ComplementaryandAlternativeTherapiesforNursingPractice4thEdition.pdf

COMPLEMENTARY AND
ALTERNATIVE THERAPIES
FOR NURSING PRACTICE

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F o u r t h E d i t i o n

Karen Lee Fontaine
Professor, College of Nursing,
Purdue University Calumet,

Hammond, Indiana

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Library of Congress Cataloging-in-Publication Data
Fontaine, Karen Lee, 1943–author.
[Complementary & alternative therapies for nursing practice]
Complementary and alternative therapies for nursing practice / Karen Lee Fontaine, professor,
College of Nursing, Purdue University Calumet, Hammond, Indiana.—Fourth edition.
pages cm
Revision of: Complementary & alternative therapies for nursing practice.—3rd ed.—©2009.
Includes bibliographical references and index.
ISBN-13: 978-0-13-334650-3
ISBN-10: 0-13-334650-1
1. Nursing. 2. Alternative medicine. I. Title.
RT42.F64 2015
610.73—dc23
2013045244

Publisher: Julie Alexander
Publisher’s Assistant: Regina Bruno
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Program Manager: Erin Rafferty
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Executive Marketing Manager:
Phoenix Harvey

Marketing Specialist: Debi Doyle
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Cover Image: © Kara-Kotsya/Fotolia
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10 9 8 7 6 5 4 3 2 1

ISBN-13: 978-0-13-334650-3
ISBN-10: 0-13-334650-1

Dedication

This book is dedicated to Peggy Gerard, Dean, and
Kathy Nix, Undergraduate Coordinator, College of Nursing,

Purdue University Calumet for all their support and
enthusiasm as complementary and alternative medicine

was integrated into the curriculum.

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CONTENTS

Preface ix

Acknowledgments xiii

Reviewers xiv

UNIT 1 Healing Practices: Complementary and
Alternative Therapies for Nurses 1

Chapter 1 Integrative Healing 3

Chapter 2 Basic Concepts Guiding Alternative
Therapies 19

Chapter 3 The Role of Evidence-Based Health Care in
Complementary and Alternative Therapies 37

UNIT 2 Systematized Health Care Practices 47
Chapter 4 Traditional Chinese Medicine 49

Chapter 5 Ayurvedic Medicine 70

Chapter 6 Native American Healing and Curanderismo 90

UNIT 3 Botanical Healing 111
Chapter 7 Herbs and Nutritional Supplements 113

Chapter 8 Aromatherapy 133

Chapter 9 Homeopathy 149

Chapter 10 Naturopathy 162

UNIT 4 Manual Healing Methods 169
Chapter 11 Chiropractic 171

Chapter 12 Massage 183

Chapter 13 Pressure Point Therapies 202

Chapter 14 Hand-Mediated Biofield Therapies 217

Chapter 15 Combined Physical and Biofield Therapy 230

UNIT 5 Mind–Body Techniques 239
Chapter 16 Yoga 241

Chapter 17 Meditation 256

Chapter 18 Hypnotherapy and Guided Imagery 269

v

Chapter 19 Dreamwork 286

Chapter 20 Intuition 301

Chapter 21 Music as a Therapeutic Tool 311

Chapter 22 Biofeedback 320

Chapter 23 Movement-Oriented Therapies 327

UNIT 6 Spiritual Therapies 339
Chapter 24 Shamans 341

Chapter 25 Faith and Prayer 352

UNIT 7 Other Therapies 367
Chapter 26 Bioelectromagnetics 369

Chapter 27 Animal-Assisted Therapy 378

Appendix Alternative Therapies for Common Health Problems 393

Index 417

vi Contents

TRY THIS

vii

Energy 34
Massage 88
Positive Thoughts 107
Herbal Remedies 128
Soothing Potions 144
Top 10 Remedies 157
Pet Remedies 158
Visualization 167
Energy Boosters 181
Massage 199
Foot Massage 213
Experience Your Energy Field 227
Emotional First Aid 235
Redirecting the Flow of Energy 236
Heart Breathing 252
Loving–Kindness Meditation 266

Renovating Your Day 283
Shrinking Antagonistic

Forces 283
Improving Dream Recall 298
Positive Affirmations 308
Practice Intuition 309
Music for Stress Reduction 316
Mind Control of Muscular

Strength 324
Feel Your Qi 335
Wave Hands Like Clouds (Water

T’ai Chi) 336
Shamanic Journey 349
Absorbing Earth Energy 375
Going to the Mountains 376
Interacting with Your Pet 389

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PREFACE

The profession of nursing has advanced beyond the Western biomedical
model to incorporate many healing tools used by our Asian, Latino, Native
American, African, and European ancestors. We are rapidly rediscovering
that these ancient principles and practices have significant therapeutic value.
Some see this movement as a “return to our roots.” Others believe it is a
response to runaway health care costs, growing dissatisfaction with high-tech
medicine, and increasing concern over the adverse effects and misuse of med-
ications. The growth of consumer empowerment also fuels this movement.

As nurses, how do you begin to assimilate thousands of years of healing
knowledge? How do you begin this journey of integrating practices into your
own lives? In your professional practice, how do you model healthful living?
How do you help clients choose their own healing journeys? How do you
break down the barriers between conventional and complementary and alter-
native medicine (CAM)? Learning about CAM practices, like anything else, is
a slow process involving a steady accumulation of bits of information and
skills that eventually form a coherent pattern called knowledge. Although it is
possible to learn a great deal about healing practices from reading, thinking,
and asking questions, you must in the long run learn about healing through
participation. Without hands-on experience, you can be a good student, but
you can never be a great nursing practitioner of the healing arts. I trust this
book will be one step in a lifelong exploration of and experiences with healing
practices.

Consumers do not wish to abandon conventional medicine, but they do
want to have a range of options available to them including herbs and nutri-
tional supplements, manual healing methods, mind–body techniques, and
spiritual approaches. Some CAM practices, such as exercise, proper nutrition,
meditation, and massage, promote health and prevent disease. Others, such
as herbs and homeopathic remedies, address specific illnesses. Many other
CAM practices do both. The rise of chronic disease rates in Western society is
increasingly motivating consumers to consider self-care approaches. As
recently as the 1950s, only 30% of all disease was chronic, and curable—largely
infectious—diseases dominated, for which medical interventions were both
appropriate and effective. Now, 80% of all disease is chronic. Western medi-
cine, with its focus on acute dis s, trauma, and surgery, is considered to
be the best high-tech medical care in the world. Unfortunately, it is not
responding adequately to the current epidemic of chronic illnesses.

Ethnocentrism, the assumption that one’s own cultural or ethnic group is
superior to others, has often prevented Western health care practitioners
from  learning “new” ways to promote health and prevent chronic illness.
With consumer demand for a broader range of options, we must open our
minds to the idea that other cultures and countries have valid ways of
preventing and curing diseases that could be good for Western societies.

ix

x Preface

Although the information may be new to us, many of these traditions are hun-
dreds or even thousands of years old and have long been part of the medical
mainstream in other cultures.

I have titled this book Complementary and Alternative Therapies for Nursing
Practice because I believe we need to merge CAM approaches with Western-
based nursing practices. I have tried to provide enough information about
alternative therapies to help guide practice decisions. This text, as an over-
view and practical guide for nurses, does not pretend to be an exhaustive col-
lection of all the facts and related research in CAM, nor does it offer meticulous
documentation for all claims made by the various therapies. The goal of the
text is to motivate you, the reader, to explore CAM approaches, increase your
knowledge about factors that contribute to health and illness, and expand
your professional practice appropriately.

It is possible to classify alternative practices in any number of ways.
I  have chosen to present more than 40 approaches categorized into seven
units. In Unit 1, I introduce the philosophical approaches to both Western bio-
medicine and complementary and alternative medicine, as well as evidence-
based health care in CAM therapies. Concepts common to many approaches
are defined and discussed, such as energy, breath, spirituality, and healing.
Unit 2 presents a number of health care practices that have been systematized
throughout the centuries worldwide. These typically include an entire set of
values, attitudes, and beliefs that generate a philosophy of life, not simply a
group of remedies. The chapters cover Traditional Chinese Medicine,
Ayurvedic medicine, and Native American healing and curanderismo. Unit 3
comprises chapters relating to botanical healings used by 80% of the world’s
population. Chapters cover herbs and nutritional supplements, aromather-
apy, homeopathy, and naturopathy. Unit 4 presents manual healing
methods—some from ancient times and some developed in the latter half of
the 20th century. The chapters discuss chiropractic, massage, pressure point
therapies, hand-mediated biofield therapies, and combined physical and
biofield therapies. The chapters in Unit 5 cover types of mind–body tech-
niques for healing and include yoga, meditation, hypnotherapy and guided
imagery, dreams, intuition, music as a therapeutic tool, biofeedback, and
movement-oriented therapies. Unit 6 presents two spiritual approaches to
therapeutic intervention: working with shamans and the use of faith and
prayer. Unit 7 includes two chapters on miscellaneous practices: bioelectro-
magnetics and animal-assisted therapy.

The appendix provides specific information on managing the types of
common health problems that respond well to alternative therapies and life-
style modification.

This book does not recommend treatments but, rather, describes alterna-
tive practices, their backgrounds and claims, preparation of practitioners, con-
cepts, diagnostic methods, treatments, and evidence from research studies.
“Integrated Nursing Practice” is an important section of every chapter
designed to help you, the nurse, expand your practice by providing you with
specific information and suggestions. “Try This” features throughout the

Preface xi

chapters provide you with examples of how you can integrate these practices
into your own life and also give you ideas for client education. A list of
resources is also included in the chapters.

In this new fourth edition, I have continued the “Considering the Evi-
dence” feature with all new research relating to the chapter topic. Eight of
these features present a systematic review of randomized control trials, while
two present primary research . “Considering the Evidence” boxes not only
present current studies but also are designed to further critical thinking and
perhaps inspire you to design studies to answer your own questions. Each
study answers the following questions: What was this study about? How was
the study done? What were the results of the study? What additional ques-
tions might I have? And how can I use this study?

Changes to the fourth edition:

• Updated all research sections and greatly increased the number of sys-
tematic reviews of randomized controlled trials

• Changed the focus of the chapter on music from music therapy to music
as a therapeutic tool to broaden the focus for the practicing nurse

• Expanded the lists of resources to include more international resources
• Deleted polarity therapy and crystal healing for lack of research and

evidence
• Added sections on

• Music thanatology
• Aromachology
• Restorative yoga
• Latest technology for biofeedback self-tracking

• Expanded cautions for pregnant women and young children

Nurses are in a unique position to take a leadership role in integrating
alternative healing methods into Western health care systems. Nurses have
historically used their hands, heart, and head in more natural and traditional
healing interactions. By virtue of their education and relationships with
clients, nurses can help consumers assert their right to choose their own
healing journey and the quality of their life and death experiences.

My dear friend and colleague has written the following letter to you
about her lived experience uniting biomedicine with CAM approaches.

Dear Reader,

It is both a pleasurable and enlightening experience for me to contribute to
your text, Complementary and Alternative Therapies for Nursing Practice , through
the development of the “Considering the Evidence” feature. I approach this
work hopeful that it may inspire you, the reader, to engage in critical thinking,
assist in your understanding of the significance of research to inform
your  nursing practice and, perhaps, propose studies to answer your own
researchable questions. However, with this edition, I have asked Karen Lee
Fontaine to allow me the privilege of sharing with you my personal journey
with complementary and alternative therapies. I hope I can thus inspire you

xii Preface

to reflect on and embrace the important content of this text. After learning of
my diagnosis of bilateral breast cancer, I actively participated in myriad
Western medicine therapies while integrating complementary and alternative
therapies. Although the chemotherapy experience was both mentally and
physically challenging, I considered the massage therapist as part of “my
team,” and I looked forward to this dimension of comfort during this
challenging time. Engaging in yoga enhanced “restful sleep” as a response to
the overwhelming fatigue that frequently accompanies Western therapies
such as chemotherapy and radiation and just the daily awareness that “you
have cancer.” Acupressure relieved uncomfortable postoperative symptoms.
T’ai chi continues to be an opportunity to focus on myself and reflect on the
positives associated with this journey. Reiki and reflexology is my specified
“me time.” As I engage in the associated deep breathing exercises, it stimu-
lates my mind to drift to affirmative thoughts and so many positive memories
from my life. For me, “living with cancer “is more of an “inconvenience” in
my life’s journey. I can appreciate this may not be the experience for every-
one, but I can personally assure you that integrating many of the therapies
discussed in this text allows me a “quality of life” while simultaneously
working with conventional medicine’s goal for a “quantity of life.” With the
combination of both, I feel I have been given the power to survive!

I hope my story gives you a sense of hope and empowerment in caring
for persons both professionally and personally who are embarking on a stren-
uous journey related to their health. I can recall in my nursing practice experi-
encing feelings of helplessness when caring for persons undergoing complex
t reatments with so many uncertainties related to their health outcome. I can
attest that your understanding, knowledge, and support in the implementa-
tion of complementary and alternative therapies can significantly affect their
“quality of life” and allow you the privilege of making a difference in their
health journey.

Warm regards,
Dolores M. Huffman, RN, PhD

ACKNOWLEDGMENTS

I would like to express thanks to the many people who have inspired, com-
mented on, and in other ways assisted in the writing and publication of the
fourth edition of this book. On the publishing and production side at Pearson,
I was most fortunate to have an exceptional team of editors and support staff.
My thanks go to Julie Alexander, Publisher, and Erin Rafferty, Program
Manager, who provided support and guidance throughout this project. Maria
Reyes, Project Manager, kept this book on schedule and dedicated her time
and skill to its completion.

I would like to thank all those who reviewed this text and provided sug-
gestions and guidance for the fourth edition.

Karen Lee Fontaine
Purdue University Calumet

Contributors
Dolores M. Huffman, RN, PhD

Associate Professor
College of Nursing
Purdue University Calumet
Director of Transfer: Northwest Indiana Center for Evidence Based Practice:
A Joanna Briggs Institute Collaborating Centre
Hammond, IN

Sheila O’Brien Lewis, BScN, MHSc
Associate Lecturer
Department of Nursing, Faculty of Health
York University
Toronto, ON, Canada

Leslie Rittenmeyer, PsyD, CNS, RN
Professor
Collegel of Nursing
Purdue University Calumet
Research Associate: Northwest Indiana Center for Evidence Based Practice:
A Joanna Briggs Institute Collaborating Centre
Hammond, IN

xiii

xiv

Dot E. Baker, Ed.D., MSN.,
BSN.

Professor
Wilmington University
Georgetown, DE

Debra Rose Wilson, PhD, RN,
IBCLC, AHN-BC, CHT

Professor
Middle Tennessee State
University
Murfreesboro, TN
Walden University
Minneapolis, MN

Lynn Rew, Ed.D, RN, AHN-
BC, FAAN

Professor
The University of Texas at
Austin
Austin, TX

Sheila Stroman, PhD, RN
Assistant Professor
University of Central Arkansas
Conway, AR

Susan Cohen, DSN, APRN,
FAAN

Associate Professor
University of Pittsburgh
Pittsburgh, PA

Kimberly Arcoleo, PhD, MPH
Professor

Ohio State University
Columbus, OH

Lori Edwards, DrPH, RN,
APRN, BC

Instructor
Johns Hopkins University School
of Nursing
Baltimore, MD

Rose Mary Gee, PhD, RN
Assistant Professor
Georgia Southern University
Statesboro, GA

Sue Hritz, MEd, PC, RN, CHT,
PHN

Lecturer
Kent State University
Kent, OH

Gretchen Ezaki, MSN, RN
Instructor
Fresno City College
Fresno, CA

Kathleen Murphy, PhD, MMT
Assistant Professor
University of Evansville
Evansville, IN

Vicki Moran, MSN/MPH, RN
Instructor
Saint Louis University
St. Louis, MO

REVIEWERS

Healing Practices:
Complementary
and Alternative

Therapies for
Nurses

Happiness, grief, gaiety, sadness are by nature contagious.
Bring your health and your strength to the weak and sickly,

and so you will be of use to them. Give them, not your
weakness, but your energy, so you will revive

and lift them up.

Henri-Frederic Amiel

1 U N I T

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1
Integrative Healing

Time is generally the best doctor.

Ovid

Most of nursing education in the United States, Canada, the United Kingdom, Europe, and Australia—often referred to as Western countries—has been under the
umbrella of biomedicine, and thus Western nurses are familiar
and comfortable with its beliefs, theories, practices, strengths,
and limitations. Fewer nurses have studied alternative medical
theories and practices and as a result may lack information or
even harbor misinformation about these healing practices. Unlike
the profession of medicine in general, however, the profession of
nursing has traditionally embraced two basic concepts embodied
by alternative therapies—holism and humanism—in its approach
with clients. Nurses have long believed that healing and caring
must be approached holistically and that biological, psychologi-
cal, emotional, spiritual, and environmental aspects of health and
illness are equally important. This humanistic perspective
includes propositions such as the mind and body are indivisible,
people have the power to solve their own problems, people are
responsible for the patterns of their lives, and well-being is a com-
bination of personal satisfaction and contributions to the larger
community. This theoretical basis gives nurses a solid foot in each
camp and places them in the unique position to help create a
bridge between biomedicine and alternative medicine ( Buchan,
Shakeel, Trinidade, Buchan, & Al-See, 2012 ; Halcon, Chlan,
Kreitzer, & Leonard, 2003 ; Peplau, 1952 ; Quinn, 2000 ; Shreffler-
Grant, Hill, Weinert, Nichols, & Ide, 2007 ).

BACKGROUND

Many interesting exchanges around the world have debated the
appropriate terminology of various healing practices. Some people

3

4 Unit 1 • Healing Practices

become vested in the use of particular terms and have difficulty getting past the
language limitations. For example, many people view the term alternative medi-
cine as being too narrow or misleading and are concerned that the term lacks a
full understanding of traditional healing practices. It would be helpful for a
common language to be developed without these constraints. As language
evolves, the terms used today may be quite different from those used 20 years
from now. For consistency, the terms chosen for this text are conventional med-
icine or biomedicine to describe Western medical practices, and the terms
alternative medicine or complementary medicine to describe other healing
practices. Traditional medicine refers to indigenous medical systems such as
Traditional Chinese Medicine (TCM). There are no universally accepted terms.
The following list presents commonly used words and their counterparts:

Mainstream Complementary/Alternative
Modern Ancient
Western Eastern
Allopathic Homeopathic; holistic
Conventional Unconventional
Orthodox Traditional
Biomedicine Natural medicine
Scientific Indigenous healing methods

The line between conventional and complementary and alternative
medicine is imprecise and frequently changing. For example, is the use of
megavitamins or diet regimens to treat disease considered medicine, a life-
style change, or both? Can having one’s pain lessened by massage be consid-
ered a medical therapy? How should spiritual healing and prayer—some of
the oldest, most widely used, and least studied traditional approaches—be
classified? Although the terms alternative and complementary are frequently
used, in some instances they represent the primary treatment modality for an
individual. Thus, conventional medicine sometimes assumes a secondary role
and becomes a complement to the primary treatment modality.

Conventional Medicine

Biomedical or Western medicine is only about 200 years old. It was founded
on the philosophical beliefs of René Descartes (1596–1650)—that the mind and
body are separate—and on Sir Isaac Newton’s (1642–1727) principles of
physics—that the universe is like a large mechanical clock in which every-
thing operates in a linear, sequential form. This mechanistic perspective of
medicine views the human body as a series of body parts. It is a reductionist
approach that converts the person into increasingly smaller components: sys-
tems, organs, cells, and biochemicals. People are reduced to patients, patients
are reduced to bodies, and bodies are reduced to machines. Health is viewed
as the absence of disease or, in other words, nothing is broken at present, and
sick care is focused on the symptoms of dysfunction. Physicians are trained to

Chapter 1 • Integrative Healing 5

fix or repair broken parts through the use of drugs, radiation, surgery, or
replacement of body parts. The approach is aggressive and militant—
physicians are in a war against disease, with a take-no-prisoners attitude. Both
consumers and practitioners of biomedicine believe it is better to

• do something rather than wait and see whether the body’s natural pro-
cesses resolve the problem.

• attack the disease directly by medication or surgery rather than try to
build up the person’s resistance and ability to overcome the disease.

Biomedicine views the person primarily as a physical body, with the
mind and spirit being separate and secondary or, at times, even irrelevant. It
is powerful medicine in that it has virtually eliminated some infectious dis-
eases, such as smallpox and polio. It is based on science and technology, per-
sonifying a highly industrialized society. As a “rescue” medicine, the
biomedical approach is appropriate. It is highly effective in emergencies, trau-
matic injuries, bacterial infections, and some highly sophisticated surgeries. In
these cases, treatment is fast, aggressive, and goal oriented, with the responsi-
bility for cure falling on the practitioner.

The priority of intervention is on opposing and suppressing the symp-
toms of illness. This approach is evidenced in many medications with prefixes
such as an or anti , as in analgesics, anesthetics, anti-inflammatories, and anti-
pyretics. Biomedicine characterizes each disease in terms of its mechanisms of
action, based on the belief that most individuals are affected in the same way.
Thus, treatment is basically the same for most people. Because conventional
medicine is preoccupied with parts and symptoms and not with whole work-
ing systems of matter, energy, thoughts, and feelings, it does not do well with
long-term systemic illnesses such as arthritis, heart disease, and hypertension.
Despite higher per capita spending on health care in the United States than in
all other nations, in 2013, U.S. life expectancy ranked only 37th, and the infant
mortality rate ranked 33rd among the nations studied ( World Health
Rankings, 2013 ). The United States has failed to be a world leader in providing
a healthier quality of life.

Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) is an umbrella term for as
many as 1,800 therapies practiced worldwide. Many forms have been handed
down over thousands of years, both orally and in written records. These ther-
apies are based on the medical systems of ancient peoples, including Egyp-
tians, Chinese, Asian Indians, Greeks, and Native Americans. Others, such as
osteopathy and naturopathy, evolved in the United States during the past two
centuries. Still others, such as some of the mind–body and bioelectromagnetic
approaches, are on the frontier of scientific knowledge and understanding.
The National Center for Complementary and Alternative Medicine (NCCAM)
at the National Institutes of Health (NIH) defines CAM therapies as a broad
range of healing philosophies, approaches, and …