critical thinking

 

 

Complementary & alternative therapy

 

 

•                     Introduction.

•                     Definitions of terms:-

o   Complementary medicine.

o   Alternative medicine.

o   Integrative medicine.

•                     Basic concepts:-

o   Holism. 

o   Humanism.

o   Balance.

o   Spirituality.

o   Energy.

o   Healing environment.

•                     Reason for growing interest in CAM.

•                     Limitations of CAM.

•                     Five main Domains of CATs.

•                     Alternative medical system.

o   Mind body spirit therapy.

o   Biologically based therapies (natural products).

o   Manipulative & body based practices.

o   Energy therapies.

•                     Nursing & CATs.

•                     Role of nurse in CATS.

•                     References.  

 

Introduction:

The term complementary and alternative medicine (CAM) includes as many as 1800 other therapies practiced all over the world.

Many of these have been handed down over thousands of years, both orally and written records. They are based on the Eastern medical system of ancient people, including Egyptians, Chinese, Asian, Indians, Greek and Native Americans.

Complementary and alternative therapy (CAM) is becoming acceptable to general public and increasingly used around the world.

Most of Complementary and alternative therapy are based on holistic approach which note the response of person as a whole on all levels - mind, body and spirit, some of these therapies are self-administer and some are practitioner-administered.

 

Definition of terms:- 

Complementary medicine:-

It refers to the use of CAM together with conventional medicine.

Alternative medicine:-

It refers to use of CAM in place of conventional medicine.

Integrative medicine:-

Combines treatment from conventional medicine and CAM for which there is some high quality evidence of safety and effectiveness.

 

Basic concepts:-

Holism:-

Although they represent diverse approaches, alternative therapies share certain attributes. They are based on the paradigm of whole system and the belief that people are more than physical bodies with fixable and replaceable parts. Combined mental, emotional, spiritual, relationship and environmental components, referred to as holism, are considered to play crucial and equal roles in a person state of health. Interventions are individualized within the entire context of the person's life.

 

Humanism:-

The humanist perspective includes proposition such as the following. The mind and body are indivisible, people have the power to solve their own problems, people are responsible for the patterns of their lives, and well-being is a combination of personal satisfaction and contributions to the larger community.

 

Balance:-

In terms of optimal wellness, the concept of balance consists of finding a desirable point between two opposite forces rather than being purely in one state or another. Balance has mental, physical, emotional, spiritual, and environmental components. Not only does each component have to be balanced, equilibrium is needed among the components

 

 

Spirituality:-

Spirit is the live-lines, richness, and beauty of one’s life. It is who are and how we are in the world. Spirituality includes the drive to become all that one can be, and is bound to intuition, creativity, and motivation. Spirituality is that which gives people meaning and purpose in their lives. It involves finding significant meaning in the entirety of life, including illness and death.

Energy:-

The concept of energy has been recognized in most cultures for centuries. Energy is viewed as the force that integrates the body, mind, and spirit; it is that which connects everything.

Healing environment:-

Healing environment are created when nurse empower clients by providing the knowledge, skills, and support that allow them to tap into their inner wisdom and make healthy decisions for themselves.

Nurses creates healing environments when they take the time to be with clients in deeply caring ways.

 

Reasons for growing interest in CATs

•        Dissatisfaction with traditional health care system.

o   High cost.

o   Low accessibility.

o   Focus on disease rather than person.

o   Ignore a lot of patients need because it ignores a holistic approach.

o   Stress of exposure to stranger, manipulation.

o   Side effect.

•        Socio cultural acceptance.

•        Increasing evidence based research.

•        Focus on healing not treatment.

•        Emphasis on health promotion and prevention of diseases.

•        Shrinking world around us allowed us to be acquainted with CAM. 

 

Limitations of CATs:-

•        Lack of standardization in most of them to the right way of use.

•        Lack of regulation and research that make it evidence based practice which make it dangerous.

•        Inadequate training and certification of their providers.

•        Patient can put themselves in danger when reject medical treatment outright in favor of alternative therapies.

•        Misuse of certain herbs can produce toxic effect.

 

 

Main five domains of CATs:-

§  Alternative medical systems.

§  Mind body sprit therapy. 

§  Biologically based therapies (natural products).

§  Manipulative and body based practices.

§  Energy therapies.

 

1-Alternative medical systems (AMS):-

They involve complete system of theory & practice that have evolved independently from or parallel to conventional medicine.

Many are traditional systems of medicine that are practiced by individual cultures throughout the world.

 

Examples:-

a.       Traditional Chinese Medicine.

b.       Ayurveda medicine.

c.       Homeopathy.

d.       Naturopathy.

 

a.       Traditional Chinese medicine (TCM):

It includes a range of traditional medical practices originating in China, includes acupuncture, herbs, massage.

Traditional Chinese medicine is largely based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated interconnected systems, and that those systems usually work in balance to maintain health &focus on interaction of people with their environment to maintain health.

Acupuncture

Definition:

Acupuncture means 'needle piercing" or use of needle method of stimulating specific anatomic points in the body (acu-point) by insertion of  very fine, sterile, short  needles into the skin for therapeutic purposes. 

Mode of action:

In traditional Chinese medicine, acupuncture is linked to the belief that disease is caused by disruption to the flow of energy, or (qi) in the body.

Acupuncture stimulate point on or under skin called (acupuncture points) releasing this qi.

Then qi travels through channels called meridians for spirituality and healing.

Today, acupuncture treatments carried out in hospitals and other health care facilities are not based on the same principles.

Scientists have been trying to study the mechanism of acupuncture for years and come up with several hypotheses.

 

Main mechanisms of action:

1-Conduction of electromagnetic signals:

Needle application stimulate acupuncture points enables electromagnetic signals to be relayed at it greater rate than under normal conditions. These signals started the flow of pain killer such as endorphins.

2- Activation of opioid systems:

 Dering acupuncture several types of opioids may release into central nervous systems which reduce pain.

3-Changes in brain chemistry sensation and involuntary body functions:

Acupuncture also has effect on parts on the central nervous system related to sensation and involuntary movement such as processes by which body temperature are regulated ,blood flow and blood pressure.

Before acupuncture:

There are some general rules of thumbs when it comes to preparing for acupuncture 

1.       Set aside time before and after your appointment:

Make sure that when you are scheduling your acupuncture appointment that you are not engaged in too stressful an activity.

 

2.       Bring a list of all current medication:

This is because there are certain herb-drug interactions that can have harmful effects like warfarin.

3.       Eat an appropriate amount before acupuncture:

Most experts recommend that client eat something two hour prior acupuncture.

Avoid heavy meal.

4.       Wear loose –fitting clothes.

5.       Avoid caffeine before acupuncture:

Don’t drink coffee at least two hours, because it is a stimulant, coffee increases the body fight or flight response.

During procedure

Each one performs acupuncture has unique style, to determine the type of puncture of treatment, that will help.

A puncture points are situated in all area of the body.

Sometimes the appropriate points are far removed from the area of pain.

Acupuncture practitioner will tell client the general site of planned treatment and whether client need to remove any clothes .A gown towel or sheet will provided.

The client lies on a padded table for treatment.

Needle insertion: acupuncture needles are inserted to various depths at strategic points on your body. The needle very thin, so insertion causes little dis comfort. Between 5and 20 needles are used in atypical treatment. The client may fell mild aching sensation when a needle reaches the correct depth.

Needle manipulation: the practitioner may gently move or twirl the needles after placement or apply heat or mild electrical pulses to the needles.

Needle removal: in most cases the needles remain for 10-20 minutes. There is usually no pain when needles are removed.

After acupuncture:

 The 24 hours following each acupuncture session can be as effect as treatment itself.

1-Rest: it allows the physical and emotional restoring that acupuncture sets in motion to continue.

2-Go on light on exercise: exercise is fine –light, gradual movement can be a nice adjunct to acupuncture treatment.

3- Apply heat packs and avoid ice or ice packs.

4- Massage: it is perfect acceptable after acupuncture, it promote rest and calm.

5- Stay hydrated and avoids caffeine and alcohol.

6- Eat healthy food: avoid fast food, high in sugar snacks Replace it with fruits, vegetables and high protein diet.

 

The most common problems for which acupuncture is used include:

1-      Low back pain. 

2-      Migraine headaches.

3-      Sciatica.

4-      Depression &anxiety.

5-      Osteoarthritis.

6-      Muscle pain.

7-      Sinusitis.

8-      Myofacial pain. 

9-      Premenstrual symptoms.

10-Chronic pulmonary disease (Asthma).

11-Smoking and other addiction.

 

 

Complication of Acupuncture:-

 

1-      Infection from unsterilized needles, broken needles, needles left in place for an extended length of time.

2-       Puncture of an internal organ.

3-      Bleeding.

4-      Fainting.

5-      Seizures.

6-      Post treatment drowsiness.

 

Contraindication of Acupuncture:

1-      Person who have bleeding disorders.

2-      Skin infection.

3-      Cardiac arrhythmia.

4-      Epilepsy.

5-      Person with pacemaker. 

6-      Pregnant women. 

 

B-Ayurveda:

Ayurveda, which literally means "the science of life," is a natural healing system developed in India.

It is a comprehensive system of medicine based on the belief that health depend on balance between the body, mind, and spirit to restore health.

 

C-Naturopathy:

 It is a system of healing originating from Europe that views disease as a manifestation of alterations in the processes by which the body naturally heals itself. It emphasizes health restoration as well as disease treatment. 

Naturopathy includes diet modification stress reduction, exercises, herbal medicine, massage and manipulation, and lifestyle counseling.

 

D-Homeopathy:-

 

It is a self-healing system assisted by small doses of medicines which is useful in a variety of acute and chronic disorders.

 

2-mind-body modalities:-

 

Definition:

Are techniques designed to enhance the mind’s positive impact on the body, and behavior. Mind-body therapies follow the beliefs of Chinese medicine that the self is comprised of the mind and body

 

Mode of action:

 There is a dynamic relationship between the mind and body and the ways in which the mental, emotional, spiritual and social aspects interact, affect behavior and health. Thus, to maximize the opportunity for health and healing, all aspects, or the “whole” of the person, need to be recognized and engaged in the therapeutic process.

Example: 

•        Meditation.

•        Yoga.

•        Visual imagery.

•        Meditation.

•        Biofeedback.

•        Animal assisted therapy.

•        Humor.

•        Relaxation.

 

Meditation:

Definition:

Is a technique used to quiet the mind and focus it in the present and to release fears, worries, anxieties concerning the past and the future. It produces a state of peace and rest combined with mental alertness.

Meditation evokes a restful state, decreased heart rate and respiratory rate, and oxygen consumption 

Mode of action:

It is focusing the mind  on single object, thought or activity  to pay attention as repeating single word , listening a repetitive gong or counting your breath and notice when the mind wanders (focused attention meditation)or non-reactive monitoring of the content of experience from moment to moment(open monitoring meditation) to achieve a mentally clear& emotionally calm and stable.

 

How to meditate:-

 1-Take a seat: find a place to sit that you feels calm and quite.

 2-Set a time limit: if you beginner choose a short time as 5 or 10 minutes.

3-Notice your body: you can sit in a chair comfortable.

4-Feel your breath: count it and gradually focus on breath details

5-Notice when your mind has wandered: your attention will leave the breath and wander to another place .during your noticing that your mind has wandered, simply return to your breath attention

6-Don’t judge yourself over the content of thoughts

7-Close with kindness: open your eye, notice any sound in the environment and notice how your body feels right

Clinical applications of meditation:

♦        Improve breathing patterns in asthmatics patient.

♦        Lower blood pressure in hypertensive client.

♦        Lower blood glucose levels in diabetics. 

♦        Decreases episodes of angina pectoris. 

♦        Reduce anxiety.

♦        Improve mode.

Limitation of meditation:

Person who are on thyroid regulating therapy , anti-depressant, or anti-anxiety.

 

3-Biologically based therapies:

Definition:

Is the use of substance found in nature such as herbs, foods, and vitamins to restore immunity (internal body defense) to fight infection.

Mode of action:

Many whole medical systems use herbs in their system for treatment of disease and reduction of symptoms.

Examples of BBT:

•        Aromatherapy 

•        Herbal therapy

•        Dietary supplementation

 

Herbal medicine

Definition:

Using herbs or substances from plants naturally found in inherent medicinal qualities. Herbal medicines can be taken in the form of tablets, extracts, teas, essential oils or ointments.

 

Examples: 

♦        Echinacea and goldenseal are used for respiratory infections.

♦        Ginkgo biloba is used to dilate cerebral blood vessels and reduce symptoms of memory loss and mental confusion.

Benefits:

♦        Herbal medicines are 100% natural as they are produced with extracts of natural plants. They do not make use of any chemicals or artificial flavoring. 

♦        Being safe, they can be directly applied to the wounds, or added to the food. 

♦        Herbal remedies are very easy to prepare. 

♦        Is considerably cheaper than the chemical drugs

♦        Can be easily and safely self-administered.

♦        Improve the operation of the immune system by improving resistance against illnesses. 

♦        Can be used for treating almost any health problem known. 

♦        Herbal medicines help in reducing weight and obesity naturally. 

♦        Other major and minor health problems that are treated by herbs are common cold, sleep disorder, allergy, arthritis, cancer, digestive problems, hair and skin problems, anxiety disorder, respiratory problems, hypertension, diabetes, etc.

 

Disadvantage 

♦        Take long time to work 

♦        No dosage or warnings specified

♦        The individual may be not able to identify a poisonous plant or specific part of plant.

 

 

 

 

4- Manipulative and body methods

Definition

Are therapies involved manipulation or movement of one or more parts of the body as a means of achieving health and healing. 

Mode of action

These therapies focus primarily on the structures and systems of the body, including bones and joints, soft tissues, and the circulatory and lymphatic systems. 

Examples of MBM:

♦        Chiropractic

♦        Reflexology

♦        Massage

♦        Tai chi

♦        Exercises

 

Chiropractic therapy:

Definition:

This therapy is grounded in the principle that the body can heal itself when the skeletal system is correctly aligned and the nervous system is functioning properly.

Treatment is consists of manipulation and other modalities to decrease discomfort and aid the healing process, including: ice, heat, electrical muscle stimulation, and nutritional supplements.

N.B: it requires a series of visits.

Procedure

In the initial visit: chiropractor takes health history, perform physical exam with paying attention to your spine.

During the procedure: 

♦        Chiropractor place you in a specific position to treat affected area, often you are positioned lying face down on a specially designed, padded, table.

♦        Chiropractor uses his hand to apply controlled, sudden force to a joint, pushing it beyond its usual ROM .you may hear cracking sounds as he moves your joint during the session. 

After the procedure

Some people experience minor side effects for few days .this may include (headache, fatigue, or pain).

Clinical applications of chiropractic:

♦        vertebral subluxation

♦        headaches

♦        vertigo

♦        tinnitus

 

 

5-Energy therapy

Definition:

Method of transmission  healing energy to patient body through hands of practitioner to restore body energy.

It is based on the belief that there are energy fields that flow through &around the body .This energy feeds and nourishes the organism and is carried via two energetic structures that interact with each other: chakras and the etheric energy

Chakras: Are concentrated areas of energy aligned vertically in the body that relate to each other as well as to specific areas of the body, mind, and spirit. (Bio-fields) 

 

 

 

 

The etheric (aura): consists of at least seven layers of energy that surround the body and relate to chakras (electromagnetic fields)

 

 

 

 

 

Mode of action:

 In bio-fields therapies: act by correcting imbalances in the internal bio field, such as by restoring the flow of qi through meridians to reinstate health.

 As acupressure and therapeutic touch.

 In electromagnetic fields: employ mechanical vibrations (such as sound) and electromagnetic forces, including visible light, magnetism, and monochromatic radiation (such as laser beams). They involve the use of specific, measurable wavelengths and frequencies to treat patients, E.g. static and pulsating electromagnetic therapy.

 

    Examples

•        Therapeutic touch

•        Light therapy

•        Reiki

•        Acupressure

•        Acupuncture

•        Magnet therapy

Therapeutic touch:

 

Definition:

 It is a training specific therapy that consists of placing the practitioner's hands either on or close to the body of a person.

Mode of action:

 

Therapeutic touch involves the practitioner scanning the body of the client and diagnosing areas of accumulated tensions.

Phases of Therapeutic touch:-

 

It consists of five phases:-

1-Centering:

 Is the process whereby the practitioner becomes aware and fully present during the entire treatment.

2-Assessement:

 Assess the patient in which the practitioner moves his or her hands in arrhythmic and symmetrical movement from the head to the toes. During this phase the practitioner notices the quality of energy flow and detects accumulations of energy. The physiological indicators of energy imbalance are perceived as feeling of congestion, pressure, warmth, coolness, blockage, or tingling.

3-Unruffling:-

 The practitioner unruffled the energy flow or facilitate, the symmetrical and rhythmical flow of energy through the body. This technique is accomplished by long downward strokes over the energy field located over the entire body. 

4-Treatment:-

 During the actual treatment the practitioner directs and balances the energy attempting to rebalance the energy flow. This is achieved rather by the practitioner touching the body or maintaining the hands in a position a few inches away from the body. 

5-Evaluation:-

 It consists of evaluation and reassessment of the client's energy field. If a rebalance has occurred, the practitioner detects a more symmetrical, freely flowing energy field and greater wellbeing.

Clinical applications of therapeutics touch:

-Reduce anxiety.

-Reduce headache pain.

-Improve mood.

-Reduce phantom limb pain.

Nursing and CATs:-

Some of complementary therapies and their basic philosophies have been a part of nursing since its beginning and have their roots in Florence nightingale's book notes on nursing who expressed a holistic view of nursing when she said that nursing should ''put us in best possible conditions for nature to restore or to preserve health, to prevent or cure disease or injury.

  Complementary therapies are receiving increasing attention within nursing, the implementation of complementary therapies has given nurses a great degree of autonomy and independence from physician and institutionalized facilities and away of enriching their own field of practice, among the many alternative therapies that nurse now practice are therapeutic touch ,relaxation technique ,music and sound therapy aromatherapy 

The public's increasing use of alternative therapies requires nurse to become prepared to practice in this area or at least knowledgeable. 

Role of nurse in CATS:

ü        Nurses who under take to administer alternative therapies under go on approved education and training program and be competent to offer CAT

ü        The Nurse should carry out researches in CAT field which help to provide a rich broad specific database 

ü        Before introducing CAT to the client the nurse need to assess person's knowledge ,value and belief in such therapy 

ü        The nurse should obtain informed consent from client before administering CAT

ü        The nurse should evaluate health status of the client through assessment and collection of health data 

ü        The nurse should provide health teaching and health counseling about CAT

ü         The nurse should review and monitor therapy and treatment plan

 

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