18. Complementary Therapies

1. Conventional medicine—practiced by medical doctors or doctors of osteopathy, and other allied health professionals (e.g., registered nurses, psychologists, or physical therapists)

2. CTs: group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine

3. Integrative medicine—the eventual combination of CT and medicine

4. Reliable evidence of complementary medicine efficacy is needed before its integration into clinical practice.

1. “Complementary and alternative medicines” (CAMs) commonly used.

2. The term CAMs will be used when referring to medical practice.

3. In this chapter, CTs will be used to describe these interventions, as this term more appropriately describes nursing practice.

1. Searches conducted in 2008 on Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Google Scholar revealed a plethora of articles on CAM. Diverse patient and ethnic populations represented, and treatment of a variety of diseases and conditions was detailed.

2. When health insurance plans offered CT coverage, it varied by state and was often limited. Most CTs were paid out-of-pocket.

3. Health insurance covers the following:

1. In 1992, the National Institutes of Health established the Office of Alternative Medicine (OAM).

2. Congress expanded the OAM into the NCCAM in 1998.

3. The annual budget was increased to $121.6 million in 2008.

4. CAM is defined by the NCCAM as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.

5. A review of clinical trials listed on the NCCAM website lists 235 completed clinical trials, (90 that are beginning the recruiting process, and over 100 that are in progress as of March 2009).

1. Acupuncture/acupressure

2. Aromatherapy

3. Ayurveda

4. Chiropractic

5. Dietary supplements

6. Energy healing

7. Guided imagery

8. Herbal therapies

9. High-dose vitamin or megavitamin therapies

10. Homeopathy

11. Magnetic therapy

12. Massage

13. Meditation

14. Music

15. Naturopathy

16. Osteopathic

17. Prayer

18. Qigong

19. Reiki

20. Relaxation techniques

21. Therapeutic touch

22. Yoga

1. National surveys indicate that CTs are widely used and increasing in popularity.

2. Use of CTs tends to be higher among patients who are:

3. People who use CTs also use medical doctors.

4. CTs are used less frequently by:

5. CTs are used most frequently for:

6. Unsupervised use, which is a form of expanded self-care, is the usual method of use for most CTs. There is usually no involvement of either a medical doctor or a complementary medicine practitioner.

7. The increasing use of CTs has occurred despite the fact that the majority of costs have been paid out-of-pocket.

1. In Denmark in 1987, 10% of the population used CTs.

2. In Australia in 1993, 49% of the population used CTs.

3. The United Kingdom spent $94 million on herbal remedies and $30 million on homeopathic remedies.

4. Germany spent $541 million on herbal remedies and $528 million on homeopathic remedies.

5. In Germany, herbal medicine is well integrated into the medical culture.

1. Dissatisfaction with conventional treatment

2. Desire to try all options, especially among cancer patients

3. Anecdotal information from friends or acquaintances

4. Belief that CTs are less harmful than conventional therapies

5. Many CTs are holistic and encompass a spiritual component, which is lacking in conventional medicine.

1. The use of traditional randomized, double-blind, placebo-controlled clinical trials with CTs presents certain challenges.

2. It would be extremely difficult to design and implement randomized, double-blind, placebo-controlled clinical trials of all the CTs that are in use today.

3. Many of the CTs have been in use for thousands of years, with vast anecdotal success.

4. Treatment plans with CTs are often individualized and are thus hard to replicate.

5. CTs are increasingly being integrated with conventional medicine, rather than being used alone or in the place of conventional medicine.

6. Pharmaceutical companies invest between $350 and $500 million in a 10-year period to bring a new drug to market; when the drug is marketed, the money is recouped.

7. Obtaining financial support for research on herbs is difficult because there is no financial incentive for investment by pharmaceutical companies.

1. A study of older adults residing in Minnesota revealed that 62.9% used CAMs, while only 53% disclosed their CAM use to their primary care providers.

2. The flourishing use of herbal preparations increases the need to question preoperative patients about their use of herbals.

3. Many people do not view herbals as “medicine” or may be reluctant to disclose their uses of CT to conventional practitioners, such as nurses or doctors.

4. The preoperative nurse must make specific and repeated inquires to the patient about the potential use of herbals.

1. Are plant-derived products used for medicinal and health purposes (Table 18-1).

2. Thirty percent of all modern drugs derived from plants

3. The use of herbals has increased significantly in the past 10 years.

4. Herbals may have many allergic reactions as well as interactions with prescription drugs.

5. Perioperative patients are exposed to a great number of pharmacological agents during their surgical experience.

1. In 1994, herbal medications were classified as dietary supplements in the Dietary Supplement Health and Education Act.

2. This law exempts herbals from the safety and efficacy requirements that must be met by prescription and over-the-counter drugs. It requires:

3. There is no guarantee that the herb(s) listed on the packaging are actually present, that the ingredient is bioavailable, the dosing is appropriate, or whether the next bottle will have the same composition.

4. The Food and Drug Administration must show that an herbal product is unsafe before it can be removed from the market.

5. There is no mechanism for reporting of herbal adverse effects, or herbal and drug interactions; thus, they are grossly underreported.

1. In Germany, France, the United Kingdom, and Canada, regulating agencies enforce standards of herb quality and safety assessment of manufacturers.

2. The German Commission E Monographs are a comprehensive study of herbals.

3. Significant numbers of studies are being conducted in Germany, France, Japan, China, and India.

1. Vitamins are complex organic substances found in most foods that are essential for the normal function of the body.

2. Dietary supplements correct a dietary deficiency.

3. A number of commonly used vitamins and dietary supplements interact with perianesthetic drugs in similar ways to herbals (Table 18-2).

1. Nurses are in a unique position to combine conventional Western medicine and CTs.

2. Integrative and holistic nature of nursing lends to the esoteric nature of many complementary interventions.

3. Forty-seven percent of state boards of nursing permit the practice of some CAMs (Arizona, Arkansas, California, Connecticut, Illinois, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Mississippi, Missouri, New Hampshire, New York, Nevada, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Texas, Vermont, and West Virginia).

4. The practice of CAMs is under discussion in seven states: Delaware, District of Columbia, Georgia, Minnesota, New Jersey, New Mexico, and Washington.

5. The remaining 40% of states have no formal position on CAMs (Alabama, Alaska, Colorado, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Michigan, Montana, Oklahoma, Puerto Rico, Rhode Island, South Carolina, Tennessee, Utah, Virgin Islands, Virginia, Wisconsin, and Wyoming).

1. Aromatherapy

2. Massage

3. Music

4. Relaxation therapy

5. Therapeutic touch

6. Guided imagery

1. Based on traditional Chinese medical theory, and has been in existence for at least 2500 years

2. Involves inserting thin-gauged needles into specific anatomical points in the body for therapeutic purposes

3. Disrupted patterns of energy flow (qi) that travel in meridians are rebalanced by acupuncture

4. Insertion points tend to correspond to areas where connective tissue is the thickest.

5. Acupressure uses the fingers, hands, elbows, or other devices to press on the surface of the skin on the same anatomical points used in acupuncture; no needles are involved.

6. Acupressure and acustimulation devices may be used to treat postoperative nausea and vomiting.

1. Ayurvedic medicine is traditional Hindu medicine, and was developed more than 5000 years ago.

2. Ayurveda means the “science of life.”

3. The physician prevents or treats diseases by restoring the balance of body, mind, and spirit with diet, exercise, meditation, herbs, massage, and controlled breathing.

1. Focuses on the relationship between bodily structure and function

2. Focuses on how that relationship affects the preservation and restoration of health

3. Uses spinal manipulation and adjustments to bring about healing

1. A Western system of care based on the belief that very dilute substances are able to stimulate a healing response in the body

2. Developed by Samuel Hahnemann, a German physician who practiced medicine in the late 1700s

3. Stimulates the body’s defense mechanisms to cure symptoms by administering minute doses of medicinal substances; these same substances at higher doses would actually cause symptoms or disease.

1. Electromagnetic fields are invisible lines of force that are present in the earth and are believed to be produced by electric currents flowing at the earth’s core.

2. Often used to relieve pain

1. A cultivation of the mind through quieting, and observing one’s inner state

2. Learning to slow down and examine passing sensations in minute detail

3. The practitioner allows pain, emotions, and bodily sensations to be experienced as a natural progression of life.

4. Results in:

1. Arose in the late nineteenth century in America

2. Works with natural healing forces within the body to restore health through nutrition, exercise, homeopathy, acupuncture, herbal medicine, hydrotherapy, massage, counseling, and/or pharmacology

1. A form of conventional medicine that emphasizes that diseases arise in the musculoskeletal system

2. Its paradigm is that all the body’s systems work together, and a disturbance in one system may affect functioning in other body systems.

1. Addresses a “Supreme Being” or a “Higher Power” and implies a relationship between the individual and the “Higher Power”

2. Control of healing is given to a higher being.

3. Resembles meditation, bringing similar benefits such as lowered blood pressure and a strengthened immune system

1. Pronounced “chee kung”

2. An ancient term denoting the vital energy of the body, and gong is the skill to work with qi

3. Part of traditional Chinese medicine

4. Combines movement, meditation, and regulation of breathing to remove blockages that stop or slow the flow of qi and to ensure an equal balance of qi within the body

5. Qigong masters can treat organ systems or body areas with or without physical contact.

6. Used to enhance the immune system, treat heart disease, stroke, hypertension, osteoporosis, cancer, and senility

1. Practiced by Egyptians as early as 2330 b.c.

2. A touch modality based on the principle that reflexes exist on each foot and hand that correspond to the glands, organs, and parts of the body.

3. Three different methods exist.

4. Used to reduce anxiety, stress and tension, and facilitate sleep

1. A Japanese word denoting “Universal Life Energy”

2. Based on a belief that when spiritual energy is channeled through a Reiki practitioner, the patient’s spirit is healed, which heals the body

1. An East Indian practice that has existed for 5000 years

2. The word yoga comes from the Sanskrit word yui, which means to unite.

3. A central belief of yoga is that a healthy body, mind, and spirit are needed for a healthy person.

4. Involves stretching exercises, breathing control, and meditation

5. Yoga training results in decreased sympathetic tone, decreased peripheral vascular resistance, improved cardiac output, and lowered blood pressure and heart rate.