Complementary and Alternative Therapies

Complementary and
Alternative Therapy
C. Matthews MSN, RN
Marilee Elias, MSN, RN
Spring 2012
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Reading
Required:
Wilkinson-Ch. 40
Ignatavicius Ch. 2
Suggested Additional reading:
Lilley Ch. 8 Over the counter drugs
and Herbal products
Some references in this presentation will
be from pages in your textbooks other
than required chapters highly
recommended reading.
C. Matthews RN, MSN
03/09/17 M. Elias RN, MSN 2
Course Outcomes
1. Identify the roles of the nurse in a variety
of community settings to maintain optimal
level of wellness.
2. Client - centered teaching.
3. Apply the nursing process to meet the
physiological and psychosocial needs of
clients and their families at the end of life.
4. Standards of safe medication
administration.
C. Matthews RN, MSN

03/09/17 M.Elias RN, MSN SP10 3
UNIT OUTCOMES
1. Integrate complementary therapies into health
promotion activities for the well client.
2. Assess client need for Complementary or Alternative
therapy.
3. Identify use of Complementary or Alternative therapy.
4. Evaluate outcomes of Complementary or Alternative
therapy practices.
5. Provide non-pharmacological measures for pain relief.
6. Identify quackery or unscrupulous practitioners.
C. Matthews RN, MSN

CONTENT FOR ALTERNATIVE
THERAPIES
I. Systems of Health Care
Traditional Chinese Medicine
Native American medicine
Homeopathy
II. Mind-Body Therapies
A. Journaling
B. Imagery
C. Meditation
III. Manipulative Therapies
D. Massage
E. Tai Chi
C. Matthews RN, MSN

CONTENT FOR ALTERNATIVE THERAPIES
IV. Biologic Based Therapies

A. Aromatherapy
B. Herbal preparations
V. Energy Therapies
Healing touch
Therapeutic touch
Reiki
C. Matthews RN, MSN

History of Western Medicine
C. Matthews RN, MSN

Ancients -- Myths & Religion
Basis For Medical Practice
C. Matthews RN, MSN

History of Western
Medicine:
Ancient Greece & Rome
Hippocrates
Galen
C. Matthews RN, MSN

Early Christian
era ushers in
hospitals and
health care
similar to
established Arab
Medicine
C. Matthews RN, MSN

Middle Ages
Midwives
Witches
Physicians
C. Matthews RN, MSN

Renaissance
C. Matthews RN, MSN

Lister
Nightingale
C. Matthews RN, MSN

03/09/17 M. Elias RN, MSN SP11 13
20th and 21st

Centuries
C. Matthews RN, MSN

03/09/17 M. Elias RN, MSN SP11 14
Integrative Health Care is
A Concept of Coordinated Health Care
that Includes ALL the Treatments
(Conventional and CAMs) and Health
Practices that Your Patient uses in
their Life.
How do We get our Patients to Tell us

about the CAMs they use?
Course outcome #1 C. Matthews RN, MSN
Unit outcome #1 M. Elias RN, MSN SP11 15
What is Holism?
Concept focused on Relationships
among all living things.
Therapeutic Encounters include:
Enhancing Resistance to Illness
Reducing aggravating behaviors
Stress Management
Goal is Optimal state of Wellness for
each unique person

RNs must be familiar with C. A.
M.
The 2007 National Health Interview
Survey (NHIS), which included a
comprehensive survey of CAM use by
Americans, showed that
approximately 38percent of adults
use CAM. NCCAM
retrieved 3/16/11 from http://nccam.nih.gov/health/whatiscam/

What is CAM?
Complementary modalities
(therapies): used in conjunction
with conventional medical
practice. (Wilkinson, p. 1019)
Alternative Modalities(therapies):
used instead of traditional care.
(Wilkinson, p.1019)
C. Matthews RN, MSN

RN must:
1.Be non-judgmental despite personal
opinions
2. Build rapport by showing client respect if
not, he may be afraid to tell about CAM use
3. Understand that C.A.M. can be beneficial,
when used correctly
4. Be aware that C.A.M. can be dangerous if
it interacts or interferes with conventional
treatment
RN must:
5. Be willing to teach the public about
the positive and negative information
regarding C.A.M.
6. Be aware that use of C.A.M. is
popular and increasing and must be
included in the history & physical
7. Know that Herbals, in particular,
can have significant effect on
prescription drugs and body function
Course outcome #1,2 C. Matthews RN, MSN

National Center for
Complementary and
Alternative
Medicine
National Institutes of Health
established NCCAM.
Purposes:
Fund studies evaluating effectiveness of
C.A.M.
Advance health professional knowledge
re: C.A.M.
Serve as a clearinghouse for information
about these therapies
C. Matthews RN, MSN
03/09/17 M. Elias RN, MSN SP11 21
NCCAM Domains of C.A.M.
Ignatavicius pg 8; Wilkinson p. 1020
National Center for Complementary

and Alternative Medicine 5
categories
Systems of Health Care
Mind-body therapies
Manipulative and body-based therapies
Biologically based therapies
Energy therapies
C. Matthews RN, MSN

Mind-Body
Meditation
Stress relief/ reduce anxiety
Relaxation
Reduced levels of lactic acid
Decreased oxygen consumption
Slowed heart rate
Decreased blood pressure
Improved function of immune system
Reduce pain
Relieve symptoms of psoriasis
Improve health
(References: Ignativicius; Wilkinson)
C. Matthews RN, MSN

Unit outcomes #1-5 M. Elias RN, MSN SP11 23
Relaxation
Used post-operatively (Ignatavicius, p. 299)
Relaxation techniques (Ignatavicius, p. 56-
57)
To reduce anxiety, tension & emotional
tension which can exacerbate pain
Relaxation (Wilkinson Vol 2, p. 967; Vol 1, pg 806-807)
Progressive muscle relaxation
(PMR) (Wilkinson p. 807)
Promoting sleep
Can be taught in home setting
Nurses can use for reduction of pain & stress.
C. Matthews RN, MSN

Guided Imagery
Distraction when confronting pain,
discomfort or fear
Making decisions and altering behavior
Caution: not recommended for emotionally
unstable or cognitively impaired client
Helps reduce pain.
Reduction of nausea & vomiting.
Decreasing anxiety
Promoting comfort during cancer treatment
Ignatavicius, 6th ed. p. 9
C. Matthews RN, MSN

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

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

03/09/17 M. Elias RN, MSN SP11 27
Spiritual
spiritual beliefs how they affect
health
Longer life span

Predictors of health outcomes
Effects on specific diseases
Page 249 Wilkinson
C. Matthews RN, MSN

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

Spiritual
Intercessory prayer
An organized and regular form of prayer
in which someone communicates with
his or her higher power on behalf of
another who is in need.
Healing prayer
Studies showing evidence of
improvement
Wilkinson, p 259-260
C. Matthews RN, MSN

Spiritual
Nurses should expect to work in
collaboration with others, particularly
ministers, pastors and chaplains, to meet
the complex spiritual needs of all
patients.
Potential problem: the nurse and patient
have different views of spirituality
Respect patients wishes
If patient asks for spiritual intervention that
is inconsistent with the nurses beliefs, seek
assistance from another nurse or chaplain.
C. Matthews RN, MSN
Manipulative and body-based
methods
Movement & exercise
Strengthens circulatory & respiratory
function
Endorphins
Helps regulate metabolism
Enhances Immune system
C. Matthews RN, MSN

Manipulative and Body-based
Therapies
Yoga
life forces in correct balance and flow
Concentration, strength, flexibility,
symbolic movements
Breathing, movement & posture
Tai Chi
Promotes the flow of qi or energy
throughout the body
Ignatavicius, p. 11
Reduces sx. of fibromyalgia
Used in cardiac rehab programs, can lower
BP
C. Matthews RN, MSN
Other Movement Therapies
Dance Therapy
C. Matthews RN, MSN

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

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

Unit outcomes #1-5 M.Elias RN, MSN SP10 36
Energy Based Therapies
A group of
techniques that work
with the bodys
energy field by the
use of the hands to
direct or redirect the
energy to enhance
balance within the
field. (see Wilkinson page alternativecancer.us/aura.jpg
1033-34)
C. Matthews RN, MSN

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

Therapeutic massage
Precaution Wilkinson p. 1033
Therapeutic touch
Caution for touch Ignatavicius 6th ed., page 13
Healing touch
Reiki
Acupressure
Reflexology
C. Matthews RN, MSN

TT (Therapeutic Touch)
Integral to assessment
Bonding
Communication
Soothing, calming, comfort
orientation
Contraindications
When NOT to touch Ignatavicius pg. 13
C. Matthews RN, MSN

Reiki
Create Energy Balance
Patient draws Energy
Reiki Masters & Training
Reiki is a Japanese technique for

stress reduction and relaxation that
also promotes healing. It is
administered by "laying on hands"
and is based on the idea that an
unseen "life force energy" flows
through us and is what causes us to
be alive.
http://www.centurylink.net/search/index.php?
q=google&context=www.centurylink.net
C. Matthews RN, MSN

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

Acupuncture
Derived from traditional Chinese
medicine and other countries and
alternative systems
Qi (chi) Energy travels through 72
Meridians in the body
Needles are applied to Acupoints on
the Meridians to restore the flow of
qi
C. Matthews RN, MSN
Acupuncture uses for
Migraine headache Ignatavicius, p.
953
Pain and Anesthesia Ignatavicius p.

57
C. Matthews RN, MSN

The dreaded nausea and vomiting which commonly
occurs in some patients undergoing chemotherapy
and inevitably, with the use of certain classes of
agents, can often be worse than the disease itself.
Most oncologists have experienced the patients
who start vomiting at the thought of their next clinic
visit. At the University of Los Angeles (UCLA)
School of Medicine, a well-controlled study
completed over two Years ago, the authors of the
published paper reported significant reduction of
nausea and vomiting when pre-treated with. It is
now routinely administered before, after and in
between chemotherapy treatment sessions for
control or nausea and emesis. Such treatments are
relatively simple and easily executed in an
outpatient setting. Its effectiveness helps in
minimizing the use of standard, expensive multi-
drug anti-nausea regimens with their attendant side
effects, given along with the chemotherapeutic
agents.
Acupuncture in Cancer Treatment by Eugene Mak, MD@
C. Matthews RN, MSN
http://www.medicalacupuncture.org/acu_info/articles/cancertreatment.html
Biologically Based Therapies
Dietary Therapies
Herbs
Vitamins
Aromatherapy
Course outcome #2, 3 & C. Matthews RN, MSN

4 M. Elias RN, MSN SP11 46
Unit outcomes #1-5
Dietary Therapies
Nutraceuticals and phytonutrients
Protective or healing agents found in
plant and animal foods.
Free radicals: unstable molecules that
alter genetic codes and trigger the
development of cancer growth in cells.
Antioxidants: react with free radicals,
preventing their damaging effects
Sources of antioxidants: vitamin C, beta-
carotene, vitamin E

Unit outcomes #1-5
Dietary Therapies
Macrobiotic Diets
Yin/ yang of foods
Balanced foods
Foods to avoid: processed and treated
foods, red meat, sugar, dairy products,
eggs, caffeine
Caution: children and pregnant women
may have deficiency in Vitamins D and
B12
Unit outcomes #1-5
Aromatherapy
Wilkinson page 1030
Essences from oils extracted from

plants & flowers.
Conditions responsive to
aromatherapy:
Stress and anxiety
Muscular and rheumatic pains
Digestive disorders
Skin conditions

Unit outcomes #1-5
Aromatherapy
Can be used for sense of smell, but
also as compresses, baths or topical
C. Matthews RN, MSN

03/09/17 M. Elias RN, MSN SP11 50
Aromatherapy
(Ignativicius, p.12)
Lavender promotes relaxation & sleep
Peppermint stimulation, concentration
Sandalwood ease depression
Tea tree treating MRSA?
Chamomile relaxation
Lemon promotes sleep/ tx for
insomnia and/or digestive disorders

Unit outcomes #1-5
Herbals
Cherokee story
humans were without diseases until
the animals created them in retribution
for the lack of respect humans had
shown them. The plants, however, felt
that the animals were much too harsh
and volunteered themselves to provide
a cure for every disease the animals
had created.
Cavendar, p. 55
Course outcome # 3 & 4 C. Matthews RN, MSN

HERBALS what RN needs to
know
Major drawback: May delay important
diagnosis and treatment.
Nursing Intervention: Make certain MD or
ARNP is aware of clients use of herbals.
Nursing action: What to assess & instruct
pre-op client regarding herbal therapy.

Unit outcomes #1-5
HERBALS what RN needs to
know
FDA categorized herbals as food and
nutritional supplements not as drugs
The Dietary Supplement Health & Education

Act (DSHEA) of 1994 allowed herbs to be
sold as dietary supplements as long as
there are no health claims written on labels
DSHEA requires no proof of safety or

efficacy and sets no standards for products
labeled as supplements, i.e. no guarantee
the herb is properly prepared
Unit outcomes #1-5
Commonly used Herbals
Ignatavicius page 12 table 2-3
Know intended uses for each

Know Caution & adverse effects of
each
Gingko bilboa
Garlic
Echinacea
Ginseng
St. Johns Wort

Unit outcomes #1-5
Ginko Biloba
Reduce Memory Problems, Dementia,
Peripheral Vascular Disease
Antioxidant & Vasodilatory Properties
BUT can cause BLEEDING when
used with Anticoagulants
Avoid before surgery
Also cause Headache, GI Upset

Unit outcomes #1-5
Garlic
Lowers Cholesterol, Lowers BP,
Natural Antibiotic,
Natural Anti-platelet Agent
BUT Causes BLEEDING with other
Anti-platelet Drugs
Potentiates Anti-diabetic Drugs
Avoid before Surgery

Unit outcomes #1-5
Echinacea
BuildsImmunity, Helps Wound
Healing
Use > 8 Weeks & Possible Immune
Function Suppression
NOT Recommended for People with
Immune Diseases

Unit outcomes #1-5
Ginseng
Asian Ginseng- Diabetes, Erectile
Dysfunction, Unclear Thinking
American Ginseng- Diabetes,
Prevention of Colds & Flu
Siberian Ginseng- Prevent Colds &
Flu, reduce Severity of Herpes
Simplex type 2 Infections
BUT, BUT, BUT, BUT

Unit outcomes #1-5
Ginseng and the Big Buts
C. Matthews RN, MSN

03/09/17 M. Elias RN, MSN SP11 60
Ginseng & The BIG BUTS
Insomnia, Headache, Agitation, GI
Upset, Unusual Menstrual Bleeding,
Breast Pain, Dizziness, Increase or
Decrease BP, Hypoglycemia,
Fast/Pounding/Irregular
Heartbeat;
Severe Allergic Reaction
Not with Immune System Disorders,
Schizophrenia, Endometriosis, Fibroids
NOT FOR Long-term Use
Course outcome # 2, 3 & C. Matthews RN, MSN
Unit outcomes #1-5
St. Johns Wort
Ease Mild to Moderate Depression
BUT causes Photosensitivity
DO NOT use in Major Depression
DO NOT use with Other
Antidepressants

Unit outcomes #1-5
Herbals
Alert: Natural does not always mean
harmless.
Plants used improperly can be poisonous.
Chemicals within herbs can strengthen
the immune system, alter blood
chemistry, or protect specific organs
against disease
Caution: some individuals may have
allergies

Unit outcomes #1-5
Herbals
Special precaution with pregnant or
lactating women and children
should not use without physicians
Rationale:
knowledge
Unpredictable biologic effects
Possible allergies
Side effects
Herbs have chemical composition
Little or no regulation of production/ quality
Possible herb/drug or herb/herb interaction
Possible delay of treatment is dangerous
Unit outcomes #1-5
Herbals & the RN
Teach about signs of allergic
reactions
Teach that herbs can be

dangerous even if they are not
Rx and are natural

Unit outcomes #1-5
Herbals & the RN
Always ask about use of herbals when
getting medication history
What is the story of why the patient is

using the plant medicine or therapy?
Libster, p. 809
Teach clients to look for products

labeled standardized these more
likely to have accurate amounts of herb
and less likely to have contamination
Course outcome #2, 3 & 4 C. Matthews RN, MSN

Frankincense and Myrrh* medicinal
use
Havehad spiritual significance since
ancient times and they also were adopted
as medicines for physical ailments.
Inmodern Chinese Materia Medica, these

two resins are classified as herbs for
vitalizing circulation of blood and are
utilized for treating traumatic injury,
painful swellings, masses, and other
disorders related to stasis syndromes.
MYRRH AND FRANKINCENSE by Subhuti Dharmananda, Ph.D., May 2003 @
http://www.itmonline.org/arts/myrrh.htm

4 M. Elias RN, MSN SP11 *Will not be on the test!
67
Unit outcomes #1-5
Pain in the epigastrum, abdomen, hypochondria, and/or
heart due to qi and blood stasis, and stagnation in the
viscera and bowels or the channels ( jing) and network
vessels (luo).
Amenorrhea, dysmenorrhea, or postpartum abdominal

pain due to blood stasis.
Rheumatic complaints due to wind damp causing qi
and blood stagnation and stasis in the network vessels.
Wounds, scars, and skin inflammation with blood stasis
and necrotic tissue.
Traumatic injuries with pain, swelling, and redness due

to qi stagnation and blood stasis.
MYRRH AND FRANKINCENSE by Subhuti Dharmananda, Ph.D., May 2003 @
http://www.itmonline.org/arts/myrrh.htm
C. Matthews RN, MSN

03/09/17 M. Elias RN, MSN SP11 68
Folk Medicine
(Ignatavicius, 6th ed., page 32-33)
Learned from experience

Passed from generation to generation
Preservation of heritage/ culture
Some have been scientifically proven
(ex. Garlic)
Plants/herbs
Hot/cold
Evil Eye (Mal de Ojo)

Unit outcomes #1-5
C. Matthews RN, MSN
03/09/17 M. Elias RN, MSN SP11 70
Folk Medicine
Own terminology: (Feel free to ask the
meaning)
high blood low blood thin blood
Thick blood conjure water
fall out gimpy dropsy
risin sugar cut pain
Weeded breasts
snuffing the mother
the itch
Cavendar, 2003

Unit outcomes #1-5
What is Quackery?
A pretender
Questionable products & services
Overpromotion vs fraud
Misinformation
Useful for some purposes, not others

How to spot Quackery
Tell only part of the story
Overpromotes nutritional insurance
Play on fears about chemicals
Everyone needs supplements
Promise quick, dramatic, miraculous results
Anecdotes & testimonials
Questionable credentials
Claim persecution
Promote distrust
Take claims directly to the media, not peers
Resist peer review

Nurses Educate the Public
Teach signals of fraudulent practice
Avoid healers who:
Promise immediate relief or success
State that their way is the only sure therapy
Refuse to work with other health care
providers
Claim to have all the answers
Use testimonials that claim amazing results

One Minute Paper
Now is the time to write short
answers to:
1. What is something you heard today
that is new to you?
2. How do you plan to approach your
clients about CAM?
3. List one thing that surprised you.
4. List one thing that reinforced
something you already believed.
C. Matthews RN, MSN

03/09/17 M. Elias RN, MSN SP11 76
References
Cavender, A.(2003) Folk Medicine in Southern
Appalachia. The University of North Carolina Press,
Chapel Hill, N.C.
Ignatavicius, D.D. & Workman, M.L. (2010) Medical-
Surgical Nursing. 6th ed. Elsevier Saunders, St.
Louis, Missouri.
Libster, M.L. (2002) Delmars Integrative Herb
Guide for Nurses. Delmar Thomson Learning. United
States.
Wilkinson, J.M. & Treas, L.S. (2011) Fundamentals of
nursing, 2nd ed. FA Davis Company, Philadelphia, PA.
C. Matthews RN, MSN

03/09/17 M. Elias RN, MSN SP11 77

Complementary and Alternative Therapies

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Complementary and

Please make phones silent & visible

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

IV. Biologic Based Therapies

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

20th and 21st

C. Matthews RN, MSN

How do We get our Patients to Tell us

Course outcome #1 C. Matthews RN, MSN

retrieved 3/16/11 from http://nccam.nih.gov/health/whatiscam/

Course outcome #1 C. Matthews RN, MSN

C. Matthews RN, MSN

Course outcome #1,2 C. Matthews RN, MSN

National Center for Complementary

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

Longer life span

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

C. Matthews RN, MSN

CC. Matthews RN, MSN

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Reiki is a Japanese technique for

C. Matthews RN, MSN

C. Matthews RN, MSN

Pain and Anesthesia Ignatavicius p.

C. Matthews RN, MSN

Course outcome #2, 3 & C. Matthews RN, MSN

Course outcome #2, 3 & C. Matthews RN, MSN

Essences from oils extracted from

Course outcome #2, 3 & C. Matthews RN, MSN

C. Matthews RN, MSN

Course outcome #2, 3 & C. Matthews RN, MSN

Course outcome # 3 & 4 C. Matthews RN, MSN

Course outcome #2, 3 & C. Matthews RN, MSN

The Dietary Supplement Health & Education

DSHEA requires no proof of safety or

Know intended uses for each

Course outcome #2, 3 & C. Matthews RN, MSN

Course outcome #2, 3 & C. Matthews RN, MSN

Course outcome #2, 3 & C. Matthews RN, MSN

Course outcome #2, 3 & C. Matthews RN, MSN

Course outcome #2, 3 & C. Matthews RN, MSN

C. Matthews RN, MSN