1. Chapter 34
Complementary and Alternative Therapies in Maternity and Pediatric Nursing

2. Objectives
Define complementary and alternative medicine (CAM) therapy.
Identify the role of the nurse in CAM therapy.
Describe the involvement of the federal government in CAM therapy.
Discuss the integration of CAM therapy in nursing practice.
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3. Objectives (cont.)
Discuss the impact on nursing care of patients who use CAM therapy.
State five types of CAM therapy in common use.
State three herbal products contraindicated in pregnancy.
State three herbal products commonly used in pediatrics.
State popular herbs used during menopause.
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4. Objectives (cont.)
Discuss the use of hyperbaric oxygen therapy in the care of carbon monoxide poisoning and necrotic ulcer.
State three herbs that should be discontinued 2 weeks before surgery.
State the use of meridians, dermatomes, and reflexology lines in CAM therapy.
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5. Definition of CAM Therapies
Complementary therapy
Nontraditional therapy that is used with traditional or conventional therapy
Alternative therapy
Unconventional or nontraditional that replaces conventional or traditional therapy
Give examples of complementary therapies.
Give examples of alternative therapies.
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6. Alternative Health Care
Refer to Figure 34-1 on page 761.
Discuss each of the alternatives listed and which body system(s) it affects.
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7. CAM Therapy Also known as Integrative therapies Integrative healing
Holistic healing
Discuss the terms now classified as complementary and alternative medicine.
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8. CAM Practitioners Holistic practitioners Naturopaths
Nutritional consultants
Food therapy
Vitamin and mineral supplements
Herbalist
Practitioners of acupuncture and acupressure
Describe the differences between a holistic practitioner and a naturopathic practitioner.
What is the difference between acupuncture and acupressure?
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9. Popular Cultural Folk Healers
Mexican: Curanderos
African American: Root doctor
Asian and Chinese: Herbalist
Puerto Rican: Espiritistas or santiguadoras
Navajo: Singers
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10. Accepted Theories Gate control theory of pain relief Imagery
Journaling
Therapeutic touch
Humor
Support groups
Discuss how gate control theory “closes the gate” on painful impulses.
How do imagery, journaling, therapeutic touch, humor, and support groups assist patients in managing their pain or coping with a situation?
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11. Nurse’s Role in CAM Therapy
Cultural competence is a sensitivity and respect for practices and philosophies different from one’s own
The need for nurses to understand CAM therapy, how it can be used, and how it may interact with or enhance traditional medical and nursing care are important
Nurses need to understand basic underlying philosophies and beliefs concerning CAM interventions
Discuss cultural practices a nurse might encounter in the hospital environment.
Discuss CAM therapies and their relationships to various cultures.
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12. Nurse’s Role in CAM Therapy (cont.)
Is not to promote CAM therapy but to recognize and respect its use
Use critical thinking skills to determine interactions with traditional therapies
Work with the patient as a partner in the delivery of health care
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13. Cautions in CAM Therapy
Herbs can
Interact with cardiac drugs
Affect glucose control in patients with diabetes
Lower the concentration of some synthetic drugs
Lower the blood level of some medications for HIV/AIDS
Polypharmacy should be avoided; the use of some drugs with herbal remedies can be dangerous
Discuss how many of today’s medications and herbs have the same origins.
Give examples of herbal and medication interactions and the potential complications.
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14. Herbs to Discontinue Two Weeks Before Surgery
Echinacea
Garlic
Ginger
Gingko biloba
St. John’s wort
Ginseng
Kava kava
Feverfew
Ephedra (ma huang)
Refer to Table 34-1 on page 762.
What is the nurse’s role regarding a patient who is taking some of these herbs?
How can a nurse learn of herbs a patient might be taking?
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15. Federal Regulations
1962: Kefauver-Harris Drug Amendment Act required FDA proof of safety and effectiveness for all drugs (not including herbal products) before placing them on the market
1992: NIH formed Office of Alternative Medicine to evaluate CAM therapies
1994: Dietary Supplement Health and Education Act defined dietary supplement and prohibited claim of medicinal value
1994: DSHEA required regulations for labeling and statement that there is no FDA approval
Discuss how “supplements” can cause problems to those who take them.
How is labeling a form of regulation and what does this mean to the dietary supplement industry?
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16. Overview of Common Alternative Health Care Practices
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17. Massage Thought to bolster immune response
Rolfing—thought to improve muscle and bone function
“Cao-gio” (coin rubbing) form of skin manipulation thought to help bring the body into healthy alignment
Perineal massage in preparation for labor
Effleurage—pain relief
Gentle touch—for premature infants
Discuss how massage therapy bolsters the immune system.
What is the theory behind coin rubbing?
Refer to Figure 34-2 on page 763.
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18. Massage (cont.)
Massage and manipulative therapy are contraindicated in patients with
Cancer
Osteoporosis
Localized infection
Cardiac and circulatory disorders
Because of the increased blood flow to the affected areas
Discuss the pathophysiology of why massage therapy is contraindicated in these patients.
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19. Osteopathy Pressure point therapy
Certain areas of the body are connected to specific identified pressure points such as hands, feet, and ears
Channels conduct vital energy through the body
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20. Energy Healing
Belief that electromagnetic flow emerges from the therapist’s hand and can funnel energy into the patient
The body, the mind, the spirit, and the emotions are usually involved in this form of therapy
Light therapy, another form of energy, is used to treat a jaundiced newborn
How does light therapy help to relieve jaundice in the newborn?
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21. Reflexology
Reflex points in the hands and feet thought to correspond to every organ or part of the body
Discuss the theory regarding reflexology.
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22. Acupuncture and Acupressure
Complex meridians that are pathways to specific organs or parts of the body
It is at these points that positive or negative energy can be realigned
“Chi” energy is thought to regulate proper body function
Points to avoid during pregnancy are
Bottom of foot
Inner lower leg
Base of thumb
Most areas over abdomen
Refer to Figure 34-4 on page 764.
Compare and contrast these areas.
Discuss the meridians, dermatome, and reflexology lines.
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23. Homeopathy Uses plants, herbs, and earth minerals
Belief that disease is an energy imbalance and that prescribed remedies assist the body to reestablish correct balance
Taken sublingually
Don’t combine with caffeine, alcohol, or traditional Western medicine
Only one remedy is administered at a time
Give examples of potential complications combining homeopathy with Western medicine.
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24. Ayurveda Ancient Hindu healing regimen
Deals with biological rhythms of nature
Includes music, herbs, massage, aromatherapy, and a tailored diet
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25. Aromatherapy
Involves the use of concentrated fluid or the essence of specific herbs that are combined with steams or baths to inhale or bathe the skin
NOTE: Concentrated pure oils can cause burns on the skin if used incorrectly
In what situations would aromatherapy be beneficial for a patient?
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26. Nursing Tip
Lavender, chamomile, and sandalwood essential oils are useful in aromatherapy for children with chronic pain
Discuss the nurse’s role in the use of these essential oils.
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27. Hypnotherapy Patient enters a hypnotic state of induced sleep
Under the guidance of a practitioner, specific and potentially long-lasting suggestions are given to the patient
Some patients resist the trance state and are not candidates for hypnotherapy
Give an example in which hypnotherapy might be beneficial for a patient.
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28. Hydrotherapy Promotes relaxation
How does hydrotherapy promote relaxation?
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29. Guided Imagery
Patient focuses on a specific image which can result in the reduction of stress and increased performance
What is an example of guided imagery?
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30. Biofeedback
A type of relaxation therapy that enables the patient to recognize tension in the muscles via response on an electronic machine
When would biofeedback be used?
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31. Chiropractic Care
Deals with the relationship between the spinal column and nervous system
Involves nerve energy thought to be responsible for restoring and maintaining health
Discuss situations in which spinal manipulation should be avoided.
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32. Herbal Remedies Powerful nutritional agents Most are safe to ingest
Herbal remedies consumed during pregnancy can reach the fetus
Herbal capsules are about 4 times stronger than herbal teas
Herbal extracts are about 4 to 8 times stronger than capsules
Discuss the differences among an herbal capsule, extract, and tinctures.
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33. Common Herbs Contraindicated in Pregnancy and Lactation
Aloe vera
Garlic
Ginkgo biloba
St. John’s wort
Angelica (dong quai)
Chamomile
Feverfew
Flax (flaxseed)
Ginseng
Kava kava
Ma huang (ephedra)
Nettle
Discuss the various uses and contraindications for the herbs listed.
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34. Herbs Commonly Used in Pediatrics
Blue-green algae
Chamomile
Ephedra
Echinacea
Evening primrose oil
Fennel seed oil
Feverfew
Fish oil
Ginger
Ginkgo biloba
Ginseng
Ask students if they have used any of these herbs.
Did they prove to be effective?
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35. Herbs that Promote Menstruation
The following herbs promote menstruation and may cause miscarriage if used during pregnancy:
Cascara
Cohosh
Goldenseal
Juniper
Marjoram
Motherwort
Mugwort
Pennyroyal
Sage
Senna
Wormwood
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36. Popular Herbs Used in Menopause
Black cohosh
Sage
Dong quai
Chasteberry
Motherwort
Discuss how these herbs can assist the menopausal woman.
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37. Hyperbaric Oxygen Therapy
Uses an airtight enclosure to provide compressed air or oxygen under increased pressure
Contraindicated in pregnancy
This therapy can cause the ductus arteriosus to close, resulting in fetal death.
Give examples of situations in which hyperbaric oxygen therapy might be beneficial to a patient.
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38. Sauna/Heat Therapy Thought to help eliminate body waste
Patients should monitor their pulse during this form of treatment
This type of therapy is contraindicated in pregnancy
Discuss why patients should monitor their pulse.
Why is this therapy contraindicated during pregnancy?
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39. Question for Review
What are some CAM therapies that are currently used regularly in the labor unit?
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40. Review Objectives Key Terms Key Points Online Resources
Critical Thinking Questions
Review Questions
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