Chapter_014.ppt

Chapter 14
Complementary and Alternative Strategies
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Holistic Practice
Health defined as more than the absence of disease
Health: optimal wellness in all aspects of being
Goals
Support a person’s natural healing systems
Consider the whole person
Consider the environment surrounding person
Often considered complimentary or alternative
Moving into mainstream US practice
Useful adjuncts to nursing practice

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Holistic: encompasses emotional, spiritual, and relational well-being
Combine with the physical body
Together they define a whole person
Allopathic medicine: focus is on identifying and treating disease
Care by physician or midlevel provider
Drugs, surgery, procedures to ailments

Holistic Versus Allopathic
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Alternative Health Modalities
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Source: Nat’l Health Statistics Report # 79 – Nat’l Center for Health (2015)

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The American Holistic Nurses Association (AHNA) defines holistic nursing as nursing practice that heals the whole person
Per AHNA: “specialty practice that draws on nursing knowledge, theories, expertise and intuition to guide nurses in becoming therapeutic partners with people in their care.”

Holistic Nursing
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Biologically based practices
Mind and body techniques and practice
Manipulative body-based practices
Energy therapies
Ancient medical systems
Whole medical system (includes all domains)

Domains are neither mutually exclusive nor inclusive—considerable overlap

Types of Therapy
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Ayurvedic medicine (India)
Evolved over thousands of years
Herbs, massage, diet, drugs
Goal is mind-body harmony
Traditional Chinese Medicine (China)
Evolved over thousands of years
Herbs, CAM treatments, acupuncture
Balance yin and yang life forces
Describes organs via fire, earth, metal,H2O, wood

Whole Medical Systems
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Naturopathy:
Combo of traditional and 19th century European modalities based on healing power of nature
No RX, injections, x-rays or surgery
Healthy lifestyle, cleansing regimens, diets, manipulation, exercise
Homeopathy—founded by Hahnemann 1807
Administers small amounts of dilute pathogenic substances to stimulate body’s healing abilities
FDA hearings 2015—unfavorable findings

Whole Medical Systems
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Use of natural products—historic roots
Medicinal herbs found in prehistoric man
Botanical herbs inventoried in Middle Ages
Current modalities:
Nutritional counseling: good efficacy data
Herbs, vitamins, minerals (not multivitamins or CA++)
Probiotics (“friendly” bacteria)
Aromatherapy aka essential oil therapy

Uses naturally extracted plant oils to promote health
Hydrotherapy: ice, steam, sauna, compresses

Biologically Based Practices
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Spinal or bone manipulation
Application of controlled force on bone or joint
Performed by chiropractors, physical therapists, and osteopathic physicians
Chiropractic focuses as spinal alignment
Cranial and cranio-sacral therapy
Focus on skull and flow of CSF
Gentle pressure cranium, spine, sacrum
Goal to restore free movement of CSF

Manipulative and Body-Based

Modalities
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Physical therapy: variety of modalities
Manipulation, massage, heat or cold, movement, electrical impulse
Treat pain and restore function and ROM
Massage—various techniques
Manipulation of muscle and soft tissue
Reduce stress; enhance relaxation
Reflexology—manipulation and energy fields
Pressure to hands and feet
Pressure points correspond to body organs

Manipulative and Body-Based

Modalities (Cont.)
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Guided imagery: directs the imagination
Focuses on calming thoughts or experiences
Promotes sense of well-being, relaxation
Randomized controlled study shows improved quality of life and some impact on laboratory values
Meditation—focused attention, mindfulness
Quiets the mind, reduces stress
Part of some religions but not a religious activity
Variable formats: breath, chosen word, walking

Mind Body Medicine
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Hypnotherapy
Focused attention of unconscious mind
Recall of suppressed events and behavior change
Commonly used for tobacco cessation
Biofeedback—relaxation technique
Focus on vital functions: HR, BP, breathing rate
Visualizations to bring about change
Neurolinquistic programming (NLP)
Changes behavior via change in thinking/speaking

Mind Body Medicine
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Movement Arts
Qigong (Chinese)
Relaxed movement with meditation,
Controlled breathing to move qi energy and increase vital energy
Tai chi (from Chinese martial art)
Combined physical movement, breath control, meditation
Sequence of poses flows in unbroken rhythm to balance energy flow
Brings awareness moment-to-moment state of body
Produces meditative state

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Movement Arts
Yoga (Hindu)—many forms
Origins as spiritual practice
Hatha yoga—most familiar in Western culture
Involves positions and breath control
Positions relaxing or may require strength
Documented health benefits

Improves flexibility, promotes relaxation, decreased stress, improves pain management
Dance therapy—mind and body move in response to music

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Energy Therapy

Energy flows through the body
Energy nourishes organs/promotes optimal functioning
Goal: energy work releases blockages to energy flow, rebalances life energy
Cultural energy name variations
Chinese: Chi or qi
Japanese: Ki
East Indian: Prana
Western civilization: subtle energy, life energy, or universal energy

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Energy Therapy Modalities

Acupuncture
Manipulates chi or qi by stimulating (fine needles) precisely mapped points on the skin points overlie channels (meridians) through which chi travels
Acupuncture points act as valves in meridians
Valve opens/closes, corrects imbalance in chi
Stimulation via needles, electrostimulation, laser, light, burning herbs (moxibustion)
Effective: substance abuse, depression, insomnia, nausea/vomiting, pain

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Energy Therapy Modalities

Acupressure and Reflexology
Acupressure
Stimulation of meridian points by hand pressure
No oil needed; can be done with person clothed
Reflexology
Deeply applied pressure to mapped points on feet and/or hands
Pressure applied with thumbs
Pressure points correspond to organs of the body that will be stimulated by pressure

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Energy Therapy Modalities

Touch Therapies
Touch therapies fall under umbrella of energy therapies
Practitioners use their hands to direct energy (from environment) to individual
Goal is to restore balance and harmony
Examples: therapeutic touch reiki, attunement, Jin Shin Jyutsu, polarity therapy, healing touch

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Energy Therapy Modalities

Therapeutic Touch
Conceptualized by Martha Rogers
Human energy fields interact with environmental energy fields
TT involves three elements
Centering of practitioner (calm, present in moment, connected)
Assessment (sensing disturbances/imbalances by moving hands over body)
Treatment: methods to change patterns of energy field (unruffling), or direct energy to person/redistribute energy (modulation)

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Energy Therapy Modalities

Additional Modalities
Healing touch (similar to therapeutic touch)
Adds full-body techniques for moving energy and dis -specific energy interventions to modulation phase
Qigong (Chinese)
Pranic (East Indian)
Reiki (Japanese): attunement opens energy channel; brings universal energy through body to recipient
Polarity therapy: Clearing energy blockages and rebuilding health
Jin Shin Jyutsu: finger pressure to healing points

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Prayer and Distant Healing
Prayer
Different meanings to different people
Common belief aids in recovery
Research mixed on therapeutic benefit
Distant healing
Prayer for others
Method: praying circle
Sharing of energy and sending of energy to person in need
Research did not validate this therapy

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Music Therapy and Pet Therapy
Music therapy
Use music/sounds to produce desired changes in behaviors, emotions, physiological processes
Influences limbic system (involved with emotions/feelings)
Pet therapy
Two-thirds of three US households have at least one pet
Half of older Americans have a pet
Pets may improve depression, loneliness
Improve physical activity

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Nursing Presence
Being available in a situation with the wholeness of one’s individual being
Nurse’s presence can contribute to healing
“Being with” rather than “being there” or “doing to”
Attention “focused” vs attentive
Touch “caring” vs task oriented
“Listen” vs merely hearing patient

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Most Complementary and Alternative Medicine (CAM) interventions lack a strong scientific evidence base, as many have not been studied with rigorous, well-designed clinical trials.
Some CAM providers are not credentialed in a standardized national system, credentialing regulations and standards vary nationally
Safety issues for some CAM; caution needed

Safety and Effectiveness
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