Complementary Nursing Therapies

Definition

Complementary therapies are treatment modalities originating outside of Western medical practices that are used in addition to traditional Western medical practices. Alternative therapies are treatment modalities used in place of traditional Western medicine. The two terms are sometimes used interchangeably. The term integrative therapy may be used to describe the use of complementary and alternative (CAM) therapies with traditional Western medical practice. The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health defines complementary and alternative medical practices as "practices that are not currently an integral part of conventional medicine."

Description

The NCCAM groups CAM practices into five categories:

• Alternative medical systems. This category includes acupuncture and traditional Chinese medicine (TCM), the ancient Indian practice of Ayurveda, homeopathy, naturopathy, and practices considered traditional to other cultures. The term medical system means that these practices incorporate the use of dietary recommendations, exercise, meditation, and/or herbal remedies as part of the total treatment plan.
• Mind-body interventions. These include biofeedback, prayer, meditation, hypnosis, dance, music and art therapies, guided imagery, progressive muscle relaxation, and visualization. Many of these techniques aid in stress-reduction and can be taught to patients, either individually or in groups.
• Biologically based therapies. Included in this category are herbal remedies and supplements, special diets such as Dr. Dean Ornish's program (low-fat, vegetarian, meditation, exercise, and support group) for cardiac rehabilitation patients, vitamin therapy, or the use of laetrile or shark cartilage.
• Manipulative and body-based methods. Osteopathy, chiropractic, massage, and reflexology are considered manipulative therapies.
• Energy therapies. These practices are based on the philosophy that an energy field exists around the body. The goal of practices such as reiki, qi gong, and therapeutic touch (TT) is to reestablish a healthy energy field so that the body can then work to heal itself. The use of magnets to manipulate the energy field is another example.

Describing CAM practices using the vocabulary of Western medicine is often a challenge, as the concept of life force, or chi, does not exist. However, a health practitioner who has been with a dying patient will recognize that, when the patient has died, there is a physical difference in how the patient looks. They do not just look asleep, for that which made them alive is now gone. It is this rather ephemeral quality that is described as chi.

Acupuncture has existed for thousands of years. Treatment is based on the belief that the acupuncture points connect a system of meridians, or energy pathways, to the internal organs. When energy flows freely, health is experienced. Disease or illness represents a blockage of the flow of energy throughout the body. TCM uses acupuncture along with herbal remedies and diet to reestablih balanced energy. Acupuncture may use an herb called moxa to enhance the stimulation of the acupuncture points. Acupressure involves the stimulation of the meridian points by manual pressure rather than with the fine acupuncture needles. Acupuncture has been successfully used to treat dental pain and the nausea associated with pregnancy, post-surgical anesthesia, and chemotherapy. According to the NCCAM, the World Health Organization lists about 40 conditions for which acupuncture may be beneficial.

Ayurveda is a traditional Indian medical system based on the belief that disease and illness result when there is an imbalance of the three doshas, which represent qualities governing body type, as well as the seasons and the different times of day. Each body type is susceptible to its own set of illnesses. Treatment to reestablish balance involves diet, herbal supplements, yoga, meditation, and massage with certain herbal oils.

Homeopathy functions on the philosophy that substances causing illness can be used in very dilute quantities to reestablish health. The more the substance is diluted, the more potent it becomes. Homeopathic remedies come in tablet, liquid, and cream form, and are used for children as well as for adults. The Food and Drug Administration (FDA) regulates the manufacture of homeopathic remedies.

Mind-body therapies emphasize the healing power intrinsic within the human body. Biofeedback uses a machine that both records physical measurements, such as skin temperature and blood pressure, as well as giving visual or auditory cues to teach the individual to control these factors usually considered involuntary. Patients suffering from migraines may use biofeedback to learn to warm their hands and cool their foreheads, thus providing relief on demand. Patients may learn a meditation technique in order to control the effect of stress on the body, perhaps to decrease their high blood pressure. Many meditation techniques exist. In meditation, the individual tries to focus on a word, feeling, breathing pattern, or state of being in order to free the mind of other thoughts. Guided imagery is a technique encouraging individuals to utilize all their senses to create a peaceful, calming image in their mind. This technique works well with children, and can be used to distract from pain or anxiety. In progressive muscle relaxation, the individual tightens then relaxes the muscles of the body, starting with the feet and moving towards the head. This process helps the person become more aware of the feeling of tight versus relaxed muscles, and enables the body to achieve greater physical relaxation. Nurses can teach these techniques to their patients, empowering them with ways to manage the stress in their daily lives.

Herbal remedies and supplements are used for therapeutic purposes and may be a part of an alternative system, such as Chinese medicine or naturopathy. They may be taken in tablet form, drunk as a tea, applied in a carrier cream, or inhaled in a vapor. Aromatherapy uses essential oils to stimulate the brain through the sense of smell to bring about a physiological effect such as relaxation or mood elevation. While individual herbal remedies are being investigated, such as the use of garlic to reduce cholesterol levels, or the use of saw palmetto for benign protastic hyperplasia (enlarged prostate), the interaction of herbs with standard medications has often not been thoroughly researched.

Infant massage can be taught to new parents to facilitate bonding, and to teach them how to soothe their newborn. Infant massage has been used with infants in the intensive care unit to reduce their level of stress from being in an over-stimulating, noisy environment, address their emotional needs, foster weight gain, and enable earlier discharge.

Reflexology involves a directed massage of the feet or hands. Points on the hands and feet are believed to correspond with internal organs, similar to the connection between acupuncture points, meridians, and internal organs. In reflexology, the practitioner applies pressure to specific points on the feet or hands to stimulate or remove energy blockages, thereby promoting healing and restoring health.

Prayer and the use of support groups are other important methods that can have an impact on an individual's health. Individuals with cancer who attended support groups were found to live longer than those who did not attend a support group.

Therapeutic touch (TT) is an energy technique developed by a registered nurse and university professor, Dr. Dolores Kreiger. Practitioners use their hands to sense the energy around a patient, feeling for areas where the energy is stagnant, or blocked. The patient may feel a sense of warmth or tingling while the practitioner is working to rebalance the energy. The goal is to promote the patient's innate ability to self-heal by reestablishing free-flowing energy. TT has been used to decrease pain, allowing a patient to prolong the time period between pain medication, to accelerate the rate of wound healing, and to promote relaxation.

Viewpoints

A 1998 study reported that in 1997 an estimated $21.2 billion was spent on CAM services, of which $12.2 billion was spent out-of-pocket. This figure is greater than the amount spent for all hospitalizations in the United States in 1997. Nurses may choose to believe in the validity of CAM or to believe that these, or some of these, practices represent medical quackery. Regardless of their personal belief, nurses need to recognize that many of their patients will believe and/or follow these practices. Respect for a patient's belief system is fundamental to the practice of nursing. Because of this, nurses must become knowledgeable about CAM practices in order to provide better nursing care to their patients. As research studies using CAM practices report beneficial outcomes, the definition of which therapies are considered alternative and which are considered mainstream changes. For this reason, it may be best not to label a therapy as CAM in discussing its use with a patient. In addition, patients' cultural backgrounds affect which therapies are mainstream to them.

KEY TERMS

Chi, qi— Life-force energy existing in and around the body.

Osteopathy— A practice of medicine that focuses on the care of the toal person with an emphasis on the musculoskeletal system.

Professional implications

As patient interest in and use of CAM increases, nurses need to be aware of these practices, regardless of whether or not they have been scientifically proven to be effective. CAM and nursing intersect at many points, including:

• History and assessment. As the nurse documents the patient's pertinent medical history, CAM practices need to be included. Asking open-ended questions, such as, "What do you use to help your migraine pain?" may elicit a different response from the patient than the question, "Do you use alternative medicine for your migraine pain?" A 1999 study of women with breast cancer reported that while 72% of the women were engaged in at least one form of complementary medicine, only 54% informed their health care professional of their CAM use, although 94% told their alternative practitioner what medical treatments they were receiving. Reasons cited included concern of ridicule and perceived lack of interest from the professional. Patients requiring surgery may take herbal remedies that could interact with anesthesia medications. Knowledge of all the medications and supplements that the patient is taking could be critical.
• Triage. Nurses may receive telephone calls from patients who want to know if a particular herbal remedy is effective for their or their child's condition. In addition, patients may call after taking a remedy and experiencing an adverse side effect. Knowledge of herbal remedies could facilitate proper diagnosis.
• Nurse as practitioner. Nurses may choose to study CAM practices, become proficient in their use, and integrate their use into an existing nursing practice. However, nurses must keep in mind the legal implications of adding CAM therapies to their existing practice, to ensure they continue to practice within the legal boundaries of their license.

Resources

BOOKS

Ellis, Janice Rider, and Celia Love Hartley. Nursing in Today's World, 7th Edition. Philadelphia, PA: Lippincott, 2001.

Milton, Doris, and Samuel Benjamin. Complementary and Alternative Therapies: An Implementation Guide to Integrative Health Care. Chicago: Health Forum, Inc., 1999.

PERIODICALS

Adler, S. R., and J. R. Fosket. "Disclosing Complementary and Alternative Medicine Use in the Medical Encounter: A Qualitative Study in Women with Breast Cancer." Journal of Family Practice 48, no. 6 (June 1999): 453-8.

Eisenberg, D. M., et al. "Trends in Alternative Medicine Use in the United States, 1990–1997: Results of a Follow-Up National Survey." Journal of the American Medical Association 280, no. 18 (November 1997): 1569-75.

Griffin, Teresa M. "Introduction of a Positive Touch Programme: The Value of Infant Massage." Journal of Neonatal Nursing 6, no. 4 (July 2000): 112-116.

Hodge, Peggy, and Susan Ullrich. "Does Your Assessment Include Alternative Therapies?" RN 62, no. 6 (June 1999): 47.

Jones, Kristy. "Clinical Aromatherapy and Touch: Complementary Therapies for Nursing Practice." ANNA Journal 26, no. 5 (October 1999): 527.

ORGANIZATIONS

American Holistic Nurses Association (AHNA). P.O. Box 2130, Flagstaff, AZ 86003-2130. (800) 276-2462. 〈http://www.ahna.org〉.

OTHER

National Center for Complementary and Alternative Medicine. NCCAM Clearinghouse, P.O. Box 8218, Silver Spring, MD 20907-8218. (888) 644-6226. 〈http://nccam.nih.gov〉.