Complementary and Alternative Medicine in Nursing Care

 

Dr. V. Indra

Assistant Professor, University of Hail, Kingdom of Saudi Arabia

 

 

ABSTRACT:

The use of Complementary therapies and Alternative Medicine (CAM) in nursing care has increased in popularity in recent years, both with patients and nurses. Due to this increase in clinical use, nurses, midwives and health visitors should be familiar with the types of complementary therapy used most commonly in the professional setting, as well as having some knowledge of their potential. As there is a lack of research based evidence for each therapy, this may create problems for inclusion in clinical practice. It is also useful for nurses to know where to obtain information about a range of other therapies that patients might be using independently.

CAM includes therapies such as acupuncture, dietary supplements, reflexology, yoga, massage, chiropractic services, Reiki, and aromatherapy. Many CAM therapies focus on the concept of energy. The literature describes the use of CAM in individuals with neurological diseases such as dementias, multiple sclerosis, neuropathies, spinal cord injury, and epilepsy. Nurses have a unique opportunity to provide services that facilitate wholeness. They need to understand all aspects of CAM, including costs, patient knowledge, and drug interactions, if they are to promote holistic strategies for patients seeking to achieve a higher quality of life.

 

 

INTRODUCTION:

Complementary health-related therapies are enjoying growing popularity among the general public. Complementary therapies are used to complement conventional health care practices. They include a wide range of treatment modalities, such as herbal therapies and manual healing, such as reflexology and acupuncture. The therapies are not discipline-specific, and the knowledge required to provide them is not specific to nursing.

 

 

They are considered mainstream by some members of the public and some health professionals and extremely controversial by others. Because some complementary therapies do not have a scientific basis, and it isn’t always clear how they work, their use often raises more questions than answers. Providing some therapies could create ethical dilemmas for nurses, particularly if the nurse’s values conflict with those of the client. This paper is designed to help nurses determine when and whether it is appropriate to incorporate complementary therapies into their nursing practice. It does not identify a “right” answer, because the decision to provide a complementary therapy depends on a number of factors  [1].

 

CAM is defined as practices or products that are not part of conventional medicine. Complementary therapies are used together with conventional medical treatments, while alternative therapies are used instead of conventional medical treatments. The term integrative medicine is also used. In integrative medicine, conventional therapies are combined with CAM where there is evidence of safety and effectiveness [2].

 

CM is commonly used to treat pain, psychosocial problems, cardiovascular diseases, lung diseases, among others, as well as to provide symptomatic relief for cancer pain. This therapeutic approach focuses on the holistic care of the individual with a particular emphasis on client involvement. Many of these therapies also include the belief that an internal self-healing process exists within the person. The holistic effect of CM has been demonstrated in a previous clinical trial involving the use of auriculotherapy (a CM approach for stimulating acupuncture points on the ears to achieve therapeutic effect). This therapy did not only positively influence the sleep behavior of the participants but also managed certain minor ailments associated with sleep disturbances, such as headache, dizziness and nocturnal polyuria [3].

 

Categorization of CAM:

Complementary and alternative medicine is categorized into five domains:

 

Natural Products:

Therapies use substances found in nature. Examples: herbal medicine (botanicals), vitamins, minerals, dietary supplements, probiotics.

 

Mind–Body Therapies:

Interventions use a variety of techniques to enhance the mind’s ability to affect body functions and symptoms. Examples: imagery, meditation, yoga, music therapy, prayer, journaling, biofeedback, humor, Tai Chi, art therapy, acupuncture.

 

Manipulative and Body-Based Therapies:

Therapies are based on manipulation or movement of one or more parts of the body. Examples: chiropractic medicine, massage, bodywork such as rolfing.

 

Energy Therapies:

Therapies focus on the use of energy fields such as magnetic and bio-fields that are believed to surround and permeate the body. Examples: healing touch, therapeutic touch, Reiki, external Qi gong, magnets.

 

Systems of Care:

Whole systems of care are built on theory and practice and often evolved apart from an earlier than Western medicine. Each has its own therapies and practices. Examples include traditional Chinese medicine, Ayurvedic, naturopathy, and homeopathy.

 

 

Traditional Healers:

Healers use methods from indigenous theories, beliefs, and experiences handed down from one generation to the next. An example is the Native American healer or shaman [4].

 

THINGS TO CONSIDER BEFORE COMMENCING THERAPY:

The new Code states that one must preserve safety and always practice in line with the best available evidence.

To achieve this, one must:

1.    Make sure that any information or advice given is evidence-based, including information relating to using any healthcare products or services.

2.    Maintain the knowledge and skills needed for safe and effective practice.

3.    In every case appropriateness of the complementary therapy must be considered for both the condition of the patient and any co-existing treatments.

4.    It is essential that the patient is aware of the purpose of the therapy and its effects, that you have assessed their understanding and that they give informed consent.

5.    All complementary and alternative medicines should be recorded alongside other medicinal products and prescribed on patient prescription charts.  One needs to ensure your employer has accepted vicarious liability for any complementary/alternative therapy you may undertake or that you have indemnity cover for your practice [5].

 

PATIENT EXPERIENCE:

The results of observation at a Macmillan terminal care unit with several staff who are CAM practitioners revealed that patients gain many psychological and personal benefits from CAM. The following benefits were noted in observing nurse-led reflexology and aromatherapy/massage sessions [6]:

·      Assists with side-effects of orthodox treatments such as nausea, constipation, pain, insomnia,        oedema, muscular pains and tension

·      Induces feelings of well-being, enabling patients to feel better

·      Facilitates touch, which is important as patients with cancer can feel very isolated

·      Gives a positive experience, unlike so many of the other treatments they may be having

·      Provides emotional support and helps relieve stress and tension

·      Reduces levels of anxiety by relaxing patients

·      Gives patients time to talk if they choose

·      Increases confidence and helps with altered body image

·      Provides individual attention, making patients feel human and individual

·      Encourages self-help and empowers people

Risk Factors of CAM:

These risk factors include [7]: 

·      Clients who have rejected conventional care for an acute or chronic illness and have placed all their hope in CAM with little knowledge of the efficacy of the CAM therapies  

·      Clients who have delayed treatment for a treatable illness on the basis of self-diagnosis without a medical evaluation of the health problem 

·      Clients who have spent considerable monies for therapies not covered by insurance and as a result are at risk for financial hardship or difficulty 

·      Clients who independently mix CAM with prescribed conventional therapies without knowledge of the contraindications and associated risks 

·      Women of child-bearing age or who are pregnant using herbal or nutritional supplements without the guidance of a health-care professional 

·      Clients in emergency departments or clinics with atypical symptoms or failure to respond to prescribed therapy

 

FUTURE DIRECTIONS:

Barriers hindering the wide use of CAM include lack of knowledge about the subject, inaccessibility to competent practitioners, and lack of evidence supporting the effectiveness of therapies. Nearly two-thirds of CAM users preferred not to discuss the use of CAM with their doctors for fear of doctor’s disapproval, disinterest, or inability to help. Although nurses tend to demonstrate a positive attitude towards CAM because of their appreciation of a holistic approach to health, they seem to lack a comprehensive understanding of the associated risks and benefits of CAM and feel uncomfortable discussing this therapeutic approach to their patients [8].

 

Fortunately, the awareness of incorporating CAM in the existing curricula of nursing and medicine has increased in recent years. The increase in knowledge regarding CAM among health care professionals may lead to a more open and positive attitude towards these treatment modalities. This awareness may to help promote a culture in which patients feel comfortable to disclose the use of CAM to health care professionals, and thus allow monitoring of adverse drug effects and/or interactions, as well as the delivery of culturally competent care [9].

 

The public and the health care providers should be well informed and must easily gain access to an updated list of qualified and competent practitioners for individual therapy when considering these therapies as additional treatment choices. Many studies on CAM are limited by small sample size, lack of an equivalent placebo-control group to establish a strong causal relationship, and inadequacy in terms of rigorous scientific testing. Nurses and other health care professionals should play an active role to initiate or participate in several research activities in this area. As such, patients can receive evidence-based guidance regarding CAM [10].

 

CONCLUSION:

As CAMs increases, it is important for RNs (Registered Nurses) to have an understanding of these therapies and products. Clients have the right to make their own personal decisions related to their care. RNs provide appropriate information so choices and decisions are informed.

 

REFERENCES:

1.     World Health Organization (WHO).WHO Traditional Medicine Strategy: 2014-2023. Geneva, Switzerland. World Health Organization; 2013.

2.     NCCAM (National Center for Complementary and Alternative Medicine). Complementary, alternative, or integrative health: What’s in a name? [Cited 2015 July 26].

3.     Wu J, Lu Z, Hayes M, Donovan D, Lore R. Integration of acupuncture into family medicine teaching clinics. J Altern Complement Med. 2009; 15(9):1015-9.

4.     Korhan EA, Khorshid L, Uyar M. The effect of music therapy on physiological signs of anxiety in patients receiving mechanical ventilator support. J Clin Nurs. 2011; 20(7-8):1026-34.

5.     Mottern R. Using hypnosis as adjunct care in mental health nursing. J Psychosoc Nurs Ment Health Serv. 2010; 48(10):41-4.

6.     Drackley NL, Degnim AC, Jakub JW, Cutshall SM, Thomley BS, Brodt JK, et al. Effect of massage therapy for postsurgical mastectomy recipients. Clin J Oncol Nurs. 2012; 16(2):121-4.

7.     McNeilly P. Complementary therapies for children: aromatherapy. Paediatr Nurs. 2004; 16(7):2 8-30.

8.     Archer C. Research issues in complementary therapies. Complement Ther Nurs Midwifery. 1999; 5(4): 108-14.

9.     Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2008; (12):1-23.

10.   Fontaine KL. Complementary and alternative therapies for nursing practice. 4th ed. Boston: Pearson Education; 2015.

 

 

 

 

 

 

Received on 05.02.2018        Modified on 19.03.2018

Accepted on 26.04.2018       ©A&V Publications All right reserved