1. Complementary and Alternative Therapies Chapter 17 Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Slide 2Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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  Include exercise, massage, reflexology, prayer, biofeedback, creative therapies, guided imagery, acupuncture, relaxation strategies, chiropractic therapy, therapeutic touch, and herbalism

3. Slide 3Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Alternative Therapies  May include the same interventions as complementary therapy, but frequently become the primary treatment modality that replaces traditional or conventional medicine Complementary and Alternative Therapies

4. Slide 4Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Slide 5Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Slide 6Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Slide 7Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

8. Slide 8Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

9. Slide 9Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

10. Slide 10Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Ginger Root

11. Slide 11Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

12. Slide 12Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Slide 13Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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, osteoarthritis, whiplash, and musculoskeletal sprains.

14. Slide 14Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

15. Slide 15Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.)

16. Slide 16Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

17. Slide 17Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.)

18. Slide 18Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

19. Slide 19Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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

20. Slide 20Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Aromatherapy

21. Slide 21Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

22. Slide 22Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

23. Slide 23Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

24. Slide 24Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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, anti-inflammatory action, spasmolytic activity, healing acceleration, and antiedema activity Contraindications  Pregnancy, pacemakers, insulin delivery systems, cochlear implants, and defibrillators

25. Slide 25Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

26. Slide 26Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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 psychophysiologic responses such as an alteration in immune function

27. Slide 27Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

28. Slide 28Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Guided imagery

29. Slide 29Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

30. Slide 30Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Animal-Assisted Therapy 1994—first time used in the United States Therapeutic purposes Complementary therapy in acute and long-term settings Dogs used more than cats

31. Slide 31Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

32. Slide 32Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

33. Slide 33Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

34. Slide 34Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

35. Slide 35Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.)

36. Slide 36Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

37. Slide 37Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. T’ai Chi/Taiji Fusion of martial arts and Daoist philosophical concepts Yin and yang Suited for people of various physical capabilities Benefits include improvement in balance, leg strength, cardiorespiratory function, range of motion, and arthritis.

38. Slide 38Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Biofeedback Noninvasive Determines a patient’s neuromuscular and autonomic nervous system response Measures specific body functions Goal is for patients to become aware of their responses and, in conjunction with relaxation techniques, to be able to control their responses

39. Slide 39Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

40. Slide 40Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 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.