Download Chapter 23

Chapter 21
Complementary and Alternative
Therapies
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
1
History of CAM Therapy
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
2
Objectives




Define key terms listed.
Define both complementary and alternative
therapies.
Review the federal government’s involvement
in alternative therapies.
Discuss the history of complementary and
alternative therapies in nursing.
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
3
Terminology for Complementary
and Alternative Medicine (CAM)






Allopathic care
Complementary therapy
Integrative health care
Holistic health care
Natural alternative care
Stress management
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
4
Historic Context of CAM
Therapies





Ancient China—natural balance of yin and
yang
India—Ayurveda, where imbalance explained
disease; therefore restoration came from
herbs, exercise, and yoga
Greek physician, Galen, influenced beginning
of modern medicine
Newtonian era of 18th century—objective
observations
United States in mid-1800s—mix of many
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
5
Traditional Chinese Medicine




Basis for alternative therapies
Qigong: uses breathing, meditation, selfmassage
Tai chi: martial art based on physical fitness
Moxibustion: involves burning oil called moxa,
then applying it to an accupoint; heat
regulates flow of chi (energy)
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
6
Federal Regulations


Office of Alternative Medicine of the National
Institutes of Health was created in 1992
Dietary Supplement Health and Education Act
(DSHEA) 1994
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
7
Nursing Acceptance of CAM
Therapy Modalities




Nightingale’s holistic approach
Orem’s self-care framework
Watson’s theory of human caring
Nurses need to become aware of herbal
products and folk remedies to avoid
potentially dangerous interactions and side
effects

Can enhance care nurse provides and avoid
potential negative outcomes that could result if
nurse was not aware
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
8
Discussion Question 1

What are some of the different types of CAM
therapy and the nursing interventions that
may need to be modified to meet the needs
of the patient?
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
9
Selected CAM Therapies
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
10
Objectives



List and discuss four complementary and
alternative therapies used to relax women in
labor.
List and discuss three complementary and
alternative therapies used to lessen pain
during labor.
State three herbal products that should be
avoided during pregnancy.
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
11
Acupressure




Traditional Chinese therapy
Hundreds of sensitive acupoints along
meridians
Blockage of flow of one point can lead to
disease or discomfort
Nerve trigger points coincide with same
acupressure points
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
12
Acupressure (cont.)

How therapy is performed



Uses finger, palm, or knuckle at points along
meridians
Chinese version involves massage-like kneading
motion
What therapy hopes to accomplish



Triggers the body to release natural pain-killing
compounds
Tones the body
Promotes general health and well-being
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
13
Acupressure (cont.)

Contraindications




May not be good choice for person with brittle
bones, history of spinal or other orthopedic injury,
or for those who bruise easily
Pregnant women should avoid any pressure near
or on abdominal area
Avoid in legs and feet if circulatory problem or
varicose veins
Possible side effects


May feel lightheaded or groggy for short period
May be caused by a buildup of endorphins
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
14
Acupuncture



Insertion of slender needles into specific
points of body
Also based on meridians
Stimulation of these points thought to
influence positive-negative energy (chi)
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
15
Acupuncture (cont.)

How therapy is performed

Insertion of tiny needles at specific points along
the body
 Needles may be twirled or connected to mild
electric current
 Needles left in place for 20 to 30 minutes

What therapy hopes to accomplish


The release of natural pain-killing substances
called endorphins, which blunt the perception of
pain
Can reduce nausea and vomiting during
pregnancy
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
16
Acupuncture (cont.)

Contraindications




Easy bruising or bleeding
On blood thinners
Pregnant women should avoid needle insertion on
abdomen
Possible side effects


Infection if needles are not sterile before
application
If not performed by a skilled and reputable
practitioner, can cause nerve or organ injury
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
17
Aromatherapy


Use of plant oils to promote wellness
Improvement derived from emotional
response to pleasing scents rather than any
physiologic effects
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
18
Aromatherapy (cont.)

How therapy is performed



Relies on use of concentrated essential oils from
various trees and plants
Inhalation, massage
What therapy hopes to accomplish

To calm or stimulate
 Relieve muscle soreness
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
19
Aromatherapy (cont.)

Contraindications


Many essential oils should be avoided during
pregnancy because of toxic side effects on
developing fetus
Possible side effects

In pregnancy, can increase risk of abortion,
gestational hypertension, hemorrhage
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
20
Biofeedback



Allows individual to gain control over
physiologic reactions that are ordinarily
subconscious
Malfunctions in autonomic responses
contribute to medical problems
Requires intensive focused concentration as
one learns to control autonomic functions
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
21
Biofeedback (cont.)

How therapy is performed



Application of noninvasive sensors to various
points on body
Person taught mental and physical exercises that
can address the function causing the problem
What therapy hopes to accomplish


Once individual has learned pattern of actions,
can assert control without the aid of the feedback
device
Reduce tension, anxiety, combat insomnia, or
fatigue
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
22
Biofeedback (cont.)

Contraindications


If person has implanted medical device,
biofeedback techniques that require an electrical
device should not be used to gain control over
physiologic reactions
Possible side effects


Notably free of side effects
It should not be used as a substitute for medical
care
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
23
Hypnosis



Altered state of consciousness, like
daydreaming
Provides link to subconscious mind
Does not work on everyone
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
24
Hypnosis (cont.)

How therapy performed

Focus on a point; breathing becomes slow and
regular
• Person becomes deeply relaxed; conscious mind no
longer controls every thought or emotion


Facilitator makes suggestions (e.g., how to make
an unwanted symptom or habit disappear)
What therapy hopes to accomplish


Reduce stress by putting individuals into relaxed
state, offering positive suggestions, and
eliminating negative thoughts
Can improve circulation, shorten labor
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
25
Hypnosis (cont.)

Contraindications


Considered safe for everyone, although persons
with history of psychosis need careful evaluation
before hypnosis would be provided
Possible side effects

Safe in most situations
 Hypnotic suggestion works only if the recipient
accepts it
 Cannot make person do something that he or she
would not consciously do
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
26
Transcutaneous Electrical
Nerve Stimulation (TENS)



“Energy medicine”
Used for all types of localized pain
Advocated for condition such as labor
contractions, menstrual pain, jaw muscle
pain, cancer pain, and nerve damage
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
27
Transcutaneous Electrical
Nerve Stimulation (TENS) (cont.)

How therapy performed




Small electronic unit with electrodes applied to
skin
Sends pulsed currents
In labor, electrodes are placed on either side of
thoracic and sacral spine
What therapy hopes to accomplish



To drown out pain signals, preventing the signal
from reaching the brain
Reduce the sensation of pain
Reduce the need for analgesia
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
28
Transcutaneous Electrical
Nerve Stimulation (TENS) (cont.)

Contraindications




Only provide after full medical consultation
Do not use on persons with poorly controlled
seizures or implanted medical devices
Do not use before 37 weeks gestation
Possible side effects


No harmful side effects have been reported when
used in healthy pregnant women in labor
Effectiveness reduced if person is using
benzodiazepines or corticosteroids
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
29
Visualization and Guided
Imagery



Concentration on images held in the mind’s
eye
Form of mind-to-body technique
Works in connection between brain and
involuntary nervous system
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
30
Visualization and Guided
Imagery (cont.)

How therapy is performed



Begins with general relaxation exercises, then
moves to visualization
Builds up image to use all five senses
What therapy hopes to accomplish

Lower blood pressure, control heart rate
 Can have direct effect on the nervous and
endocrine systems
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
31
Visualization and Guided
Imagery (cont.)

Contraindications


Generally safe for all
Possible side effects

No known side effects, unless memory of
unpleasant event should occur
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
32
Expressive Therapy
and Sound Therapy

Expressive



Nonthreatening outlet to express feelings that are
difficult to put into words
Used as coping strategy
Sound

Music used to improve patients’ moods,
counteract depression, reduce tension, induce
sleep
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
33
Expressive Therapy
and Sound Therapy (cont.)

What therapy hopes to accomplish


Contraindications


Enhance relaxation, especially during labor
None known
Possible side effects


Volume should be kept low to prevent hearing loss
No other known side effects
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
34
Hydrotherapy



Use of water to promote comfort and
relaxation
Reduces anxiety, triggers release of
endorphins to lessen pain sensation during
labor
Warm water allows local vasodilation and
muscle relaxation
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
35
Hydrotherapy (cont.)

How therapy is performed


Water can stimulate nipples, triggering more
oxytocin production, which stimulates labor
What therapy hopes to accomplish


Due to oxytocin release, speeds up cervical
dilation and delivery
Relaxation, comfort, improved circulation that
detoxifies body
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
36
Homeopathy



Small amount of a substance that causes a
symptom can actually relieve the symptoms
Dilute solutions of herbs, animal products, or
chemical substances
Homeopathic products contain little of desired
herbs
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
37
Homeopathy (cont.)

What therapy hopes to accomplish



Possible side effects


Promote and improve health using smallest dose
possible to stimulate the desired reaction
Remedies based on individual symptoms rather
than disease entities
Sold OTC, with exemption from standard
regulatory procedures
Contraindications

Coffee, menthol, and strong flavors should be
avoided, since they may reduce effect of product
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
38
Massage and Touch Therapy



Can provide relief for tension, anxiety,
insomnia, muscle pain, headache, and back
pain
Not capable of curing any medical disorder
Effleurage is one method used during labor
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
39
Massage and Touch Therapy
(cont.)

How the therapy is performed


Type of massage determines amount of pressure;
method of strokes used; whether fingertips, hands,
or forearms are used
What the therapy hopes to accomplish


Healing by promoting flow of blood and lymph,
relieving tension, and loosening muscles and
connective tissue
Helps to reduce buildup of waste products;
therefore increased fluid intake after is
encouraged
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
40
Massage and Touch Therapy
(cont.)

Contraindications





Not advised if infectious skin disease, rash, or
unhealed wounds are present
Tendency to form to blood clots
Certain circulatory problems
Should not be done over a known tumor or bruises
Possible side effects



Can aggravate existing edema
Pressure on skin can be painful, especially if the
person has a nerve injury
Avoid immediately after surgery
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
41
Reflexology


Reflexes, zones, or pathways run along the
body and terminate in the palms, soles, ears,
tongue, and head
All systems and organs are reflected on skin,
but especially the hands and feet
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
42
Foot Reflexology
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
43
Foot Reflexology (cont.)

How the therapy is performed


What the therapy hopes to accomplish



Using their hands (or rubber ball), reflexologists
apply pressure to specific reflex points on the feet
and hands
Restore body’s natural equilibrium
Break up blockage of the “flow” further along
energy or reflex channels
Contraindications


Vascular or foot injuries
During pregnancy, reflex zone to uterus should not
have sustained pressure applied
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
44
Yoga





Set of exercises
Increases efficiency of heart
Slows respiratory rate
Lowers blood pressure
Improves fitness, promotes relaxation,
reduces stress and anxiety
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
45
Yoga (cont.)

How the therapy is performed



Usually given in group setting
Includes three disciplines
• Breathing exercises
• Body postures
• Meditation
What the therapy hopes to accomplish


Strengthening muscles, encouraging relaxation
Achieve a state of balance and harmony between
body and mind
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
46
Yoga (cont.)

Contraindications




Should not do if have back injury or recent surgery
Should receive clearance from health care
provider before undertaking classes
Not ideal time to begin classes if pregnant
because of some of the positions
Possible side effects

Stiffness at the beginning but will loosen as
continue to take classes
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
47
Herbal Medicine

Can be




Gentle and healthy
Irritating to the skin and GI tract
Toxic to mother and developing fetus
Some more potent than others (tinctures and
extracts)

Not all are mixed or manufactured the same way
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
48
Common Herbs Contraindicated
in Pregnancy and Lactation
Herb
Use
Contraindication
Aloe vera
Prevents constipation
Promotes wound healing
Causes engorgement of pelvic
vessels; can cause spontaneous
abortion
Garlic
Decreases cholesterol
Avoid excessive amounts during
pregnancy
Do not use with other antiplatelet
medications
Ginger
Lessens nausea
Increases bleeding times
Ginkgo
Lessens depression
Can cause hemorrhage
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
49
Herbs and Menopause

Natural management techniques include




Exercise
Relaxation
Diet
Herbs
• Black cohosh, sage, dong quai, chasteberry, motherwort
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
50
Nutrition



Soy: lipid-lowering properties; may help
prevent bone resorption that occurs in
estrogen deficiency
Fish oil: Omega-3 and N-3 polyunsaturated
fatty acids have decreased sudden cardiac
death in high-risk patients
Magnesium: in geriatric women, deficiency
may contribute to decreased bone density
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
51
Magnet Therapy


Also known as electromagnetic therapy
Thought to stimulate living cells and increase
blood flow
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
52
Discussion Question 2

What are the nursing responsibilities
regarding patients who state that they take
herbal supplements?
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
53
Review Key Points
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
54