1. Chapter 37 Integrative Care
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2. 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
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3. Complementary and Alternative Medicine (CAM)
Alternative therapies
Used as a substitute for conventional therapies
Complementary therapies
In tandem with conventional treatments
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4. 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
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5. 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
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6. 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
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7. 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
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8. 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.
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9. 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."
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10. 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)
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11. 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.
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12. Ayurvedic Medicine Originated in India around 5000 BC
Individual has responsibility for his or her own health
Promotes prevention
Natural methods of treatment
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13. Traditional Chinese Medicine
Derived from Taoism
Qi, or yin and yang = life force
Health is the balance between yin and yang
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14. 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.
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15. 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.
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16. Eastern View of Mind-Body-Spirit
Acupuncture
Imagery
Therapeutic touch
Therapeutic massage
Relaxation
Bioenergetics
Biofeedback
Qi gong
Yoga
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17. 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
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18. 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
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19. 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
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20. 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
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21. 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
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22. 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
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23. 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
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24. 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
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25. 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.
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26. 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
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27. 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.
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28. 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
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29. 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.
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30. 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.
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31. 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.
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32. 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.
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33. 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
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34. 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
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35. 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
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36. Information Resources
NIH supplies research support
NCCAM: a clearinghouse for information on CAM
Assists consumers in making wise choices
Conducts and facilitates biomedical research
National Library of Medicine (NLM) and NCCAM created CAM on PubMed
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