COMPLEMENTARY/ALTERN ATIVE THERAPY

Only Nature Heals.. Hippocrates

OBJECTIVES
At

the end of the discussion, the students will be able to: Describe the historical influences on current complementary/alternative modalities. Understand the connection between mind and body and the effect of this relationship on a persons health. Comprehend and identify the various complementary/alternative therapies

Understand

the use of complementary/alternative modalities throughout the life cycle, and the concept of the nurse as an instrument of healing in holistic nursing practice.

DEFINITION
Alternative Therapy - Sometimes called unconventional therapy, refers to a therapy used instead of conventional/contemporary/main stream/allopathic therapy. e.g. using acupuncture in place of analgesics Complementary Therapy - Refers to a therapy used in

e.g. guided imagery, music, and relaxation techniques are used to control pain in addition to pain medications.

Historical Influences on Contemporary Practices

Ancient

Greece healing system consist of myths, symbols, and rites administered by trained priest healers. China based on the belief in the oneness of all things in nature. India ayurveda a healing system based on hindu philosophy and indian philosophy, energy force in the

Ayurveda

body and mind are filled with vital energy (prana) that is the life force, that emphasizes prevention above curing. Shamanistic Tradition shamanism a practice of entering altered states of consciousness with the intent of helping others. Allopathic Medicine its fundamental principle is that body and mind are separate entities. Views the human as a collection of separate body parts. Focuses on

Goals of Complementary/Alternative Medicine (CAM)

Health

Promotion Pain Relief Treatment of Chronic Illness Spiritual growth

Categories of CAM
Mind-Body: Self Regulatory Techniques - can consciously control some functions of SNS ( CR, RR, and BP ) 2. Body-Movement: Manipulation Strategies - employ techniques for moving or manipulating various body parts to achieve therapeutic outcomes. 3. Energetic Touch Healing a group of techniques that work with the bodys energy field by the use of the hands
1.

4. Spiritual Therapies a state of wholeness is dependent not only on ones relationship to the physical and interpersonal environment but also to the spiritual aspects of self. 5. Nutritional Therapies for the past few years, nutritional interventions for prevention and treatment of disease have been increasingly used by the public.

I. Mind - Body

a. Relaxation as a result of flight or fight response, the body releases epinephrine, speeds up metabolism, and increases HR, RR. These techniques offer a way for a person to reduce stress and return to normal physiologic state. According to Cardiologist Herbert Benson (1975) He called relaxation response as a state of increased arousal of the parasympathetic NS, which leads to a relaxed physiological state.

One method for achieving relaxation is (PMR) Progressive Muscle Relaxation, this is the alternate tensing and relaxing of muscles. Aids to relaxation Training are; music or nature sounds, hypertonic saline relaxation tanks, isolation chambers, yoga, and imagery. Can be used by nurses to help their client reduce pain and stress.

Elements of a Relaxation Response

Quiet

environment Comfortable position Focused attention Passive attitude Practice

b. Meditation opening of the mind by focusing ones attention. This practice can bring about physiological changes. People who meditate strive for a sense of oneness within themselves and a sense of relatedness to a greater power and the universe. Breath Coaching, nurses can teach this modality to clients by using verbal cues, counting inhalations and exhalations, and showing the client how to take

Therapeutic Benefits of Meditation

Stress

Relief Relaxation Reduced levels of lactic acid Decreased Oxygen Consumption Slowed HR Decreased BP Improved functioning of Immune System * To evoke relaxation response thru meditation repeat a word or short phrase that has special

C. Imagery is a type of thinking without words in which the senses are used to evoke ones imagination. In nursing it is not a new concept in fact it has been used before by nurses as written in Notes on Nursing by Florence Nightingale, they help ill persons by altering their thoughts through images of nature, such as bouquet of flowers. Nurses can create guided imagery as long as the client can hear and understand the suggestions made by the nurses of meaningful and physiologically correct images.

For example; a nurse can show a chart of the stages of bone healing to a fractured client. Imagery is very helpful in reducing pain and anxiety during procedures, it also decreases medication and the need for restraint. Aside from using it as a distraction for pain, discomfort and fear, it is also a powerful tool for making decisions and altering behaviors.

d. Biofeedback is a measurement of physiological responses that yields information about the relationship between the mind and the body and helps client learn how to manipulate those responses through mental activity. Uses a specially designed device that measures bodily responses. Interpretation of these responses are

Biofeedback is beneficial in rehabilitation settings to help clients who have lost sensation and function as a result of illness/injury. It also enhances relaxation in tense muscles, relieves tension, headaches, bruxism, reduces pain in temporomandibular joint syndrome, and relieves backache. Temperature Biofeedback is also useful in training people to purposely warm their hands to treat Raynauds Disease, to lower

e. Hypnosis induces altered states of

consciousness or awareness ( trance ) during which the person is more receptive to suggestion. It also enhances the clients ability to form images. Therapeutic use of suggestion is the heart of Hypnosis. Suggestions can be phrased indirectly or directly. Effective for pain, anxiety, and other physiological disturbances It does not however cure magically nicotine/alcohol and drug addiction, and it must be used with other treatment modalities.

II. Body Movement: Manipulation Strategies

a.

Movement and Exercise - as a therapeutic intervention and health promoting activity is associated with athletic exercise, dance, celebration, and healing rituals. - Nurses can help clients use movement as therapy in a variety of ways, such as ROM, water exercises, PT, and

Benefits of Exercise Improves Circulation Enhances respiratory function Promotes elimination Stimulates the release of endorphins Helps regulate metabolism Enhances immune function Yoga - an ancient ritual movement that involves completing a series of postures carried out in sequential order. Three main elements: breathing, movement, posture It requires concentration, strength, flexibility and use of symbolic movements.

 Tai Chi is based on the

philosophy of the quest for harmony with nature and the universe through the laws of the complementary (yin and yang) balance. When perfect harmony exists, everything functions effortlessly, spontaneously, perfectly, and in accordance with the laws of nature. Consists of a series of dance like movements. Enhances stamina, agility, balance and boosts energy.

b. Chiropractic the major principle in

this therapy is that the brain sends vital energy to every organ in the body via the nerves originating in the spinal column. Disease results from interferences along the pathway in the Spinal Cord, therefore manipulation of the spinal column is useful in alleviating a variety of illnesses. Is widely accepted by the medical community. Nurses should encourage clients considering chiropractic services to

III. Energetic Touch Healing one of the most universal CAM a. Touch

modalities. Simply defined as the means of perceiving or experiencing through tactile sensation. According to Montague (1986 ) touch is the earliest sense to develop in human being and thus provides a basic means of interacting with others and the environment. The nurse must convey positive intentions when touching a client because it involves personal contact. When in doubt, the nurse should withhold touch until effective

Uses of Touch: 1. Is an integral part of assessment. 2. Promotes bonding between nurse and client. 3. Is an important means of communication, especially when other senses are impaired 4. Assists in soothing, calming, and comforting 5. Helps keep the client oriented. Contraindication: It is important to know when not to touch. It maybe difficult for persons who have been neglected, abused, or injured to accept touch therapy. Touching those who are distrustful or angry may escalate negative behaviors. Persons with burns or overly sensitive skin may not benefit from touch.

b. Therapeutic Massage is the application of pressure and motion by the hands with the intent of improving the recipients well being. It involves kneading, rubbing, and using friction. Nurses have been administering back rubs to provide comfort to hospitalized clients. A backrub or massage can achieve many results, including relaxation,

BASIC MASSAGE TECHNIQUES Effleurage: The whole hand is used. Gliding and long rhythmic strokes are used. Firm, even-pressured strokes are directed toward the heart to assist blood return. Lighter pressure is used when moving away from the heart. Petrissage: Pressing, squeezing, kneading, and rolling movements by both hands (use entire hand) are used. Deep circulation is enhanced. C-shaped motions stimulate the muscle body. Promotes muscle relaxation. Friction: Thumb pads, heel of hand, or fingertips are used. Focused, deep, circular motions are used. Penetrates deeper muscle layers. Is done after effleurage and petrissage.

Tapotement: Palms, fingertips, and knuckles are used. Brisk, vigorous, rhythmic, percussive movements are used. Hands alternately tap, cup, slap, and pummel muscles. Invigorates and stimulates tired muscles. Vibration: Very fine, rapid, shaking movements are administered by the entire hand. Stimulates or relaxes muscles. Precautions with Massage Massage should be used with caution for people with heart disease, diabetes, hypertension, or kidney disease because increased circulation in these conditions may be harmful. Massage should never be attempted in areas of circulatory abnormalities such as aneurysm, varicose veins, necrosis, phlebitis, or thrombus or in areas of soft-tissue injury, open wounds, inflammation, joint or bone injury, dermatitis, recent surgery, or sciatica

c. Therapeutic Touch - is based on ancient healing practices (laying of hands) consists of assessing alterations in a persons energy field and using the hands to direct energy to achieve a balanced state. Can be learned in workshops, can be done with hands either on or off the body in the energy field, complements medical treatments and has reasonably consistent and reliable results. Relaxation may be achieved as quickly as 2-5 minutes. Research has shown that TT is effective in wound healing, relaxation and immunologic functioning.

Phases of Therapeutic Touch

Phase Centering

Definition

Technique

Assessment (Scanning)

Unruffling (Clearing)

Treatment (Balancing, Rebalancing, or Intervention)

Evaluation

Bringing body, mind, and emotions Become centered by use of: to Controlled breathing a quiet, focused state of Imagery consciousness Meditation Being still Being nonjudgmental Hold hands 2 to 6 inches away from persons energy field while Using the hands to determine the moving the hands from the head to nature of the clients energy field the feet in a rhythmic, symmetrical Being attuned to sensory cues manner. (e.g., warmth, coolness, static, pressure, Use slightly more vigorous hand tingling) movements from midline while to detect changes in clients energy continuing to move in a rhythmic and symmetrical manner from the Facilitating the symmetrical and head to the feet. rhythmic flow of energy through the Field Because each practitioner experiences the living energy field uniquely, the law of opposites serves Projecting, directing, and as a guideline for intervening (e.g., if modulating energy on the basis of the nature of a pulling or drawing sensation is detected, then direct energy to the the living energy field depleted area until it feels Assisting to reestablish order in replenished). the Continue to assess, clear, and System balance the field while remaining centered Reassess the field.

d. Healing Touch is an energy based therapeutic modality that alters the energy field through the use of touch. Was developed by Janet Mentgen. Used for headaches, spinal problems and pain. Uses centering a process of bringing oneself to an inward focus of serenity before initiating treatment. Is a useful tool to employ before performimg any treatment or before any

e. Shiatsu Acupressure Shiatsu means finger pressure Acupressure a process that uses needles and heat to deliver treatment. In shiatsu, blocked energy within the client is released by application of fingers, thumbs and heel of the hand along certain pressure points (meridians). Nurses should be self aware and grounded when they are using shiatsu acupressure;

f. Acupuncture is the use of needles inserted at specific points on the body (energy pathways) to promote healing. Is done to manipulate the energy flow throughout the body; treatment focuses on correcting the flow of chi when imbalances occur. TCM believes that meridians conduct chi between the bodys surface and internal organs. Acupuncture is believed to stimulate the CNS to release chemicals into the muscles, SC, and brain

Used

for chronic pain relief. Studies have been done: more than half of women with major depressive disorder who received acupuncture improved significantly Moxibustion-application of heat from burning herbs at acupuncture points to pregnant women with breech presentation significantly increased the number of normal head-first births.

g. Reflexology is rooted in ancient healing arts. Current use of this therapy is credited to the work of William H. Fitzgerald, a physician who discovered that applying pressure to certain parts of the fingers could relieve pain in other body parts (1900s). Eunice Ingham (1930s) discovered that certain points on the feet were more responsive to pressure and provided better pain relief than points on the hand. The theory on reflexology states that illness manifests if there are calcium and acid deposits in a persons foot. Pressing specific points on the foot stimulates energy movement by removing the accumulated toxins in the body. Used for chronic conditions such as: asthma, sinus infections, migraines, irritable bowel syndrome, kidney stones and

IV. Spiritual Therapies

a.

Faith Healing at the heart of spiritual or faith healing is the practitioners belief that one has to purify ones self and reach a state of unity with God or a Higher Power. This is usually done thru prayers. Before a healer performs the healing, he adapts a passive and receptive mood in order to be a channel for divine power

b. Healing Prayer - when individuals pray, They believe that they are Communicating with God or Higher Power. Prayer is an integral part of A persons spiritual life, and as such can affect well being. Research has shown that religious practices such as worship and prayer have significant health and survival implications Meditation and prayer elicit physiological calm and a sense of peacefulness

a. Nutraceuticals refer to any natural subsatnces found in plant or animal foods that act as protective or healing agents. Phytonutrients chemicals found in plants. The best source of nutrient is fresh whole foods preferably eaten in their natural form

V. Nutritional Therapies

Actions and Sources of Major Phytonutrients

Sources Actions

PhytoNutrient Ascorbic acid Capsaicin

Citrus fruits, broccoli, most fruits Binds iron, preventing it from and becoming a cancer-causing Vegetable preoxidant Red chili peppers Helps prevent carcinogens from binding with DNA at the cellular level Reduces the risk of gastrointestinal cancers Soybeans, flaxseed, nuts Inhibits growth of tumors Apples, pears, plums, prunes Improves colon health; encourages growth of beneficial intestinal flora Protects against prostate cancer; helps block UVA and UVB rays Helps reduce menopausal symptoms; may block some cancers (i.e., breast, prostate) Inhibits uptake of cholesterol from foods; blocks hormonal role in cancer production

Catechins Green tea, black tea Fiber lignans Fiber pectins Lycopene Tomatoes, tomato sauce Phytoestrogens Soy products, alfalfa sprouts Phytosterols Plant oils, corn, sesame, soy, safflower, pumpkin, wheat Protease inhibitors Soybeans and soy products,

b. Antioxidants and Free Radicals Antioxidants is a molecule capable of slowing down oxidation of other molecules; reducing agents. Beneficial effects: cancer prevention, reduction of heart disease, retardation of aging. e.g. Vitamin E, C and gluthathione Antioxidants scavenge free radicals ( unstable molecules that alter genetic codes ) in the blood stream. Sources: Fruits, Vegetables, beta carotene Vitamin E.

c. Herbal Therapy has been a powerful tool in folk healing for centuries. Many drugs commonly used today were derived from folk herbal medicine like Salicin found in white willow bark has been used by TCM and native americans for pain relief, this same salicin is a precursor to salicylic acid. Different herbs contain contain different compounds that can boost immune system, alter blood chem, protect specific organ against disease.

CONDITIONS THAT RESPOND WELL TO HERBAL THERAPY Allergies Arthritis Digestive problems (indigestion, diarrhea) Headache Insomnia Kidney and urinary tract infections Menopausal symptoms Menstrual problems High or low blood pressure

Medicinal Value of Herbs Herb 1. Aloe Vera (Aloe Vera) Medicinal Use (s) Promotes wound healing Minor Cuts and Abrasions Burns Promotes wound healing (Cuts, Abrasions) Minor Burns, Sun Burn, Acne, Oral Thrush Vaginal Thrush (as a douche)

2. Calendula (Calendula (Officinalis)

3. Celery Seed (Apium graveolens) Cholesterol-lowering effect, dizziness, Headache, Diuretic 4. Chamomile (Matricaria chamomilla; Anthemis nobilis) Produces a calming effect, nausea, tension HA

5. Dandelion (taraxacum officinale)Diuretic, decreases edema (premenstrual) Indigestion 6. Eucalyptus (Eucalyptus Antibacterial, decongestant effect

Herb
8. Feverfew (Tanacetum Parthenium) 9. Garlic (Allium Sativum)

Medicinal Use (s)

Migraine HA Decreases cholesterol, protects and treats respiratory infections, expectorant Nausea (motion sickness, morning sickness) Stimulates circulation in feet and hands, Expectorant, relieves indigestion and flatulence, diarrhea Enhances cerebral blood flow, Mild depression, Dementia, Impotence, Peripheral vascular insufficiency, PMS, Memory Impairment Headache, reduces muscle spasms, increases relaxation Liver disorders, Hepatitis, Cirrhosis, Gallstones HA, Sinus Congestion, Digestive aid Mild to moderate depression, sleep disorders, Viral infections Antibacterial

10. Ginger (zingiber officinale)

11. Ginkgo (Ginkgo biloba)

12. Lavender (Lavandula Angustifolia) 13. Milk Thistle (Silybum marianum) 14. Peppermint (Mentha x Peperita) 15. St. Johns Wort (Hypericum pereforatum) 16. Sage (Salvia officinalis)

VI. Other CAM

a.

Aromatherapy is defined as the therapeutic use of concentrated essences or essential oils that have been extracted from plants and flowers. When these oils are used for massage or for inhalation, it may produce a stimulating, uplifting, relaxing or soothing effect. It also produce endorphins and rejuvenate the immune system Some essential oils have

CONDITIONS RESPONSIVE TO AROMATHERAPY Stress and anxiety-related problems Muscular and rheumatic pains Digestive disorders (e.g., nausea) Female sexual health conditions (e.g., PMS, postpartal problems, and menopausal symptoms) Skin conditions

b. Humor is a frequently used therapy. Humor has many therapeutic effects: Increased ability to cope with pain Enhanced immune functioning Reduced preprocedural anxiety Humor can be used effectively to relieve anxiety and promote relaxation, improve respiratory function, enhance immunological function, and decrease pain by producing endorphins

Using Humor as a Therapeutic Intervention 1. Establish a trusting nurseclient relationship. 2. Conduct a humor assessment to determine the type of humor appreciated by the client and the clients usual response to humor. 3. Follow the clients lead in the type of humorous strategies used (i.e., jokes, satire, puns). 4. Involve the family and significant others in the humor. 5. Use humor as an adjunct, not a substitute, for pain medication. 6. Continually evaluate the humor strategy for its effectiveness.

c.

Pet Therapy the use of animals to enhance health status has a long history. In Britain in the 18th 19th century, pets were used in institutionalized patients to give a sense of meaning and purpose to their lives because of developmental delays. According to Florence Nightingale a small pet is often an excellent companion for the sick, especially for long chronic cases. Pets are also helpful in elderly people to fight loneliness Uses: help overcome physical limitation, improve

d. Music Therapy music enters the bodymind through the auditory sense. Therapeutic use of music consists of playing music to elicit positive changes in behavior, emotions, or physiological response Music is often combined with imagery as it can add to the relaxation response and therefore heighten the individuals imagination. Music can be used to relax or stimulate. The basic elements of music (rhythm, pitch, and intensity) are transmitted by sensory impulses from the cochlea to the thalamus, where they are mediated, then

Ways In Which Music Has Been Used as Therapeutic Intervention Music is used by hospice nurses to reduce clients pain and ease the transition to death. Neonatal nurses often use lullabies to calm infants who are on ventilators or are irritable. Many labor and delivery nurses provide tape players and cassettes of relaxing music to clients. In rehabilitation units, relaxing music is often played. People with rheumatoid arthritis used guided imagery and music for 18 weeks and reported a reduction in pain as well an improved ability to ambulate. Children with attention deficit disorder (ADD) who listened to Mozart had better attention spans, improved mood control, decreased impulsivity, and improved social skills.

Nursing And Complementary/Alternative Approaches

Nurses

play an important role in educating consumers of this unconventional interventions by providing information about the safety and efficacy of these methods. Major challenge is promotion of integrative care in which clients use the best of CAM and conventional medicine. Consumers should be taught to recognize sings of fraudulent practices and healers. Should establish a setting in which clients feel free to express all issues related to their health. Other Nursing Interventions: provide clients with information about appropriate use of CAM; protect clients from unsafe practices and practitioners.

Signs of Fraudulent Practitioners: Promise immediate relief or success.

State that their way is the only sure therapy. Refuse to work with other health care providers. Claim to have all the answers. Place more priority on money than the clients well being. Use testimonials that claim amazing results. Make statements using phrases such

Nurse as Instrument of Healing When the nurse serves as an instrument of healing, the objective is to help the clients call forth their inner resources for healing. In order to accomplish this goal, nurses must develop the following attributes: Knowledge base: Initially established in nursing school and then continuously expanded through lifelong learning Intentionality: A conscious direction of goals that is essential in helping the healer to focus Respect for differences: Demonstrated by honoring clients culturally based health beliefs Ability to model wellness: Tending to own needs and attempting to stay as healthy and balanced

Population

Complementary/Alternative Therapies for Use throughout the Life Cycle

Recommended Complementary Therapies Massage (with modifications) Energetic-touch therapies Sound (e.g., recorded human heartbeat) Gentle movement Touch (stroking, skin-to-skin contact) Massage (with modifications) Energetic-touch therapies Music (e.g., lullabies) Movement (e.g., rocking) Massage Energetic-touch therapies Music (e.g., playing and listening to songs, singing) Movement Play (all activities should be age-appropriate) Humor Imagery Storytelling Art/drawing Aromatherapy (with precautions)

Premature infants

Infants

Toddlers and Pre schoolers

Population School-age children

Recommended Complementary Therapies Massage Energetic-touch therapies Music (playing and listening) Movement (e.g., dance) Play (all activities should be age-appropriate) Humor (e.g., riddles, jokes) Imagery Storytelling Art/drawing Aromatherapy (with precautions) Hypnosis Yoga Tai chi Pet therapy

Adolescents Adults

All Modalities All Modalities Massage (emphasis on lower back and legs) Energetic-touch therapies Breath coaching Imagery Hypnosis

Women during childbirth

Population Recommended Complementary Therapies Older adults Massage (lighter pressure and modifications for bodys status) Aromatherapy (with precautions) Heat and cold applications (with precautions) Any other modalities discussed in this chapter, as appropriate to condition and with precautions Terminally ill Massage Reflexology Energetic-touch therapies Music-thanatology Prayer Any other modalities discussed; as