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 CAM therapies, nurses must become knowledgeable about the uses, limitations, and precautions associated with these new practices and products. Professional nurses have an obligation to understand such practices and products in order to advise patients and effectively incorporate pertinent therapies into the patient's care. Nurses who have knowledge and skills in this area are in key positions to empower patients for self-care that complements traditional medicine.


CAM includes healing philosophies, practices, and products that fall outside what Western society considers mainstream medicine and that are not typically taught in the educational programs of physicians, nurses, and other health professionals.

The past few decades have witnessed CAM progress from a fringe movement to a highly popular, widely used group of therapies. Recent surveys reveal that more than 4 out of every 10 Americans have visited an alternative health care practitioner and most are paying for these services out of their own pockets (Eisenberg et al., 1998).

Rather than emerging from the leadership of health care professionals, the growing popularity of CAM has been consumer driven. Several factors contribute to consumers' desire for CAM:

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 CAM. In addition, the media regularly reports these findings, contributing to consumers' awareness of the body of evidence.

CAM practices and products are consistent with the values, beliefs, and philosophic orientations toward health held by many people (Astin, 1998). With rare exceptions, consumers prefer natural approaches that afford them an active role in their care over high-tech interventions that relegate them to a passive, obedient role. They want to connect with their health care providers, have their individuality recognized, and gain education and skills to effectively make decisions and direct their care. Increasingly consumers are seeking measures to enhance not just their bodies, but also their minds and spirits. The quality of their lives is equally, if not more, important to the quantity of years they live. Consumers often discover that CAM promotes many principles of holistic care that they value, such as individual empowerment, self-care, and a high quality of life.


A wide range of healing therapies are encompassed in CAM, yet most share some common principles at their core (Eliopoulos, 1999):

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). In CAM there is the assumption that the body heals itself. Alternative healing therapies enhance the body's ability to self-heal.

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 CAM. Practitioners of healing therapies explore the underlying cause of a problem and customize approaches accordingly. It is rare in CAM to find a standing protocol that treats all persons with similar conditions similarly.

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 United States, the National Institutes of Health (NIH) established the Office of Alternative Medicine in 1992 to evaluate these complementary and alternative practices and products. In 1998 the Office of Alternative Medicine became a  freestanding center within NIH and was named the National Center for Complementary and Alternative Medicine (NCCAM). NCC AM has categorized CAM into five fields of practice (Box 15-1); the Center supports research and serves as a clearinghouse for information on alternative practices and products.

Consumers' growing use and the increased integration of CAM therapies into conventional care place a demand on nurses to become familiar with these therapies. Some of the frequently used CAM therapies are discussed below.


Practiced in China for over 2000 years, acupuncture is a major therapy within traditional Chinese medicine. It is based on the belief that there are invisible channels throughout the body called meridians through which energy flows. This energy is called Qi (pronounced chee) and is considered the vital life force. It is believed that illness and symptoms develop when the flow of energy becomes blocked or imbalanced. Health is restored when the energy becomes unblocked; this is achieved by stimulating acupuncture points on the meridian(s) affected.

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 India for over 5000 years. Ayurveda means "the science of life" and is a system of care that promotes spiritual, mental, and physical balance. Noninvasive approaches are used to achieve balance and include yoga, massage, diet, purification regimens, breathing exercises, meditation, and herbs.

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

• Palliation

• 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

Chiropractic medicine is a popular and widely accepted CAM therapy in the United States, perhaps because it was developed and practiced here for over a century. Chiropractors are licensed in every state, and most insurance companies will pay for chiropractic treatments.

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.

Dietary Supplements

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 the United States until the early nineteenth century, when medicine's shift toward a more scientific approach caused drugs to be viewed more favorably than herbs. But in the 1960s when the movement toward natural health began to swell, interest in herbal products increased. The use and sales of herbal remedies have grown significantly since.

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 (

15-3) and know where to obtain information on other herbs when needed (see
15-2). Because of consumers' widespread use of herbs, questions regarding use of all supplements and education to ensure safe use are significant nursing responsibilities.


Homeopathy is a branch of medicine developed in the late eighteenth century by Samuel Hahnemann. It was widely practiced in the United States until the early 1900s when modern (i.e., conventional) medicine discredited it as being unscientific and ineffective. Homeopathy remained popular in other parts of the world, however, and recently has become popular again in our country.

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.

Magnet Therapy

Although a mainstream therapy in Germany and Japan, magnets have only recently become popular in the United States. The major uses of magnet therapy are for pain and wound healing.

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 the United States in the 1970s when Harvard Medical School cardiologist Herbert Benson published research on the "Relaxation Response" (Benson and Beary, 1974). Benson reported that after 20 minutes of meditation, participants' heart rate, respirations, blood pressure, oxygen consumption, carbon dioxide production, and serum lactic acid levels decreased. This led to meditation being used for a variety of conditions, including stress, anxiety, pain, and high blood pressure.

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 Europe during the nineteenth century led to the development of spas that offered natural treatments to promote health and healing. Soon the movement spread to the United States, and in 1896 the American School of Naturopathy was founded. Naturopathic physicians and treatment facilities using natural cures became popular in the early part of the twentieth century. For example, John Kellogg ran such a facility in Battle Creek in which he became famous for the natural breakfast cereals that he used. As time progressed, medications and high-tech interventions caused naturopathy to pale by comparison; however, as consumers are seeking approaches that are more natural, this form of alternative medicine is making a comeback.

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 medicine (e.g., Bastyr University, Southwest College of Naturopathic Medicine and Health Sciences, and National College of Naturopathic Medicine). A handful of states license naturopaths and require that they must have graduated from an accredited program. However, there are many individuals practicing as naturopaths who have obtained their education and experience through other means or who practice in states that do not require licensure; thus learning about the credentials of naturopath before receiving services is beneficial for clients.

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

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 National Center for Complementary and Alternative Medicine at 888-644-6226,


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 CAM, particularly care of the body, mind, and spirit. In fact, this is what holistic nursing is all about. Nurses must ensure that the integration of CAM into their practice is done within a holistic paradigm to truly make them healing therapies and not merely disconnected procedures within an already fragmented health care system.

Facilitating Clients' Use of Complementary and Alternative Medicine

Nurses need to incorporate CAM into their nursing practice. This begins during the assessment process by exploring clients' use of CAM practices and products. As it is not unusual for clients to use these without the knowledge of their physicians, nurses may be the first health professional with whom clients have discussed this issue. Factors to assess include:

CAM practices and products being used and their sources.

• Appropriateness of use of CAM practices and products.

• Side effects and risks associated with use of CAM.

• Conditions for which CAM currently is not used that could benefit by its use.

Through the assessment process nurses may identify the need to educate clients about the appropriateness of the CAM products and practices they are using. For example, a client with a pacemaker who uses magnets needs to be advised against continuing this practice; likewise, a client drinking ginseng tea at bedtime requires an explanation that his insomnia may be the result of the stimulant effects of the herb.

There may be situations in which nurses identify that specific conditions could benefit from the use of CAM therapies. As client advocates, nurses would bring this to the attention of the physician and other members of the health care team and make recommendations accordingly.

Nurses traditionally have been responsible for the coordination of client care. As CAM therapies are integrated into conventional care, nurses are the logical professional discipline to oversee the various parts and ensure that they are working in harmony for the client's benefit. Nurses can learn to use many alternative healing measures to enhance nursing care. Among these are acupressure, aromatherapy, biofeedback, imagery, massage, and therapeutic touch. Nurses should seek whatever additional education and training required to gain competency in these therapies and ensure compliance with state licensing laws.

Integrating Complementary and Alternative Medicine Into Conventional Settings

Nursing leadership can be exercised in helping conventional clinical settings integrate CAM therapies. In fact, nursing's holistic orientation and traditional coordination responsibilities make nurses logical for this role. Let us look at the way in which one nurse accomplished this.

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.

Oddsei - What are the odds of anything.