Chapter 32
Complementary and
Alternative Therapies
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Background
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Many conditions are difficult to treat with
allopathic medicine.
Researchers estimate that up to 75% of
patients seek care from their primary
physician for stress, pain, and health
conditions for which causes are unknown.
Surveys estimate that 38.3% to 62.1% of the
U.S. population uses complementary and
alternative medicine (CAM).
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Case Study
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Joan Brauer is a 46-year-old woman newly
diagnosed with hypertension. She works full
time, helps care for her widowed mother, and
is raising a family of three children with her
husband, Tomas.
Alonzo is a nursing student assigned to
Joan’s care at the clinic.
Joan is skeptical about taking
antihypertensive medication and asks Alonzo
about alternative treatments.
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Definitions
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CAM—a group of diverse medical and health care
systems, practices, and products that are not
presently considered to be part of conventional
medicine.
Complementary—therapies used in addition to
conventional treatment (aka integrative therapies)
Alternative—therapies that replace allopathic medical
care
Whole medical systems—based on different
philosophies and life systems
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Categories of CAM
Biologically based therapies
Energy therapies
Manipulative and body-based methods
Mind-body interventions
Whole medical systems
Movement therapies
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Integrative Health Care
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Many medical and nursing schools
incorporate CAM therapy content into the
curriculum.
Some have integrative health care programs
that allow health care consumers the
opportunity to be treated by a team of
providers consisting of both allopathic and
complementary practitioners.
Nurses have historically practiced in an
integrative fashion, using the term holistic.
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Holistic Nursing
Regards and
treats the
mind-bodyspirit of the
patient
Uses holistic nursing
interventions such as
relaxation therapy, music
therapy, touch therapies, and
guided imagery
The American Holistic Nurses Association
maintains Standards of Holistic Nursing
Practice.
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Factors to Consider
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The history of each therapy (many have been
used by cultures for thousands of years to
support health and ameliorate suffering)
Nursing’s history and experience with a
particular therapy
Other forms of evidence reporting outcomes
and safety data, including case study and
qualitative research
Cultural influences and context for certain
patient populations
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Nursing-Accessible Therapies
Relaxation therapy
Meditation and breathing
Imagery
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Relaxation Therapy
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Definitions:
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Stress response
 Relaxation response
 Progressive relaxation
 Passive relaxation
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Clinical applications: lowers heart rate and
blood pressure, decreases muscle tension
Limitations
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Yoga
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Meditation and Breathing
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Meditation is any activity that limits stimulus
input by directing attention to a single
unchanging or repetitive stimulus, so the
person is able to become more aware of self.
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Lowers oxygen consumption, reduces respiratory
and heart rates, and reduces anxiety
Lowers blood pressure (BP) in hypertensive
patients and lowers breathing rates in asthmatic
patients and in cancer patients
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Imagery or Visualization
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A mind-body therapy that uses the conscious
mind to create mental images to stimulate
physical changes in the body, improve
perceived well-being, and/or enhance selfawareness
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Creative visualization is one form of self-directed
imagery based on mind-body connectivity.
Clinical applications: pain control ++
Limitations: a few side effects
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Case Study (cont’d)
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Alonzo realizes that to reassure Joan, he
needs to assess her needs. Alonzo interviews
Joan about her daily life and discovers that
she feels stressed at work and at home.
Joan says that although her husband helps
her with housework, they have not required
the children to do so. Joan feels like she’s “on
duty” 24-7 because of the shopping, cooking,
and housework, in addition to her job. Alonzo
and Joan discuss how she could delegate
some of her home tasks to her children.
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Training-Specific Therapies
Biofeedback
Acupuncture
Therapeutic touch
Chiropractic
Therapy
Traditional Chinese
medicine
Natural products and
herbal therapies
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Biofeedback
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A mind-body technique that uses instruments
to teach self-regulation and voluntary selfcontrol over specific physiological responses
Instruments measure, process, and provide
information about neuromuscular and
autonomic nervous system activity.
Immediate feedback is provided in physical,
physiological, auditory, and/or visual signals.
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Acupuncture
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Regulates or realigns vital energy (qi), which flows
through channels in the form of a system of pathways
called meridians
Involves insertion of needles into acupoints through
which qi can be influenced.
Modifies the body’s response to pain and how pain is
processed by central neural pathways and cerebral
function
Effective for pain
Also used to treat other disorders with varying
effectiveness
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Acupuncture (cont’d)
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Case Study (cont’d)
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Alonzo emphasizes to Joan that even though
CAM methods may help her blood pressure,
she needs to take her hypertensive
medication as prescribed. Joan agrees to do
so as long as Alonzo helps her learn about
other possible ways to improve her health.
Alonzo gives Joan information about
relaxation therapy, imagery, and meditation.
They decide to discuss which method Joan
would like to try on her next visit.
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Therapeutic Touch
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Practitioner places open palms on or close to
the patient’s body.
Five phases: centering, assessing, unruffling,
treating, and evaluating
Practitioner uses long downward strokes to
touch or maintain the hands in a position a
few inches from the body
May be effective in treating pain, dementia,
trauma, and anxiety
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Therapeutic Touch (cont’d)
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Chiropractic Therapy
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Goal: restore structural and functional
imbalances
Joint manipulation, physical therapies,
lifestyle counseling (diet and exercise)
Improves acute pain and disability, enhances
conventional treatment of pediatric asthma
Contraindicated for bone infections, fractures,
dislocations, osteoporosis
Some risks, although uncommon, are
present.
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Traditional Chinese Medicine
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Whole system of healing
Health viewed as “life in balance”; harmony
Includes several therapies: herbs, exercise, diet,
acupuncture, moxibustion, meditation, ++
Yin and yang are opposing, complementary forces
that exist in dynamic equilibrium.
Disruption of vital energy (qi) causes disease.
Chinese herbs not regulated by the U.S. Food and
Drug Administration (FDA).
Ask about all parts of TCM therapy; herbs, teas, and
supplements may interact with allopathic treatment.
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Natural Products and Herbal
Therapies
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A natural product is a chemical compound or
substance produced by a living organism.
Herbal medicines are not approved for use as drugs
and are not regulated by the FDA.
Although many herbs are safe and effective for a
variety of conditions, “natural” does not equal “safe.”
Some interact with prescription and over-the-counter
medications.
Look for U.S. Pharmacopeia (USP)-verified dietary
supplement mark.
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Case Study (cont’d)
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At Joan’s follow-up visit, Joan tells Alonzo
she would like to learn the relaxation
response. Joan is excited about having
control over a behavior that can help her
manage her blood pressure, so she eagerly
learns.
Joan reports that she and Tomas have
assigned the children household duties, and
so Joan had a free hour the night before—
and didn’t know what to do with it!
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Quick Quiz!
1. An athletic young woman has just broken her
leg while training for a marathon. The use of
meditation has many physiological properties
that will help the young woman to
A. Raise blood pressure.
B. Increase mood swings.
C. Increase oxygen consumption.
D. Lower muscle tension.
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Nursing Role in CAM Therapies
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Need to encourage dialogue about the use of
CAM
Responsibility to understand the benefits of
therapies that encourage active patient
participation
Multiple practitioner approach: integrative
Holistic in nature
Follow Nurse Practice Act Scope of Practice.
Work closely with patient.
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