Complementary, alternative, and integrative modalities Randall S. Mangrum, DNP, RN Virginia Society of Medical Assistants April 27, 2019

Disclosure I have no actual or potential conflict of interest in relation to this program/presentation.

Learning Outcomes Explain the difference between complementary, alternative, and integrative modalities. Discuss systems of health care that have contributed to the development of new modalities. Introduce modalities that may be encountered in practice. Describe the role of the health care practitioner in assisting a client with complementary, alternative, and integrative modalities.

Resource National Center for Complementary and Integrative Health (NCCIH) https://nccih.nih.gov

Complementary, Alternative, and Integrative Health Care Practices According to a 2012 national survey, many Americans—more than 30 percent of adults and about 12 percent of children—use health care approaches that are not typically part of conventional medical care or that may have origins outside of usual Western practice.  Many times we use the words complementary, alternative, and integrative health care practices interchangeably; however they are not the same: - Complementary modalities refer to a therapy that is used in addition to a conventional modality - Alternative modalities refer to a therapy that is used instead of a conventional modality. - Integrative health care often brings conventional and complementary approaches together in a coordinated way. It emphasizes a holistic, patient-focused approach to health care and wellness—often including mental, emotional, functional, spiritual, social, and community aspects—and treating the whole person rather than, for example, one organ system. It aims for well-coordinated care between different providers and institutions. (National Center for Complementary and Integrative Health, 2018; Williams & Hopper, 2019)

Systems of Health Care Influencing Traditional Western Health Care Western Health Care (Allopathic medicine) Ayurvedic Medicine Traditional Chinese Medicine Chiropractic Medicine Homeopathic Medicine Naturopathic Medicine American Indian Medicine Osteopathic Medicine The most common name for allopathic medicine is Western Medicine. Allopathic medicine is a method of treating disease with remedies that produce effects different from those caused by the disease itself. For example, when a patient has a bacterial infection, a Western medical practitioner prescribes an antibiotic to eliminate the invading pathogen. This system of medicine uses a variety of therapies and the approach to health care is based on scientific investigation. Western medicine practitioners have made the most significant advances and developments in modern medicine. Ayurveda is the ancient Hindu system of medicine that originated in India. Ayurveda maintains that illness is the result of falling out of balance with nature. Treatment of disease usually involves prescribing a diet, herbal remedies, breath work, physical exercise, yoga, meditation, massage, and rejuvenation or detoxification. Traditional Chinese medicine is thousands of years old. It involves such practices as acupuncture, acupressure, herbs, and massage. This approach to medicine involves treatment of energy disturbances. Chiropractic medicine is based on the belief that illness is a result of neuromusculoskeletal dysfunction. The main treatment modality used is manual adjustment and manipulation of the vertebral column and the limbs. The goal is to remove interference with nerve function so the body can heal itself. Homeopathy is based on the principle that “like cures like”, meaning that tiny doses of a substance that created the symptoms of disease in a healthy person will relieve those symptoms in a sick person. Naturopathy primarily uses natural therapies such as nutrition, herbs, hydrotherapy counseling, physical medicine, and homeopathy to treat disease and prevent illness. American Indian medical practices vary from tribe to tribe; however, this is viewed as a community-based system that follows rituals and shamanistic healing practices such as sweat lodges, chanting, singing, and prayer. The belief is that toxic substances are drawn out in the sweat. Osteopathic medicine is the practice of medicine that emphasizes the interrelationship of the body’s nerves, muscles, bones, and organs. Osteopathy involves treating the whole person and recognizes that the body has the ability to heal itself. This approach stresses the importance of diet, exercise, and fitness with a focus on prevention. ( Williams & Hopper, 2019)

Commonly Used Modalities Category of Therapy Examples Biologically Based Modalities Herbal medicine, Nutrition and special diet therapies, Nutritional supplements Mind-body modalities Art therapy, guided imagery, meditation and relaxation, music/sound therapies, prayer, yoga Manipulative and body-based modalities Acupressure, Chiropractic medicine, Massage Energetic modalities Biofeedback, Magnet Therapy, Reiki, Spiritual healing, Therapeutic touch Miscellaneous therapies Aquatherapy/hydrotherapy, Aromatherapy, Chanting, Kinesiology, Light therapy, Pet therapy Keep in mind that many individuals may use one or more categories of therapies, but may not report their use to their health care provider ( Williams & Hopper, 2019)

Herbal Therapy – Common Herbs and Their Intended Uses Purported Uses Garlic Reduces LDL, raises HDL, may decrease B/P Ginkgo biloba May improve memory and help cognitive function in Alzheimers disease Ginseng May decrease stress and increase alertness. Claims to lower cholesterol and balance blood glucose, slow the aging process and treat memory loss St. John’s wort May help mild to moderate depression, may be effective against viral infections It is important to note that herbal remedies are not food items. They have potent medicinal effects. They can interact with prescribed medications and can complicate surgical procedures. It is important that health care providers question clients to determine if they are using any herbal remedies. For example, common herbal preparations like garlic, ginkgo, and ginseng can increase the risk of bleeding when take with anticoagulant or antiplatelet medications. St. John’s wort is widely used for depression. This therapy can interact adversely with many drugs including other antidepressant agents, antianxiety agents, birth control, digoxin, immunosuppressant therapy, seizure medications – There are over 40 drugs identified that have major interaction warnings with St. John’s wort. ( Williams & Hopper, 2019)

Guided Meditation https://www.youtube.com/watch?v=OCorElLKFQE

Tai Chi https://www.youtube.com/watch?v=enk0bOv-gF8

Biofeedback https://www.youtube.com/watch?v=MpnHkbuN4Nw

Reiki https://www.youtube.com/watch?v=thMT8W6qAwg

Light Therapy https://www.youtube.com/watch?v=ksf7Q9pZxig

Role of the Healthcare Practitioner Be open-minded Promote safety Advise the patient to: Discuss the use of the modality with the HCP Take a look at the background, qualifications, and competence of the practitioner. Check credentials and check to see if their practice is regulated Visit the practitioner’s office to evaluate the conditions of the setting Talk with others Consider the cost

References Links to YouTube Videos directly on each slide National Center for Complementary and Integrative Health. (2018). Complementary, alternative, or integrative health: What’s in a name? Retrieved from https://nccih.nih.gov/health/integrative-health Williams, L., & Hopper, P. (2019). Understanding medical-surgical nursing (6th ed.). Philadelphia, PA: F. A. Davis