Complementary and Alternative Therapies



Complementary and Alternative Therapies


Virginia (Jennie) Shaw




Learning Outcomes



1. Compare and contrast the conventional model and the integrative model for health care.


2. Describe four categories of complementary and alternative therapies.


3. Choose the key concepts to include when teaching patients about herbal supplements.


4. Name three commonly used herbal products and their indications for use.


5. Describe the nurse’s role related to complementary and alternative therapies.


6. Explain how the nurse can assess a patient’s use of complementary and alternative therapies.


7. Describe ways that the nurse can use complementary and alternative therapies to provide self-care.



Key Terms







Reviewed by Jane A. Madden, RN, MSN, Professor of Nursing, Pikes Peak Community College, Colorado Springs, Colorado.


Historically wellness has been viewed as incorporating the physical, emotional, mental, and spiritual realms. Hippocrates, the father of medicine, advised a daily aromatic bath and fragrant massage for the maintenance of health. Florence Nightingale believed that nursing puts patients in the best condition for nature to act on them. The concepts of holism and balance guided the belief that the body heals itself and works to maintain homeostasis. The concepts of spirituality and harmony with nature were inseparable from the concepts of health and wellness.


This view of “wholeness” began to change with the works of René Descartes (1596–1650) and Sir Isaac Newton (1642–1727). They postulated that the body is a series of parts that can be broken down and studied. This mechanistic approach views the body as a machine; whatever part is broken is analyzed and then repaired, without regard for other aspects of the person involved. The conventional model of health care is based on this approach. Health care focuses on the physical body, often to the exclusion of the mind and the spirit. Emphasis is placed on what can be seen, measured, and quantified.


This conventional model has guided American health care for more than 100 years. About 40 years ago Americans began to explore health care therapies that were outside this model. This consumer-led movement fostered development of a new model of health care, a more “integrative” model. In this model, consumers combine the use of complementary and alternative therapies with conventional therapies. The conventional and integrative health care models are compared in Table 6-1.



The integrative model focuses on (1) personal responsibility for health; (2) joining of mind-body-spirit; and (3) use of natural, less invasive modalities. This model promotes health and wellness, not just treatment of diseases. Consumers desire more involvement in their health care decisions. They desire modalities that are more natural, less costly, and safer. The rise of chronic diseases and stress-related disorders has also led to consumers’ interest in complementary and alternative therapies.



Complementary and Alternative Therapies


Complementary and alternative therapies (CAT) are a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.1 This definition highlights what might be considered “complementary and alternative” in one country or at one period of history might be considered “conventional” in another place or time. What is classified as complementary and alternative therapies is constantly changing. When these therapies are proven safe and effective, they are often adopted into conventional medicine.


Terms frequently used to describe health-related approaches that are outside the dominant system of health care include alternative, complementary, and integrative. Alternative therapies are therapies used in place of conventional medicine, whereas complementary therapies are used in conjunction with conventional medicine. Integrative therapies combine treatments from conventional medicine with complementary and alternative therapies that have evidence of safety and effectiveness.


Many complementary and alternative therapies are harmonious with the values of nursing. Nurses emphasize healing, recognize the provider-patient relationship as a partnership, and focus on health promotion and illness prevention. The American Holistic Nurses Association (AHNA) was established to focus nursing care on the whole person—recognizing the interconnectedness of body, mind, spirit, and environment. The AHNA highlights the practice of holistic nursing.


Holistic nursing is based on a body of knowledge; evidence-based research; sophisticated skill sets; defined standards of practice; and a philosophy of living and being that is grounded in caring, relationship, and interconnectedness.2 AHNA (www.ahna.org) advances the profession of holistic nursing by providing continuing education in holistic nursing, helping to improve the health care workplace through the incorporation of the concepts of holistic nursing, educating professionals and the public about holistic nursing and integrative health care, and promoting research and scholarship in the field of holistic nursing.3


Health care professionals have raised important questions about the effectiveness and safety of complementary and alternative approaches in the face of their increased use. In response to this need, the National Center for Complementary and Alternative Medicine (NCCAM) was established (http://nccam.nih.gov). A branch of the National Institutes of Health (NIH), NCCAM serves as the federal government’s lead agency for scientific research on complementary and alternative therapies. The mission of NCCAM is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care.4


NCCAM has four areas of focus: (1) advancing scientific research, (2) training CAM researchers, (3) sharing news and information, and (4) supporting integration of proven CAM therapies. The website provides a wealth of information for consumers and professionals, including clinical practice guidelines and literature reviews for the health care professional.


A large study conducted by NCCAM and the National Center for Health Statistics (as a part of the National Health Interview Survey [NHIS]) showed that approximately 38% of adults used CAT within the past 12 months.5 In another survey Americans were asked why they use CAT, and 55% responded they believed their health would be improved if conventional medical treatments were combined with CAT.6 Because of this growing use of CAT, you need to have a basic understanding of this topic and know where to find reliable in-depth information. A list of helpful websites is provided at the end of the chapter.



NCCAM Categories


Because the field of CAT is broad and ever changing, it is helpful to place therapies into broad categories. NCCAM groups these therapies into four broad categories, recognizing that one therapy may fit into more than one category (Table 6-2).





Natural Products


The category of natural products includes herbal therapy, dietary supplements, vitamins, minerals, and other “natural products.” The NHIS found that 17.7% of American adults had used a natural product in the previous year. These products were the most commonly used CAT.5


Herbal therapy is the use of individual herbs or combinations of herbs for therapeutic benefit. An herb is a plant or plant part (bark, roots, leaves, seeds, flowers, or fruit) that produces and contains chemical substances that act on the body. It is estimated that approximately 25,000 plant species are used medicinally throughout the world, and approximately 30% of modern prescription drugs are derived from plants. Botanical medicine is the oldest form of medicine; archaeologic evidence suggests that Neanderthals used plant-based remedies 60,000 years ago. Today about 80% of the world’s population relies extensively on plant-derived remedies.


Medicinal plants work in much the same way as drugs; both are absorbed and trigger biologic effects that can be therapeutic. Many have more than one physiologic effect and thus have more than one condition for which they can be used. The range of action of herbs is extensive.


Overall the use of herbal therapy continues to increase. Although most herbal products can safely be used without professional assistance, side effects and interactions with prescription drugs have been described. There is concern that side effects from the use of herbal products are underreported, thus promoting the impression that herbal products are completely safe to use.


Because consumers tend not to share their use of herbal products with their primary health care provider, herb-drug interactions may also be underreported. Patients who are scheduled for surgery should be advised to stop taking herbal products 2 to 3 weeks before surgery. Patients who are being treated with conventional drug therapy should be advised to discontinue herbal products with similar pharmacologic effects because the combination may lead to an excessive reaction or to unknown interaction effects. Patient teaching guidelines related to herbal therapy are presented in Table 6-4.




image Complementary & Alternative Therapies


Complementary & Alternative Therapies Boxes Throughout Book


Information related to various complementary and alternative therapies can be found in the following boxes throughout the book.


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Nov 17, 2016 | Posted by in NURSING | Comments Off on Complementary and Alternative Therapies

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