Transcript REIMBURSEMENT ISSUES

Chapter 17
Complementary and Alternative
Therapies
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Complementary and Alternative
Therapies
• Complementary Therapies
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Therapies used in addition to conventional treatment
recommended by the person’s health care provider
Complement the conventional treatment
Include exercise, massage, reflexology, prayer,
biofeedback, creative therapies, guided imagery,
acupuncture, relaxation strategies, chiropractic
therapy, therapeutic touch, and herbalism
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Complementary and Alternative
Therapies
• Alternative Therapies
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May include the same interventions as
complementary therapy, but frequently become the
primary treatment modality that replaces traditional or
conventional medicine
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Complementary and Alternative
Therapies
• Many alternative therapies do not interfere with
those therapies prescribed by a physician, but some
can have serious interactions.
• The nurse needs to project an open, nonjudgmental
attitude when obtaining a health history so that the
patient feels comfortable in providing all information
about any therapies he or she is currently receiving.
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Herbal Therapy
• Many current medicines have their origins in herbs.
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Digitalis comes from the foxglove herb.
• Recently, there has been an increased interest
among the general population about the use of
herbs and natural supplements to treat illness and
maintain health.
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Herbal Therapy
• Herbs vary from pharmaceuticals in several ways.
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Herbal preparations usually use the whole plant.
One herb may be used for a variety of purposes and
is usually gentler than pharmaceuticals.
Pharmaceuticals that are derived from herbs separate
the active ingredients and use only that part, thereby
being stronger.
Herb manufacturers are not held to the same stringent
standards as are manufacturers of pharmaceuticals.
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Herbal Therapy
• Many herbal medicines are sold as foods or food
supplements in health food stores and through
private companies because they have not received
approval for use as drugs.
• The goal of herbal therapy is to restore balance
within the individual by facilitating the person’s selfhealing ability.
• Many herbs are potentially toxic if used incorrectly.
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Herbal Therapy
• Treatment can be provided in a variety of ways.
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Dried herbs can be taken orally in a capsule or tablet
form.
 Tinctures are made by placing herbs in alcohol or
vinegar until the liquid absorbs the properties of the
herb; the liquid is then strained and used.
 Tea may be made of an infusion of herbs and hot
water and drunk, or a moist compress can be made
from the tea and applied to the affected area.
 Herbs can be applied topically by making a salve or
ointment to be applied to the skin.
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Ginger Root
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Chiropractic Therapy
• Has been in existence since the late 1800s.
• Doctors of chiropractic medicine undergo extensive
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training in manipulation of the musculoskeletal
system.
It is based on holistic beliefs in the body’s ability to
take care of itself.
The chiropractic doctor adjusts the joints of the body
through gentle manipulation to restore the area to
proper alignment.
A doctor of chiropractic medicine does not prescribe
medications.
Other treatments such as hot and cold packs may be
used.
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Acupuncture and Acupressure
• Acupuncture
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A method of stimulating certain points on the body by
the insertion of special needles to modify the
perception of pain, normalize physiological functions,
or treat/prevent disease.
This is the primary treatment modality used by
physicians of Chinese medicine.
The most common problems for which acupuncture is
used include low back pain, myofascial pain, simple
and migraine headaches, sciatica, shoulder pain,
tennis elbow, osteoarthritis, whiplash, and
musculoskeletal sprains.
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Figure 17-2
(From Leahy, J.M., Kizilay, P.E. [1998]. Foundations of nursing practice: a nursing process approach.
Philadelphia: Saunders.)
Acupuncture uses fine needles inserted at specific points to open the
meridians.
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Acupuncture and Acupressure
• Acupressure
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This involves the use of gentle pressure at similar
points on the body.
 Pressure may be applied with a finger or a small blunt
object.
 It is used primarily for the prevention and relief of
symptoms of muscle tension.
 Acupressure reduces tension, increases circulation,
and enables the body to relax deeply.
 By relieving stress, acupressure increases resistance
to disease and promotes wellness.
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Figure 17-1
(From Potter, P.A., Perry, A.G. (2005). Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Massage therapy can be used to relieve tension.
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Therapeutic Massage
• Massage performed by training professionals
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manipulates the soft tissues of the body and assists
with healing.
Massage can either be relaxing or energizing.
It should be conducted in a warm, relaxing
atmosphere.
Oils or lotions may be used during the massage.
Massage is contraindicated for phlebitis or
thrombosis and infectious skin diseases.
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Aromatherapy
• Pure essential oils, produced from plants, are used
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to provide health benefits.
The oils can be used for inhalation, or they may be
applied topically.
Scent may be dispersed into the air through the use
of candles or oil dispersers.
Oils can also be used in bathing.
Different scents are thought to invoke different
responses in the body.
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Relaxation, stimulation, improved digestion, increased
hormone production, and improved circulation or
memory
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Aromatherapy
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Reflexology
• It is thought that the entire body can be reached by
applying pressure to specific areas on the feet.
• Reflexology is based on the premise that there are
zones and reflexes in different parts of the body that
correspond to and and are relative to all parts,
glands, and organs of the entire body.
• The manipulation of specific reflexes removes
stress, placing the body in a parasympathetic
healing state and enabling the disharmonies to be
released by a physiological change in the body.
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Reflexology
• Four Main Benefits
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Relaxation with the removal of stress
Enhanced circulation
Assisting the body to normalize metabolism naturally
Complementing all other healing modalities
• Warnings, Contraindications, and Precautions
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Pressure on the corresponding reflex areas should be
decreased for patients with heart problems, blood
problems, high blood pressure, epilepsy, and
diabetes.
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Magnet Therapy
• Magnets have been used for thousands of years to
help heal and improve overall health.
• They are thought to increase circulation to the
affected area and to promote healing, as well as
stimulate acupuncture points.
• Common physiologic responses
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Vasodilatation, analgesic action, anti-inflammatory
action, spasmolytic activity, healing acceleration, and
antiedema activity
• Contraindications
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Pregnancy, pacemakers, insulin delivery systems,
cochlear implants, and defibrillators
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Imagery
• Uses the conscious mind to create mental image to
evoke physical changes in the body, improve
perceived well-being, and enhance self-awareness
• Frequently combined with some form of relaxation
training to facilitate the effect of the relaxation
technique
• Can be self-directed or guided
• Can evoke powerful psychophysiologic responses
such as an alteration in immune function
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Guided imagery
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Relaxation Therapy
• Relaxation is the state of generalized decreased
cognitive, physiological, or behavioral arousal.
• The process of relaxation elongates the muscle
fibers, reduces the neural impulses sent to the brain,
and thus decreases the activity of the brain and
other body systems.
• It decreases heart and respiratory rates, blood
pressure, and oxygen consumption.
• The long-term goal of relaxation therapy is for the
person to continually monitor himself or herself for
indications of tension and then consciously let go
and release the tension.
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Animal-Assisted Therapy
• 1994—first time used in the United States
• Therapeutic purposes
• Complementary therapy in acute and long-term
settings
• Dogs used more than cats
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Yoga
• “The joining of the mind, body, and spirit to enrich
the quality of one’s life and to enhance one’s health”
(O’Hara et al., 1998)
• Basic principles
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Control of the body through correct posture and
breathing
Control of the emotions and mind
Meditation and contemplation
• Regular practice can tone the muscles that balance
all parts of the body, including internal organs, heart,
lungs, glands, and nerves. Flexibility of the spine is
increased, and deep relaxation and reduction in
stress are promoted.
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Figure 17-3
(From Potter, P.A., Perry, A.G. (2005). Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Yoga is useful in control of the body through correct posture,
breathing, meditation, and contemplation.
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T’ai Chi/Taiji
• Fusion of martial arts and Daoist philosophical
concepts
• Yin and yang
• Suited for people of various physical capabilities
• Benefits include improvement in balance, leg
strength, cardiorespiratory function, range of motion,
and arthritis.
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Biofeedback
• Noninvasive
• Determines a patient’s neuromuscular and
autonomic nervous system response
• Measures specific body functions
• Goal is for patients to become aware of their
responses and, in conjunction with relaxation
techniques, to be able to control their responses
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Nursing Role in Complementary
and Alternative Therapies
• Nurses need to be aware of their state nurse
practice act with regard to complementary therapies
and to practice accordingly within the scope of the
law.
• Nurses work closely with their patients and are in the
unique position of becoming familiar with the
patient’s religious and cultural viewpoints and
existential issues.
• Nurses may be able to determine which CAM
therapies would be more appropriately aligned with
these beliefs and offer recommendations
accordingly.
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