Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 33 Complementary, Alternative, and Integrative Healing Practices Nursing Role in CAM Identify CAM use by client. Identify client s need for CAM. Identify when CAM use is inappropriate or contraindicated. Nursing Role in CAM (cont'd) Suggest CAM therapies to others. Encourage clients to consider CAM therapies. Enlist support of treatment team, family members, and friends. Help clients to find providers. 1
Safety and Effectiveness Counsel clients in appropriate use of CAM for specific conditions. Educate clients and families about the safe use of CAM therapies and about possible CAM-prescribed medication interactions. Informed Health Consumers Advantages and disadvantages Risks Side effects and adverse effects Expected results Length of treatment Interaction with conventional Western medications CAM Practitioner Expertise Clients should research background, credentials, and certification/licensure of a potential CAM practitioner. Reliable sources of information/referrals: national organizations of CAM practitioners, health regulatory bodies, other health care providers, current and former clients, interview 2
Quality and Costs of Service Delivery Clients should visit the practitioner s office, clinic, or hospital to personally check the conditions under which treatment will be given. Are conditions safe and clean? Are regulated standards for medical care and safety adhered to? Are services reimbursable? Selecting Appropriate Clients The appropriate client for CAM therapy: Is motivated to participate in the interventions Is able to concentrate Can follow often complex directions Monitoring Plan of Care Clients must discuss all CAM treatments and therapies with primary physical or mental care providers. Clients medications should be closely monitored to avoid dangerous interactions. Client and family education is an important component of the plan of care. 3
CAM Therapies Whole medical systems Mind-body medicine Biologically based practices Manipulative and body-based practices Energy therapies Deep Breathing & Relaxation Benefits: pain management, lowered blood pressure, reduced stress and anxiety, treatment of depression Body scanning to assess tension Enhancing relaxation with music Breathing awareness Progressive relaxation Visualization and Imagery Benefits: reduced stress, relaxation, healing, pain relief, symptom control Guided imagery Visualization for relaxation or guidance Visualization for symptom control or healing 4
Hypnotherapy and Self Hypnosis Hypnotherapy benefits: reduced pain, anxiety, stress, hypertension, insomnia, irritable bowel syndrome. Self-hypnosis benefits: anxiety relief and reduce pain without undue cost Meditation Meditation benefits: help with stress, mood disturbance, anxiety, depression, pain of chronic illness, other conditions Medical meditation benefits: treatment for anxiety disorder, diabetes, depression, hypertension Pressure Point Therapies Benefits of acupuncture: Influences body s self-regulating system; reduce nausea and vomiting after surgery and with chemotherapy; eases withdrawal and treats addiction in alcoholics, drug addicts, and smokers Benefits of acupressure: healing, pain relief, physical and emotional wellbeing 5
Touch Therapies Benefits of massage: may reduce anxiety, improve muscle relaxation, aid in promoting wound healing, and reduce pain; may reduce agitated behavior and depression Benefits of chiropractic: treat some back problems; risk of spinal compression fractures, traumatic rupture of vertebral artery Nurse Developed Bio-field Therapies Benefits of Therapeutic Touch and Healing Touch: sense of relaxation and relief from pain Herbals & Botanicals Benefits: symptom relief in a wide variety of conditions, but must be used with caution 6
Herbal Therapies Construed as safe because herbs are natural Potential for toxicity and harmful interactions with prescribed medications Few herbs used in treatment of emotional symptoms or mental disorders Herbal Therapies (cont'd) Some herbals and botanicals may: Potentiate the effects of psychotropics Block the effects of psychotropics Increase the extent of adverse side effects Box 33-2 Mental Health Problems and Related CAM Therapies 7
Box 33-2 (continued) Mental Health Problems and Related CAM Therapies Box 33-2 (continued) Mental Health Problems and Related CAM Therapies Using Natural Remedies There may be insufficient reliable information available to judge the effectiveness or safety of many herbs. A common misconception is that herbs and supplements are always safe and possibly more effective. Clients should discuss with their health care provider all natural remedies they use. 8
Natural Products Used for Psychiatric Symptoms Psychiatric Symptom Anxiety Dementia Depression Natural Medicine Kava Ginkgo leaf extract SAMe, St. John s wort Natural Products Used for Psychiatric Symptoms (cont'd) Psychiatric Symptom Encephalopathy/ Peripheral neuropathy Insomnia Dementia of Alzheimer s type Natural Medicine Thiamine Melatonin, valerian Omega-3 fatty acids Natural Products and Psychotropics Not to Be Taken Together Psychotropic Anticonvulsants Carbamazepine Fluoxetine Antipsychotics Lithium Benzodiazepines Natural Medicine Sage Psyllium Melatonin Ginseng Green tea, psyllium Kava, melatonin (Not all-inclusive. See Table 33-3.) 9
Table 33-3 Medication a Commonly Used Natural Medicines That Should Not Be Taken in Combination With Psychotropic Table 33-3 (continued) Psychotropic Medication a Commonly Used Natural Medicines That Should Not Be Taken in Combination With Biofeedback, rtms & EMDR Benefits of biofeedback: useful in treating tension headaches, insomnia, muscle or colon spasm, pain, hypertension, asthma, stuttering, bruxism (grinding of the teeth), and epilepsy; decrease anxiety and phobic reactions 10
Biofeedback, rtms & EMDR (cont'd) Benefits of rtms: treatment for depression Benefits of EMDR: treatment for PTSD Resources American Holistic Nurses Association The American Holistic Nurses Association is a nonprofit membership association for nurses and other holistic healthcare professionals. AHNA promotes the education of health care professionals, and the public in all aspects of holistic caring and healing. Resources (cont'd) National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine leads federal scientific research on complementary and alternative medicine. This site explores complementary and alternative healing practices through rigorous science, offers training for researchers, and provides information to the public and professionals. 11
Resources (cont'd) QuackWatch QuackWatch is a nonprofit corporation whose purpose is to combat healthrelated frauds, myths, fads, fallacies, and misconduct. It answers inquiries about products and services, attacks misleading advertising, and reports illegal marketing. Resources (cont'd) ScienceDaily ScienceDaily is an Internet online magazine and Web portal devoted to science, technology, and medicine. This link is to the article Evidence-based Medicine Sufficient For Complementary And Alternative Medicine Research? Resources (cont'd) University of Michigan Health Systems The University of Michigan Health Systems website provides public access to a table of Selected Herb-Drug Interactions. 12