Complementary and Alternative Therapy

Complementary and Complementary and Alternative TherapyAlternative Therapy

C. Matthews MSN, RNC. Matthews MSN, RN

Marilee Elias, MSN, RNMarilee Elias, MSN, RN

Spring 2012Spring 2012

Please make phones silent & visible

ReadingReading Required:Required:

– Wilkinson-Ch. 40 Wilkinson-Ch. 40 – Ignatavicius – Ch. 2 Ignatavicius – Ch. 2

Suggested Additional reading:Suggested Additional reading:– Lilley – Ch. 8 “Over the counter drugs Lilley – Ch. 8 “Over the counter drugs

and Herbal products”and Herbal products”

Some references in this presentation will Some references in this presentation will be from pages in your textbooks other be from pages in your textbooks other than required chapters – highly than required chapters – highly recommended reading.recommended reading.

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M. Elias RN, MSNM. Elias RN, MSN

C. Matthews RN, MSN C. Matthews RN, MSN M.Elias RN, MSN SP10M.Elias RN, MSN SP10 33

Course OutcomesCourse Outcomes1. Identify the roles of the nurse in a variety 1. Identify the roles of the nurse in a variety

of community settings to maintain optimal of community settings to maintain optimal level of wellness.level of wellness.

2. Client - centered teaching.2. Client - centered teaching.

3. Apply the nursing process to meet the 3. Apply the nursing process to meet the physiological and psychosocial needs of physiological and psychosocial needs of clients and their families at the end of life.clients and their families at the end of life.

4. Standards of safe medication 4. Standards of safe medication administration.administration.

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UNIT OUTCOMESUNIT OUTCOMES1. Integrate complementary therapies into health 1. Integrate complementary therapies into health

promotion activities for the well client.promotion activities for the well client.2. Assess client need for Complementary or 2. Assess client need for Complementary or

Alternative therapy.Alternative therapy.3. Identify use of Complementary or Alternative 3. Identify use of Complementary or Alternative

therapy.therapy.4. Evaluate outcomes of Complementary or 4. Evaluate outcomes of Complementary or

Alternative therapy practices.Alternative therapy practices.5. Provide non-pharmacological measures for pain 5. Provide non-pharmacological measures for pain

relief.relief.6. Identify quackery or unscrupulous practitioners.6. Identify quackery or unscrupulous practitioners.

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CONTENT FOR ALTERNATIVE CONTENT FOR ALTERNATIVE THERAPIES THERAPIES

I. Systems of Health CareI. Systems of Health Care– Traditional Chinese MedicineTraditional Chinese Medicine– Native American medicineNative American medicine– HomeopathyHomeopathy

II. Mind-Body Therapies II. Mind-Body Therapies – A. Journaling A. Journaling – B. Imagery B. Imagery – C. Meditation C. Meditation

III. Manipulative Therapies III. Manipulative Therapies – D. Massage D. Massage – E. Tai Chi E. Tai Chi


M.Elias RN, MSN SP11M.Elias RN, MSN SP11

CONTENT FOR ALTERNATIVE THERAPIESCONTENT FOR ALTERNATIVE THERAPIES

IV. Biologic Based TherapiesIV. Biologic Based Therapies– A. Aromatherapy A. Aromatherapy – B. Herbal preparations B. Herbal preparations

V. Energy TherapiesV. Energy Therapies– Healing touchHealing touch– Therapeutic touchTherapeutic touch– ReikiReiki

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History of Western MedicineHistory of Western Medicine

77C. Matthews RN, MSN C. Matthews RN, MSN

M.Elias RN, MSN SP11M.Elias RN, MSN SP1104/20/2304/20/23

Ancients -- Myths & Religion – Ancients -- Myths & Religion – Basis For Medical PracticeBasis For Medical Practice



History of Western History of Western Medicine:Medicine:

Ancient Greece & RomeAncient Greece & Rome HippocratesHippocrates

GalenGalen




Early Christian Early Christian era ushers in era ushers in hospitals and hospitals and health care health care similar to similar to established Arab established Arab MedicineMedicine




Middle AgesMiddle Ages– MidwivesMidwives– WitchesWitches– PhysiciansPhysicians




RenaissanceRenaissance




– ListerLister– NightingaleNightingale


M. Elias RN, MSN SP11M. Elias RN, MSN SP1104/20/2304/20/23


20th and 21st 20th and 21st CenturiesCenturies


M. Elias RN, MSN SP11M. Elias RN, MSN SP1104/20/2304/20/23

Integrative Health Care isIntegrative Health Care is

A Concept of Coordinated Health Care A Concept of Coordinated Health Care that Includes ALL the Treatments that Includes ALL the Treatments (Conventional and CAMs) and Health (Conventional and CAMs) and Health Practices that Your Patient uses in Practices that Your Patient uses in their Life.their Life.

How do We get our Patients to Tell us How do We get our Patients to Tell us about the CAMs they use?about the CAMs they use?

Course outcome #1 Course outcome #1 Unit outcome #1Unit outcome #1 1515

C. Matthews RN, MSN C. Matthews RN, MSN M. Elias RN, MSN SP11M. Elias RN, MSN SP11

What is Holism?What is Holism?

Concept focused on Relationships Concept focused on Relationships among all living things.among all living things.

Therapeutic Encounters include:Therapeutic Encounters include:– Enhancing Resistance to IllnessEnhancing Resistance to Illness– Reducing aggravating behaviorsReducing aggravating behaviors– Stress Management Stress Management – Goal is Optimal state of Wellness for Goal is Optimal state of Wellness for

each unique personeach unique person

Course outcome #1 Course outcome #1 Unit outcome #1Unit outcome #1 1616


RNs RNs mustmust be familiar with C. A. be familiar with C. A. M. M.

““The 2007 National Health Interview The 2007 National Health Interview Survey (NHIS), which included a Survey (NHIS), which included a comprehensive survey of CAM use by comprehensive survey of CAM use by Americans, showed that Americans, showed that approximately 38 percent of adults approximately 38 percent of adults use CAM.” use CAM.” NCCAM NCCAM

retrieved 3/16/11 from retrieved 3/16/11 from http://nccam.nih.gov/health/whatiscam/

Course outcome #1 Course outcome #1 Unit outcome #1Unit outcome #1

C. Matthews RN, MSN C. Matthews RN, MSN M. Elias RN, MSN SP11M. Elias RN, MSN SP11 1717


What is CAM?What is CAM?

Complementary modalities Complementary modalities (therapies)(therapies): used in conjunction : used in conjunction with conventional medical with conventional medical practice. practice. (Wilkinson, p. 1019)(Wilkinson, p. 1019)

Alternative Modalities(therapies)Alternative Modalities(therapies): : used instead of traditional care. used instead of traditional care. (Wilkinson, p.1019)(Wilkinson, p.1019)

Unit outcome #3Unit outcome #3


RN must:

1.Be non-judgmental despite personal opinions

2. Build rapport by showing client respect – if not, he may be afraid to tell about CAM use

3. Understand that C.A.M. can be beneficial, when used correctly

4. Be aware that C.A.M. can be dangerous if it interacts or interferes with conventional treatment

Course outcome #1Course outcome #1Unit outcome #1Unit outcome #1


RN must:5. Be willing to teach the public about

the positive and negative information regarding C.A.M.

6. Be aware that use of C.A.M. is popular and increasing and must be included in the history & physical

7. Know that Herbals, in particular, can have significant effect on prescription drugs and body function

Course outcome #1,2Course outcome #1,2Unit outcome #1Unit outcome #1

National Center for National Center for Complementary and Complementary and Alternative MedicineAlternative Medicine National Institutes of Health National Institutes of Health

established NCCAM.established NCCAM. Purposes:Purposes:

– Fund studies evaluating effectiveness of Fund studies evaluating effectiveness of C.A.M.C.A.M.

– Advance health professional knowledge Advance health professional knowledge re: C.A.M.re: C.A.M.

– Serve as a clearinghouse for information Serve as a clearinghouse for information about these therapiesabout these therapies


M. Elias RN, MSN SP11M. Elias RN, MSN SP11 2121


NCCAM Domains of NCCAM Domains of C.A.M.C.A.M.

Ignatavicius pg 8; Wilkinson p. 1020Ignatavicius pg 8; Wilkinson p. 1020 National Center for Complementary National Center for Complementary

and Alternative Medicine – 5 and Alternative Medicine – 5 categoriescategories– Systems of Health CareSystems of Health Care– Mind-body therapiesMind-body therapies– Manipulative and body-based therapiesManipulative and body-based therapies– Biologically based therapiesBiologically based therapies– Energy therapiesEnergy therapies

Unit outcome #3Unit outcome #3


Mind-BodyMind-Body MeditationMeditation

– Stress relief/ reduce anxietyStress relief/ reduce anxiety– RelaxationRelaxation– Reduced levels of lactic acidReduced levels of lactic acid– Decreased oxygen consumptionDecreased oxygen consumption– Slowed heart rateSlowed heart rate– Decreased blood pressureDecreased blood pressure– Improved function of immune systemImproved function of immune system– Reduce painReduce pain– Relieve symptoms of psoriasisRelieve symptoms of psoriasis– Improve healthImprove health

(References: Ignativicius; Wilkinson)(References: Ignativicius; Wilkinson)

Unit outcomes #1-5Unit outcomes #1-5


RelaxationRelaxation

Used post-operativelyUsed post-operatively (Ignatavicius, p. 299)(Ignatavicius, p. 299)

Relaxation techniquesRelaxation techniques (Ignatavicius, p. 56-(Ignatavicius, p. 56-57)57)

– To reduce anxiety, tension & emotional To reduce anxiety, tension & emotional tension which can exacerbate paintension which can exacerbate pain

Relaxation Relaxation (Wilkinson Vol 2, p. 967; Vol 1, pg 806-807)(Wilkinson Vol 2, p. 967; Vol 1, pg 806-807)

Progressive muscle relaxation Progressive muscle relaxation (PMR) (PMR) (Wilkinson p. 807)(Wilkinson p. 807)

Promoting sleepPromoting sleep Can be taught in home settingCan be taught in home setting Nurses can use for reduction of pain & stress. Nurses can use for reduction of pain & stress.



Guided Imagery Guided Imagery – Distraction when confronting pain, Distraction when confronting pain,

discomfort or fear discomfort or fear – Making decisions and altering behaviorMaking decisions and altering behavior– Caution: not recommended for Caution: not recommended for

emotionally unstable or cognitively emotionally unstable or cognitively impaired clientimpaired client

– Helps reduce pain.Helps reduce pain.– Reduction of nausea & vomiting.Reduction of nausea & vomiting.– Decreasing anxietyDecreasing anxiety– Promoting comfort during cancer Promoting comfort during cancer

treatmenttreatment– Ignatavicius, 6Ignatavicius, 6thth ed. p. 9 ed. p. 9



Mind - Body Biofeedback Biofeedback (see Wilkinson text p. 1027)(see Wilkinson text p. 1027)

JournalingJournaling– Provides a vehicle for expressing Provides a vehicle for expressing

feelingsfeelings HypnosisHypnosis

– Advanced training is NECESSARY Advanced training is NECESSARY HumorHumor

– Biochemical Responses?Biochemical Responses?– Physiologic Responses?Physiologic Responses?


Spiritual Spiritual

Life force beliefs found in most cultures. (Wilkinson, p 1020)

Faith healing (Wilkinson page 260)




Spiritual Spiritual spiritual beliefs – how they affect spiritual beliefs – how they affect

healthhealth

Longer life spanLonger life span Predictors of health outcomesPredictors of health outcomes Effects on specific diseases Effects on specific diseases

– Page 249 WilkinsonPage 249 Wilkinson


PrayerPrayer Most Widely Used CAM in U.S.Most Widely Used CAM in U.S. (NCCAM, 2004)(NCCAM, 2004)

C.A.M. interventions C.A.M. interventions (Wilkinson page 257)(Wilkinson page 257)

PrayerPrayer– For SelfFor Self– For OthersFor Others– Healing Prayer ServicesHealing Prayer Services– Prayer GroupsPrayer Groups

Unit outcomes #1-5Unit outcomes #1-5 2929C. Matthews RN, MSN C. Matthews RN, MSN

M. Elias RN, MSN SP11M. Elias RN, MSN SP11


Spiritual

Intercessory prayerIntercessory prayer– An organized and regular form of An organized and regular form of

prayer in which someone prayer in which someone communicates with his or her higher communicates with his or her higher power on behalf of another who is in power on behalf of another who is in need. need.

Healing prayerHealing prayer– Studies showing evidence of Studies showing evidence of

improvementimprovement Wilkinson, p 259-260 Wilkinson, p 259-260



Spiritual Nurses should expect to work in Nurses should expect to work in

collaboration with others, particularly collaboration with others, particularly ministers, pastors and chaplains, to ministers, pastors and chaplains, to meet the complex spiritual needs of all meet the complex spiritual needs of all patients.patients.

Potential problem: the nurse and patient Potential problem: the nurse and patient have different views of spiritualityhave different views of spirituality– Respect patient’s wishesRespect patient’s wishes– If patient asks for spiritual intervention If patient asks for spiritual intervention

that is inconsistent with the nurse’s that is inconsistent with the nurse’s beliefs, seek assistance from another beliefs, seek assistance from another nurse or chaplain.nurse or chaplain.



Manipulative and body-based Manipulative and body-based methodsmethods

Movement & exerciseMovement & exercise– Strengthens circulatory & respiratory Strengthens circulatory & respiratory

functionfunction– EndorphinsEndorphins– Helps regulate metabolismHelps regulate metabolism– Enhances Immune systemEnhances Immune system



Manipulative and Body-based Therapies

Yoga – “life forces in correct balance and flow– Concentration, strength, flexibility,

symbolic movements– Breathing, movement & posture

Tai Chi– Promotes the flow of qi or energy

throughout the body– Ignatavicius, p. 11

– Reduces sx. of fibromyalgia– Used in cardiac rehab programs, can lower

BP


Other Movement TherapiesOther Movement Therapies

Dance TherapyDance Therapy



Chiropractic and OsteopathyChiropractic and Osteopathy

ChiropracticChiropractic– Relationship between Body Structure Relationship between Body Structure

and Functionand Function– Subluxation & AdjustmentSubluxation & Adjustment

Osteopaths D.O. vs. M.D.Osteopaths D.O. vs. M.D.– Includes Osteopathic ManipulationIncludes Osteopathic Manipulation



MassageMassage

– Muscles & Soft TissuesMuscles & Soft Tissues– Benefits of MassageBenefits of Massage– Contraindications for MassageContraindications for Massage– Can we (nurses) do Massage?Can we (nurses) do Massage?


M.Elias RN, MSN SP10M.Elias RN, MSN SP10


Energy – Based TherapiesEnergy – Based Therapies

“A group of techniques that work with the body’s energy field by the use of the hands to direct or redirect the energy to enhance balance within the field.” (see Wilkinson page 1033-34)

alternativecancer.us/aura.jpg


CC. Matthews RN, MSN CC. Matthews RN, MSN M. Elias RN, MSN SP11M. Elias RN, MSN SP11 3838


Energy fields http://images.google.com/images?hl=en&q=layers+of+body+energy+field&btnG=Search+Images&gbv=2

– Layers – Chakras – Reflexology ‘zones’ http://images.google.com/images?

gbv=2&hl=en&q=reflexology+zones&btnG=Search+Images

– Traditional Chinese Medicine – 12 Meridians (Ignatavicius, 6th ed., page 9)

– Acupressure ‘meridians’ (Wilkinson figure 40-3 page 1024) – Acupuncture chi/blockages

www.windsofchange.eu.com/chakra.html



Energy – Based TherapiesEnergy – Based Therapies Therapeutic massageTherapeutic massage

– Precaution – Precaution – Wilkinson p. 1033Wilkinson p. 1033

Therapeutic touchTherapeutic touch– Caution for touch – Caution for touch – Ignatavicius 6Ignatavicius 6thth ed., page 13 ed., page 13

Healing touchHealing touch ReikiReiki AcupressureAcupressure Reflexology Reflexology




TT (Therapeutic Touch)TT (Therapeutic Touch)– Integral to assessmentIntegral to assessment– BondingBonding– CommunicationCommunication– Soothing, calming, comfortSoothing, calming, comfort– orientationorientation

Contraindications Contraindications – When When NOTNOT to touch – to touch – Ignatavicius pg. 13Ignatavicius pg. 13


ReikiReiki Create Energy BalanceCreate Energy Balance Patient draws EnergyPatient draws Energy Reiki Masters & TrainingReiki Masters & Training



http://www.centurylink.net/search/index.php?q=google&context=www.centurylink.net

“Reiki is a Japanese technique for stress reduction and relaxation that also promotes healing. It is administered by "laying on hands" and is based on the idea that an unseen "life force energy" flows through us and is what causes us to be alive.”

Reflexology/AcupressureReflexology/Acupressure Reflexology Reflexology

– Ancient EgyptAncient Egypt– Energy Zones Top to BottomEnergy Zones Top to Bottom– Pressure PointsPressure Points– What conditions benefit from it?What conditions benefit from it?

AcupressureAcupressure– Meridians & Pressure PointsMeridians & Pressure Points



AcupunctureAcupuncture

Derived from traditional Chinese Derived from traditional Chinese medicine and other countries and medicine and other countries and alternative systemsalternative systems

Qi Qi (chi)(chi) Energy travels through 72 Energy travels through 72 Meridians in the bodyMeridians in the body

Needles are applied to Acupoints on Needles are applied to Acupoints on the Meridians to restore the flow of the Meridians to restore the flow of qiqi




Acupuncture – uses forAcupuncture – uses for

Migraine headacheMigraine headache – – Ignatavicius, p. Ignatavicius, p.

953953 Pain and AnesthesiaPain and Anesthesia – – Ignatavicius p. Ignatavicius p.

5757

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M.Elias RN, MSN SP10M.Elias RN, MSN SP10 4545

The dreaded nausea and vomiting which commonly occurs in some patients undergoing chemotherapy and inevitably, with the use of certain classes of agents, can often be worse than the disease itself. Most oncologists have experienced the patients who start vomiting at the thought of their next clinic visit. At the University of Los Angeles (UCLA) School of Medicine, a well-controlled study completed over two Years ago, the authors of the published paper reported significant reduction of nausea and vomiting when pre-treated with. It is now routinely administered before, after and in between chemotherapy treatment sessions for control or nausea and emesis. Such treatments are relatively simple and easily executed in an outpatient setting. Its effectiveness helps in minimizing the use of standard, expensive multi-drug anti-nausea regimens with their attendant side effects, given along with the chemotherapeutic agents.

Acupuncture in Cancer Treatment by Eugene Mak, MD@ http://www.medicalacupuncture.org/acu_info/articles/cancertreatment.html

Biologically Based TherapiesBiologically Based Therapies

Dietary TherapiesDietary Therapies HerbsHerbs VitaminsVitamins AromatherapyAromatherapy

Course outcome #2, 3 & Course outcome #2, 3 & 44Unit outcomes #1-5Unit outcomes #1-5 4646



Dietary TherapiesDietary Therapies Nutraceuticals and phytonutrientsNutraceuticals and phytonutrients Protective or healing agents found in Protective or healing agents found in

plant and animal foods.plant and animal foods. Free radicals: unstable molecules that Free radicals: unstable molecules that

alter genetic codes and trigger the alter genetic codes and trigger the development of cancer growth in cells.development of cancer growth in cells.

Antioxidants: react with free radicals, Antioxidants: react with free radicals, preventing their damaging effectspreventing their damaging effects– Sources of antioxidants: vitamin C, beta-Sources of antioxidants: vitamin C, beta-

carotene, vitamin Ecarotene, vitamin E

Course outcome #2, 3 & Course outcome #2, 3 & 44Unit outcomes #1-5Unit outcomes #1-5


Dietary TherapiesDietary Therapies

Macrobiotic Diets Macrobiotic Diets – Yin/ yang of foodsYin/ yang of foods– Balanced foods Balanced foods – Foods to avoid: processed and treated Foods to avoid: processed and treated

foods, red meat, sugar, dairy products, foods, red meat, sugar, dairy products, eggs, caffeineeggs, caffeine

– Caution: Caution: children and pregnant women children and pregnant women may have deficiency in Vitamins D and may have deficiency in Vitamins D and BB1212



Aromatherapy – Aromatherapy – Wilkinson page 1030Wilkinson page 1030

Essences from oils extracted from Essences from oils extracted from plants & flowers.plants & flowers.

Conditions responsive to Conditions responsive to aromatherapy:aromatherapy:– Stress and anxietyStress and anxiety– Muscular and rheumatic painsMuscular and rheumatic pains– Digestive disordersDigestive disorders– Skin conditionsSkin conditions


AromatherapyAromatherapy

Can be used for sense of smell, but also as compresses, baths or topical




Aromatherapy(Ignativicius, p.12)

Lavender – promotes relaxation & sleep Peppermint – stimulation, concentration Sandalwood – ease depression Tea tree – treating MRSA? Chamomile – relaxation Lemon – promotes sleep/ tx for insomnia

and/or digestive disorders



HerbalsCherokee story “…humans were without diseases until

the animals created them in retribution for the lack of respect humans had shown them. The plants, however, felt that the animals were much too harsh and volunteered themselves to provide a cure for every disease the animals had created.”

Cavendar, p. 55

Course outcome # 3 & 4Course outcome # 3 & 4Unit outcomes #1-5Unit outcomes #1-5


HERBALS – what RN needs to HERBALS – what RN needs to knowknow

Major drawback: May delay important diagnosis and treatment.

Nursing Intervention: Make certain MD or ARNP is aware of client’s use of herbals.

Nursing action: What to assess & instruct pre-op client regarding herbal therapy.



HERBALS – what RN needs to HERBALS – what RN needs to knowknow

FDA categorized herbals as food and nutritional supplements not as drugs

The Dietary Supplement Health & Education

Act (DSHEA) of 1994 allowed herbs to be sold as dietary supplements as long as there are no health claims written on labels

DSHEA requires no proof of safety or efficacy and sets no standards for products labeled as supplements, i.e. no guarantee the herb is properly prepared



Commonly used HerbalsIgnatavicius page 12 – table 2-3

Know intended uses for each Know Caution & adverse effects of

each– Gingko bilboa– Garlic– Echinacea– Ginseng– St. John’s Wort


Ginko BilobaGinko Biloba Reduce Memory Problems, Reduce Memory Problems,

Dementia, Peripheral Vascular Dementia, Peripheral Vascular DiseaseDisease

Antioxidant & Vasodilatory PropertiesAntioxidant & Vasodilatory Properties BUT BUT can cause can cause BLEEDINGBLEEDING when when

used with Anticoagulantsused with Anticoagulants AvoidAvoid before surgery before surgery Also cause Headache, GI UpsetAlso cause Headache, GI Upset



GarlicGarlic Lowers Cholesterol, Lowers BP, Lowers Cholesterol, Lowers BP,

Natural Antibiotic, Natural Antibiotic, Natural Anti-platelet AgentNatural Anti-platelet Agent BUTBUT Causes Causes BLEEDINGBLEEDING with other with other

Anti-platelet DrugsAnti-platelet Drugs Potentiates Potentiates Anti-diabetic DrugsAnti-diabetic Drugs Avoid Avoid before Surgerybefore Surgery



EchinaceaEchinacea

Builds Immunity, Helps Wound Builds Immunity, Helps Wound HealingHealing

Use Use > 8 Weeks > 8 Weeks & Possible & Possible Immune Immune Function Suppression Function Suppression

NOT NOT Recommended for People with Recommended for People with Immune DiseasesImmune Diseases



Ginseng Ginseng Asian Ginseng-Asian Ginseng- Diabetes, Erectile Diabetes, Erectile

Dysfunction, “Unclear” ThinkingDysfunction, “Unclear” Thinking American Ginseng-American Ginseng- Diabetes, Diabetes,

Prevention of Colds & FluPrevention of Colds & Flu Siberian Ginseng-Siberian Ginseng- Prevent Colds & Prevent Colds &

Flu, reduce Severity of Herpes Flu, reduce Severity of Herpes Simplex type 2 InfectionsSimplex type 2 Infections

BUT, BUT, BUT, BUT…BUT, BUT, BUT, BUT…



Ginseng and the Big ButsGinseng and the Big Buts



Ginseng & The BIG Ginseng & The BIG BUTSBUTS Insomnia, Headache, Agitation, GI Insomnia, Headache, Agitation, GI

Upset, Unusual Menstrual Bleeding, Upset, Unusual Menstrual Bleeding, Breast Pain, Dizziness, Increase or Breast Pain, Dizziness, Increase or Decrease BP, Hypoglycemia, Decrease BP, Hypoglycemia, Fast/Pounding/Irregular Fast/Pounding/Irregular Heartbeat;Heartbeat;

Severe Allergic ReactionSevere Allergic Reaction Not Not with Immune System Disorders, with Immune System Disorders,

Schizophrenia, Endometriosis, FibroidsSchizophrenia, Endometriosis, Fibroids NOT FOR Long-term UseNOT FOR Long-term UseCourse outcome # 2, 3 & Course outcome # 2, 3 & 44Unit outcomes #1-5Unit outcomes #1-5 6161


St. John’s WortSt. John’s Wort

Ease Mild to Moderate DepressionEase Mild to Moderate Depression BUT BUT causes Photosensitivitycauses Photosensitivity DO NOT DO NOT use in Major Depressionuse in Major Depression DO NOT DO NOT use with Other use with Other

Antidepressants Antidepressants




HerbalsHerbals Alert: “Natural” does not always mean

harmless. Plants used improperly can be poisonous. Chemicals within herbs can strengthen

the immune system, alter blood chemistry, or protect specific organs against disease

Caution: some individuals may have allergies



Herbals Special precaution with pregnant or

lactating women and children – should not use without physician’s knowledgeRationale:

Unpredictable biologic effectsPossible allergiesSide effectsHerbs have chemical compositionLittle or no regulation of production/ qualityPossible herb/drug or herb/herb interactionPossible delay of treatment is dangerous



Herbals & the RNHerbals & the RN

TeachTeach about signs of allergic about signs of allergic reactionsreactions

TeachTeach that herbs can be that herbs can be dangerous even if they are not dangerous even if they are not Rx and are “natural”Rx and are “natural”



Herbals & the RN AlwaysAlways ask about use of herbals when ask about use of herbals when

getting medication historygetting medication history

““What is the story of why the patient is What is the story of why the patient is using the plant medicine or therapy?”using the plant medicine or therapy?”

– Libster, p. 809Libster, p. 809

TeachTeach clients to look for products clients to look for products labeled labeled ‘‘standardized’standardized’ – – these more these more likely to have accurate amounts of likely to have accurate amounts of herb and less likely to have herb and less likely to have contaminationcontamination

Course outcome #2, 3 & 4Course outcome #2, 3 & 4Unit outcomes #1-5Unit outcomes #1-5


Have had spiritual significance since ancient times and they also were adopted as medicines for physical ailments.

In modern Chinese Materia Medica, these two resins are classified as herbs for vitalizing circulation of blood and are utilized for treating traumatic injury, painful swellings, masses, and other disorders related to stasis syndromes.

– MYRRH AND FRANKINCENSE by Subhuti Dharmananda, Ph.D., May 2003 @ http://www.itmonline.org/arts/myrrh.htm

*Will not be on the test!Course outcome #2, 3 & Course outcome #2, 3 & 44Unit outcomes #1-5Unit outcomes #1-5

Frankincense and MyrrhFrankincense and Myrrh** medicinal medicinal useuse

Pain in the epigastrum, abdomen, hypochondria, Pain in the epigastrum, abdomen, hypochondria, and/or heart due to qi and blood stasis, and and/or heart due to qi and blood stasis, and stagnation in the viscera and bowels or the channels stagnation in the viscera and bowels or the channels ((jingjing) and network vessels () and network vessels (luoluo). ).

Amenorrhea, dysmenorrhea, or postpartum Amenorrhea, dysmenorrhea, or postpartum abdominal pain due to blood stasis. abdominal pain due to blood stasis.

Rheumatic complaints due to wind damp causing qi Rheumatic complaints due to wind damp causing qi and blood stagnation and stasis in the network and blood stagnation and stasis in the network vessels. vessels.

Wounds, scars, and skin inflammation with blood Wounds, scars, and skin inflammation with blood stasis and necrotic tissue. stasis and necrotic tissue.

Traumatic injuries with pain, swelling, and redness Traumatic injuries with pain, swelling, and redness due to qi stagnation and blood stasis.due to qi stagnation and blood stasis.

– MYRRH AND FRANKINCENSEMYRRH AND FRANKINCENSE by Subhuti Dharmananda, Ph.D., by Subhuti Dharmananda, Ph.D., May 2003 @ May 2003 @ http://www.itmonline.org/arts/myrrh.htmhttp://www.itmonline.org/arts/myrrh.htm




Folk Medicine(Ignatavicius, 6th ed., page 32-33)

Learned from experience Passed from generation to generation Preservation of heritage/ culture Some have been scientifically proven

(ex. Garlic) Plants/herbs Hot/cold “Evil Eye” (Mal de Ojo)Course outcome #2, 3 & Course outcome #2, 3 & 44Unit outcomes #1-5Unit outcomes #1-5




Folk Medicine

Own terminology: (Feel free to ask the meaning)– “high blood” “low blood” “thin blood”– “Thick blood” conjure water– “fall out” gimpy dropsy– risin’ sugar cut pain– Weeded breasts– “snuffing the mother”– “the itch”

– Cavendar, 2003





What is Quackery?What is Quackery?

A pretenderA pretender Questionable products & servicesQuestionable products & services Overpromotion vs fraudOverpromotion vs fraud MisinformationMisinformation Useful for some purposes, not othersUseful for some purposes, not others



How to spot QuackeryHow to spot Quackery Tell only part of the storyTell only part of the story Overpromotes nutritional insuranceOverpromotes nutritional insurance Play on fears about chemicalsPlay on fears about chemicals ‘‘EveryoneEveryone needs supplements’ needs supplements’ Promise quick, dramatic, miraculous resultsPromise quick, dramatic, miraculous results Anecdotes & testimonialsAnecdotes & testimonials Questionable credentialsQuestionable credentials Claim persecutionClaim persecution Promote distrustPromote distrust Take claims directly to the media, not Take claims directly to the media, not

peerspeers Resist peer reviewResist peer review



Nurses Educate the Public

Teach signals of fraudulent practice Avoid ‘healers’ who:

– Promise immediate relief or success– State that their way is the only sure therapy– Refuse to work with other health care

providers– Claim to have all the answers– Use testimonials that claim amazing results


One Minute PaperOne Minute PaperNowNow is the time to write is the time to write short short

answers answers to:to:1.1.What is something you heard today What is something you heard today

that is that is newnew to you? to you?2.2.How do you plan to How do you plan to approachapproach your your

clients about CAM?clients about CAM?3.3.List one thing that List one thing that surprisedsurprised you. you.4.4.List one thing that List one thing that reinforcedreinforced

something you already believed.something you already believed.




ReferencesReferences Cavender, A.(2003) Cavender, A.(2003) Folk Medicine in Southern Folk Medicine in Southern

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