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Complementary and Alternative Therapy
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C. Matthews RN, MSN M.Elias RN, MSN SP10
State Standard 15) Review health topics surrounding complementary and alternative medicine such as acupuncture, biofeedback, and herbal treatments. Develop a public service announcement or academic poster presentation intended to inform consumers or health professionals about the specific topic. Include general information, purported benefits, uses in the United States, side effects and/or risks, relevant research, cost, and links to more information. Cite evidence from print and digital resources such as research journals, the National Institute of Health, the Mayo Clinic, and Medline Plus. 12/14/2017 C. Matthews RN, MSN M.Elias RN, MSN SP10
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C. Matthews RN, MSN M.Elias RN, MSN SP10
Objectives Students will be able to… Identify the role of a healthcare worker in regards to complementary and alternative therapies. Define complementary and alternative therapies Identify common complementary and alternative therapies in use today through creation of a educational brochure. 12/14/2017 C. Matthews RN, MSN M.Elias RN, MSN SP10
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Integrative Health Care is
A Concept of Coordinated Health Care that Includes ALL the Treatments (Conventional and Alternative therapies) and Health Practices that Your Patient uses in their Life. How do We get our Patients to Tell us about the Alternative Therapies they use? Course outcome #1 Unit outcome #1 C. Matthews RN, MSN M. Elias RN, MSN SP11
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What is Holism? Holism is treating the patient as a whole and respecting alternative therapies they use Goal is Optimal state of Wellness for each unique person Patients may use Alternative therapies to: Enhancing Resistance to Illness Reducing aggravating behaviors Stress Management Course outcome #1 Unit outcome #1 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Healthcare worker must:
1.Be non-judgmental despite personal opinions 2. Build rapport by showing client respect – if not, he may be afraid to tell about alternative therapy use 3. Understand that alternative therapies can be beneficial, when used correctly 4. Be aware that alternative therapies can be dangerous if they interacts or interfere with conventional treatment Course outcome #1 Unit outcome #1 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Healthcare worker must:
5. Be willing to teach the public about the positive and negative information regarding Alternative therapies 6. Be aware that use of alternative therapies are popular and increasing and must be included in the history & physical 7. Know that Herbals, in particular, can have significant effect on prescription drugs and body function Course outcome #1,2 Unit outcome #1 C. Matthews RN, MSN M. Elias RN, MSN SP11
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C. Matthews RN, MSN M.Elias RN, MSN SP10
What is CAM C-complementary A- Alternative M-medications 12/14/2017 C. Matthews RN, MSN M.Elias RN, MSN SP10
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2 types of CAM Complementary modalities (therapies): used in conjunction with conventional medical practice. (Wilkinson, p. 1019) Alternative Modalities(therapies): used instead of traditional care. (Wilkinson, p.1019) Unit outcome #3 C. Matthews RN, MSN M. Elias RN, MSN SP11
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National Center for Complementary and Alternative Medicine
NCCAM (National Center for complementary and Alternative Medicine) Purposes: Fund studies evaluating effectiveness of C.A.M. Advance health professional knowledge re: C.A.M. 12/14/2017 C. Matthews RN, MSN M. Elias RN, MSN SP11
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NCCAM Domains of C.A.M. Ignatavicius pg 8; Wilkinson p. 1020
National Center for Complementary and Alternative Medicine –categories Mind-body therapies Manipulative and body-based therapies Biologically based therapies Energy therapies Unit outcome #3 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Mind-Body Meditation Stress relief/ reduce anxiety Relaxation
Reduced levels of lactic acid Decreased oxygen consumption Slowed heart rate Decreased blood pressure Improved function of immune system Reduce pain Relieve symptoms of psoriasis Improve health (References: Ignativicius; Wilkinson) Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Relaxation Used post-operatively (Ignatavicius, p. 299)
Relaxation techniques (Ignatavicius, p ) To reduce anxiety, tension & emotional tension which can exacerbate pain Relaxation (Wilkinson Vol 2, p. 967; Vol 1, pg ) Progressive muscle relaxation (PMR) (Wilkinson p. 807) Promoting sleep Can be taught in home setting Nurses can use for reduction of pain & stress. Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Guided Imagery Distraction when confronting pain, discomfort or fear
Making decisions and altering behavior Caution: not recommended for emotionally unstable or cognitively impaired client Helps reduce pain. Reduction of nausea & vomiting. Decreasing anxiety Promoting comfort during cancer treatment Ignatavicius, 6th ed. p. 9 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Mind - Body Journaling Hypnosis Humor
Provides a vehicle for expressing feelings Hypnosis Advanced training is NECESSARY Humor Quick research -How does the body respond to humor physically and mental? C. Matthews RN, MSN M. Elias RN, MSN SP11 Unit outcomes #1-5
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Spiritual Life force beliefs found in most cultures. (Wilkinson, p 1020) Faith healing (Wilkinson page 260) Based upon religious beliefs 12/14/2017 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Prayer Most Widely Used CAM in U.S. (NCCAM, 2004) Prayer For Self
For Others Healing Prayer Services Prayer Groups Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Spiritual Nurses should expect to work in collaboration with others, particularly ministers, pastors and chaplains, to meet the complex spiritual needs of all patients. Potential problem: the nurse and patient have different views of spirituality Respect patient’s wishes If patient asks for spiritual intervention that is inconsistent with the nurse’s beliefs, seek assistance from another nurse or chaplain. Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Manipulative and body-based methods
Movement & exercise Strengthens circulatory & respiratory function Endorphins Helps regulate metabolism Enhances Immune system Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Manipulative and Body-based Therapies
Yoga “life forces in correct balance and flow Concentration, strength, flexibility, symbolic movements Breathing, movement & posture Tai Chi Promotes the flow of qi or energy throughout the body Ignatavicius, p. 11 Reduces sx. of fibromyalgia Used in cardiac rehab programs, can lower BP Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Other Movement Therapies
Dance Therapy Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Chiropractic and Osteopathy
Relationship between Body Structure and Function Subluxation & Adjustment Quickly research what these are D.O. (doctor of osteopathy) vs. M.D. A D.O.’s training includes Osteopathic Manipulation Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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C. Matthews RN, MSN M.Elias RN, MSN SP10
Massage Muscles & Soft Tissues Benefits of Massage Relaxation Release muscle tension Help with muscle strain Increases blood flow Contraindications for Massage Certain medications Pregnancy Unit outcomes #1-5 C. Matthews RN, MSN M.Elias RN, MSN SP10
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Energy – Based Therapies
Body is believed to be made of different Energy fields Layers Reflexology ‘zones’ Based in Traditional Chinese Medicine Acupressure and Acupuncture are based off of these energy fields and points Unit outcomes #1-5 CC. Matthews RN, MSN M. Elias RN, MSN SP11
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Energy – Based Therapies
TT (Therapeutic Touch) Integral to assessment Bonding Communication Soothing, calming, comfort orientation Contraindications When NOT to touch Certain religions Personal thoughts of touch Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Reflexology/Acupressure
Ancient Egypt Energy Zones Top to Bottom Pressure Points Quickly research What conditions benefit from it? Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Acupuncture Derived from traditional Chinese medicine and other countries and alternative systems Needles are applied to Acupoints on the Meridians to restore the flow of qi Used for Migraine headache Pain and Anesthesia Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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C. Matthews RN, MSN M.Elias RN, MSN SP10
The dreaded nausea and vomiting which commonly occurs in some patients undergoing chemotherapy and inevitably, with the use of certain classes of agents, can often be worse than the disease itself. Most oncologists have experienced the patients who start vomiting at the thought of their next clinic visit. At the University of Los Angeles (UCLA) School of Medicine, a well-controlled study completed over two Years ago, the authors of the published paper reported significant reduction of nausea and vomiting when pre-treated with. It is now routinely administered before, after and in between chemotherapy treatment sessions for control or nausea and emesis. Such treatments are relatively simple and easily executed in an outpatient setting. Its effectiveness helps in minimizing the use of standard, expensive multi-drug anti-nausea regimens with their attendant side effects, given along with the chemotherapeutic agents. Acupuncture in Cancer Treatment by Eugene Mak, 12/14/2017 C. Matthews RN, MSN M.Elias RN, MSN SP10
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Biologically Based Therapies
Dietary Therapies Herbs Vitamins Aromatherapy Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Dietary Therapies Protective or healing agents found in plant and animal foods. Special diets are followed to reduce Free radicals: unstable molecules that alter genetic codes and trigger the development of cancer growth in cells. Special diets to attain Antioxidants: react with free radicals, preventing their damaging effects Sources of antioxidants: vitamin C, beta-carotene, vitamin E Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Aromatherapy – Wilkinson page 1030
Essences from oils extracted from plants & flowers. Conditions responsive to aromatherapy: Stress and anxiety Muscular and rheumatic pains Digestive disorders Skin conditions Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Aromatherapy Can be used for sense of smell, but also as compresses, baths or topical 12/14/2017 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Aromatherapy (Ignativicius, p.12)
Lavender – promotes relaxation & sleep Peppermint – stimulation, concentration Sandalwood – ease depression Tea tree – treating MRSA? Chamomile – relaxation Lemon – promotes sleep/ tx for insomnia and/or digestive disorders Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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HERBALS – what to know Major drawback: May delay important diagnosis and treatment. Intervention: Make certain MD or ARNP is aware of client’s use of herbals. action: What to assess & instruct pre-op client regarding herbal therapy. Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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HERBALS – what to know FDA categorized herbals as food and nutritional supplements not as drugs Are not FDA approved The Dietary Supplement Health & Education Act (DSHEA) of 1994 allowed herbs to be sold as dietary supplements as long as there are no health claims written on labels DSHEA requires no proof of safety or efficacy and sets no standards for products labeled as supplements, i.e. no guarantee the herb is properly prepared Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Commonly used Herbals Gingko bilboa Garlic Echinacea Ginseng
St. John’s Wort Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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C. Matthews RN, MSN M.Elias RN, MSN SP10
Activity In your assigned groups Create an educational brochure for the community over an alternative therapy of your choice. Include information over the therapy such as how is it performed, how is it suppose to help, info, benefits, uses in the US, FDA approved, risks, side effects, fun facts, and would you personally undergo it? You will present these. 12/14/2017 C. Matthews RN, MSN M.Elias RN, MSN SP10
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Ginko Biloba Reduce Memory Problems, Dementia, Peripheral Vascular Disease Antioxidant & Vasodilatory Properties BUT can cause BLEEDING when used with Anticoagulants Avoid before surgery Also cause Headache, GI Upset Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Garlic Lowers Cholesterol, Lowers BP, Natural Antibiotic,
Natural Anti-platelet Agent BUT Causes BLEEDING with other Anti-platelet Drugs Potentiates Anti-diabetic Drugs Avoid before Surgery Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Echinacea Builds Immunity, Helps Wound Healing
Use > 8 Weeks & Possible Immune Function Suppression NOT Recommended for People with Immune Diseases Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Ginseng Asian Ginseng- Diabetes, Erectile Dysfunction, “Unclear” Thinking American Ginseng- Diabetes, Prevention of Colds & Flu Siberian Ginseng- Prevent Colds & Flu, reduce Severity of Herpes Simplex type 2 Infections BUT, BUT, BUT, BUT… Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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St. John’s Wort Ease Mild to Moderate Depression
BUT causes Photosensitivity DO NOT use in Major Depression DO NOT use with Other Antidepressants Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Herbals Alert: “Natural” does not always mean harmless.
Plants used improperly can be poisonous. Chemicals within herbs can strengthen the immune system, alter blood chemistry, or protect specific organs against disease Caution: some individuals may have allergies Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Herbals Special precaution with pregnant or lactating women and children – should not use without physician’s knowledge Rationale: Unpredictable biologic effects Possible allergies Side effects Herbs have chemical composition Little or no regulation of production/ quality Possible herb/drug or herb/herb interaction Possible delay of treatment is dangerous Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Herbals Always ask about use of herbals when getting medication history “What is the story of why the patient is using the plant medicine or therapy?” Libster, p. 809 Teach clients to look for products labeled ‘standardized’ – these more likely to have accurate amounts of herb and less likely to have contamination Course outcome #2, 3 & 4 Unit outcomes #1-5 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Course outcome #2 Unit outcome #6 C. Matthews RN, MSN M. Elias RN, MSN SP11
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What is Quackery? A pretender Questionable products & services
Overpromotion vs fraud Misinformation Useful for some purposes, not others Course outcome #2 Unit outcome #6 C. Matthews RN, MSN M. Elias RN, MSN SP11
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How to spot Quackery Tell only part of the story
Overpromotes nutritional insurance Play on fears about chemicals ‘Everyone needs supplements’ Promise quick, dramatic, miraculous results Anecdotes & testimonials Questionable credentials Claim persecution Promote distrust Take claims directly to the media, not peers Resist peer review Course outcome #2 Unit outcome #6 C. Matthews RN, MSN M. Elias RN, MSN SP11
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Nurses Educate the Public
Teach signals of fraudulent practice Avoid ‘healers’ who: 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 Use testimonials that claim amazing results Course outcome #2 Unit outcome #6 C. Matthews RN, MSN M. Elias RN, MSN SP11
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References Cavender, A.(2003) Folk Medicine in Southern Appalachia. The University of North Carolina Press, Chapel Hill, N.C. Ignatavicius, D.D. & Workman, M.L. (2010) Medical-Surgical Nursing. 6th ed. Elsevier Saunders, St. Louis, Missouri. Libster, M.L. (2002) Delmar’s Integrative Herb Guide for Nurses. Delmar Thomson Learning. United States. Wilkinson, J.M. & Treas, L.S. (2011) Fundamentals of nursing, 2nd ed. FA Davis Company, Philadelphia, PA. 12/14/2017 C. Matthews RN, MSN M. Elias RN, MSN SP11
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