Complementary and Alternative Therapies
acupressure (Ă K-ū-PRĔSH-ŭr, p. 409)
allopathic care (ăl-ō-PĂ TH-ĭk, p. 407)
alternative therapy (p. 407)
aromatherapy (p. 410)
biofeedback (p. 411)
complementary therapy (p. 407)
effleurage (ĕf-loo-RĂ HZH, p. 414)
holistic health care (hō-lĭs-tĭk, p. 407)
homeopathy (hō-mē- ŎP-ă-thē, p. 414)
hydrotherapy (hī-drō-THĔR-ă-pē, p. 413)
hypnosis (p. 411)
imagery (p. 413)
integrative health care (ĬN-tĕ-GRĀ-tĭv, p. 407)
natural alternative care (NAC) (p. 407)
reflexology (rē-flĕk-SŎL-ŏ-jē, p. 415)
transcutaneous electrical nerve stimulation (TENS) (tră ns-kū-TĀ-nē-ŭs, p. 412)
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.
The Changing Health Care Environment
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).
In ancient China, a system of medical care was developed as part of philosophic teaching. The normal activities of the human body affected the balance of yin and yang, two opposing but complementary principles. A similar but distinct system, Ayurveda, was developed in India centuries ago. Imbalance was the major explanation of disease. Changes to the lifestyle to restore balance included herbs, exercise, and yoga. The Greek physician Galen’s ideas influenced what would eventually become the beginning of modern medicine. During the Newtonian era of the eighteenth century, emphasis was placed on objective observations. By the mid-1800s, medicine in the United States was a mixture of many different contributions of philosophies from various countries. Then a great change occurred in medicine with the advent of vaccines and antibiotics.
As a result of the increased interest in CAM, the Office of Alternative Medicine of the National Institutes of Health (NIH) was created in 1992 to evaluate the modalities being used. Since 1998, this office has grown significantly. It was given increased status when it was renamed the National Center for Complementary and Alternative Medicine (NCCAM). The mandate of this federally funded agency is to investigate and evaluate alternative therapies and their effectiveness. NCCAM serves as a public clearinghouse and a research training program. There are 11 institution-affiliated centers of research on alternative medicine throughout the United States.
Botanical (made from living plants) medicines are regulated in the United States as dietary supplements. The Dietary Supplement Health and Education Act (DSHEA) of 1994 clarified marketing regulations for herbal medicines and reclassified them as dietary supplements, distinct from food or drugs. Under DSHEA, dietary supplements that include plant extracts, enzymes, vitamins, minerals, and hormonal products are available to consumers without prescription. The physiologic effects of the product can be noted, but no claims about prevention or cure of specific conditions can be made. Products must display the following disclaimer: “This product has not been evaluated by the Food and Drug Administration.” The Scientific Review of Alternative Medicine journal is an example of a publication dedicated to evaluating CAM therapy based on reviews of medical research studies.
Nursing Acceptance of Complementary and Alternative Therapy Modalities
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.
Selected Complementary and Alternative Therapies
Acupressure is a traditional Chinese therapy that has been used for centuries. It is administered by a variety of practitioners, some of whom combine acupressure with other forms of Asian medicine, such as herbology.
According to traditional Chinese medicine, the body’s healing energy flows along an invisible system of energy channels, called meridians. Twelve to 14 meridians connect vital organs throughout the body. Chinese practitioners have located hundreds of sensitive acupoints along these meridians. They believe that a blockage in the flow of one point on a meridian can cause disease and discomfort in the organ or tissue. Western medical science has since shown that nerve trigger points coincide with these same acupressure points.
How the Therapy Is Performed
Acupressure uses finger, palm, or knuckle pressure at points located along meridians. The Chinese variation involves a massage-like kneading motion. It may be performed on a floor mat or massage table, and the person receiving the treatment usually wears comfortable, loose clothing. Practitioners may administer pressure to various points. Wristbands that apply acupressure to decrease nausea and vomiting during travel and during pregnancy have had positive clinical trials and are widely advertised.
What the Therapy Hopes to Accomplish
Acupressure, as a massage, can be relaxing. It may work by triggering the body to release natural pain-killing compounds such as endorphins. It can be regarded as a way of toning the body and promoting general health and well-being. Some studies (Quinlan & Hill, 2003; Cunningham, Simpson, & Brown, 2006) showed a decrease in nausea and vomiting during pregnancy with acupressure.
The massage is administered in a slow and steady manner, although it can involve forceful pressure. Thus, it may not be a choice for a person with brittle bones (osteoporosis) or a history of spinal or other orthopedic injury or those who bruise easily. Acupressure is recommended to ease discomforts of pregnancy and childbirth. However, any pressure near or on the abdominal area should be avoided. Pressure should also be avoided on the legs and feet if the patient has circulation problems or varicose veins.
Possible Side Effects
After an acupressure treatment, some individuals report feeling lightheaded or slightly groggy for a short time. This feeling may be caused by a build-up of endorphins.
Acupuncture is the insertion of slender needles into specific points of the body. It is based on the principle that the body has complex meridians that are pathways to specific organs. Acupuncture points are the areas of the body in which these meridians surface. Stimulation of these points is thought to influence positive-negative energy (chi) that regulates body function. Acupuncture is a popular pain relief strategy practiced in the United States today.
How the Therapy Is Performed
The “puncture” refers to insertion of tiny needles at specific points on the surface of the body. The insertion of the disposable needles has been described as feeling like a mosquito bite. The needles may be stimulated by twirling them or connecting them to a mild electrical current, which can cause a mild tingling sensation. The needles are left in place up to 20 to 30 minutes.
What the Therapy Hopes to Accomplish
Both acupressure and acupuncture use meridians, and some acupoints have been shown to coincide with nerve trigger points (dermatomes). The basis for the effectiveness of acupressure is the gate control theory (see Chapter 8). Acupuncture 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 norepinephrine. According to the NCCAM (2006), well-performed scientific studies have provided evidence of acupuncture reducing nausea and vomiting associated with pregnancy. It is also useful for low back pain, menstrual cramps, and headaches.
People at risk of easy bruising or bleeding and those taking a blood-thinning medication should avoid acupuncture. Pregnant women should avoid needle insertion on or near the abdomen.
Possible Side Effects
Careless application or improperly sterilized needles can cause serious complications if a blood vessel is punctured or injury to organs or nerves occurs. Therefore, acupuncture should be performed by a skilled and reputable practitioner. As with acupressure, individuals may feel lightheaded for a short time after treatment. This is usually attributed to the release of endorphins.
Aromatherapy is the use of plant oils to promote wellness. It can improve one’s quality of life, whether or not it has other benefits. Improvement is derived from an emotional response to pleasing scents rather than any physiologic effects. It may enhance relaxation and reduce stress; for some people, it has helped lessen insomnia. Aromatherapy is recognized by the NIH as a complementary and alternative therapy (Krebs, 2006).
How the Therapy Is Performed
The therapy relies on the use of concentrated essential oils extracted from various trees and plants. Many oils are used as a form of home remedy. The use of herbal teas and vapors is reported to have good effects on labor and pregnancy for some women. A few drops of lavender oil (diluted in a bathtub of warm water) are sometimes used to promote relaxation (Lowdermilk & Perry, 2007). Inhalation may improve respiratory conditions. Massage and rubbing aromatic oil into the skin may be calming or stimulating and may relieve muscle soreness. Some people have been able to reduce their intake of antiinflammatory drugs with aromatherapy. Essential oils are mixed with a carrier oil, such as vegetable or safflower, to reduce skin irritation (Krebs, 2006).
What the Therapy Hopes to Accomplish
Fragrant oils have been used for thousands of years to lubricate the skin. For some women, scented candles and potpourri have a relaxing effect. Practitioners suggest that the inhaled vapors will have a medicinal and relaxing effect on the body.
Essential oils are very concentrated and extremely potent, and many can be toxic, so they should never be ingested. Some of the well-known oils are contraindicated, such as cedar wood and juniper, in pregnancy (Table 21-1). Also, pregnant women appear to have a particularly sensitive sense of smell; therefore, aromatherapy mixtures, if used, should be well diluted.
|Pennyroyal||Can cause abortion|
|Rosemary, sage, thyme, camphor||Hypertensives; can complicate gestational hypertension|
|Peppermint||Can cause adverse pregnancy outcome|
|Oils containing citral||Interact with melanocytic hormones; cause photosensitivity|
|Geranium||Has anticoagulant effect|
|Black pepper, caraway, cinnamon, hyssop, nutmeg, thyme||Cause cardiovascular adaptations contraindicated in pregnancy|
|Benzoin, cedarwood, garlic, chamomile, eucalyptus, fennel, lavender, rose, sandalwood||Increase diuresis; contraindicated in severe blood loss|