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

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

3. 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.

4. Resource
National Center for Complementary and Integrative Health (NCCIH)

5. 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)

6. 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)

7. 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)

8. 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)

9. Guided Meditation

10. Tai Chi

11. Biofeedback

12. Reiki

13. Light Therapy

14. 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

15. 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
Williams, L., & Hopper, P. (2019). Understanding medical-surgical nursing (6th ed.). Philadelphia, PA: F. A. Davis