1. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1 CHAPTER 17 Complementary and Alternative Therapies

2. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 2 Complementary and Alternative Therapies Complementary Therapies  Therapies used in addition to conventional treatment recommended by the person’s health care provider  Complement the conventional treatment  Includes exercise, massage, reflexology, prayer, biofeedback, creative therapies, guided imagery, acupuncture, relaxation strategies, chiropractic therapy, therapeutic touch, and herbalism

3. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 3 Complementary and Alternative Therapies Alternative Therapies  May include the same interventions as complementary therapy, but frequently become the primary treatment modality that replaces traditional or conventional medicine

4. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 4 Many alternative therapies do not interfere with those therapies prescribed by a physician, but some can have serious interactions. The nurse needs to project an open, nonjudgmental attitude when obtaining a health history so that the patient feels comfortable in providing all information about any therapies he or she is currently receiving. Complementary and Alternative Therapies

5. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 5 Herbal Therapy Many current medicines have their origins in herbs.  Digitalis comes from the foxglove herb. Recently, there has been an increased interest among the general population about the use of herbs and natural supplements to treat illness and maintain health.

6. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 6 Herbal Therapy Herbs vary from pharmaceuticals in several ways.  Herbal preparations usually use the whole plant.  One herb may be used for a variety of purposes and is usually gentler than pharmaceuticals.  Pharmaceuticals that are derived from herbs separate the active ingredients and use only that part, thereby being stronger.  Herb manufacturers are not held to the same stringent standards as are manufacturers of pharmaceuticals.

7. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 7 Herbal Therapy Many herbal medicines are sold as foods or food supplements in health food stores and through private companies because they have not received approval for use as drugs. The goal of herbal therapy is to restore balance within the individual by facilitating the person’s self- healing ability. Many herbs are potentially toxic if used incorrectly.

8. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 8 Herbal Therapy Treatment can be provided in a variety of ways.  Dried herbs can be taken orally in a capsule or tablet form.  Tinctures are made by placing herbs in alcohol or vinegar until the liquid absorbs the properties of the herb; the liquid is then strained and used.  Tea may be made of an infusion of herbs and hot water and drunk, or a moist compress can be made from the tea and applied to the affected area.  Herbs can be applied topically by making a salve or ointment to be applied to the skin.

9. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 9 Chiropractic Therapy Has been in existence since the late 1800s. Doctors of chiropractic medicine undergo extensive training in manipulation of the musculoskeletal system. It is based on holistic beliefs in the body’s ability to take care of itself. The chiropractic doctor adjusts the joints of the body through gentle manipulation to restore the area to proper alignment. A doctor of chiropractic medicine does not prescribe medications. Other treatments such as hot and cold packs may be used.

10. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 10 Acupuncture and Acupressure Acupuncture  A method of stimulating certain points on the body by the insertion of special needles to modify the perception of pain, normalize physiological functions, or treat/prevent disease.  This is the primary treatment modality used by physicians of Chinese medicine.  The most common problems for which acupuncture is used include low back pain, myofascial pain, simple and migraine headaches, sciatica, shoulder pain, tennis elbow, osteroarthritis, whiplash, and musculoskeletal sprains.

11. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 11 Figure 17-2 Acupuncture uses fine needles inserted at specific points to open the meridians. (From Leahy, J.M., Kizilay, P.E. [1998]. Foundations of nursing practice: a nursing process approach. Philadelphia: Saunders.)

12. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 12 Acupuncture and Acupressure Acupressure  This involves the use of gentle pressure at similar points on the body.  Pressure may be applied with a finger or a small blunt object.  It is used primarily for the prevention and relief of symptoms of muscle tension.  Acupressure reduces tension, increases circulation, and enables the body to relax deeply.  By relieving stress, acupressure increases resistance to disease and promotes wellness.

13. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 13 Figure 17-1 Massage therapy can be used to relieve tension. (From Potter, P.A., Perry, A.G. (2005). Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

14. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 14 Therapeutic Massage Massage performed by training professionals manipulates the soft tissues of the body and assists with healing. Massage can either be relaxing or energizing. It should be conducted in a warm, relaxing atmosphere. Oils or lotions may be used during the massage. Massage is contraindicated for phlebitis or thrombosis and infectious skin diseases.

15. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 15 Aromatherapy Pure essential oils, produced from plants, are used to provide health benefits. The oils can be used for inhalation, or they may be applied topically. Scent may be dispersed into the air through the use of candles or oil dispersers. Oils can also be used in bathing. Different scents are thought to invoke different responses in the body.  Relaxation, stimulation, improved digestion, increased hormone production, and improved circulation or memory

16. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 16 Reflexology It is thought that the entire body can be reached by applying pressure to specific areas on the feet. Reflexology is based on the premise that there are zones and reflexes in different parts of the body that correspond to and and are relative to all parts, glands, and organs of the entire body. The manipulation of specific reflexes removes stress, placing the body in a parasympathetic healing state and enabling the disharmonies to be released by a physiological change in the body.

17. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 17 Reflexology Four Main Benefits  Relaxation with the removal of stress  Enhanced circulation  Assisting the body to normalize metabolism naturally  Complementing all other healing modalities Warnings, Contraindications, and Precautions  Pressure on the corresponding reflex areas should be decreased for patients with heart problems, blood problems, high blood pressure, epilepsy, and diabetes.

18. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 18 Magnet Therapy Magnets have been used for thousands of years to help heal and improve overall health. They are thought to increase circulation to the affected area and to promote healing, as well as stimulate acupuncture points. Common physiologic responses  Vasodilatation, analgesic action, antiinflammatory action, spasmolytic activity, healing acceleration, and antiedema activity Contraindications  Pregnancy, pacemakers, insulin delivery systems, cochlear implants, and defibrillators

19. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 19 Imagery Uses the conscious mind to create mental image to evoke physical changes in the body, improve perceived well-being, and enhance self-awareness Frequently combined with some form of relaxation training to facilitate the effect of the relaxation technique Can be self-directed or guided Can evoke powerful psychophysiological responses such as an alteration in immune function

20. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 20 Relaxation Therapy Relaxation is the state of generalized decreased cognitive, physiological, or behavioral arousal. The process of relaxation elongates the muscle fibers, reduces the neural impulses sent to the brain, and thus decreases the activity of the brain and other body systems. It decreases heart and respiratory rates, blood pressure, and oxygen consumption. The long-term goal of relaxation therapy is for the person to continually monitor himself or herself for indications of tension and then consciously let go and release the tension.

21. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 21 Yoga “The joining of the mind, body, and spirit to enrich the quality of one’s life and to enhance one’s health” (O’Hara et al., 1998) Basic principles  Control of the body through correct posture and breathing  Control of the emotions and mind  Meditation and contemplation Regular practice can tone the muscles that balance all parts of the body, including internal organs, heart, lungs, glands, and nerves. Flexibility of the spine is increased, and deep relaxation and reduction in stress are promoted.

22. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 22 Figure 17-3 Yoga is useful in control of the body through correct posture, breathing, meditation, and contemplation. (From Potter, P.A., Perry, A.G. (2005). Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

23. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 23 Nursing Role in Complementary and Alternative Therapies Nurses need to be aware of their state nurse practice act with regard to complementary therapies and to practice accordingly within the scope of the law. Nurses work closely with their patients and are in the unique position of becoming familiar with the patient’s religious and cultural viewpoints and existential issues. Nurses may be able to determine which CAM therapies would be more appropriately aligned with these beliefs and offer recommendations accordingly.