Chapters 1 and 3
DQ: In understanding conventional and alternative medicine, it is helpful to study the assumptions basic to their theories, practices, and research. What are these assumptions and how will they impact your nursing practice?
Please abide by APA 7th edition format in your writing.
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COMPLEMENTARY AND ALTERNATIVE THERAPIES FOR NURSING PRACTICE
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F o u r t h E d i t i o n
Karen Lee Fontaine Professor, College of Nursing, Purdue University Calumet,
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Many of the designations by manufacturers and seller to distinguish their products are claimed as trademarks. Where those designations appear in this book, and the publisher was aware of a trademark claim, the designations have been printed in initial caps or all caps. Library of Congress Cataloging-in-Publication Data Fontaine, Karen Lee, 1943–author. [Complementary & alternative therapies for nursing practice] Complementary and alternative therapies for nursing practice / Karen Lee Fontaine, professor, College of Nursing, Purdue University Calumet, Hammond, Indiana.—Fourth edition. pages cm Revision of: Complementary & alternative therapies for nursing practice.—3rd ed.—©2009. Includes bibliographical references and index. ISBN-13: 978-0-13-334650-3 ISBN-10: 0-13-334650-1 1. Nursing. 2. Alternative medicine. I. Title. RT42.F64 2015 610.73—dc23 2013045244
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This book is dedicated to Peggy Gerard, Dean, and Kathy Nix, Undergraduate Coordinator, College of Nursing,
Purdue University Calumet for all their support and enthusiasm as complementary and alternative medicine
was integrated into the curriculum.
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UNIT 1 Healing Practices: Complementary and Alternative Therapies for Nurses 1
Chapter 1 Integrative Healing 3
Chapter 2 Basic Concepts Guiding Alternative Therapies 19
Chapter 3 The Role of Evidence-Based Health Care in Complementary and Alternative Therapies 37
UNIT 2 Systematized Health Care Practices 47 Chapter 4 Traditional Chinese Medicine 49
Chapter 5 Ayurvedic Medicine 70
Chapter 6 Native American Healing and Curanderismo 90
UNIT 3 Botanical Healing 111 Chapter 7 Herbs and Nutritional Supplements 113
Chapter 8 Aromatherapy 133
Chapter 9 Homeopathy 149
Chapter 10 Naturopathy 162
UNIT 4 Manual Healing Methods 169 Chapter 11 Chiropractic 171
Chapter 12 Massage 183
Chapter 13 Pressure Point Therapies 202
Chapter 14 Hand-Mediated Biofield Therapies 217
Chapter 15 Combined Physical and Biofield Therapy 230
UNIT 5 Mind–Body Techniques 239 Chapter 16 Yoga 241
Chapter 17 Meditation 256
Chapter 18 Hypnotherapy and Guided Imagery 269
Chapter 19 Dreamwork 286
Chapter 20 Intuition 301
Chapter 21 Music as a Therapeutic Tool 311
Chapter 22 Biofeedback 320
Chapter 23 Movement-Oriented Therapies 327
UNIT 6 Spiritual Therapies 339 Chapter 24 Shamans 341
Chapter 25 Faith and Prayer 352
UNIT 7 Other Therapies 367 Chapter 26 Bioelectromagnetics 369
Chapter 27 Animal-Assisted Therapy 378
Appendix Alternative Therapies for Common Health Problems 393
Energy 34 Massage 88 Positive Thoughts 107 Herbal Remedies 128 Soothing Potions 144 Top 10 Remedies 157 Pet Remedies 158 Visualization 167 Energy Boosters 181 Massage 199 Foot Massage 213 Experience Your Energy Field 227 Emotional First Aid 235 Redirecting the Flow of Energy 236 Heart Breathing 252 Loving–Kindness Meditation 266
Renovating Your Day 283 Shrinking Antagonistic
Forces 283 Improving Dream Recall 298 Positive Affirmations 308 Practice Intuition 309 Music for Stress Reduction 316 Mind Control of Muscular
Strength 324 Feel Your Qi 335 Wave Hands Like Clouds (Water
T’ai Chi) 336 Shamanic Journey 349 Absorbing Earth Energy 375 Going to the Mountains 376 Interacting with Your Pet 389
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The profession of nursing has advanced beyond the Western biomedical model to incorporate many healing tools used by our Asian, Latino, Native American, African, and European ancestors. We are rapidly rediscovering that these ancient principles and practices have significant therapeutic value. Some see this movement as a “return to our roots.” Others believe it is a response to runaway health care costs, growing dissatisfaction with high-tech medicine, and increasing concern over the adverse effects and misuse of med- ications. The growth of consumer empowerment also fuels this movement.
As nurses, how do you begin to assimilate thousands of years of healing knowledge? How do you begin this journey of integrating practices into your own lives? In your professional practice, how do you model healthful living? How do you help clients choose their own healing journeys? How do you break down the barriers between conventional and complementary and alter- native medicine (CAM)? Learning about CAM practices, like anything else, is a slow process involving a steady accumulation of bits of information and skills that eventually form a coherent pattern called knowledge. Although it is possible to learn a great deal about healing practices from reading, thinking, and asking questions, you must in the long run learn about healing through participation. Without hands-on experience, you can be a good student, but you can never be a great nursing practitioner of the healing arts. I trust this book will be one step in a lifelong exploration of and experiences with healing practices.
Consumers do not wish to abandon conventional medicine, but they do want to have a range of options available to them including herbs and nutri- tional supplements, manual healing methods, mind–body techniques, and spiritual approaches. Some CAM practices, such as exercise, proper nutrition, meditation, and massage, promote health and prevent disease. Others, such as herbs and homeopathic remedies, address specific illnesses. Many other CAM practices do both. The rise of chronic disease rates in Western society is increasingly motivating consumers to consider self-care approaches. As recently as the 1950s, only 30% of all disease was chronic, and curable—largely infectious—diseases dominated, for which medical interventions were both appropriate and effective. Now, 80% of all disease is chronic. Western medi- cine, with its focus on acute disorders, trauma, and surgery, is considered to be the best high-tech medical care in the world. Unfortunately, it is not responding adequately to the current epidemic of chronic illnesses.
Ethnocentrism, the assumption that one’s own cultural or ethnic group is superior to others, has often prevented Western health care practitioners from learning “new” ways to promote health and prevent chronic illness. With consumer demand for a broader range of options, we must open our minds to the idea that other cultures and countries have valid ways of preventing and curing diseases that could be good for Western societies.
Although the information may be new to us, many of these traditions are hun- dreds or even thousands of years old and have long been part of the medical mainstream in other cultures.
I have titled this book Complementary and Alternative Therapies for Nursing Practice because I believe we need to merge CAM approaches with Western- based nursing practices. I have tried to provide enough information about alternative therapies to help guide practice decisions. This text, as an over- view and practical guide for nurses, does not pretend to be an exhaustive col- lection of all the facts and related research in CAM, nor does it offer meticulous documentation for all claims made by the various therapies. The goal of the text is to motivate you, the reader, to explore CAM approaches, increase your knowledge about factors that contribute to health and illness, and expand your professional practice appropriately.
It is possible to classify alternative practices in any number of ways. I have chosen to present more than 40 approaches categorized into seven units. In Unit 1, I introduce the philosophical approaches to both Western bio- medicine and complementary and alternative medicine, as well as evidence- based health care in CAM therapies. Concepts common to many approaches are defined and discussed, such as energy, breath, spirituality, and healing. Unit 2 presents a number of health care practices that have been systematized throughout the centuries worldwide. These typically include an entire set of values, attitudes, and beliefs that generate a philosophy of life, not simply a group of remedies. The chapters cover Traditional Chinese Medicine, Ayurvedic medicine, and Native American healing and curanderismo. Unit 3 comprises chapters relating to botanical healings used by 80% of the world’s population. Chapters cover herbs and nutritional supplements, aromather- apy, homeopathy, and naturopathy. Unit 4 presents manual healing methods—some from ancient times and some developed in the latter half of the 20th century. The chapters discuss chiropractic, massage, pressure point therapies, hand-mediated biofield therapies, and combined physical and biofield therapies. The chapters in Unit 5 cover types of mind–body tech- niques for healing and include yoga, meditation, hypnotherapy and guided imagery, dreams, intuition, music as a therapeutic tool, biofeedback, and movement-oriented therapies. Unit 6 presents two spiritual approaches to therapeutic intervention: working with shamans and the use of faith and prayer. Unit 7 includes two chapters on miscellaneous practices: bioelectro- magnetics and animal-assisted therapy.
The appendix provides specific information on managing the types of common health problems that respond well to alternative therapies and life- style modification.
This book does not recommend treatments but, rather, describes alterna- tive practices, their backgrounds and claims, preparation of practitioners, con- cepts, diagnostic methods, treatments, and evidence from research studies. “Integrated Nursing Practice” is an important section of every chapter designed to help you, the nurse, expand your practice by providing you with specific information and suggestions. “Try This” features throughout the
chapters provide you with examples of how you can integrate these practices into your own life and also give you ideas for client education. A list of resources is also included in the chapters.
In this new fourth edition, I have continued the “Considering the Evi- dence” feature with all new research relating to the chapter topic. Eight of these features present a systematic review of randomized control trials, while two present primary research . “Considering the Evidence” boxes not only present current studies but also are designed to further critical thinking and perhaps inspire you to design studies to answer your own questions. Each study answers the following questions: What was this study about? How was the study done? What were the results of the study? What additional ques- tions might I have? And how can I use this study?
Changes to the fourth edition:
• Updated all research sections and greatly increased the number of sys- tematic reviews of randomized controlled trials
• Changed the focus of the chapter on music from music therapy to music as a therapeutic tool to broaden the focus for the practicing nurse
• Expanded the lists of resources to include more international resources • Deleted polarity therapy and crystal healing for lack of research and
evidence • Added sections on
• Music thanatology • Aromachology • Restorative yoga • Latest technology for biofeedback self-tracking
• Expanded cautions for pregnant women and young children
Nurses are in a unique position to take a leadership role in integrating alternative healing methods into Western health care systems. Nurses have historically used their hands, heart, and head in more natural and traditional healing interactions. By virtue of their education and relationships with clients, nurses can help consumers assert their right to choose their own healing journey and the quality of their life and death experiences.
My dear friend and colleague has written the following letter to you about her lived experience uniting biomedicine with CAM approaches.
It is both a pleasurable and enlightening experience for me to contribute to your text, Complementary and Alternative Therapies for Nursing Practice , through the development of the “Considering the Evidence” feature. I approach this work hopeful that it may inspire you, the reader, to engage in critical thinking, assist in your understanding of the significance of research to inform your nursing practice and, perhaps, propose studies to answer your own researchable questions. However, with this edition, I have asked Karen Lee Fontaine to allow me the privilege of sharing with you my personal journey with complementary and alternative therapies. I hope I can thus inspire you
to reflect on and embrace the important content of this text. After learning of my diagnosis of bilateral breast cancer, I actively participated in myriad Western medicine therapies while integrating complementary and alternative therapies. Although the chemotherapy experience was both mentally and physically challenging, I considered the massage therapist as part of “my team,” and I looked forward to this dimension of comfort during this challenging time. Engaging in yoga enhanced “restful sleep” as a response to the overwhelming fatigue that frequently accompanies Western therapies such as chemotherapy and radiation and just the daily awareness that “you have cancer.” Acupressure relieved uncomfortable postoperative symptoms. T’ai chi continues to be an opportunity to focus on myself and reflect on the positives associated with this journey. Reiki and reflexology is my specified “me time.” As I engage in the associated deep breathing exercises, it stimu- lates my mind to drift to affirmative thoughts and so many positive memories from my life. For me, “living with cancer “is more of an “inconvenience” in my life’s journey. I can appreciate this may not be the experience for every- one, but I can personally assure you that integrating many of the therapies discussed in this text allows me a “quality of life” while simultaneously working with conventional medicine’s goal for a “quantity of life.” With the combination of both, I feel I have been given the power to survive!
I hope my story gives you a sense of hope and empowerment in caring for persons both professionally and personally who are embarking on a stren- uous journey related to their health. I can recall in my nursing practice experi- encing feelings of helplessness when caring for persons undergoing complex t reatments with so many uncertainties related to their health outcome. I can attest that your understanding, knowledge, and support in the implementa- tion of complementary and alternative therapies can significantly affect their “quality of life” and allow you the privilege of making a difference in their health journey.
Warm regards, Dolores M. Huffman, RN, PhD
I would like to express thanks to the many people who have inspired, com- mented on, and in other ways assisted in the writing and publication of the fourth edition of this book. On the publishing and production side at Pearson, I was most fortunate to have an exceptional team of editors and support staff. My thanks go to Julie Alexander, Publisher, and Erin Rafferty, Program Manager, who provided support and guidance throughout this project. Maria Reyes, Project Manager, kept this book on schedule and dedicated her time and skill to its completion.
I would like to thank all those who reviewed this text and provided sug- gestions and guidance for the fourth edition.
Karen Lee Fontaine Purdue University Calumet
Contributors Dolores M. Huffman, RN, PhD
Associate Professor College of Nursing Purdue University Calumet Director of Transfer: Northwest Indiana Center for Evidence Based Practice: A Joanna Briggs Institute Collaborating Centre Hammond, IN
Sheila O’Brien Lewis, BScN, MHSc Associate Lecturer Department of Nursing, Faculty of Health York University Toronto, ON, Canada
Leslie Rittenmeyer, PsyD, CNS, RN Professor Collegel of Nursing Purdue University Calumet Research Associate: Northwest Indiana Center for Evidence Based Practice: A Joanna Briggs Institute Collaborating Centre Hammond, IN
Dot E. Baker, Ed.D., MSN., BSN.
Professor Wilmington University Georgetown, DE
Debra Rose Wilson, PhD, RN, IBCLC, AHN-BC, CHT
Professor Middle Tennessee State University Murfreesboro, TN Walden University Minneapolis, MN
Lynn Rew, Ed.D, RN, AHN- BC, FAAN
Professor The University of Texas at Austin Austin, TX
Sheila Stroman, PhD, RN Assistant Professor University of Central Arkansas Conway, AR
Susan Cohen, DSN, APRN, FAAN
Associate Professor University of Pittsburgh Pittsburgh, PA
Kimberly Arcoleo, PhD, MPH Professor
Ohio State University Columbus, OH
Lori Edwards, DrPH, RN, APRN, BC
Instructor Johns Hopkins University School of Nursing Baltimore, MD
Rose Mary Gee, PhD, RN Assistant Professor Georgia Southern University Statesboro, GA
Sue Hritz, MEd, PC, RN, CHT, PHN
Lecturer Kent State University Kent, OH
Gretchen Ezaki, MSN, RN Instructor Fresno City College Fresno, CA
Kathleen Murphy, PhD, MMT Assistant Professor University of Evansville Evansville, IN
Vicki Moran, MSN/MPH, RN Instructor Saint Louis University St. Louis, MO
Healing Practices: Complementary and Alternative
Therapies for Nurses
Happiness, grief, gaiety, sadness are by nature contagious. Bring your health and your strength to the weak and sickly,
and so you will be of use to them. Give them, not your weakness, but your energy, so you will revive
and lift them up.
1 U N I T
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1 Integrative Healing
Time is generally the best doctor.
Most of nursing education in the United States, Canada, the United Kingdom, Europe, and Australia—often referred to as Western countries—has been under the umbrella of biomedicine, and thus Western nurses are familiar and comfortable with its beliefs, theories, practices, strengths, and limitations. Fewer nurses have studied alternative medical theories and practices and as a result may lack information or even harbor misinformation about these healing practices. Unlike the profession of medicine in general, however, the profession of nursing has traditionally embraced two basic concepts embodied by alternative therapies—holism and humanism—in its approach with clients. Nurses have long believed that healing and caring must be approached holistically and that biological, psychologi- cal, emotional, spiritual, and environmental aspects of health and illness are equally important. This humanistic perspective includes propositions such as 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 com- bination of personal satisfaction and contributions to the larger community. This theoretical basis gives nurses a solid foot in each camp and places them in the unique position to help create a bridge between biomedicine and alternative medicine ( Buchan, Shakeel, Trinidade, Buchan, & Al-See, 2012 ; Halcon, Chlan, Kreitzer, & Leonard, 2003 ; Peplau, 1952 ; Quinn, 2000 ; Shreffler- Grant, Hill, Weinert, Nichols, & Ide, 2007 ).
Many interesting exchanges around the world have debated the appropriate terminology of various healing practices. Some people
4 Unit 1 • Healing Practices
become vested in the use of particular terms and have difficulty getting past the language limitations. For example, many people view the term alternative medi- cine as being too narrow or misleading and are concerned that the term lacks a full understanding of traditional healing practices. It would be helpful for a common language to be developed without these constraints. As language evolves, the terms used today may be quite different from those used 20 years from now. For consistency, the terms chosen for this text are conventional med- icine or biomedicine to describe Western medical practices, and the terms alternative medicine or complementary medicine to describe other healing practices. Traditional medicine refers to indigenous medical systems such as Traditional Chinese Medicine (TCM). There are no universally accepted terms. The following list presents commonly used words and their counterparts:
Mainstream Complementary/Alternative Modern Ancient Western Eastern Allopathic Homeopathic; holistic Conventional Unconventional Orthodox Traditional Biomedicine Natural medicine Scientific Indigenous healing methods
The line between conventional and complementary and alternative medicine is imprecise and frequently changing. For example, is the use of megavitamins or diet regimens to treat disease considered medicine, a life- style change, or both? Can having one’s pain lessened by massage be consid- ered a medical therapy? How should spiritual healing and prayer—some of the oldest, most widely used, and least studied traditional approaches—be classified? Although the terms alternative and complementary are frequently used, in some instances they represent the primary treatment modality for an individual. Thus, conventional medicine sometimes assumes a secondary role and becomes a complement to the primary treatment modality.
Biomedical or Western medicine is only about 200 years old. It was founded on the philosophical beliefs of René Descartes (1596–1650)—that the mind and body are separate—and on Sir Isaac Newton’s (1642–1727) principles of physics—that the universe is like a large mechanical clock in which every- thing operates in a linear, sequential form. This mechanistic perspective of medicine views the human body as a series of body parts. It is a reductionist approach that converts the person into increasingly smaller components: sys- tems, organs, cells, and biochemicals. People are reduced to patients, patients are reduced to bodies, and bodies are reduced to machines. Health is viewed as the absence of disease or, in other words, nothing is broken at present, and sick care is focused on the symptoms of dysfunction. Physicians are trained to
Chapter 1 • Integrative Healing 5
fix or repair broken parts through the use of drugs, radiation, surgery, or replacement of body parts. The approach is aggressive and militant— physicians are in a war against disease, with a take-no-prisoners attitude. Both consumers and practitioners of biomedicine believe it is better to
• do something rather than wait and see whether the body’s natural pro- cesses resolve the problem.
• attack the disease directly by medication or surgery rather than try to build up the person’s resistance and ability to overcome the disease.
Biomedicine views the person primarily as a physical body, with the mind and spirit being separate and secondary or, at times, even irrelevant. It is powerful medicine in that it has virtually eliminated some infectious dis- eases, such as smallpox and polio. It is based on science and technology, per- sonifying a highly industrialized society. As a “rescue” medicine, the biomedical approach is appropriate. It is highly effective in emergencies, trau- matic injuries, bacterial infections, and some highly sophisticated surgeries. In these cases, treatment is fast, aggressive, and goal oriented, with the responsi- bility for cure falling on the practitioner.
The priority of intervention is on opposing and suppressing the symp- toms of illness. This approach is evidenced in many medications with prefixes such as an or anti , as in analgesics, anesthetics, anti-inflammatories, and anti- pyretics. Biomedicine characterizes each disease in terms of its mechanisms of action, based on the belief that most individuals are affected in the same way. Thus, treatment is basically the same for most people. Because conventional medicine is preoccupied with parts and symptoms and not with whole work- ing systems of matter, energy, thoughts, and feelings, it does not do well with long-term systemic illnesses such as arthritis, heart disease, and hypertension. Despite higher per capita spending on health care in the United States than in all other nations, in 2013, U.S. life expectancy ranked only 37th, and the infant mortality rate ranked 33rd among the nations studied ( World Health Rankings, 2013 ). The United States has failed to be a world leader in providing a healthier quality of life.
Complementary and Alternative Medicine
Complementary and alternative medicine (CAM) is an umbrella term for as many as 1,800 therapies practiced worldwide. Many forms have been handed down over thousands of years, both orally and in written records. These ther- apies are based on the medical systems of ancient peoples, including Egyp- tians, Chinese, Asian Indians, Greeks, and Native Americans. Others, such as osteopathy and naturopathy, evolved in the United States during the past two centuries. Still others, such as some of the mind–body and bioelectromagnetic approaches, are on the frontier of scientific knowledge and understanding. The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) defines CAM therapies as a broad range of healing philosophies, approaches, and …
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