OBJECTIVES DISCLOSURE MEDICINE IN PERIANESTHESIA: FOR NURSES Catherine Standish Deb Massey Describe the concepts involved in holistic health/integrative medicine Identify common therapies used in integrative medicine and those appropriate in the perianesthesia environment Discuss holistic/integrative medicine resources available No relevant financial relationships to disclose Note: The following information is not intended for self-diagnosis or self-treatment. Please consult a qualified health care professional before beginning any treatment plan Note: Integrative therapy use in medical institutions must be approved before use CONFUSED??? COMMON DEFINITIONS Modern/Allopathic/Conventional/Western Medicine: Current cultural health practices in the United States that include pharmaceuticals & surgery (Reductive theory of healthcare). Alternative Medicine: Any therapies used in place of conventional or mainstream care in that culture. Complementary Medicine: Therapies used along with the conventional or mainstream medicine. Complementary and Alternative Medicine = CAM Integrative Medicine: Integrating CAM therapies into conventional or mainstream medicine (Based upon evidence of safety and effectiveness in a relationship-based care model) HOLISTIC VIEW OF HEALTH The focus on the whole person, not just a specific disease Mind, body & spirit are inseparable Good health is not just the absence of disease The body has an innate power to heal itself Lifestyle factors contribute to health & illness Holistic Health: Care of the whole person including body, mind, spirit, emotions, and relationships in the context of his or her values, beliefs, and community. *Reference: Total Fitness for the 21st Century: Conference Report [PDF 550KB], Institute for Alternative Futures, Uniformed Services University of the Health Sciences. Published December 30, 2009. *Reference: www.uptodate.com
HISTORY OF HOLISTIC HEALTH HOLISTIC HEALTH MOVEMENT WHY MEDICINE? One of the fastest growing fields in healthcare 5000 years ago Chinese book about internal medicine defining acupuncture, meridians and therapy's of touch Ancient Egyptian illustrations in pyramids depicting waves of energy coming from healers The Majorville Medicine wheel in Alberta Canada Native American medicine wheel also dates back 5000 years Seeds of holism grew out of the Social movements in the 60 s & 70 s Increased consumer Demand Consumer Driven Movement 1978 American Holistic Medical Association 1978 American Holistic Dental Association 1982 American Holistic Veterinary Association 1983 American Holistic Nurses Association 1987 MN Holistic Nurses Association 2006 Holistic Nursing was officially recognized by the American Nurses Association (ANA) The hidden mainstream of American medicine. -David Eisenberg American s spend $14.9 billion on complementary/alternative medicine (CAM) yearly [National Health Interview Survey, 2007] Reasons: Cost of prescription drugs, access to health insurance, too much reliance on drugs, views on wellness conflict with physician s views, and many prefer a more empowered approach to healthcare (self-healing) MINNESOTA LEGAL GUIDELINES NORTH & SOUTH DAKOTA LEGAL GUIDELINES ASPAN STANDARDS REGARDING USE OF CAM Provides a list of 12 parameters for integrative therapy use among nurses. NORTH DAKOTA SOUTH DAKOTA No specific position statement Provides general guidelines granting nurses authority to practice Integrative Therapies within context of safe nursing practice. Personally possesses specialized nursing knowledge, judgment and skill and current competence to perform the act with reasonable skill and safety NO LIABILITY for licensed providers or nurses for making referrals MN Statute 146A. Complementary and Alternative Health Care Practices Licensed vs unlicensed practitioners Use of CAM in hospitals NDCC 43-12.1-02 (5c) definition of "nursing" related to supportive and restorative care and nursing treatment of complementary and alternative therapies. 10/2012 It is within the scope of practice for the licensed nurse to perform complementary and alternative therapies if the following requirements are met : A written policy and procedure is maintained by the entity; Evidence of satisfactory completion of a formal, continuing education program; Has been authorized to perform the procedure; The licensed nurse has the knowledge, skill, and judgment. Nurse Practice Act has no mention of the words holism/holistic as defined or recognition of holistic nursing as a specialty No position statement Position Statement on Cultural Diversity and Sensitivity in Perianesthesia Nursing Practice Pain & Comfort Clinical Guideline Includes Heat/cold therapy, relaxation breathing, imagery, music, distraction, biofeedback PONV-PDNV Clinical Guideline Complementary modalities: P6 Acupoint stimulation (acupressure) Herbal supplements i.e. isopropyl alcohol, peppermint
OTHER NURSING ORGANIZATIONS THAT SPECIFY USE OF CAM COMMON MODALITIES MANIPULATIVE/BODY-BASED Both conventional and complementary or alternative therapies fall within the scope of nursing practice. (AHNA, 2012) Chiropractic Osteopathy Hospice & Palliative Nurses Association (HPNA, 2011) Oncology Nurses Society (ONS, 2009) Acupuncture/pressure Society of Pediatric Nurses (SPN, 2006) Lymphatic Therapy M Technique Physical Therapy MIND-BODY INTERVENTIONS BIOLOGICALLY-BASED APPROACHES ENERGY THERAPIES Yoga Music Therapy Diets Healing Touch Guided Imagery Stress-Management Herbs Reiki Hypnotherapy Qigong Vitamins Magnets Meditation T ai Chi (Chuan) Biofeedback Therapeutic Touch MBSR, rosary, mantras, prayer, etc. Art Therapy Hydrotherapy Prayer Counseling/Psychotherapy Color Therapy Spirituality
ALTERNATIVE MEDICAL SYSTEMS SAFETY & EFFECTIVENESS Homeopathy Naturopathy Osteopathic medicine Ayurvedic Medicine Traditional Chinese Medicine Limited research is sometimes lacking for complementary therapies (some are hard to quantify) NCCIH is currently sponsoring research & conducting clinical trials Safety & effectiveness is sometimes unknown Select practitioners with care based on training & experience Some dietary supplements interact with medication or other supplements, have side effects of their own Most supplements are not tested on pregnant women, nursing mothers, or children Tell your healthcare providers about any complementary/alternative practices you use PERIANESTHESIA & MEDICINE PRE-OP ASSESSMENT Common herbal supplements with possible perianesthesia implications COMMON INTERVENTIONS/ TREATMENTS IN PERIANESTHESIA Importance of Assessment Aloe Vera Cathartic effects; hypokalemia Black Cohosh...Hypotension; bradycardia Narcotics Common Problems 1. Nausea 2. Anxiety 3. Pain Importance of Self-care Chamomile...Increased sedation Echinacea..Can inhibit hepatic enzymes Garlic..Anticoagulant effects; inhibits platelet function Gingko Biloba.Platelet inhibition; coagulation issues St John s Wort.Potentiates anesthetic effects Melatonin...Can slow wake-up time Non-Narcotic Pain Meds NSAIDS Antiemetics Benzodiazepines Local/Regional Acupressure Music Therapy Guided Imagery Positioning The Power of Presence *Reference: Schick, L. & Windle, P. (2016). Perianesthesia nursing core curriculum: Preprocedure, phase I and Phase II PACU nursing (3rd ed.). St. Louis: Elsevier Heat/Cold Therapy
ANXIETY ANXIETY PAIN MUSIC AROMATHERAPY Lorazepam (ativan) onset 5-15 min; peak 15-20 min Diazepam (valium) onset 1-3 min, peak 3-4 min Guided Imagery/Meditation Breathing Techniques Intercessory Prayer Meditation Yoga Qigong Narcotics NSAIDS Local Anesthetics Acute vs. Chronic Positioning Midazolam (versed) onset 1-3 min; peak 5-30 min Restraints Presence (i.e. family, nurse, clergy) Diversion (i.e. art, relaxation channel, music, animal therapy) Feng Shui in hospital rooms MASSAGE Reflexology Acupuncture/Acupressure Healing Touch (touch therapies) Kava-kava A natural product shown to elicit a calming effect Caution: Associated with abnormal liver function tests Essential oils/aromatherapy Energy Therapy (i.e. Reiki, healing touch) PAIN NAUSEA NAUSEA MIND-BODY STRATEGIES The relaxation response Meditation Prayer MBSR Guided imagery MASSAGE Decreases pain, anxiety, & nausea Historical part of nursing practice ACUPRESSURE SP6 Point (inner ankle) Lower back/sacral area Auricular (ear) ENERGY THERAPIES Reiki, Healing Touch, Therapeutic Touch AROMATHERAPY Many choices/uses MOVEMENT THERAPIES May not be appropriate for our setting Prophylactic & Rescue Antiemetics Dexamethasone (Decadron) Droperidol (Inapsine) Ondansetron (Zofran) Granisetron (Kytril) Metoclopramide (Reglan) Prochloperazine (Compazine) Promethazine (Phenergan) Scopolamine (transdermal) IV Fluid Bolus P6 Stimulation (acupressure) Supplemental oxygen MIND-BODY Guided imagery Deep breathing/progressive muscle relaxation Hypnosis; music; yoga ENERGY & BODY-BASED Acupressure Acupuncture HERBAL Ginger 1g powder form; preop Peppermint essential oil Isopropyl alcohol (70%) 2-3 inhalations Homeopathic remedies NUTRITIONAL Small amts PO Avoid milk Ginger/peppermint Vomiting-pitching-barfing-upchucking-ralphing-pucking-retching-gaging-dry heaves-nausea- queasiness-ponv
COMMON CHALLENGES FOR PERIANESTHESIA NURSES CAM THERAPIES COMMONLY USED DISEASES/CONDITIONS FAST-PACED HEAVY WORK-LOAD TIME-CONSUMING DOCUMENTATION CONDITIONS CHANGE RAPIDLY NON-AVAILABILITY OF RESOURCES NEGLECTING SELF-CARE WHY ORGANIZATIONS OFFER COMPLEMENTARY/ALTERNATIVE MEDICINE RESOURCES University of MN Center for Spirituality & Healing Free online learning modules- integrative learning practices http://www.csh.umn.edu REFERENCES AHNA: (2013). Holistic nursing: Scope and standards of practice. American Holistic Nurses Association & American Nurses Association, Silver Springs, MD: Nursebooks.org American Holistic Nurses Association website (2016). Retrieved from http://www.ahna.org/ Dossey, B. & Keegan, L. (2013). Holistic nursing: A handbook for practice. (6th ed.). American Holistic Nurses Association Helming, M., Barrere, C., Avino, K. & Shields, D. (2014). Core curriculum for holistic nursing. (2nd ed.). Burlington, MA: Jones & Bartlett Learning Stress reduction exercises, research, and education; conferences http://www.ahna.org Kreitzer, M. & Koithan, M. (2014). Integrative nursing. New York: Oxford University Press. Micozzi, M.S. (Ed.). (2011). Fundamentals of complementary and alternative medicine (4th ed.) St. Louis: Saunders Elsevier. American Holistic Health Association Free, impartial wellness resources http://www.ahha.org National Center for Complementary and Alternative Medicine. (2012). Retrieved from http://nccam.nih.gov/ Northrup, C. (2003). Medical practice as a spiritual journey. In Horrigan, B.J. (Eds.). Voices of integrative medicine (pp. 428-435). St Louis: Elsevier, Churchill Livingston. MN Holistic Nurses Association Minneapolis & Rochester chapters http://www.minnhna.org Schick, L. & Windle, P. (2016). Perianesthesia nursing core curriculum: Preprocedure, phase I and Phase II PACU nursing (3rd ed.). St. Louis: Elsevier Schick, L. & Windle, P. (2010). Perianesthesia nursing core curriculum: Preprocedure, phase I and Phase II PACU nursing (2rd ed.). St. Louis: Elsevier National Center for Complementary & Integrative Health (NCCIH) Free contact hours, education, research, statistics http://www.nccih.nih.gov Schlitz, M., & Amorok, T. (Eds.) (with Micozzi, M. S.). (2005). Consciousness and healing: Integral approaches to mind- body medicine. St.Louis: Elsevier, Churchill Livingston. CDC: National Center for Health Statistics
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