Integrative/Holistic

Health: Acupuncture &

Acupressure
NUR 470 Acute & Chronic Illness Management II
Lorna Bianco MSN, RN

Lab Group C: Rhianna Cain, Anna

Gladbach, Bella Heines, Paris Johnson,
Samantha Kennepohl, Izzy Macdougall,
Joe Ochoa, Chance Sasser
 01 Introduction
02 Clinical Question
03 Current Practice
04 Research Synopsis

Table of 05

06
Recommendations
Strengths and

Contents 07
Limitations
EBP Recommendations
Application/
08 Implementation to
Nursing Practice
09 Cost Analysis
 Introduction
● Pain: complex and multifaceted concept
○ describes unpleasant sensory
experiences
○ cause suffering
○ decrease a person's quality of life.
● Pain management goals/outcomes:
○ relieve suffering, enhance quality of
life, and improve functioning.
● Assessment of pain may be impacted by
the inability to self report.
(In-Seon, L., & Younbyoung, C., 2022)
 Acupuncture
● A practice that uses thin needles inserted into the
body at various points
● Human body is connected through meridians.
● Qi: energy flow that is responsible for health
○ Disruption of Qi can lead to disease within the
body
○ Treated with needles placed on meridians

(In-Seon, L., & Younbyoung, C., 2022)

(Jia, L. M., 2020)
● Traditional Chinese
medicine that applies
the principles of Qi
● Uses physical
pressure on specific
Acupressure
points of the body to
manipulate Qi

(Shady, 2020)
 What is the best practice for pain
management in critical care patients?

“In critical care patients (P), does acupuncture or

acupressure (I) compared to pharmacological treatment (C)
affect a patient’s pain/agitation level (O) during their
hospital unit stay (T)?”
 Current Practice

Pharmacological Treatments
- First-line treatment
- Opioids
- Side effects: sedation, delirium,
respiratory depression, ileus, and
immunosuppression
- Acetaminophen, Nefopam, Ketamine
 Current Practice
Arizona Guidelines for Opioid Prescribing
for Acute Pain
- Non-opioid medications/therapies first for
mild-moderate
- Initiate opioids at lowest dose for no longer
than 3-5 days and reassess pain
- No long-acting opioids

(AZDHS, 2019)
 Current Practice

Non-pharmacological treatments
- Common tx: repositioning, ensuring a calm
environment, distraction, and comfort
equipment.
 What Can Be
Done?
Acupuncture: clinical discipline
practiced for the purpose of
restoring physiologic balance and
normal function within the body
and with the environment
Reduce opioid reliance and avoid adverse effects!
 What Can Be Done?

Acupuncture - APRN Auricular Acupuncture -

- Specialized training, skills,
and ongoing education
- Scope of practice:
acupressure, acupuncture,
cupping, dry needling, electro
acupuncture, laser
acupuncture, etc.
RN
- Protocolized auricular
acupuncture with education,
skills, and demonstrated
supervised competency

A multidisciplinary approach to reduce pain and

improve function.

(AZBON, n.d.)
 Research
Overall reduction in pain Acupuncture points can be
used to focus therapy

Quicker pain relief than Research involved

pharmacological interventions mechanically ventilated
pts/ICU pts

Barriers to training– fatigue, Less need for pain medication

lack of resources

Barriers to training– fatigue, Ear acupuncture is effective

lack of resources and feasible
 Strengths & Limitations

Strengths Limitations
● Results are ● Self Assessment– Decreased
supported by other objectivity and reliability
studies ● Focus on specific population–
● Reliable tools used cannot generalize results
to analyze data ● Limited sample sizes
● All authors involved ● Lack of control group or
randomization
 Recommendations
Acupuncture shows
clinically relevant
reduction in pain
intensity in clinical care
settings.

However, it is not utilized

in most hospitals as a This is because it
nonpharmacological requires specialized
method. training, and is
perceived as time
consuming and to
some as invasive.
 Implementation to Nursing Practice
● Acupuncture and acupressure require specialized
training
● American Holistic Nurses Credentialing Corporation -
route for nurses to earn Holistic Nurse Board Certification
(HN-BC)
● HN-BC
○ Focuses on the patient as a whole
○ Requires:
■ unrestricted RN license from accredited
university
■ 48 CE hours
■ Recertify every 5 years, needing 2000
practicing hours or 1 year of full-time practice (RegisteredNursing.org, 2023)
(AHNCC, 2023)
 Acupuncture Timeline
May 2023 November 2023
- Start training our Nurse - First class takes
Educator certification exam
- Start advertising new -New HN-BC nurses begin
certification program to getting scheduled for
nurses throughout hospital Holistic Nursing shifts

August 2023 January 2024

- First class of nurses begins -Next class of nurses
-12 4-hour classes, once a week of starts their 3
-AHNCC Application = $495 month program
 Risks vs. Benefits
Risks Benefits

Patient ●
●
Risk for infection
Risk of bleeding/bruising
●
●
Decreased pain and anxiety
Lack of dependence of pain
● Invasive procedures medication
● Possibility of unnecessary ● Psychosocial well-being
treatment increased
● Faster pain relief
● Decreased risk of polypharmacy

Nursing ●
●
New charting requirements
Increased pt care demands
● Longer lasting pain relief–
decreased med administration
● Difficulty maintaining ratios
● Increased exposure to sharps
injury

Hospital ● Increased funding for

supplies, charting updates,
● Reduction in medication errors–
decreased lawsuits
training ● Increase in pt satisfaction
 EVALUATION
S- Patient’s in the ICU receiving high-risk pain medications such as opioids or PCA
pumps

M- Can receive acupuncture/acupressure treatments once every 24 hours

A- To achieve lesser pain ratings on a pain scale of 1-10, or in some patients that
are non-verbal, lower ratings on a non-verbal pain scale

R- Nurses that are trained on site through hospital certifications (acupuncture) or if

hospital scope of practice allows Nurses to complete non-invasive procedures (in
this case this would be acupressure)

T- Acupuncture/acupressure to be completed at least once every 24 hours for

patients that are resistant to take pain medications, high thresholds for pain
medications, and for patients that request non-pharmacological interventions
 Cost Analysis
Cost of training
Average Tucson ICU RN hourly salary: $39.04
Theoretical compensation for HN-BC certified nurses: $1.75/ hour
Total hourly salary: $40.79, extra $21.00 per shift and $3,024 per year.
Class cost is $495, considering the compensation breaking even for class cost takes 2 months.
In the 5 years until required recertification, nurse’s profit is $14,505.

Cost of equipment per month

Cost of disposable needles advantage medical sales 100 pack is $9.89
Average acupuncture treatment uses 20 needles
1 patient gets 1 acupuncture treatment per day and Average ICU has 40 beds:
8 packs x $9.89 = $79 daily in ICU = $28,835 annually
$28,835 + $3024 (5 nurses per session x 4 sessions) = $31,859 annually
(RegisteredNursing.org, 2023)
(AHNCC, 2023)
https://www.advantagemedical.com/
 Potentially Funding
It can be assumed that because these holistic measures are proven to be
effective there would be a noticeable decrease in total opioid spending in
patients undergoing elective acupuncture/acupressure.

A way to offset these funds is through applying for a Health Resources and
Services Administration (HRSA) grant.
 Summary
● ISSUE: The need for non-pharmacological interventions in pain management for
high acuity patients.
● BEST PRACTICE: Using acupuncture/acupressure as an adjunct to reduce
systemic overuse of opioid medications to promote better patient outcomes.
● SUPPORT: Current research consistently supports the clinical significance of
acupuncture/acupressure use in reducing pain.
● APPLICATION TO FACILITY: 7 months of training followed by reassessments
of intervention at 3 months, 6 months, & 1 year post intervention to determine effect
on opioid use and reported pain severity post treatment.
● COST ANALYSIS: If implemented, decrease total overall spending towards opioids.
Future profit towards hospitals by removing the need for outpatient referral.
● RISK VS. BENEFITS: Infection and injury risk requiring increased funding vs.
reduction in medication errors, faster pain relief, and improved well-being.
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