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Traditional Western health care, also known as allopathic care, follows a disease-oriented model that uses technology and bioscience, such as drugs, to treat illness and achieve wellness. The focus is on treatment and cure that are based on evidence provided by research.

Complementary therapy refers to therapy that is used along with conventional treatments. For example, in treatment of hypertension with medication plus relaxation or biofeedback measures, biofeedback assists or complements the medication so that it minimizes the drug’s side effects while maximizing treatment effects. Alternative therapy is an unorthodox or unconventional form of therapy. It includes therapies that generally replace or substitute for a traditional or orthodox treatment. Many of the therapies considered complementary and alternative medicine (CAM) in the United States may be traditional therapies in other cultures and have been practiced in other countries for years.

Integrative health care is a blend of the best of both allopathic and CAM therapies. It combines allopathic or traditional Western medical practice with complementary and alternative therapies. Integrative health care focuses on the least invasive, least toxic, least costly methods of patient care, based on an understanding of the individual’s physical, emotional, psychological, and spiritual aspects (Rakel, 2007). Integrative health care uses scientific research findings as a basis for care but requires the patient’s active participation in designing a comprehensive care plan.

Holistic health care implies a wholeness, or comprehensive care involving physical, mental, and spiritual aspects of care in a healthy environment. Through the years, as technology, managed care systems, and health insurance organizations tended to depersonalize health care, consumers have turned toward self-care and have assumed responsibility for their own health. Health promotion and disease prevention, rather than treatment and cure of disease, became the focus of health care. Changes in lifestyle behaviors, nutrition habits, and the use of mental and spiritual healing powers of the body are important aspects of holistic health care.

Natural alternative care (NAC) refers to practices, including self-care, that may be helpful in providing comfort and healing but are not rooted in evidence-based research. Some NAC practices have not been previously considered as health care practices. NAC care may include bibliotherapy (reading self-help books), journaling (writing private thoughts and reactions), expressions in art, prayer, or affirmations of positive thought. NAC practices are often combined with other CAM therapies and referred to as NACAM.

Stress management is an important aspect of wellness, and assisting a patient in coping with or managing stress requires cultural competence, an understanding of and respect for the cultural practices and traditions that influence the patient’s responses.

Mainstream (traditional) medicine follows a disease-oriented model with technology playing an important role in the care, whereas CAM emphasizes prevention, principles of healthy lifestyles, and mental and spiritual healing powers in the body’s system. Consumers are becoming increasingly educated and are actively moving toward a holistic or integrative approach to health care. The roles of the physician and hospital are shifting from treating people to helping people treat themselves. The result is a rise in consumer-driven, patient-focused care. The growth of the wellness movement indicates the beginning of a change in health care in the Western model of medicine. Many of the CAM therapies are based on the accepted theories of (1) gate control theory of reduced pain and (2) that natural endorphins control pain and can be stimulated by drugs or alternative means (Box 21-1; see also Chapter 8).

Traditional Chinese medicine is the basis for many alternative therapies. Popular traditional Chinese medicine practices include:

In the United States, nursing has been promoting self-care for many years through Orem’s self-care framework (Orem, 2001) and through Watson’s theory of human caring, assessing, and intervening on behalf of the whole person (Watson, 1996). The holistic approach has been a basic part of nursing since the work of Florence Nightingale. Modalities for self-care, such as the use of relaxation and imagery, have increasingly been brought into nursing settings. Touch and massage have been therapeutic modalities of nursing care since the inception of modern nursing. Professional nursing associations, such as the American Holistic Nurses Association, have formed to educate nurses concerning self-care activities and treatment of the whole person.

Many CAM therapies are based upon accepted theories such as the gate control theory of pain relief (see Chapter 8). Nurses use complementary therapies such as imagery, journaling, therapeutic touch, humor, and support groups. In the obstetric unit, guided imagery, prayer, music, massage, storytelling, and aromatherapy are often used by nurses to help women cope with their labor experience. Health consumers expect to be active participants in their own health care, and many use some sort of CAM therapy. Some foods, vitamin and mineral supplements, and herbal therapy are all common forms of CAM therapy practiced in many homes.

The increasing demand by the consumer for CAM therapies makes it imperative that nurses acquaint themselves with types of therapies used by patients at home. In doing so, the nurse can collaborate with the patient, family, community, and multidisciplinary health care team to provide holistic care. These practices enhance rather than inhibit or conflict with nursing care. Many patients from different cultures who have been using home remedies or folk medicine, conventional medicine, or traditional medicine are involved in alternative care. The 2003 social policy statement of the American Nurses Association states, “Nursing helps to serve society’s interests in the area of health. The nursing profession has made and continues to make a substantial contribution toward evolution of a health-oriented system of care.”

The nurse’s role is not to advocate or discourage the use of any CAM therapy but to recognize and respect its use in patients and to use critical thinking skills to determine interactions with traditional therapy, with the patient as a partner.