1. Complementary and Alternative Therapy

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Other Movement Therapies
Dance Therapy
Unit outcomes #1-5
C. Matthews RN, MSN
M. Elias RN, MSN SP11

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. Course outcome #2
Unit outcome #6
C. Matthews RN, MSN
M. Elias RN, MSN SP11

47. 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

48. 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

49. 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

50. 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