Transcript Relaxation therapy Meditation and breathing Imagery

Chapter 32
Complementary and
Alternative Therapies
BACKGROUND
• Many conditions are difficult to treat with
allopathic medicine.
• Researchers estimate that up to 75% of patients
seek care from their primary physician for stress,
pain, and health conditions for which causes are
unknown.
• Surveys estimate that 38.3% to 62.1% of the U.S.
population uses complementary and alternative
medicine (CAM).
CASE STUDY
• Joan Brauer is a 46-year-old woman newly
diagnosed with hypertension. She works full time,
helps care for her widowed mother, and is
raising a family of three children with her
husband, Tomas.
• Alonzo is a nursing student assigned to Joan’s
care at the clinic.
• Joan is skeptical about taking antihypertensive
medication and asks Alonzo about alternative
treatments.
DEFINITIONS
• CAM—a group of diverse medical and health
care systems, practices, and products that are
not presently considered to be part of
conventional medicine.
• Complementary—therapies used in addition to
conventional treatment (aka integrative
therapies)
• Alternative—therapies that replace allopathic
medical care
• Whole medical systems—based on different
philosophies and life systems
CATEGORIES OF CAM
Biologically based therapies
Energy therapies
Manipulative and body-based methods
Mind-body interventions
Whole medical systems
Movement therapies
INTEGRATIVE HEALTH CARE
• Many medical and nursing schools incorporate
CAM therapy content into the curriculum.
• Some have integrative health care programs that
allow health care consumers the opportunity to be
treated by a team of providers consisting of both
allopathic and complementary practitioners.
• Nurses have historically practiced in an integrative
fashion, using the term holistic.
HOLISTIC NURSING
Regards and
treats the
mind-bodyspirit of the
patient
Uses holistic nursing
interventions such as
relaxation therapy, music
therapy, touch therapies, and
guided imagery
The American Holistic Nurses Association
maintains Standards of Holistic Nursing
Practice.
FACTORS TO CONSIDER
• The history of each therapy (many have been used
by cultures for thousands of years to support health
and ameliorate suffering)
• Nursing’s history and experience with a particular
therapy
• Other forms of evidence reporting outcomes and
safety data, including case study and qualitative
research
• Cultural influences and context for certain patient
populations
NURSING-ACCESSIBLE THERAPIES
Relaxation therapy
Meditation and breathing
Imagery
RELAXATION THERAPY
• Definitions:
•
•
•
•
Stress response
Relaxation response
Progressive relaxation
Passive relaxation
• Clinical applications: lowers heart rate and
blood pressure, decreases muscle tension
• Limitations
YOGA
MEDITATION AND BREATHING
• Meditation is any activity that limits stimulus input
by directing attention to a single unchanging or
repetitive stimulus, so the person is able to
become more aware of self.
• Lowers oxygen consumption, reduces respiratory and
heart rates, and reduces anxiety
• Lowers blood pressure (BP) in hypertensive patients and
lowers breathing rates in asthmatic patients and in
cancer patients
IMAGERY OR VISUALIZATION
• A mind-body therapy that uses the conscious mind to
create mental images to stimulate physical changes
in the body, improve perceived well-being, and/or
enhance self-awareness
• Creative visualization is one form of self-directed imagery
based on mind-body connectivity.
• Clinical applications: pain control ++
• Limitations: a few side effects
CASE STUDY (CONT’D)
• Alonzo realizes that to reassure Joan, he needs
to assess her needs. Alonzo interviews Joan
about her daily life and discovers that she feels
stressed at work and at home.
• Joan says that although her husband helps her
with housework, they have not required the
children to do so. Joan feels like she’s “on duty”
24-7 because of the shopping, cooking, and
housework, in addition to her job. Alonzo and
Joan discuss how she could delegate some of
her home tasks to her children.
TRAINING-SPECIFIC THERAPIES
Biofeedback
Acupuncture
Therapeutic touch
Chiropractic
Therapy
Traditional Chinese
medicine
Natural products
and herbal
therapies
BIOFEEDBACK
• A mind-body technique that uses instruments to
teach self-regulation and voluntary self-control
over specific physiological responses
• Instruments measure, process, and provide
information about neuromuscular and
autonomic nervous system activity.
• Immediate feedback is provided in physical,
physiological, auditory, and/or visual signals.
ACUPUNCTURE
• Regulates or realigns vital energy (qi), which
flows through channels in the form of a system of
pathways called meridians
• Involves insertion of needles into acupoints
through which qi can be influenced.
• Modifies the body’s response to pain and how
pain is processed by central neural pathways
and cerebral function
• Effective for pain
• Also used to treat other disorders with varying
effectiveness
ACUPUNCTURE (CONT’D)
CASE STUDY (CONT’D)
• Alonzo emphasizes to Joan that even though
CAM methods may help her blood pressure, she
needs to take her hypertensive medication as
prescribed. Joan agrees to do so as long as
Alonzo helps her learn about other possible ways
to improve her health.
• Alonzo gives Joan information about relaxation
therapy, imagery, and meditation. They decide
to discuss which method Joan would like to try
on her next visit.
THERAPEUTIC TOUCH
• Practitioner places open palms on or close to
the patient’s body.
• Five phases: centering, assessing, unruffling,
treating, and evaluating
• Practitioner uses long downward strokes to touch
or maintain the hands in a position a few inches
from the body
• May be effective in treating pain, dementia,
trauma, and anxiety
THERAPEUTIC TOUCH (CONT’D)
CHIROPRACTIC THERAPY
• Goal: restore structural and functional
imbalances
• Joint manipulation, physical therapies, lifestyle
counseling (diet and exercise)
• Improves acute pain and disability, enhances
conventional treatment of pediatric asthma
• Contraindicated for bone infections, fractures,
dislocations, osteoporosis
• Some risks, although uncommon, are present.
TRADITIONAL CHINESE MEDICINE
• Whole system of healing
• Health viewed as “life in balance”; harmony
• Includes several therapies: herbs, exercise, diet,
acupuncture, moxibustion, meditation, ++
• Yin and yang are opposing, complementary
forces that exist in dynamic equilibrium.
• Disruption of vital energy (qi) causes disease.
• Chinese herbs not regulated by the U.S. Food
and Drug Administration (FDA).
• Ask about all parts of TCM therapy; herbs, teas,
and supplements may interact with allopathic
treatment.
NATURAL PRODUCTS AND HERBAL
THERAPIES
• A natural product is a chemical compound or
substance produced by a living organism.
• Herbal medicines are not approved for use as drugs
and are not regulated by the FDA.
• Although many herbs are safe and effective for a
variety of conditions, “natural” does not equal
“safe.”
• Some interact with prescription and over-thecounter medications.
• Look for U.S. Pharmacopeia (USP)-verified dietary
supplement mark.
CASE STUDY (CONT’D)
• At Joan’s follow-up visit, Joan tells Alonzo she
would like to learn the relaxation response. Joan
is excited about having control over a behavior
that can help her manage her blood pressure,
so she eagerly learns.
• Joan reports that she and Tomas have assigned
the children household duties, and so Joan had
a free hour the night before—and didn’t know
what to do with it!
QUICK QUIZ!
1. An athletic young woman has just broken her leg
while training for a marathon. The use of
meditation has many physiological properties that
will help the young woman to
A. Raise blood pressure.
B. Increase mood swings.
C. Increase oxygen consumption.
D. Lower muscle tension.
NURSING ROLE IN CAM THERAPIES
• Need to encourage dialogue about the use of
CAM
• Responsibility to understand the benefits of
therapies that encourage active patient
participation
• Multiple practitioner approach: integrative
• Holistic in nature
• Follow Nurse Practice Act Scope of Practice.
• Work closely with patient.