Complementary and alternative therapies: the nurse's role.
Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine (National Center for Complementary and Alternative Medicine [NCCAM], 2004). CAM is sometimes called mind-body medicine because it is an approach to healing that uses the power of thought and emotions to positively influence physical health (USADrug, 2005). Complementary therapies are interventions used with conventional or traditional therapies. Alternative therapies are interventions used instead of conventional medicine for the purpose of treating or ameliorating disease. Both focus on the body, mind, and spirit. They include acupuncture, acupressure, dietary supplements, homeopathic medicine, meditation, reflexology, yoga, aromatherapy, energy medicine, massage, Reiki, and therapeutic touch.
NCCAM (2004) delineates five categories of CAM:
* Alternative medical systems are built upon complementary systems of theory and practice (e.g., homeopathic medicine, traditional Chinese medicine).
* Body-mind interventions are techniques designed to enhance the mind's capacity to affect the body (e.g., support groups, cognitive-behavioral therapy, prayer, music).
* Biologically based therapies incorporate substances found in nature (e.g., herbs, foods, vitamins, dietary supplements).
* Manipulative and body-based therapies are based on manipulation or movement of one or more body parts (e.g., chiropractic manipulation, massage).
* Energy-based therapies use energy fields (e.g., Reiki, therapeutic touch, the use of magnets).
This article discusses the focus of CAM therapies and reviews the use of CAM in neuroscience populations. CAM nursing interventions are suggested and presented within a case study.
The Focus of CAM
The purpose of CAM therapies is to heal. Nurses are natural healers; in partnership with patients, they restore balance and integrity to patients' minds and bodies. Consequently, both the quality and quantity of patients' years of life can be increased, as suggested by Healthy People 2010 (U.S. Department of Health and Human Services, 2000). CAM therapies are noninvasive, often cost less than traditional interventions, and utilize the innate healing abilities of healthcare practitioners. Use of CAM therapies may be limited by insurance companies and viewed cautiously by both healthcare providers and patients because of limited evidence and the nontraditional characteristics of CAM.
Many CAM therapies focus on the concept of energy. The body is viewed as an energy system that has meridians or energy transport systems as well as chakras or energy centers (Eden, 1998). CAM practitioners believe that the human body is a latticework of energy fields and that, if one wants to age well, one must "energy" well. Acupuncture, acupressure, reflexology, Reiki, and therapeutic touch are based on the concept of the body as an energy system. Therefore, when the body is not healthy, there are corresponding disturbances in its energy system that should be identified and treated. Flow and balance can be noninvasively restored in an energy system by the use of massage, tapping, exercises, and postures such as those used in yoga (Table 1).
The Use of CAM in Neuroscience Populations
Research has been conducted about the general use of CAM and its application to cancer states. However, the neuroscience population would benefit from the use of CAM because other neuroscience treatment options are often limited. A National Health Interview Survey involving more than 31,000 respondents found that 62% said that they used CAM therapies when prayer for health reasons was included, compared with 36% when prayer was not included (Barnes, Powell-Griner, McFann, & Nahin, 2002). Study respondents commonly used CAM therapies to treat back discomfort, colds, neck problems, joint pain, anxiety, and depression.
Tindle, Davis, Phillips, and Eisenberg (2005) compared the use of CAM in 1997 with its use in 2002. Researchers found an increase in the use of herbal supplements and yoga but a decrease in the use of chiropractic services. In both years, the most commonly used therapies were herbal treatments, relaxation techniques, and chiropractic services. The researchers concluded that the use of CAM by American adults remained stable during the 5-year period.
Numerous investigators have studied the use of CAM by cancer patients. CAM is often used to prevent recurrence or increase quality of life (Beebe-Dimmer et al., 2004; Henderson and Donatelle, 2004). Vitamins are most commonly used by cancer patients, followed by herbs, meditation, and massage (Ashikaga, Bosompra, O'Brien, & Nelson, 2002).
A review of the literature on the use of CAM in neuroscience populations found investigations of individuals with dementia or Alzheimer's disease and multiple sclerosis (MS). According to the Alzheimer's Society (2004), individuals with Alzheimer's disease use gingko biloba, silymarin, choto-san, kami-untan-to, yishi capsule, aromatherapy, music, acupuncture, antioxidants, melatonin, and bright-light therapy. A telephone survey showed a 10% use of complementary medicine for cognitive problems, limited use of alternative medicine, and a 29% use of complementary therapy for general health (Hogan & Elby 1996). Woods, Craven, and Whitney (2005) reported results of a randomized, double-blind, three-group study involving dementia; 57 patients were observed for 3 days during which therapeutic touch was used. Significant differences (p = .03) were found among the groups, especially in restlessness and vocalization.
Surveys have addressed CAM use by persons with MS. Researchers found that 36 of 100 individuals responding to a survey most often used homeopathy and herbs (Pucci, Cartechini, Taus, & Giuliani, 2004). Thirteen percent of respondents had received physician referrals for CAM. Individuals with more disability used more therapies. Lack of knowledge has been identified as a major reason why CAM is not used by Canadians with MS (Page, Verhoef, Stebbins, Metz, & Levy, 2003). A survey mailed to 3,140 people with MS yielded an average return rate of 27%, with 57% of respondents acknowledging CAM use (e.g., herbs, chiropractic services, massage, acupuncture; Nayak, Matheis, Agostinelli, & Shiflett, 2001). In addition, a desire for holistic health care and dissatisfaction with traditional medicine were found to drive CAM use in individuals with MS.
U.S. researchers found that approximately 40% of surveyed individuals with peripheral neuropathies and spinal cord injury used acupuncture (Brunelli & Gorson, 2004; Nayak et al., 2001). Pain control was the major reason for CAM use by persons with peripheral neuropathies; spinal cord-injured patients found massage most beneficial. A report of CAM use by epilepsy patients in India indicated a 32% rate of use among the 1,000 respondents (Tandon, Prabharkar, & Pandhi, 2002).
In summary research on the use of CAM in neuroscience populations is limited. Few experimental studies are cited in the literature. Research studies have surveyed different numbers of participants. Some studies were performed outside of the United States. The use of different instruments to measure CAM use limits consistent application of results and generalization. Research about CAM use in some disease states and conditions (e.g., stroke, brain tumors, Parkinson's disease, headaches) is almost nonexistent. It is obvious that more randomized clinical trials with adequate power to detect effect are needed (Miller, Liebowitz, & Newby 2004).
The Role of Nurses
Nurses need to understand patient issues surrounding CAM use. Insurance coverage can drive the use of CAM therapies (Wolsko, Eisenberg, Davis, Ettner, & Phillips, 2002). Even if an individual is interested in pursuing CAM therapy, insurance may not cover the associated costs. In 2000, 30 insurance companies covered at least one complementary treatment (American Cancer Society, 2004). The cost of CAM therapies varies from approximately $9 for spiritual healing to $49 for nutritional advice, but they are generally less expensive than traditional or conventional treatments (Bridevaux, 2004).
The literature suggests that one of the forces driving the use of CAM therapies is the belief that the intervention works and can make a difference (Berman & Straus, 2004). Individuals with a chronic illness use CAM therapies as a result of taking personal responsibility for their health, reevaluating therapeutic options, and adopting a practical lifestyle (Thorne, Paterson, Russell, & Schultz, 2002). Nurses need to assess patients' beliefs, knowledge, and current use of CAM before developing a plan of care that includes CAM utilization. Researchers have found that knowledge of CAM among older adults is limited (Williamson, Fletcher, & Dawson, 2003). This patient population should be a target for education by nurses. The literature also suggests that certain individual characteristics (i.e., gender, age, cultural differences) may influence CAM use. Females use these therapies more than men, especially in the African American and Hispanic populations. In general, older adults use more chiropractic services, herbs, massage, and acupuncture than other therapies. Older African Americans and Hispanics prefer herbs and teas (Cushman, Wade, Factor-Litvak, Kronenberg, & Firester, 1999; Dello Buono, Urciuoli, Marietta, Padoani, & DeLeo, 2001; Williamson, Fletcher, & Dawson, 2003).
In teaching patients about CAM therapies, the nurse should suggest that the patient gather as much information about the therapy as possible. Patients need to be encouraged to become educated consumers of products and services. It is recommended that a significant other accompany patients to appointments involving CAM for support and understanding of therapies (American Cancer Society, 2004). Numerous patient resources are available (e.g., Web sites, toll-free telephone numbers of organizations, lists of CAM specialists). Providing this information can be especially helpful and save time for the patient. Remind patients that they should not delay conventional treatments that are the standard of care as they seek complementary therapies.
Researchers find that patients often do not consult their physicians or healthcare providers before starting CAM. The reasons for this are unclear (Brunelli & Gorson, 2004). Keeping patient safety in mind, it is imperative that nurses explore CAM use with patients, with an emphasis on potential harmful interactions between present and recommended conventional treatments and CAM therapies (Miller et al., 2004; Tindle et al., 2005). Patients must be educated on drug interactions, including interactions with anesthetic agents These discussions, including the specific therapies and associated patient education, must be documented in the patient's record.
Tsen, Segal, Pothier, and Bader (2000) found that 51% of patients used vitamins before surgery and 21% of patients used herbs including echinacea, gingko biloba, St. John's wort, garlic, and ginseng. St. John's wort may interfere with anticoagulation and enhance the action of warfarin, resulting in potential clotting abnormalities. Norred (2002) surveyed patients preoperatively and found that 77% used some type of CAM, including vitamins, dietary supplements, herbs, and homeopathic therapies, with 34% using a CAM therapy that could interact with anesthetics and inhibit coagulation.
More research is needed on the use of CAM in neuroscience populations and on the attitudes and knowledge of neuroscience practitioners. Clinical outcomes, efficacy, and safety should be the major foci of future investigations (Berman & Straus, 2004; Miller et al., 2004).
Nurses interested in a holistic approach to health care should explore the availability of CAM services in their facilities. Nurses can assist in the development of policies and procedures for the use of CAM services, especially dietary supplements. Cohen, Sandier, Hrbek, Davis, and Eisenberg (2005) surveyed 39 academic medical centers and found limited integration of CAM services into healthcare environments. Only half of nursing schools surveyed in 2003 (N = 148) included CAM in their course of study (Dutta et al., 2003). Nurses have the opportunity to work with nursing schools to expand their curricula to address CAM therapies.
Marie, a 41-year-old White female with a 20-year history of rheumatoid arthritis, was diagnosed with multiple sclerosis 4 years ago. Recent magnetic resonance imaging showed bilateral white matter lesions with enhancement suggesting demyelinating plaque. Marie lives with her parents and two children. Since early 2004, she has been wheelchair bound. Her medication regimen Includes glatiramer acetate, meloxicam, baclofen, methylphenidate, sulfasalazine, sertraline, a multivitamin, vitamin C, and calcium. In addition, Marie takes St. John's wort and herbal supplements.
Marie noticed a red spot forming on her buttocks in April 2004. She presented to her primary physician in August with a stage III sacral decubitus ulcer and was subsequently admitted to an acute care hospital for surgical consultation and possible debridement. Marie underwent debridement of her wound. Biopsies yielded sensitivities to clindamycin and levofloxacin. A 6-week course of antibiotics was ordered by an infectious disease specialist. Because of the holidays and patient request, Marie was discharged home with home care services, wound vacuum to facilitate closure, a hospital bed with an air mattress, and a gel-seat cushion.
Marie was interested in using CAM therapies to help her wound heal. She obtained a referral to a physician specializing in homeopathic medicine, who prescribed several therapies to be performed in collaboration with a trained CAM practitioner: gentle massage around the affected area to increase blood flow and oxygen; acupuncture to stimulate the movement of energy to the affected area; acupressure to also increase energy flow; and Reiki (i.e., the use of hands over the wound) to decrease pain and bring healing energy to the area. After 1 month, the wound displayed pink, granulated tissue and a small decrease in size.
Hippocrates said, "There is a natural healing force within us, and it is the greatest force in getting well." A variety of CAM therapies can be used in neuroscience populations. Nurses, as natural healers, need knowledge of CAM therapies, their interactions with conventional treatments, and related research to safely facilitate patients" exploration and utilization of CAM.
Alzheimer's Society. (2004). After the diagnosis: Complementary therapies and dementia. Retrieved July 2004 from www.alzheimers.org.
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Ashikaga, T., Bosompra, K., O'Brien, P., & Nelson, L. (2002). Use of complementary and alternative medicine by breast cancer patients: Prevalence, patterns and communication with physicians. Supportive Care in Cancer, 10, 542-548.
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Questions or comments about this article may be directed to Susan Fowler, PhD RN CNRN, at firstname.lastname@example.org. She is a clinical nurse researcher at Morristown Memorial Hospital in Morristown, NJ.
Linda Newton, MA RNC LPC, was working at Easter Seals, Somerville, NJ, at the time this article was written.
Copyright (c) 2006 American Association of Neuroscience Nurses 0047-2606/08/3804/00261$5.00
Table 1. Complementary and Alternative Medicine Therapies Based on an Energy System Therapy Energy Focus Acupuncture Certain areas along the meridians or energy path- ways are stimulated with the use of needles to increase the flow of energy. Acupressure Same as acupuncture, except finger pressure is used instead of needles along the meridians to break blockages and increase flow of vital energy. Reflexology The hands and feet are viewed as the microcosms of the body. The practitioner uses the thumb to work out blockages found in the hand or foot to free that meridian and increase the flow of energy. Reiki Uses hands-on healing and working with life-force energy to help reduce pain or stress and increase relaxation and energy levels. Therapeutic touch Practitioner's hands are approximately 6 inches away from person but within the surrounding field of energy or aura. Hands work with energy for healing above or within with the aura. Note. Adapted from Energy Healing, by D. Eden, 1998, New York: Penguin Putnam; and "Reiki: A Complementary Therapy for Nursing Practice," by L. Nield-Anderson and A. Ameling, 2001, Journal of Psychosocial Nursing, 39,42-49.
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|Author:||Fowler, Sue; Newton, Linda|
|Publication:||Journal of Neuroscience Nursing|
|Date:||Aug 1, 2006|
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