Understanding Complementary and Alternative Modalities in Nursing

Copyright ©2023 F.A. Davis Company Learning Outcomes  Explain the difference between complementary and alternative modalities.  Describe systems of health care that have contributed to the development of new modalities.  Identify how selected modalities are classified.

Copyright ©2023 F.A. Davis Company Learning Outcomes (continued)  Identify safety issues associated with complementary and alternative modalities.  Describe the role of the licensed practical nurse/licensed vocational nurse (LPN/LVN) in assisting a patient with complementary and alternative modalities.

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Copyright ©2023 F.A. Davis Company Complementary vs. Alternative Modalities  Complementary modality: Therapy used in addition to a conventional modality • For example: Using guided imagery or relaxation techniques for pain control in addition to prescribed drug therapy  Alternative modality: Therapy used instead of a conventional modality • For example: Using acupuncture instead of analgesics for pain  It is essential to ask your patients about CAM use so you can incorporate these modalities when appropriate and safe to do so

Copyright ©2023 F.A. Davis Company Systems of Health Care  Allopathic/Western medicine  Ayurvedic medicine  Traditional Chinese medicine • Acupuncture, acupressure, herbs, massage, qi gong  Chiropractic medicine • Neuromuscular-adjustment & manipulation of vertebrae and limbs  Homeopathic medicine  Naturopathic medicine  American Indian medicine  Osteopathic medicine

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Copyright ©2023 F.A. Davis Company Complementary and Alternative Modalities  Biologically based modalities • Herbal medicine, nutritional supplements, cannabidiol  Mind–body modalities • Guided imagery, hypnosis, meditation, prayer, yoga  Energetic modalities • Biofeedback, Reiki, spiritual healing, therapeutic touch

Copyright ©2023 F.A. Davis Company Examples of Herbal Therapy  Aloe vera  Bee pollen  Black cohosh  Capsaicin  Chamomile  Echinacea  Ephedra  Feverfew  Garlic  Ginger  Ginkgo biloba  Ginseng  Kava  Red yeast rice  Saint John’s wort This Photo by Unknown Author is licensed under CC BY

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Copyright ©2023 F.A. Davis Company Herbal Agents Warning  Have many side effects  May interact with many prescribed and over- the-counter agents  Advise patients to consult with health-care providers (HCPs) before self-prescribing.

Copyright ©2023 F.A. Davis Company Activity: Cue Recognition 5.1 Mrs. Bird is a 76-year-old home care patient on warfarin (Coumadin). Her PT/INR levels have always been stable until recently. You know that she has been interested in herbal remedies. What action do you take?

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Copyright ©2023 F.A. Davis Company Cue Recognition 5.1: Answer Rationale  Mrs. Bird may be taking an herb such as ginkgo biloba.  The risk of bleeding may be increased when ginkgo biloba is taken with nonsteroidal anti- inflammatory drugs (NSAIDs) and anticoagulants such as warfarin.

Copyright ©2023 F.A. Davis Company Herbs and Their Uses  Echinacea – reduce chance of getting a cold  Ephedra – stimulant, weight loss  Garlic – may reduce blood cholesterol, blood pressure, colon cancer, platelet aggregation & bleeding  Ginger – N&V

Copyright ©2023 F.A. Davis Company Relaxation Therapies  Progressive muscle relaxation  Guided imagery • Alleviate stress, insomnia, blood pressure and immune system  Biofeedback  Massage • Touch to achieve therapeutic results

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Copyright ©2023 F.A. Davis Company Cannabis (Marijuana)  Cannabidiol (CBD)  Tetrahydrocannabinol (THC)  Laws vary significantly among states.  Thought to offer relief from many conditions This Photo by Unknown Author is licensed under CC BY-SA-NC

Copyright ©2023 F.A. Davis Company Other Therapies  Massage therapy  Aquatherapy  Heat and cold application  Animal-assisted therapies  Detoxification This Photo by Unknown Author is licensed under CC BY-NC-ND

Copyright ©2023 F.A. Davis Company Case Study for SBAR Hand-Off Report Your patient, 28-year-old Mr. Hoffman, has been diagnosed with cancer. He is due to be discharged sometime during the next shift. Your patient’s vital signs are stable, but he rates pain as 6/10. He refuses medication to ease the pain. The oncoming nurse needs to manage his pain before his discharge.

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Copyright ©2023 F.A. Davis Company Activity: SBAR Hand-Off Report  You are preparing to give a hand-off report at the end of your shift to the on-coming nurse.  Think about the information you should include in the hand-off report.  Now turn to your neighbor and communicate a hand-off report using SBAR.  Afterwards, review suggested SBAR report on next slide.

Copyright ©2023 F.A. Davis Company SBAR Hand-Off Report: Mr. Hoffman S ituation: 28-year-old patient refusing pain medications will be discharged during your shift B ackground: Patient has cancer diagnosis A ssessment: Pain level 6/10 R ecommendation: Obtain order to provide instruction in in nonpharmacological methods to reduce pain such as guided imagery, heat and cold, massage and/or touch, and progressive relaxation. Provide written instructions.

Copyright ©2023 F.A. Davis Company Role of the LPN/LVN  Teach patients to • Discuss use of complementary or alternative modality with HCP. • Check practitioner credentials. • Visit/evaluate clinic setting. • Talk with other patients. • Consider costs.

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Copyright ©2023 F.A. Davis Company Questions for Patients to Ask  What will this modality do for me?  What are its advantages and disadvantages?  What are its risks and side effects?  How much will it cost? Will my insurance cover the cost?

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Copyright ©2023 F.A. Davis Company Questions for Patients to Ask (continued)  How long will it take? How many treatments will I need?  How will it interact with my other therapies and medications?  What research has been done on this modality?

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Copyright ©2023 F.A. Davis Company Case Study: Willow Willow is a 26-year-old woman with an 11- week-old baby that she birthed at home. She presents to the pediatric office for an initial checkup and vaccinations for her baby. Willow states that she has spoken to a naturopath and was considering using “nosodes” (homeopathic immunization made from diseased human or animal tissue or discharge) to build immunity against standard diseases.

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Copyright ©2023 F.A. Davis Company Case Study: Willow She explains that she read on the internet that allopathic vaccinations may contribute to autism in children and is unsure of which direction to turn. The nurse listens to Willow explain her thoughts on both methods. Then, the nurse suggests that although some naturopathic remedies may be effective, the scientific research doesn’t show that nosodes are an effective substitution for standard immunizations.

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Copyright ©2023 F.A. Davis Company Case Study: Willow She further explains that no evidence supports vaccinations as a cause of autism in children and, in fact, omission or substitution vaccinations have the potential to cause harm to the child. The nurse suggests that Willow speaks to the pediatrician about the use of additional naturopathic therapies to supplement allopathic vaccinations.

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Copyright ©2023 F.A. Davis Company Case Study: Discussion  This is a delicate situation because as a nurse, your focus is health promotion of your patient, but you don’t want to make Willow uncomfortable in expressing her thoughts on alternative therapies.  By presenting the scientific research on nosodes and “typical vaccinations,” the nurse is demonstrating proper use of evidence- based practice in her clinical expertise.

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Copyright ©2023 F.A. Davis Company Case Study: Discussion  Additionally, the suggestion of collaboration with Willow’s naturopath for additional therapies allows Willow to be more comfortable to adopting and understanding the use of traditional vaccinations for her child.

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Copyright ©2023 F.A. Davis Company Review Question #5 Which modalities are manipulative or body- based? Select all that apply. 1. Acupressure 2. Osteopathic manipulation 3. Therapeutic touch 4. Animal-assisted therapies

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Ch05 (5)

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