1. Complementary & Alternative Therapy
Sakura Maillet
Kathy Cress-Waugh
Kendra Miller

2. “Curing the soul; that is the first thing”
-Socrates
(as cited in Fontaine, 2005)

3. Experience Your Energy Field
(Fontaine, 2005)

4. Purpose
To address the issue of utilizing complementary and alternative therapy

5. Objectives
1) The class will be able to identify the different complementary and alternative therapies
2) The class will be able to compare the positives versus the negatives of integrating alternate therapies into nursing practice
3) The class will distinguish for themselves after the presented material whether they support or are against the use of alternative therapies
4) The class will be able to list ways that they can integrate these therapies into their nursing practice

6. Conventional Medicine
Biomedical or Western medicine
Rene Descartes ( )
Sir Issac Newton ( )
Mechanistic/ reductionistic
This vision of health care is only about 200 years old and is founded on the philosophical beliefs Rene Descartes ( )- mind and body are separate and on
Sir Issac Newton ( )- principles of physics that everything works in a linear, sequential form
This leads to a mechanistic or reductionistic approach to health care that individuals are broken down into organs and cells
Viewing health as an absents of disease therefore not broken
This system believes that it is better to do something rather than wait and see whether nature and the body can resolve the problem itself, and that the disease needs to be attacked directly by medication or surgery rather than attempting to build up a person’s resistance and ability to overcome the disease themselves. Believing that most individuals are affected the same way
Has it’s place emergencies, traumatic injuries, infections, surgeries – where treatment is fast, aggressive, and goal oriented
Even Hippocrates, the father of Western medicine, stressed a holistic approach when he taught doctors how to diagnosis their patients.
(Fontaine, 2005)

7. Alternative Therapy Holistic Albert Einstein (1879-1955) Life force
Chronic/ debilitating disease
Fontaine, 2006 states that mental, emotional, spiritual, relationship, environmental all equal components of well-being and health
Most forms of alternative medicine believe that there is an internal self-healing process that exists within each individual
That people are responsible for making their own health care decisions
And that nature, time, and patience are the greatest healers.
Albert Einstein’s Theory of relativity really reinforced that you could not affect one thing without affecting everything that is connected- mind, body, soul
The energy of the human body is called the life force which sustains the physical body and the spiritual being linked to a higher being of energy. When the life force is able to flow through your body freely the person is healthy. When the life force runs into a barrier the body is unable to obtain this energy and function to their highest potential resulting in illness or disease.
Alternative therapy is of extreme value for those with chronic or debilitating illnesses in which conventional medicine is unable to resolve. It also is a huge factor in health promotion and disease prevention.
(Fontaine, 2005)

8. Complementary Therapy
Conventional medicine & alternative therapy
Holistic care model
Helms, 2006 describes complementary therapy as conventional medicine with alternative therapy in conjunction. Allowing a wider range of opportunity for individuals to find a balance that works uniquely for them. Could be in terms of health promotion such as mind-body techniques of yoga to herbal remedies to treat illness. Even simple things such as diet and exercise are thought to be complementary therapies.
It’s really interesting that Fontaine, 2006 states that over the past 20 years the demand for complementary therapies has dramatically increased. The National Center for Complementary and Alternative Medicine (NCCAM) found that over 1/3 of adults in the US in 2004 use some form of this therapy.
In nursing we have been taught to care for the whole person- mind, body, spirit- as in alternative therapy but also administering medications as in conventional medicine therefore we see that it is a balance of both aspects. +

9. Nursing
Using our hands, heart, and head in creating healing environments
Scientific skills & spiritual commitment
Attitude and perspective
Holistic
Take care of yourself
The past 20 years nursing has been moving away from a biomedical orientation and shifted towards a nursing-caring-healing model reconnecting us with the traditions of Florence Nightingale using our hands, heart, and head in creating healing environments. Nurses have become a hybrid of scientific skills and spiritual commitment. Caring involves compassion and sensitivity to each individual client. The biomedical model supported not getting too involved or care too much about our clients although what makes our practice caring, it is not the tools we use but the attitude and perspective we bring. This could be the same with alternative therapies, if just completing the task, it still is not holistic healing, therefore it is all in the approach. To care for others we first need to care for our selves – reduce stress..
All nurses could use education in therapeutic touch, healthy dietary plans, basic use of herbs, visualization, and prayer in the healing process.
(Fontaine, 2006)

10. Basic Concepts in Alternative therapy
Balance
Spirituality
Energy
Breath
Fontaine, 2006 feels in terms of optimal health balance means mental, physical, emotional, spiritual, and environmental components in equilibrium with themselves and together as a whole. As well as the rhythms of your body such as the circadian rhythms (sleep patterns, temperature), Ultradian rhythms (REM sleep cycle), Infradian rhythms (menstrual cycle), musical rhythms (harmony) – music is used in many of the therapies
Spirituality healing practices are one of the most ancient healing methods. Spirit is the liveliness, richness, and beauty of one’s own life. Spirituality is the drive to become the best we can be and involves relationships with ourselves, others and a higher power. During stressful times in our lives people tend to search for meaning and the purpose of their pain and suffering. This should not be confused with religion which involves a search for the sacred or belonging in a group.
Energy- most spiritual traditions have a belief that energy is the bridge between spirit and physical being. Energy is viewed as the force that integrates the body, mind, and spirit, that it is what connects everything, the life force described earlier. Hundu concepts that we have 7 major energy centers- Chakras. Aura is the energy field surrounding each person as far as the outstretched arms out and up. It sends and receives messages from internal to external environments.
Breath is at the center of all spiritual and religious traditions- it is not simply a mechanical process since now scientists are beginning to recognize that it can be used for healing, improving the bodies self-repair process, and reduce vulnerability to illness. Weil, 1995 as cited in Fontaine, 2006 believes that it is the master key of all health and well-being.
(Fontaine, 2006)

11. Complementary & Alternative Therapies
Systematized Health Care Practices
Traditional Chinese Medicine
Ayurvedic Medicine
Native American Healing and Curanderismo
These comprehensive health systems each has a range of applications from preventive health care and maintenance to diagnosis and treatment of acute and chronic disorders.
They cover such theories as yin and yang- the appropriate balance of health, the effects of the season, acupuncture, diet, herbs, massage, feng shui- way of organizing your environment to live in harmony, Qi- the invisible flow of energy that circulates through plants, animals, people, the earth, the sky.
Ayuredic – the science of life
Herbs, songs, spiritual rituals, the medicine wheel
(Fontaine, 2006)

12. Botanical Healing Herbs and Nutritional Supplements Aromatherapy
Homeopathy
Naturopathy
Botanical therapy or phytotherapy- which means plant.
80% of the world’s population uses herbal medicine – most popular alternative therapy
Vitamins, minerals, diet supplements, specialized diets
We’ve all heard about St. Johns Wort which has been around for over 2,500 years Hippocrates used to prescribe this
Some examples at the end of the slide that you might want to try at home
-therapeutic use of essential oils of plants to create certain fragrances. Have the power to evoke strong physical and emotion reactions- Alzheimer's
-similar feelings- substance that is same as the patient’s symptoms- feels similar cures
-strengthens body’s way to heal itself
(Fontaine, 2006)

13. Manual Healing Methods
Chiropractic
Massage
Pressure Point Therapies
Hand-Mediated Biofield Therapies
Combined Physical and Biofield Therapies
Chiropractic means done by hand- Manipulation of the spine
Used for lower back syndromes, neck conditions, headaches, muscle spasms, carpal tunnel, sports related injuries
-Massage- manipulation of soft tissues of the body- third most common form of alternative therapy in the US. After chiropractic and relaxation techniques
The goal is to achieve or increase health to help the body heal itself. Touch is under this category- stated as a primary need just as necessary for growth and development was food, clothing, and shelter. The most intimate and powerful form of communication.
-Pressure point therapies- Stimulating points on the body to balance the body’s life energy – acupuncture or acupressure – can relieve pain, promote wellness, cure certain illnesses.
-Hand-mediated biofield therapies- The use of hands on or near the body with the intention to help or heal – balancing the energy field, increasing the flow of energy- therapeutic touch- developed by nurses- can seek certification in healing touch
-Combined physical and biofield therapies- applied kinesiology with energy field therapy
(Fontaine, 2006)

14. Mind- Body Techniques Yoga Meditation Hypnotherapy and Guided Imagery
Dreamwork
Intuition
Biofeedback
Movement-Oriented Therapies
Yoga- Fontaine, 2006 describes as a journey of the mind, body, spirit towards unity. In Western culture it tends to be more fitness focused where Eastern it is to prepare people for the experience of self-realization. It is meant to prepare the body and mind for a useful and dedicated life, producing spiritual enlightenment.
-Meditation describes a wide range of practices that involve relaxing the body and stilling the mind.
-Hypnotherapy is a state of attentive and focused concentration during which people are highly responsive to suggestion. Many people believe that guided imagery is a form of hypnosis- since it is a state of focused concentration that encourages similar changes in attitude, behaviour, and physiological reactions.connect mind, body, spirit through relaxation and imagination
Dreamwork-Belief that dreaming is one of the ways that people reflect on and make sense out of their life events.
-Intuition- is described by knowing immediately without thinking
Biofeedback- method for learned control of physiological responses of the body.
Movement-oriented therapies- A number of therapies focus on movement, body awareness, and breathing to maintain health or correct certain problems like t’ai chi
(Fontaine, 2006)

15. Spiritual Therapies Shamans Faith and Prayer (Fontaine, 2006)
Like we learned back in first year- Religion class- Fontaine, 2006 describes a shaman as a person who enters an altered state of consciousness by will to contact and utilize another type of reality to acquire knowledge and power to help heal others.
-health care sciences have begun to demonstrate that spirituality, faith, and religious aspects all impact promoting health and reducing illness.
(Fontaine, 2006)

16. Other Therapies Bioelectromagnetics Detoxifying Therapies
Animal-Assisted Therapy
Bioelectromagnetics is a new science that examines how living things interact with electromagnetic fields. Concerning again with energy fields
-Detoxification- is the belief that physical impurities and toxins must be cleared from the body to gain optimum health. There are many different methods to this concept. Hydrotherapy, colonics, sweating, baths
-Florence Nightingale was one of the first to see the connection between animal companions and health. This therapy uses specific animals as a treatment method in health and human services. Dogs and cats are great for this. I know during the summer at the nursing home recreation had days where they would bring a dog in for all the residents and they enjoyed it so much, they’re faces would light right up.
(Fontaine, 2006)

17. Factors Influencing Nurses Use of CAT
Personal use
Perception of legitimacy, efficacy, and benefits
Knowledge & experience
Nurses stress and environmental stressors
Many factors may influence critical care nurses’ use of CAT in practice.
nurses’ personal use of CAT may influence their attitudes toward CAT in general, and may increase or decrease their use of CAT.
Nurses’ perceptions of legitimacy, efficacy, and benefits may also be factors in their decisions to use CAT
Nurses’ knowledge of CAT may affect their use of these therapies in practice; if therapies are unknown to them or are therapies with which they have little experience, the nurses may be reluctant to use the therapies or to make a referral to practitioners who could administer CAT to clients
Although- if the therapies are those with which the nurses are familiar, or that they use in self-care, they may be more likely to administer these therapies to patients or to seek a referral to a specialized CAT provider for their patients. Lack of knowledge about CAT may be a barrier to use of these therapies in practice.
Nurses’ stress and environmental stressors may be associated with use of CAT. Stressful ICU environments may not be conducive for nurses to find the time or frame of mind to therapeutically listen or to provide soothing imagery.
(Tracy, Lindquist, Savik, Watanuki, Sendelbach, Kreitzer, & Berman, 2005)

18. General openness towards therapies Age Ethnic background
Religious affiliation
Other sociodemographic factors
Concerns about legal issues
Ethical issues
Lack of equipment, time, training
Also, general openness toward therapies may influence the use of the therapies.
Nurses’ age, ethnic background, religious affiliation, and other sociodemographic factors may also be associated with their use of CAT.
a lack of reimbursement or concerns about legal issues related to CAT use may be a barrier.
Nurses may face ethical issues in facilitating use of CAT when no scientific evidence supports the use of the therapies.
qualified providers may be unavailable or equipment, time, or training may be lacking.

19. Pros of Complementary and Alternative Therapy
History
Positive attitudes
Physiological and psychological benefits
Combination with conventional medicine
Cost-effective (within hospital)
“Specific to patient and not the disease” (Helms, 2006).
Some of these therapies have been used for thousands of years and so obvisously there are benefits of CAT.
For example the use of massage has been recorded in numerous texts dating as far back as the bible and many cultures including the Greeks, Romans, Egyptians. Also the use of herbs have been relied on.
There has been an increase in popularity of CAT, approx a 20% increase within four years. (Helms, 2006).
There are many physiological and psychological benefits with the use of CAT. Used to decrease stress, reduce pain, anxiety, agitation, improve mood, sleep.
- Example: simple 6min massage can improve sleep effiency and produce an average of 1 additional housr of night time sleep for patients in the critical care setting. Helms, 2006.
Some of these therapies can be used anywhere including within the hospital acute care, in the home.
The therapies provided within the hospital during admission, are cost-effective.
CAT may be used to soften the harsh edges of the high-tech environment and provide low-tech, high-touch solutaions to the problems of intensive care patients. (tracy et al. 2005). And it cane also be more effective in combination with conventional medicine, than on its own.
Many people believe that high-tech, high-cost care is impersonal. Therefore CAT is specific to the patient and not the disease. Providing holistic care and healing.

20. Pros related to Nursing
Provided by nurse
Positive attitudes
Increased interest of education
Tracy et al.2005 research that therapies that are most commonly used were diet (94.2%), exercise (92.7%), relaxation techniques (79.9%), and prayer or spiritual direction (73.1%). And also massage and counseling.
These can be easily done at the bedside and provided by a nurse.
According to Kim et al., nursing students and faculty expressed positive attitudes toward Complementary and alternative therapy.
Within the study 80% believed that CAT had many benefits .
Many researchers have suggested that the curriculum for undergraduate nursing students needs to be an integreateed curriculum that deliberately includes content on CAT and is grounded within a holistic perspective of nursing.
And Kim et al.’s research shows that 85.7% of participanbts agreed that nurses should have education and training in CAT.

21. Cons of Complimentary and Alternative Therapies or Medicine (CAT/ CAM)
Unreported use
Safety
Adverse Drug Reactions
Money/ Expenses
Nurse related issues

22. Unreported use of CAM HCP negative feelings. 47% of patient use CAM.
CAM can effect clinical disorders, and can have adverse reactions with conventional medications.
Many HCP have open negative feelings about CAM, this has lead to under reporting of use. In a survey described by Mantle, % of patients that attended the ER used CAM. Of this percentage 1/3 of the patients did not notify the HCP of this use. This can be dangerous because CAM when combined with conventional medicine can have adverse effects with regards to the clinical disorder, and prescribed treatment.
Mantle, 2006 22

23. Safety Misconception: Natural means safe.
Unknown, unmonitored, inadequate
CAM practitioners are not always educated on clinical disorders
Adverse nutrition and dietary advice
Side effects of CAM
There is a misconception that because CAM is natural that it must be safe and free of side effects. This misconception can cause many people to use CAM without fully educating themselves on the practice they are using.
-An issue related to the safety of the people using CAM concerns the qualifications and competence of CAM practitioners. The law states that non-medically qualified practitioners of CAM are free to practice their training despite the fact that many CAM practices have unknown effects, are unmonitored or inadequately researched.
-It was revealed that CAM practitioners are not always educated on how to treat certain clinical disorders . Upon examination of training curricula there is nothing to inform practitioners how to treat conditions, and they and their clients may be unaware of the possible interaction of therapies with presenting or latent conditions. Also with lack of education on certain disease misdiagnosis may occur preventing patients from seeking conventional clinical help.
- An example of adverse nutrition and dietary advice would be the Gerson regime, for cancer and other debilitating conditions, it involves
the ingestion of large quantities of raw, organic salads and soups as well as Lugol’s solution of iodine, thyroid extract, pancreatin, royal jelly and castor oil, and deaths have resulted after the prescribed four hourly coffee enemas. Many of the CAM nutrition regimes cause severe electrolyte imbalances.
- the side effects of acupuncture or chiropractic manoeuvres, include pneumothorax, cardiac tamponade and haemothorax, spinal epidural
haematoma and subarachnoid haemorrhage. An international review of reported side effects from acupuncture by Rampes and James (1995) reveals a total of 395 incidents, involving hepatitis in 126 cases, drowsiness in 79, syncope in 53, and pneumothorax in 32 cases. Several serious consequences of chiropractic manoeuvres have also been reported including vertebral artery injury, cervical fracture or dislocation.
Mantle, 2006 23

24. Adverse Drug and Therapy Reactions
Unstable blood pressure control
Unstable diabetes
Herbal remedies (over the counter)
12 adverse drug reactions in 24 months
-Some physical therapies such as massage can induce a deeply relaxed state that results in reduced blood pressure. When combined with sedative
and anti-spasmodic essential oils such as lavender, they can result in syncope or dizziness from unknown cause' in patients with unstable blood pressure control.
-Both massage and reflexology can reduce blood glucose in patients with diabetes which can cause problems in patients with unstable diabetes if treatment has been within the previous four hours, potentially causing a hypoglycemic state.
- Particular care be taken when patients report using herbal remedies. Of particular concern is the safety of imported herbs for which
there are several adverse reports either because the herbs are toxic or have been mixed with toxic substances, or because they have
been mixed with conventional drugs such as non-steriodal antiinflammatory drugs.
-In a study done by Jose, Rao, Kamath, & Jimmy, 2009 there were 12 adverse drug reaction reported in 24 months with relation to CAM with Respiratory disorders and skin disorders being the most common indication for use of the suspected medication by the patients. The adverse reactions ranged from mild to severe including asthma exacerbation, rashes, tongue discoloration, stomatitis, and Granulocytopenia (a decrease in the number of WBC).
Mantle, 2006/ Jose, Rao, Kamath, & Jimmy, 2009 24

25. Money and Expenses out of the pocket expenses
many limitations to insurer reimbursement
Consumer demand
proven efficacy
cost effectiveness
Grimaldi, 2008 explains that there is a lot of out of the pocket expenses related to CAM. Many insurers now pay for some therapies such as massage, acupuncture, and chiropractic practices there are still many limitations to reimbursement for their use. Consumer demand, proven efficacy, and cost effectiveness are still the most relevant factor in the insurers decision to pay for CAM therapies .
Grimaldi, 2008 25

26. Nursing Related Cons

27. Nurse Related Issues
Lack of information in nursing education related to CAM
Not enough time
Not enough training
Not enough Knowledge
Ethical issues
Reluctance of peers and physicians
Helms, 2006 explains that a few nursing education programs have begun to include CAM in their curricula, but most have relegated the CAM component to elective courses. Nursing education programs must respond to the growing need for CAM by including its principles and therapies in their curricula, so nurses can provide the holistic care patients are demanding, in an educated, safe, efficient manor.
The main reasons as to why nurses in the hospitals do not use CAM is they do not have enough time, knowledge, or training. There are ethical issues in facilitating use of CAT when no scientific evidence supports the use of the therapies. And many nurses do not use CAM because of the reluctance of peers and physicians even if they have been educated because of fear of judgment.
Helms, 2006/ Tracy et al, 2005 27

28. Strategies for Incorporating Complementary and
Alternative Therapies into Nursing Curricula
Provide complementary and alternative medicine (CAM) learning opportunities for faculty through workshops, seminars, and online learning modules.
• Revise course objectives to reflect CAM interventions in
patient care.
Helms, 2006 28

29. Encourage CAM interventions in care plans whenever appropriate.
Include specific CAM information relevant to theory and skill courses and clinical experiences.
Look for inclusion of CAM in textbooks before adoption.
Include CAM articles as part of required readings.
Provide adequate library resources, such as CAM journals.
Include basic CAM principles on tests.

30. Information Video about CAM!

31. Discussion Questions
1) Do you believe there is a value to these alternative therapies used in nursing?
2) What do you perceive as the barriers to using these therapies?
3) Would anyone like to share their personal experience where alternative therapies have been used? Beneficial or non-beneficial?
4) How would you integrate these therapies into your nursing practice?

32. Breathing Clouds

33. Examples Ginger Decreases nausea Boosts the immune system
Lowers blood pressure
Use 2 tsp of powered or grated root per cup of boiling water. Steep 20 mins, strain, add juice from half a lemon and honey for taste. Drink hot up to 3 cups a day.
(Fontaine, 2006)

34. Examples Mint Relaxes the digestive tract
Used to treat colds, cough, & fever
For infusion: use 1 tsp of fresh herb or 2 tsp of dried leaves per cup of boiling water. Steep 10 mins, strain, and drink up to 3 cups a day.
(Fontaine, 2006)

35. Adult Cold Cure 2 drops eucalyptus 5 drops geranium 3 drop peppermint
5 drops rosemary
Mix oils together and use in any of these ways:
Several drops in a diffuser, 2 drops on a tissue and breathe in the aroma, 4 drops in a bath, add 8 drops to 2 tbs of massage oil and massage the chest, back, neck, forehead, nose, cheekbones.
(Fontaine, 2006)