This chapter presents an overview of complementary and alternative
medicine (CAM) and products, which are rapidly gaining in popularity in Western
society. As increasing numbers of consumers and clinical settings become
interested in and actually use
USE OF ALTERNATIVE HEALING METHODS
The past few decades have witnessed
Rather than emerging from the leadership of health care professionals,
the growing popularity of
• Dissatisfaction with the conventional health care system. The impersonal nature of health care has grown with costs. Shorter hospital stays, several months' waiting periods to see a physician, hurried staff that barely have time to provide basic care, and horror stories of the adverse effects of medications are causing consumers to look for alternative approaches that are safer, less costly, and more responsive and personalized than conventional health care.
• Unwillingness to grin and bear the effects of diseases. Today's consumers are less willing than their parents to live with symptoms that alter their lifestyles or to passively accept a terminal diagnosis and wait to die. They want options and to be empowered to do everything possible to promote the best possible quality and quantity of their lives, and they are willing to look to alternative healing measures to do so.
• Shrinking world. The rapid pace and ease of information sharing has enabled individuals to learn about practices of people throughout the world.
• Growing evidence of effectiveness. The body of research
supporting the effectiveness of alternative therapies increases almost daily.
People are hearing testimonials from friends and family about the way they have
been helped by acupuncture, herbs, and other forms of
PRINCIPLES UNDERLYING ALTERNATIVE HEALING
A wide range of healing therapies are encompassed in
• The body has the ability to heal itself. Most conventional
medicine works from the premise that the elimination of sickness requires an
intervention "done to" the body (e.g., giving medications, surgery).
• Health and healing are related to a harmony of mind, body, and spirit. The mind, body, and spirit are inseparable; what affects one affects all. Healing and the improvement of health demand that all of the facets of a person be addressed, not merely a single symptom or system.
• Basic, positive health practices build the foundation for healing. Good nutrition, exercise, rest, stress management, and avoidance of harmful habits (e.g., smoking) are essential in gredients to health maintenance and the improvement of health conditions. Practitioners of healing therapies are more likely than conventional practitioners to look at total lifestyle practices rather than the diseased body part.
• Approaches to healing are individualized. The unique
composition and dynamics of each person are recognized in
• Individuals are responsible for their own healing. People can use a wide range of therapies, from conventional prescription drugs or herbal remedies, to treat illness. However, it is the responsibility of competent adults to seek health advice, make informed choices, gain necessary knowledge and skills for self-care, engage in practices that promote health and healing, and seek help when needed. Clients are responsible for getting their minds, bodies, and spirits in optimal condition to heal rather than look externally for a doctor or nurse to heal them.
A holistic philosophy, promotion of positive health habits, and the client's responsibility for facilitating his or her own health and healing are common threads among healing therapies.
Overview of Popular Alternative Healing Therapies
Hundreds of healing therapies are practiced throughout the world, with
varying degrees of evidence to support their effectiveness. As the use of these
therapies grew in the
Consumers' growing use and the increased integration of
The acupuncturist typically begins the treatment by taking a history, examining the tongue, and evaluating pulses. Based on where the acupuncturist assesses the energy imbalance to be, he or she places needles at specific points. The placement of the needles may have no relationship to the area of the body that is symptomatic. Sometimes the acupuncturist applies heat to the acupoints by burning a dried herb on the top of the needle or skin; this procedure is known as moxibustion. Electro-acupuncture, a process in which a small current of electricity is applied to the tip of the needle, is another means of stimulating acupoints.
Pain relief is the most common reason people seek acupuncture treatment, and research supports its effectiveness for this problem. The use of acupuncture for dental pain and chemotherapy-induced nausea and vomiting also has been supported by research. There is some evidence that acupuncture can be of help for nicotine withdrawal, asthma, stroke rehabilitation, carpal tunnel syndrome, and a growing list of other conditions.
Insurance companies vary in their coverage of acupuncture, so it is best for clients to call their individual insurer for determination of benefits. State health departments can be consulted for licensing requirements for acupuncturists in a given state.
Although it recently has gained popularity because of the writings and
lectures of Deepak Chopra (1993), Ayurveda has existed in
Individuals are believed to have distinct metabolic body types called doshas, which axe vata, pitta, and kapha. Signs of illness occur when the delicate balance of the doshas is disturbed. The treatment to restore balance is influenced by the body type a client possesses and could include:
• Cleansing and detoxification
• Rejuvenation through special herbs and minerals
• Mental hygiene and spiritual healing
Currently there is no process for licensing or certifying Ayurvedic practitioners. As some of the treatments could subject clients to complications (e.g., dehydration from cleansing enemas, herb-drug interactions), finding a reputable trained practitioner is important.
Biofeedback is a technique in which the client is taught to alter specific bodily functions (e.g., heart rate, blood pressure, muscle tension). The client uses various relaxation and imagery exercises to affect desired responses. Machinery such as electroencephalograms, electromyelograms, and thermistors are used to measure and offer feedback about the function that one is trying to alter. As the client becomes familiar with ways to successfully alter bodily responses, the equipment may no longer be necessary.
There are many conditions for which biofeedback can offer benefit, including urinary incontinence, anxiety, stress, irritable bowel syndrome, neck and back pain, and cardiac arrhythmias.
Chiropractic medicine is a popular and widely accepted CAM therapy in
Chiropractic medicine is based on the belief that misalignments of the spine, called subluxations, put pressure on the nerves leading to pain and disruptions in normal bodily function. The misalignment is treated by manipulation and adjustment of the spine. Typically the chiropractor's hands do the alignment, although increasingly chiropractors are using heat, electrical stimulation, and other treatments.
The past advice that vitamin and mineral supplements are unnecessary if one is eating well has been replaced with the recommendation that everyone should take a daily vitamin and mineral supplement. This shift in thinking has resulted from the realization that many people do not consume the proper nutrients through their diets. Pollutants, stress, and other factors that are more common today than in previous generations heighten the body's need for added protection. Also, unlike our ancestors who consumed produce that was picked the same day, we tend to eat more processed foods and produce that could have been in transit for several days before reaching us; therefore the foods we consume contain fewer vitamins and minerals. In fact, the Recommended Daily Allowances (RDAs) for vitamins and minerals are being reevaluated and increased.
Specific dietary supplements are believed to be beneficial for specific health conditions (e.g., vitamin E to improve arthritis and heart disease). However, too much of a good thing could prove harmful, as high doses of vitamins and minerals can lead to serious complications. For example, high doses of folk acid can mask a vitamin B12 deficiency (a cause of dementia), and calcium in excess of 2500 mg/day can cause kidney stones and impair the body's ability to absorb other minerals.
Plants have been used for medicinal purposes for nearly as long as
humans have inhabited the earth. Botanical medicine was a mainstream practice
In reality, herbs are not that foreign to conventional medicine. Thirty percent of all modern drugs are derived from plants (Kleiner, 1995), including:
• Atropine from atropa belladona.
• Digoxin from digitalis purpurea.
• Ipecac from Cephaelis ipecacuanha.
• Reserpine from Rauwolfia serpentina.
With more than 20,000 herbs and related products on the market (Herbal
roulette, 1995) staying current of uses, dosage, interactions, and adverse
effects is a near impossibility. Nurses would be wise to become familiar with
some of the most commonly used herbs (
Homeopathy is a branch of medicine developed in the late eighteenth
century by Samuel Hahnemann. It was widely practiced in the
The origin of the word homeopathy helps to understand this therapy. In Greek the word homios means similar, and pathos means suffering. The foundation of homeopathy is the Law of Similars and builds on the belief that remedies are prescribed that produce symptoms similar to those of the illness being treated. Before judging this theory to be outrageous, it should be noted that this is the same principle on which vaccines are based. In homeopathy a dilute preparation is made from a plant or other biologic material; the more dilute the preparation, the higher its potency. The solution typically is added to a sugar tablet or powder for oral use or to a lotion or ointment for external use.
The Law of Cure in homeopathy is used to evaluate the effectiveness of a remedy. If the treatment is successful, symptoms should travel from vital to less vital organs of the body, move from within the body outward, and disappear in reverse order of appearance. If symptoms do not follow this sequence, a new or additional treatment is used. In homeopathic medicine a worsening of symptoms after a remedy is given is considered a positive sign that healing is taking place.
The ideal way to use homeopathic remedies is to have a homeopath prescribe a customized remedy based on individual characteristics and symptoms. However, homeopathic practitioners are not plentiful, so the next best thing is to buy over-the-counter preparations that are labeled for their intended purpose (e.g., arthritis, headache, hayfever, cold).
Although the use of trance states for healing purposes dates back to primitive cultures, hypnotherapy was not approved as a valid medical treatment until the 1950s. This mind-body therapy is now widely and successfully used for a wide range of conditions, including chronic pain, migraines, asthma, smoking cessation, and irritable bowel syndrome.
The process of hypnosis begins by the therapist guiding the client into a relaxed state and then creating an image that focuses attention to the specific symptom or problem that needs to be improved. The client must be in a state of deep relaxation to be receptive to a posthypnotic suggestion. Most people are capable of being hypnotized if they are willing.
Imagery is the process of creating an image in the mind that can cause a specific bodily response. Although imagery is used in hypnosis, in hypnosis an image and suggestion are presented to the person, whereas in imagery the person creates an image on his or her own. The process of imagery begins by the client establishing a desired outcome (e.g., to relieve stress, enhance circulation, reduce blood pressure). The nurse or other practitioner assists the client in creating an image that helps to achieve the outcome (e.g., the nurse may describe how the blood circulates through the body, help the client develop an image of how cancer cells can be eliminated, or suggest that the client think of a peaceful place where cares can melt away), and guides the client in reaching a relaxed state. In addition to having someone guide him or her through an imagery exercise, a client can learn the process from books or use commercially prepared audiotapes.
Imagery is not a difficult mind-body healing therapy to master and can be easily implemented in virtually every practice setting.
Although a mainstream therapy in
The mechanism by which magnets work is not completely understood and is being investigated at present. It is believed that magnets relieve pain by creating a slight electrical current that stimulates the nervous system and consequently blocks nerve sensations. Magnets are hypothesized to speed wound healing by dilating vessels and increasing circulation to an area. Distributors of magnet products make additional claims about the health benefits of magnets, ranging from improving attention deficit disorder to boosting the immune system, although these benefits are yet to be proven.
Magnets come in a variety of forms, strengths, and prices. There are magnet disks that can be strapped to limbs, magnet mattresses that one can sleep on, and magnet jewelry. To be effective for therapeutic purposes, the magnet should be at least 500 Gauss (which is about eight times stronger than the magnets used for attaching things to your refrigerator door).
Persons with pacemakers should not use magnets, and they should not be applied to the abdomen of a pregnant woman.
Massage, Bodywork, and Touch Therapies
Massage for healing purposes has been used for thousands of years to maintain health. Many people today receive regular massages as an important component of their self-care to aid in stress management. In addition to promoting relaxation, massage can be beneficial for reducing edema, promoting circulation and respirations, and relieving pain, anxiety, and depression.
Massage is the manipulation of soft tissue by rubbing, kneading, rolling, pressing, slapping, and tapping movements. The term bodywork is applied to the combination of massage with deep tissue manipulation, movement awareness, and energy balancing. Touch therapies include techniques in
Because therapeutic touch (TT) is a popular alternative healing therapy among nurses, it deserves some discussion. TT became popular in nursing in the 1970s with the work and research of Delores Krieger (Krieger, 1979; 1997). Krieger advanced the theory that people are energy fields and that obstructed energy could be responsible for unhealthy states. She proposed that the nurse could draw on the universal field of energy and transfer this energy to the client. This incoming energy could help the client mobilize his or her own inner resources for healing and help unblock the client's obstructed energy. BOX
In TT there is little direct physical contact between the practitioner and the individual being treated. Rather, TT is an energy-based therapy; the nurse enters the client's energy field to assess and treat energy imbalances.
In the first step of TT, the nurse centers herself or himself and focuses on the intent to heal (this is sometimes referred to as healing meditation). During this phase the nurse quiets the mind and prepares physically and psychologically to connect with the client. This is considered a crucial step in the process to enable the nurse to be fully present in the moment with the client. This is followed by the nurse passing his or her hands over the client's body to assess the energy field and mobilizing areas in which energy is blocked or sluggish by directing energies to that area. TT is used to reduce anxiety, relieve pain, and enhance immune function.
Meditation and Progressive Relaxation
Meditation, the act of focusing on the present moment, has been used for
centuries throughout the world. This practice gained considerable attention in
Progressive relaxation is another exercise that shares some of the same benefits as meditation. Typically a person learns to guide himself or herself through a series of exercises that relax the body, such as tightening and relaxing various muscle groups. Many audiotapes are available in bookstores and health food stores that offer scripts to guide meditation and progressive relaxation exercises.
An intense interest in natural cures in
Naturopathy is built on the principle that the body has inherent healing abilities that can be stimulated to treat disease. Naturopathic doctors assess and treat the cause of the disease rather than merely alleviate symptoms. They help clients identify unhealthy practices, encourage healthy lifestyle habits, and guide them in managing health problems using natural approaches such as herbs, homeopathic remedies, diet modifications, dietary supplements, and exercise.
There are a limited number of accredited schools of naturopathic
Prayer and Faith
Many people consider their faith to be an integral part of their total being rather than a therapy, but now there is scientific evidence supporting the therapeutic benefits of faith and prayer in health and healing. Hundreds of well-conducted studies have revealed that people who profess a faith, pray, and attend religious services are healthier, live longer, have lower rates of disability, recover faster, have lower rates of emotional disorders, and otherwise enjoy better health states than those who do not (Larson, Sawyers, and McCullough, 1998). Not only do the faith and religious practices of individuals themselves affect health and healing, but research also supports the benefit of intercessory prayer.
Nurses need to appreciate that most people believe in the healing power of prayer and think that their health care providers should join them in prayer if requested. This does not suggest that nurses or other health professionals should be forced into prayer if it is contrary to their beliefs; but rather, if there is no objection from either party, prayer by the client and health care provider can be used as a valuable healing measure.
Tai chi is another practice from Traditional Chinese Medicine that is used to stimulate the flow of Qi, the life energy. It is a combination of exercise and energy work that looks like a slow, graceful dance using continuous, controlled movements of the arms and legs. There is a specific sequence of steps to follow in doing tai chi, but fortunately there are many inexpensive videos that can be used, in addition to classes that are offered to aid people in learning this practice.
Tai chi has some proven benefits, including reducing falls and improving coordination in older adults (Province, 1995) and improving function in persons with arthritis (Horstman, 1999). Many people find that tai chi helps to reduce stress and promote a general sense of well-being.
Yoga has changed from a mystical form of Hindu worship practiced more than 5000 years ago to what is now known as a system of exercises involving various postures, meditation, and deep breathing. The word yoga means union; union of body, mind, and spirit is achieved through yoga. This exercise has been found helpful for pain, anxiety, stress, high blood pressure, poor circulation, respiratory and digestive disorders, and carpal tunnel syndrome (Garfinkel et al., 2000). Yoga can be adapted to any level and capability so it can be easily used.
There are many other alternative healing modalities and new ones
appearing with regularity. Some may be safe and effective but lack sufficient
experience or clinical research to support their claims; others may be
worthless and merely an attempt to sell a product or service. Discretion is
needed. Assistance in gaining objective information regarding CAM therapies can
be obtained from the
NURSING AND COMPLEMENTARY AND ALTERNATIVE MEDICINE THERAPIES
A Holistic Approach
The use of natural or "alternative" healing measures is hardly
new to nursing. From Florence Nightingale (1860) who wrote about the importance
of creating an environment in which natural healing could occur through
contemporary nurse theorists who discuss human and environmental energy fields
(Rogers, 1970), nurses have long realized that healing quite effectively occurs
in ways not encompassed within the conventional biomedical system. Nursing also
has promoted many of the same principles evident in
Facilitating Clients' Use of Complementary and Alternative Medicine
Nurses need to incorporate
• Appropriateness of use of
• Side effects and risks associated with use of
• Conditions for which
Through the assessment process nurses may identify the need to educate
clients about the appropriateness of the
There may be situations in which nurses identify that specific
conditions could benefit from the use of
Nurses traditionally have been responsible for the coordination of
client care. As
Integrating Complementary and Alternative Medicine Into Conventional Settings
Nursing leadership can be exercised in helping conventional clinical
Becky Blake recently joined the nursing staff in a combined coronary care/step-down unit. It did not take her long to note the expert technical skill of her colleagues who could read monitors in a flash and respond to emergencies without missing a beat. The skill, efficiency, and organization of the nursing staff were evidenced by the lack of medication errors, infections, and pressure ulcers, coupled with the lowest length of stays of comparable hospital units in the area.
Yet there seemed to be something missing. Clients and their families often showed signs of anxiety and fear that were not addressed. Familiar faces reappeared as some clients were readmitted because they failed to alter lifestyle habits that contributed to their conditions. The same nursing staff who cared for people with hearts damaged by the effects of smoking, poor diet, and stress were guilty of the same practices themselves.
It came to a head for Nurse Blake one morning when she was at a bedside changing an intravenous bag and checking equipment. The client, a man in his 50s, pulled at her arm, looked Nurse Blake in the eyes, and tearfully said, "How do you think I'm going to do? I've been awake all night wondering if I'll be able to do my job, take care of my wife, see my grandkids grow up, do the things I like to do." For the first time, Nurse Blake saw beyond the body in the bed to a human being experiencing considerable emotional distress—distress that was hardly beneficial to his condition. We've managed to get this man's heart repaired, she thought, but we haven't begun to help him heal the emotional and spiritual pain that this illness created. This began a journey for Nurse Blake of discovering measures to help clients that went beyond the conventional treatments that were regularly prescribed.
Nurse Blake located a local network of holistic nurses and began attending their meetings. Through this group she learned of the difference between healing and curing and the importance of addressing the needs of body, mind, and spirit. She also heard nurses discussing their own need to be nurtured and committed to positive self-care practices. She met nurses who shared how they were using alternative healing practices and who led her to resources from which she could learn more.