integrative care/ Complementary alternative medicine (CAM)

________- non mainstream care in conjunction with standard medical care

• not replacing medical care, using it with it

complementary care

_________- non mainstream care instead of standard medical care

alternative care

_________- nonmainstream care in coordinated conjunction with standard medical care

integrative care

explain conventional health care

• focuses on what is done to the patient

• health = the absence of disease

explain integrative practice:

• focuses on what is done with the patient

• places patient at center of their care

• health= strong interrelation b/t physical , environmental, mental, emotional, spiritual, and social

• holistic (mind, body, spirit)

• focuses on prevention, wellness, & body mind interaction

• may use along with conventional medical therapies or treatments

what are some factors influencing the use of CAM

• 1 or more neurophsychiatric symptoms

• recommended by their provider

• ineffective conventional tx, rushed office visits, dissatisfaction w conventional medicine

• cost of conventional tx

• non-symptomatic, general wellness/ prevention usage

• recommended by friends/ family

• use for improvement of energy or immune fx

dont suggest CAM therapies if it will…

interfere w their meds

list some CAM/ integrative therapies

Natural Products/dietary supplements

Deep breathing

Meditation & Mindfulness

Yoga

Chiropractic care

Massage

Guided imagery

Special Diets

Homeopathy/Naturopathy

Progressive relaxation

Exercise

Biofeedback

Reflexology

Poetry

Aromatherapy

Acupuncture

Prayer & Spirituality

Mega vitamin therapy

Reiki, Energy therapies

Bright-light therapy

Expressive therapy

Therapeutic/healing touch

nurses need basic knowledge of treatments used so they can…

• provide safe and effective care for patients who use a variety of unconventional modalities to meet health needs

• fully understand the health needs of patients and ask questions about use of CAM as part of a holistic assessment

AHNA states that holistic nursing is…

all nursing that has healing the whole person as its goal

holism involves:

• identifying interrelationships b/t bio-psycho-social-spiritual dimensions of the person

• recognizing that the whole of the person is greater than the sum of its parts

• understanding the person as a unitary whole in a mutual process w the environment

for a holistic assessment, ask open ended questions on…

• pt view of their experience and concerns

• nutrition, exercise, relationships, work, cultural, religiou, and spiritual concerns, use of herbals

• integrative modalities: relaxation techniques, guided imagery, therapeutic touch, pt education

credentials to have in integrative care

Doctor of nursing practice (DNP) programs with an emphasis in

integrative health

Holistic nurse–board certified (HN-BC)

Holistic nurse baccalaureate–board certified (HNB-BC)

Advanced holistic nurse–board certified (AHN-BC)

Advanced practice holistic nurse–board certified (APHN-BC)

list some dietary supplements that can be used in CAM

• fish oil

• omega 3 fatty acids

• glucosamine

• melatonin

• pro/prebiotics/ microbiomes

• CoQ10

• vit D

• st johns wort

• echinacea

• cranberry

• garlic pills

• ginseg

• ginko biloba

• valerian

• chamomile

• lavendar

do dietary supplements have a regulation

no, no regulatory board, not monitored by FDA

with natural products, contamination and fillers ____________

dilute the effectiveness

some herbs can interact w ______

prescription meds

________________ can all interact w anticoagulants

ginko, ginseg, st johns wort, and vitamin E

______ can be hepatotoxic

kava

_________- can result in serotonin syndrome when combined w antidepressants, triptans, and methadone

• can induce metabolism of oral contraceptives and HIV meds, can worsen mania/ schizophrenia

st johns wort

st johns wort used for

depression

kava is used for

insomnia, fatigue, anxiety

golden root used for

anxiety, fatigue, depression

valerian root used for

anxiety and insomnia

chamomile used for

sleepiness and anxiety

lavender used for

anxiety, restlessness, insomnia, depression

melatonin used for

insomnia

SAMe used for

depression

fish oil/ omega 3 fatty acids used for

depression, bipolar, schizophrenia

psychiatric disorders frequently have _______ disorders and vise versa

nutritional

what 2 nutritional disorders highly coexist in ppl with psychiatric disorders

obesity and DM

________ is a nutritional disorder commonly accompanied by depression

anemia

which vitamins play a role in schizophrenia

vit C, E, and omega 3

diets high in. ___________ are associated w decreased left hippocampal volume which is associated w depression

saturated fats, refined carbs, and sugar

higher depressive symptoms are noted in men who eat __________________

a standard western diet, plenty snacking, large amt of food high in fat and sweets

higher probability of depression in women who engage in greater amts of snacking and have larger consumption of foods _________

low in fat

reduced risk of depression found in ppl who eat…

regular meals consisting of more fish, fruit, veggies, and omega 3 fatty acids

_________may increase unhealthy nutrition and cravings associated w emotional eating

stress

________ – nutritional therapy that involves taking large amounts of vitamins, minerals, and amino acids

•Plenty potential for side effects 

•Megavitamin Therapy

______________ – supplements improves Depression, fat-soluble, too much can be toxic ( malaise, fatigue, decreased appetite, increased thirst, constipation or diarrhea, bone pain, confusion) 

•Vitamin D

omega 3 fatty acids improve ________ and. ________

depression and bipolar

microbiomes improve ____________

depression and anxiety

________ are considered mainstream and is now the main domain in most mental health settings and tx approaches

mind-body approaches

what are some mind-body approaches

• relaxation techniques

• meditation/ mindfullness

• yoga (increases GABA)

• exercise

• guided imagery

• acupuncture (dry needling)

• spinal manipulation

• support groups

• massage therapy/ cupping

• cognitive behavioral therapy

explain what exercise does to the body

•Alters the dopamine, serotonin and NE levels, increases cerebral

blood flow, reduces oxidative stress levels, improves hippocampal

function and turns on pathways in the brain responsible for

cognitive function and behavior

•Effective in treating Substance Abuse Disorders (gives dopamine)

•Improves positive and negative symptoms in schizophrenia

•Reduces symptoms of ADHD in children

•Decreases anxiety

explain aromatherapy

•Use of essential oils for enhancing mental well-being and healing

•Derived from herbs and plants, may be applied topically, inhaled

or diffused into the atmosphere using a diffuser

•The sense of smell connects with the part of the brain that

controls the autonomic nervous system

•Results can be calming, pain-reducing, stimulating, sedating,

euphoria producing, memory improving, wound healing

roman chamomile:

anxiety/stress

clary sage:

relaxation, anxiety/ stress

ginger:

emotionally and physically warming

lavendar:

calming, decreases anxiety

lemon:

antistress

mandarin:

calming

neroli:

anxiety/ depression, PPD

patchouli:

depression

rose:

anxiety/ stress

vetiver:

calming

ylang ylang:

depression

other integrative therapies used in mental health

• music/ art- expressive therapies

• energy therapies

• therapeutic touch

• healing touch

• reiki (spiritual healing, increased use in cancer support groups)

• bright light therapy (SAD)

• prayer/ spirituality

CAM therapies used for anxiety:

exercise, yoga, acupuncture, homeopathy, Reiki, music, mindfulness-based stress reduction 

CAM therapies used for MDD:

exercise, nutrition, chiropractic, bright light therapy, music, Reiki, religious/spiritual, healing touch, massage 

CAM therapies used for PTSD

guided imagery, yoga, acupuncture 

CAM therapies used for substance abuse disorder

exercise, mindfulness, yoga 

CAM therapies used for bipolar disorder

exercise, mindfulness/meditation, yoga 

CAM therapies used for schizophrenia/psychosis

exercise, yoga, acupuncture 

issues with CAM:

•Controversial, complex and challenging – CBD oils

•Patients using CAM therapies not informing their

conventional health care providers

•Insurance coverage varies amongst the modalities

•Natural DOES NOT mean SAFE!

•Issues of safety and effectiveness

 Drug interactions

 No regulations with herbals

 Delay in seeking medical attention

 Health risk-benefit ratios

•“Natural” - suggests that alternative medicines are harmless,

present in nature

•Examples of unsafe natural substances– __________________

•Herbs and other food supplements do not have to undergo the

same safety review as OTC and RX meds

•Cannot be sure that the amount of the herb and active

ingredients on the label is the actual amount

▪NOT REGULATED BY FDA

arsenic, cocaine,

mercury, botulinum, plants, asbestos, mushrooms

nurses role in CAM and integrative medicine

•Collecting good assessment data about the integrative therapies that

patients are using

•Helping patients evaluate the quality of information available about CAM

therapies

•Nutritional states can cause psychiatric disturbances

•Assess for use of vitamins, protein supplements, herbal preparations,

enzymes, hormones that are considered dietary supplements

•Ask the patients about what types of activities or remedies they use when

they don’t feel well or to get better and stay healthy – ASSESSMENT

nursing implications regarding CAM/ integrative therapy:

•Most CAM can be suggested and implemented by nurses but

not without sufficient knowledge

•CAM can empower patients

•CAM can be used in conjunction with traditional medicine

•CAM is not appropriate for all patients

•CAM is gaining greater popularity and is widely used and

accepted in the psychiatric mental health setting