Chapter 37 Integrative Care Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Integrative Care Blending of conventional or allopathic (mainstream) medical practices with those of complementary and alternative medicine Conventional medicine based primarily on scientific research and treatment of the disease Conventional medicine also called: Allopathic Mainstream Orthodox Regular medicine Biomedicine Western medicine Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Complementary and Alternative Medicine (CAM) Alternative therapies Used as a substitute for conventional therapies Complementary therapies In tandem with conventional treatments Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Complementary & Alternative Medicine CAM treatments Not widely taught in medical schools Not generally used in hospitals Not consistently reimbursed by insurance companies Not scientifically validated CAM treatments and holistic approach Incorporate the entire person Biological, psychological, social, and spiritual Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Assessment Traditional areas of inquiry Integrative areas of inquiry Quality of social relationships Meaning of work Impact and methods to cope with stress What client really loves The personal gifts he or she brings to the world Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Scientific Research on CAM Therapies National Institutes of Health (NIH) established the Office of Alternative Medicine (OAM) in 1992 OAM mandated to: Facilitate evaluation of alternative treatments Serve as an information clearinghouse Support research training in CAM Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

National Center for Complementary and Alternative Medicine In 1998 OAM was renamed the National Center for Complementary and Alternative Medicine (NCCAM) Supports fair and scientific evaluation of CAM therapies Provides information to health care providers so that they can make safe and appropriate decisions about the use of CAM Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Popularity of CAM Based on 2002 National Health Interview survey, when CAM includes prayer and megavitamins, 62% of American adults indicate they use some form of CAM. Without inclusion of prayer and megavitamins, 36% of American adults use CAM. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Concerns about CAM Therapies Most Americans who use CAM do not report this to their primary health care provider. United States has no standards or regulations that guarantee safety or efficacy of herbal products. "Natural" does not mean "harmless." Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Why Consumers are Attracted to CAM Want safer treatments than currently available medications Need less expensive alternatives to conventional care CAM practitioners spend more time with clients and learn about all facets of their life Dissatisfaction with practice style of conventional medicine (rushed office visits, short hospital stays) Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Role of the Nurse Stay knowledgeable about CAM treatments. Evaluate scientific research findings about the safety and efficacy of CAM. Be able to guide patients in the safe use of CAM treatments. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Ayurvedic Medicine Originated in India around 5000 BC Individual has responsibility for his or her own health Promotes prevention Natural methods of treatment Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Traditional Chinese Medicine Derived from Taoism Qi, or yin and yang = life force Health is the balance between yin and yang Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Traditional Chinese Medicine: Five-Element Theory Everything classified as one of the five primordial elements: wood, fire, earth, metal, and water. These elements act on one another as part of a dynamic system. The transition of the five elements reflects the human condition of transformation. Transformation is the essence of healing. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Traditional Chinese Medicine: Pulse Diagnosis Practitioner palpates six pulses in each wrist by using both a light and a firm touch. Qualities of the pulse are described as fast, slow, weak, slippery. Practitioner then able to characterize the client's current, past, and future health. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Eastern View of Mind-Body-Spirit Acupuncture Imagery Therapeutic touch Therapeutic massage Relaxation Bioenergetics Biofeedback Qi gong Yoga Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Homeopathy and Naturopathy Uses small doses of specially prepared plant extracts and minerals to stimulate the body's defense mechanisms and healing processes to treat illness Naturopathy Belief that the individual assumes responsibility for his or her own recovery Emphasizes health restoration Therapies used: nutrition, homeopathy, herbal medicine, hydrotherapy, light therapy, therapeutic counseling Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Mind-Body Interventions Interventions designed to facilitate the mind's capacity to affect bodily function and symptoms Interventions include: Cognitive-behavioral approaches Support groups Education Meditation Prayer Spiritual healing Therapies using dance, music, art therapy Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Biologically Based Theories Biologically based theories may overlap with conventional medicine's use of dietary supplements, such as: Botanicals Amino acids Enzymes Organ tissues Metabolites Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Manipulative and Body-Based Methods: Chiropractic Originated in late 1800s by Daniel David Palmer Focus on relationship between structure and function, i.e. , the way in which relationship affects the preservation and restoration of health by using manipulative therapy Refers to misalignments as subluxations Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Manipulative and Body-Based Methods: Massage Therapy Includes a broad group of medically valid therapies Involves rubbing or moving the skin Four basic techniques: Effleurage Pétrissage Vibration and percussion Friction Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Massage Techniques Swedish massage Shiatsu massage Provides soothing relaxation and increase in circulation Shiatsu massage Japanese origin Used to detect and treat problems in the flow of life energy (ki) Use of fingers, thumbs, elbows, knees, or feet to apply pressure by massaging parts of the body known as acupoints Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Massage Techniques Rolfing Reflexology Focus on treatment of connective tissue and fascia Thought to lose elasticity under stress Rolfing sessions reset body Reflexology Focus on feet Based on belief that zones and points on the feet correspond to other parts of the body Treatments are to open blocked nerve pathways and improve circulation in the feet to treat problems that may exist elsewhere Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Energy Therapies Belief that a nonphysical energy force pervades the universe Energy is referred to as: qi in traditional Chinese medicine prana in Indian ayurvedic medicine ki in Japanese medicine biofield by the NCCAM Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Energy Therapies Human energy field or aura This energy takes a particular form in each person. Energy field contains a number of layers, each with energy of different frequencies. Energy is transferred between layers and into the physical body through structures called chakras. Disturbances of the energy field cause illness. Healing occurs only when energy field is balanced and energy is flowing freely. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Diet and Nutrition Megavitamin therapy (orthomolecular therapy) Involves taking large amounts of vitamins, minerals, and amino acids to treat physical and psychological illnesses Based on belief that the inability to absorb nutrients from a proper diet alone may lead to illness Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Vitamins Overdoses of vitamins can be life threatening. The use of some vitamins and medications together is contraindicated. During an assessment, ask the client about use of vitamins along with all the medications being taken. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Acupuncture Therapy used in traditional Chinese medicine Placement of needles into the skin at certain points on the body to modulate the flow of energy (qi) Qi moves through the body along specific nonvisible pathways called meridians Medical research indicates that acupuncture can: Regulate blood cell counts Trigger endorphin production Control blood pressure Used for pain relief and to treat substance abuse and emotional disorders Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Therapeutic Touch Developed in the 1970s by Dolores Krieger, a nursing professor, and Dora Kunz, a healer from Canada Many nurses have been trained in this therapy Based on belief that the healing force of the practitioner affects the client's recovery Practitioners pass their hands over the client to identify energy imbalances and promote healing by balancing the energy Practitioner's hands do not touch the client There is a lack of research supporting therapeutic touch. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Aromatherapy Use of essential oils for inhalation to activate the body's healing energy to balance mind, body, and spirit Based on theory that essential oils stimulate the release of neurotransmitters in the brain. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Aromatherapy Some individuals are sensitive or allergic to essential oils when they come into contact with the skin or are inhaled. Essential oils are flammable. Essential oils can be harmful if ingested. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Herbal Medicine Herbal remedies have been used for many years but have not been tested thoroughly to determine their efficacy. Foods are now sold with herbs added (e.g., tea with ginseng). Consumers may not know the product contains herbs. Herbs are dietary supplements. No U.S. Food and Drug Administration approval or standardization. Many medications have contraindications to the use of specific herbs. Nurses need to educate their clients about the potential harmful effects of herbal remedies. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Prayer Mid-1840s "moral treatment" was the use of compassionate psychological and spiritual treatments based on the idea that insanity was a disruption of both mind and spirit. An alternative therapy used by many Americans today. Abundant research has indicated a significant relation between religious involvement and better mental health. Spiritual assessment Determines the beliefs and practices of the client Communicates to the client that nurse is interested in and comfortable talking about spiritual issues Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Quackery and Fraud Advise clients of the “red flags” in the advertising of unproven and potentially harmful health care products and treatments: Product claimed to be a quick cure-all for many ailments Words like “scientific breakthrough,” “miraculous cure,” and “secret ingredient” used to promote product Promoter claims government, medical profession, or research scientists have conspired to suppress the product Advertisement includes amazing results Product available from only one source and payment required in advance A “no risk, money-back guarantee” promised Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Credibility of CAM Lack of financial support for research but government and nonprofit groups are providing funds for research Health insurance companies have begun to include coverage for CAM. Many medical schools have some type of curriculum offering in the area of integrative medicine. Credentialing procedures in place for acupuncture, chiropractic, naturopathy, and massage therapy Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Information Resources NIH supplies research support http://www.nih.gov NCCAM: a clearinghouse for information on CAM http://nccam.nih.gov Assists consumers in making wise choices Conducts and facilitates biomedical research National Library of Medicine (NLM) and NCCAM created CAM on PubMed Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.