin the US.Foundation for the innovative
Medicine.Retrieved March 15,2002, from http://www.faim.org/legal.htm
 Davis.J.(2000.August 22).Native Americans Knew the power of herbs but to modern-day
scientists, many botinicals remain a mystery.WebMD Medical News Retrieved from
http://my.webmd.com/content/article/1728.60591
 Kesseler W.Goodkind M. (1998.Sept 23).American mingle complementary techniques
with traditional medicine .Stanford online Report. Retrieved from
http://www.stanford.edu/dept/news/report/news/september23/altsurvey923.html
 Beecher,H.K.(1995).The powerful placebo.journal of the American Medical
Association,159,1602-1606.
 Zoorob,R.,& Morelli , V,(Eds).(2002).Primary care :Alternative therapies, 29(2),231-473

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 UNCONSCIOUSNESS
Unconsciousness is the condition of being not conscious—is a mental state that involves
complete or near-complete lack of responsiveness to people and other environmental stimuli. It is
an abnormal state resulting from disturbance of sensory perception to the extent that the patient
is not aware of what is happening around him.
Periods of unconsciousness may be momentary (the common faint or syncope) or may last
for month (for example, following a serious motor vehicle accident in which extensive brain
damage has been sustained.

To produce unconsciousness, a disorder must

(1) Disrupt the ascending reticular activating for system that is found in the center of the brain
stem and thalamus.

(2) Significantly disrupt the function of both cerebral hemispheres; or

(3) Metabolically depress the cerebrum or reticular activating system, such as drug overdose.

Degrees Or Levels Of Unconsciousness:

EXCITATORY UNCONSCIOUSNESS:

The patient does not respond coherently but easily disturbed by sensory stimuli such as bright
lights, noise, or sudden movement. He may become excited and agitated at the slightest
disturbance. This stage of unconsciousness is commonly seen in patients who are going under
anesthesia or who are partially reacted from anesthesia. In caring for such a patient the room
should be kept dimly lighted, the environment should be quiet, talking should be avoided, and
any necessary moving of the patient or activity about him should be slow and gentle.

SOMNOLENT:

Patient is extremely drowsy and will respond only of spoken to directly and perhaps touched.
This response is rarely more than a mumble or a jerky body movement in response to a stimulus.

STUPOROUS:

Patient responds only to painful stimuli such as pricking or pinching of the skin. In deep stupor
he may respond only to supraorbital or substernal pressure. This response may be reflex
withdrawal from the painful stimulus.

COMA:

The patient in deep coma doesnot respond to any stimuli. Coma ( or unconsciousness ) is a state
in which a patient is totally unaware of both self and external surroundings, and unable to

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respond meaningfully to external stimuli. Coma results from gross impairment of both cerebral
hemispheres, and/or the ascending reticular activating system.

ETIOLOGY:

Three kinds of disorders produce unconsciousness.

(1) Structural lesions in the brain that place pressure on the brain stem or in the posterior fossa,
which destroy the reticular formation;

(2) Metabolic disorders, which impair the cerebrum and the arousal functions by decreasing the
supply of oxygen or allowing waste products to accumulate and

(3) Psychogenic causes, in which the patient looks comatose but self-awareness is usually intact,
such as is seen in catatonia.

Structural lesions:

 Supratentotorial lesions (causing upper brain stemdysfunction)

 Brain Tumor
 Brain abscess(rare)
 Cerebral hemorrhage
 Cerebral infarction(large)
 Epidural hematoma/Subdural hematoma
 Subtentorial lesions(compressing or destroying the reticular formation)
 Cerebellar abscess
 Infarction
 Pontine or cerebellar hemorrhage/Tumor

Metabolic disorders and diffuse lesions:

 Diseases of neurons Metabolic encephalopathy

 Disease of other organs e.g. liver, kidney.
 Poisons, Alcohol and drugs
 Fluid and electrolyte imbalance
 Concussion and postictal states
 Infections
 Nutritional deficiency
 Hypoglycemia
 Common fainting
 Temperature regulating disorders

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Psychogenic causes:

 Hysteria or Catatonia

PATHOPHSIOLOGY:

 Consciousness is a complex function controlled by reticular activating system (RAS) and

its integrated components.
 The RAS begins in the medulla as the reticular formation that connects to the RAS
(located in the mid brain which then connects hypothalamus and thalamus).
 Integrated pathways connect to the cortex via the thalamus and to the limbic system via
the hypothalamus. Feedback systems also connect at the brainstem level.
 The reticular formation produces wakefulness, whereas the RAS and higher connections
are responsible for awareness of self and the environment.

To produce a coma, a disorder must affect both cerebral hemisphere or the brain stem itself
(in one of three ways):

Direct Toxic waste from

compression(e.g, liver ,kidney
HYPOXSIA
tumour)
Bacterial invasion
Destruction of
structures(e.g, Metabolites from
hemorrhage) in drug overdose
brainstem or
ISCHEMIA Substance abuse.
Swelling in
cerebral
hemisphere.

Chemicals needed
to carryout function
not formed

COMA

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Management of the unconscious patient:

First of all, make sure quickly that they are unconscious, and not just asleep. Often, someone else
has already done this for you. Next, the primary care is EXACTLY the same as Basic Life
Support – AIRWAY, BREATHING, CIRCULATION.

A patient who is unconscious is at a very high risk of compounding their problems by adding
to them by asphyxia, leading to death. When consciousness is lost, the tongue usually falls back
in the pharynx and obstructs the airway. The cough reflex is lost, and blood or regurgitated
stomach contents are often aspirated into the lungs. Therefore, the unconscious patient must have
their airway supported by tilting the head and lifting the chin ( sometimes with the help of an oral
or nasal airway ), and by placing them into the coma position to prevent aspiration. They must be
checked frequently to make sure they are breathing freely, by:

 Look – watch the chest moving easily, without the use of accessory muscles or the
abdomen heaving.
 Listen – with you ear at the patient mouth, or with a stethescope
 Feel – the flow of air at the mouth with your hand or cheek, and chest or abdominal
movements.

Alternatively, they may have an endotracheal tube placed, preferably by an anaesthetist. All
unconscious patients should be given supplemental oxygen therapy at a high concentration.
VERY FEW PATIENTS HAVE END STAGE OBSTRUCTIVE AIRWAYS DISEASE AS
THE CAUSE OF THEIR COMA. Therefore, give more than 24% oxygen !!!

The circulation in the unconscious patient often requires support, and so early good intravenous
access is required, with measuring of the pulse and blood pressure and appropriate treatment.

Early consultation with senior medical staff and intensive care is important in providing
optimum care for the unconscious patient. Once the ABC is sorted out, move onto D (diagnosis),
E (evaluation) and F (further management).

Diagnosis:If available, the history from relatives or ambulance staff will often give all the
necessary clues needed to make a provisional diagnosis of the cause of unconsciousness.
However, if they are a pyrexial, depressed epileptic diabetic that has been unwell recently and
then fallen down stairs………..

Making a diagnosis is important, because it will direct appropriate therapy. However, it does not
reduce the need for generic supportive care, such as that offered on intensive care. Sometimes,
the diagnosis allows the withdrawal of care, if the cause of coma is untreatable and the brain
damage irreversible.

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 Evaluation:The comatose patient should be physically examined for any helpful signs, such as
lumps on the head and non blanching rashes. The system which will be examined most intently
( and often provides the least information) is the nervous system. There are certain parts of the
central nervous system which are easy to examine, including the eyes and reflexes, but other
information is provided by the posture and muscle tone, and the respiratory pattern. The eyes do
give useful information – pupil size and equality, and direction of gaze. 

Investigations

A full blood count, and simple biochemistry, give lots of useful information which may make the
diagnosis. Other simple tests often useful in diagnosis of unexplained coma include blood sugar,
paracetamol and aspirin levels.

An investigation which is used increasingly, and often without a proper physical examination of
the patient, is the computerised tomogram of the head, the CT scan.

The procedure puts the patient at some risk while in the scanner, but it does give quite a lot of
information about what is going on inside the head. It will show space occupying lesions, bleeds
and swelling of the brain. Often the CT scan does not help, except as a route of exclusion. There
is a more sophisticated scan available, the MRI, which shows similar things but in better detail.
They take longer and are less readily available, and are so not used in the acute stages of
management very often.

Lumbar puncture is often undertaken, and will give information about infection or bleeding ( the
CSF becomes xanthochromic – yellow ).

If no diagnosis is still apparent, then just about every other test available will then be used in
whatever order comes into the clinician’s head, although sometimes the choices are based on
presumed diagnoses.

The EEG may give useful information, especially if epilepsy is suspected.

Nursing Management of the comatose patient:

This care will often be delivered in a specialist unit, usually an intensive care/therapy unit. Long
term management involves consideration of the problems suffered by a patient lying still for very
prolonged periods with no protective reflexes. These include :

A. The enviorment and family.

B. Physical care:
 maintenance of adequate oxygenation, with the assistance of artificial ventilation

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 monitoring of the CVS
 moving and position
 pressure area care
 care of the mouth, eyes and skin
 physiotherapy to protect muscles and joints
 risks of deep vein thrombosis
 risks of stress ulceration of the stomach
 nutrition and fluid balance
 urinary catheterization
 infection control
 prevention of accidents.

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BIBLIOGRAPHY:
 Potter A Patrica, Anne Griffen Perry‘s ―Fundamental Of Nursing‖, Edition 6th;
Published By: Elsevier India Private Limited, Pp 619-637
 Shabeer P. Basheer, “A Concise Book of Advanced Nursing Practice” 1st edition, 2012,
Emmss medical publishers, page no. 255-264.
 Saunder‘s Manual Of Nursing Practice, Edition Ist ; Published By W.B. Saunder
Company, Pp 620-625
 Smeltzer C. Suzzane And Brenda Bare‘s ―Medical Surgical Nursuing‖; Edition 10th;
Published By Lippincott ; Pp 481-489
 Sr. Nancy ―Principles And Practice Of Nursing‖ Edition 4th; Published By N.R.
Brothers; Pp 198-203

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