Chapter 34Chapter 34

Complementary and Alternative Complementary and Alternative Therapies in Maternity and Pediatric Therapies in Maternity and Pediatric

NursingNursing

ObjectivesObjectives

• Define complementary and alternative medicine (CAM) therapy.

• Identify the role of the nurse in CAM therapy.

• Describe the involvement of the federal government in CAM therapy.

• Discuss the integration of CAM therapy in nursing practice.

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Objectives Objectives (cont.)(cont.)

• Discuss the impact on nursing care of patients who use CAM therapy.

• State five types of CAM therapy in common use.

• State three herbal products contraindicated in pregnancy.

• State three herbal products commonly used in pediatrics.

• State popular herbs used during menopause.

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Objectives Objectives (cont.)(cont.)

• Discuss the use of hyperbaric oxygen therapy in the care of carbon monoxide poisoning and necrotic ulcer.

• State three herbs that should be discontinued 2 weeks before surgery.

• State the use of meridians, dermatomes, and reflexology lines in CAM therapy.

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Definition of CAM TherapiesDefinition of CAM Therapies

• Complementary therapy– Nontraditional therapy that is used with

traditional or conventional therapy

• Alternative therapy– Unconventional or nontraditional that replaces

conventional or traditional therapy

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Alternative Health CareAlternative Health Care

CAM TherapyCAM Therapy

• Also known as – Integrative therapies– Integrative healing– Holistic healing

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CAM PractitionersCAM Practitioners

• Holistic practitioners

• Naturopaths

• Nutritional consultants– Food therapy– Vitamin and mineral supplements

• Herbalist

• Practitioners of acupuncture and acupressure

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Popular Cultural Folk Healers Popular Cultural Folk Healers

• Mexican: Curanderos

• African American: Root doctor

• Asian and Chinese: Herbalist

• Puerto Rican: Espiritistas or santiguadoras

• Navajo: Singers

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Accepted TheoriesAccepted Theories

• Gate control theory of pain relief

• Imagery

• Journaling

• Therapeutic touch

• Humor

• Support groups

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Nurse’s Role in CAM TherapyNurse’s Role in CAM Therapy

• Cultural competence is a sensitivity and respect for practices and philosophies different from one’s own

• The need for nurses to understand CAM therapy, how it can be used, and how it may interact with or enhance traditional medical and nursing care are important

• Nurses need to understand basic underlying philosophies and beliefs concerning CAM interventions

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Nurse’s Role in CAM Therapy Nurse’s Role in CAM Therapy (cont.)(cont.)

• Is not to promote CAM therapy but to recognize and respect its use

• Use critical thinking skills to determine interactions with traditional therapies

• Work with the patient as a partner in the delivery of health care

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Cautions in CAM TherapyCautions in CAM Therapy

• Herbs can – Interact with cardiac drugs– Affect glucose control in patients with diabetes– Lower the concentration of some synthetic

drugs– Lower the blood level of some medications for

HIV/AIDS• Polypharmacy should be avoided; the use of

some drugs with herbal remedies can be dangerous

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Herbs to Discontinue Two Weeks Herbs to Discontinue Two Weeks Before SurgeryBefore Surgery

• Echinacea• Garlic• Ginger• Gingko biloba• St. John’s wort• Ginseng• Kava kava• Feverfew• Ephedra (ma huang)

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Federal RegulationsFederal Regulations

• 1962: Kefauver-Harris Drug Amendment Act required FDA proof of safety and effectiveness for all drugs (not including herbal products) before placing them on the market

• 1992: NIH formed Office of Alternative Medicine to evaluate CAM therapies

• 1994: Dietary Supplement Health and Education Act defined dietary supplement and prohibited claim of medicinal value

• 1994: DSHEA required regulations for labeling and statement that there is no FDA approval

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Overview of Common Alternative Overview of Common Alternative Health Care PracticesHealth Care Practices

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MassageMassage

• Thought to bolster immune response

• Rolfing—thought to improve muscle and bone function

• “Cao-gio” (coin rubbing) form of skin manipulation thought to help bring the body into healthy alignment

• Perineal massage in preparation for labor

• Effleurage—pain relief

• Gentle touch—for premature infants17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Massage Massage (cont.)(cont.)

• Massage and manipulative therapy are contraindicated in patients with– Cancer– Osteoporosis– Localized infection– Cardiac and circulatory disorders

• Because of the increased blood flow to the affected areas

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OsteopathyOsteopathy

• Pressure point therapy– Certain areas of the body are connected to

specific identified pressure points such as hands, feet, and ears

– Channels conduct vital energy through the body

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Energy HealingEnergy Healing

• Belief that electromagnetic flow emerges from the therapist’s hand and can funnel energy into the patient

• The body, the mind, the spirit, and the emotions are usually involved in this form of therapy

• Light therapy, another form of energy, is used to treat a jaundiced newborn

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ReflexologyReflexology

• Reflex points in the hands and feet thought to correspond to every organ or part of the body

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Acupuncture and AcupressureAcupuncture and Acupressure

• Complex meridians that are pathways to specific organs or parts of the body

• It is at these points that positive or negative energy can be realigned

• “Chi” energy is thought to regulate proper body function

• Points to avoid during pregnancy are– Bottom of foot– Inner lower leg– Base of thumb– Most areas over abdomen

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HomeopathyHomeopathy

• Uses plants, herbs, and earth minerals

• Belief that disease is an energy imbalance and that prescribed remedies assist the body to reestablish correct balance

• Taken sublingually

• Don’t combine with caffeine, alcohol, or traditional Western medicine

• Only one remedy is administered at a time

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AyurvedaAyurveda

• Ancient Hindu healing regimen

• Deals with biological rhythms of nature

• Includes music, herbs, massage, aromatherapy, and a tailored diet

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AromatherapyAromatherapy

• Involves the use of concentrated fluid or the essence of specific herbs that are combined with steams or baths to inhale or bathe the skin

• NOTE: Concentrated pure oils can cause burns on the skin if used incorrectly

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Nursing TipNursing Tip

• Lavender, chamomile, and sandalwood essential oils are useful in aromatherapy for children with chronic pain

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HypnotherapyHypnotherapy

• Patient enters a hypnotic state of induced sleep

• Under the guidance of a practitioner, specific and potentially long-lasting suggestions are given to the patient

• Some patients resist the trance state and are not candidates for hypnotherapy

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HydrotherapyHydrotherapy

• Promotes relaxation

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Guided ImageryGuided Imagery

• Patient focuses on a specific image which can result in the reduction of stress and increased performance

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BiofeedbackBiofeedback

• A type of relaxation therapy that enables the patient to recognize tension in the muscles via response on an electronic machine

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Chiropractic CareChiropractic Care

• Deals with the relationship between the spinal column and nervous system

• Involves nerve energy thought to be responsible for restoring and maintaining health

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Herbal RemediesHerbal Remedies

• Powerful nutritional agents

• Most are safe to ingest

• Herbal remedies consumed during pregnancy can reach the fetus

• Herbal capsules are about 4 times stronger than herbal teas

• Herbal extracts are about 4 to 8 times stronger than capsules

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Common Herbs Contraindicated in Common Herbs Contraindicated in Pregnancy and LactationPregnancy and Lactation

• Aloe vera• Garlic• Ginkgo biloba• St. John’s wort• Angelica (dong quai)• Chamomile

• Feverfew• Flax (flaxseed)• Ginseng• Kava kava• Ma huang (ephedra)• Nettle

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Herbs Commonly Used in Herbs Commonly Used in PediatricsPediatrics

• Blue-green algae• Chamomile• Ephedra• Echinacea• Evening primrose oil• Fennel seed oil

• Feverfew• Fish oil• Ginger• Ginkgo biloba• Ginseng

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Herbs that Promote MenstruationHerbs that Promote Menstruation

• The following herbs promote menstruation and may cause miscarriage if used during pregnancy: – Cascara– Cohosh– Goldenseal– Juniper– Marjoram– Motherwort– Mugwort– Pennyroyal– Sage– Senna– Wormwood

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Popular Herbs Used in MenopausePopular Herbs Used in Menopause

• Black cohosh

• Sage

• Dong quai

• Chasteberry

• Motherwort

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Hyperbaric Oxygen TherapyHyperbaric Oxygen Therapy

• Uses an airtight enclosure to provide compressed air or oxygen under increased pressure

• Contraindicated in pregnancy

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Sauna/Heat TherapySauna/Heat Therapy

• Thought to help eliminate body waste

• Patients should monitor their pulse during this form of treatment

• This type of therapy is contraindicated in pregnancy

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Question for ReviewQuestion for Review

• What are some CAM therapies that are currently used regularly in the labor unit?

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ReviewReview

• Objectives

• Key Terms

• Key Points

• Online Resources

• Critical Thinking Questions

• Review Questions

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