Complimentary and alternative medicine

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Modalities selected: Relaxation techniques and Guided Imagery/Meditation 

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Music Therapy, Guided Imagery, and Massage Therapy for Stress Reduction

Nancy Nurse, RN

[email protected]

Nursing 382 Holistic Nursing Assessment and Practice

Dr. Laura Schwarz, DNP, RN, CNE

Abstract

Patients of all ages with all kinds of diseases, illnesses, and injuries are affected by stress. Music therapy, guided imagery, and massage therapy were investigated for their effectiveness in stress reduction for nurses and patients. Investigation of the definitions, implementation methods, effectiveness, and benefits of each of these therapies was conducted through personal experiences and a critical review of literature. The types of individuals who would benefit from these therapies were also identified. The personal experiences provided validation of the evidence found in the literature review for the effectiveness of these therapies on stress reduction. Investigation of these therapies also identified other benefits of use. Recommendation for implementation in nursing practice is education for patients and healthcare providers on these therapy methods and their effectiveness on stress reduction.

Objectives, after attending this presentation, the attendee will be able to

1. Define complementary medicine and alternative medicine.

2. Describe definition, methods of implementation, and effectiveness of each CAM modality.

3. Articulate personal and patient benefits of each CAM modality.

CAM Abstract Instructions Virtual Nursing Symposium (VNS)

Abstracts should be 300 words or less, use Times New Roman 12-point font, be double-spaced, and written in

past

tense (see examples in content area of D2L)

Format and content for the abstracts is as follows:

Author and Presentation Information (first page)

· Title of Presentation

· Date

· Name and credentials of author

· Course and faculty

Body of Abstract (second page)

·
Description of the project or study. Include a statement of the problem and the population addressed

·
Method(s) used  (literature review, model/theory, practice change/improvement)

·
Evidence to support project or summary of results

·
Implications for practice and future recommendations.

·
Objectives: list 2-3
measurable learning objectives

for the audience
of your PowerPoint presentation, e.g. “learners will…” or “attendees will…” Please check out this resource for measurable verbs you may use in your objectives (as well as verbs to avoid)
https://www.csun.edu/sites/default/files/Bloom%27s%20verbs%20for%20CT_0.pdf.

Note: some verbs such as “understand” are not measurable.

You will be responsible for posting the PowerPoint presentation and Abstract in the Virtual Nursing Symposium found in the N382 Courseroom in the discussion area
by the due date listed in the course calendar. Ask at least four of your peers a profound question about their chosen CAMs the first day the symposium is scheduled (see calendar). The presenter is responsible for checking into their presentation thread once daily both days of the symposium to answer any questions posted by attendees.

Abstract Rubric

Element

Fully

Addressed

Partially Addressed

Insufficient or Not Addressed

Pts Poss

Pts Earned

· Description of the project or study.

· Includes a statement of the problem and the population addressed (.5 point)

· Discussion of the method(s) used (study method, literature review, model/theory, practice change/improvement) (.5 point)

· Analysis of evidence to support project or summary of results (1 point)

· Discussion of implications for practice and recommendations. (1 point)

· Objectives: lists 2-3
measurable learning objectives
for the audience (1.5 point)

Title page & abstract format according to guidelines,


Proper spelling & grammar


.5

Total Points

5

Symposium Participation (Professor will Grade)

Element

Fully

Addressed

Partially Addressed

Insufficient or Not Addressed

Pts Poss

Pts Earned

· Asks at least four peers a profound question about their chosen CAMs some time during the two days the symposium is scheduled (see calendar).

· Checks Symposium both days & responds to questions asked by others of own presentation

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Total Points

5

Instructions/Rubric for CAM PowerPoint

·
First, complete the Holistic Nursing Module and read chapter 20 in the Blais and Hayes Textbook.

· Then choose

two
Complimentary and/or Alternative Modalities. You will need to “sign up” for these-(see sign up in the content area) so that not everyone does the same thing and we get a variety), first come first served, don’t delay or you may not get your preferred choices.

· Next, experience both of your chosen CAMs, the experiences must be:

· completed during the term, not be experiences you have had in the past

· completed at least a week before the CAM PowerPoint is due (see calendar for due date)

· done for or on yourself and for your benefit-these cannot be modalities you have simply observed on patients or others

· Finally, Create a PowerPoint presentation to address each of the content areas listed in the below rubric. Include
at least
three

peer-reviewed sources of literature
for each modality (see the content area of D2L if you are not sure what constitutes peer-reviewed)

Element

Element

Fully

Addressed

Element Partially Addressed

Element In-sufficiently Addressed

Pts Poss

Pts Earned

· Introductory slide-provides an overview (1 pt)

32

·
Provide a definition and description of each chosen CAM (3 pts)

· Includes at least
three

peer-reviewed
sources for each therapy (6 pts)

· Include
why you chose to experience each particular modality (3 pts)

·
Describe* each of your actual CAM experiences (what did you do/experience for each?)

*Note: provide enough detail that the PPT viewers could
visualize/replicate the experiences

(6 pts)

· Describe what you thought of each of your experiences (positives, negatives, would you experience again? (3 pts)

· Describes what type of patients might benefit by each therapy (use peer reviewed sources to back up) (3 pts)

· Describe
benefits as well as any
limitations to therapies such as: contraindications, risks, adverse/side effects, financial limitations, allergies, time constraints (e.g. heat/ ice should have a time limit), etc. 

· (use peer reviewed sources to back up) (3 pts)

· Describes
how

nurses
might incorporate
each modality into nursing care (3 pts)

· Conclusion reviews major points (1 pts)

Format

· APA including citations and reference list

· Free of spelling, typographical, and grammatical errors.

3

PowerPoint Design

· Professional, attractive, interesting, appropriate font size & amount on slides

· Uses images, photos, diagrams, graphs, etc. to help add interest/explanation *See notes below regarding

5

Total Points

40

*Images you use in your presentation
must be

Creative Commons
(CC)
or Copyright free and
must be

given proper attribution
(citation). Follow these steps to ensure that you have both of these requirements:

1. Find your images at sites that have CC licensing
or are open sources/copyright free:

·

https://search.creativecommons.org/

·

https://support.google.com/websearch/answer/29508?hl=en

·

https://www.flickr.com/creativecommons/

·

https://www.bing.com/discover/creative-commons

2. Provide proper attribution for your images-a must:

·

How to give attribution

·

Best practices for attribution

· If image is not a CC image, must state “courtesy of” and source

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Aromatherapy, Hand Massage, and Guided Meditation for Stress Reduction

Student name, RN

[email protected]

Nursing 382 Holistic Nursing Assessment and Practice

Dr. Laura Schwarz, DNP, RN, CNE, AHN-BC


Abstract

Hospitalized patients along with nurses providing their care are subject to increased stress as a result of managing and treating acute illness. Therefore, aromatherapy, hand massage, and guided meditation therapies were examined for their effectiveness on stress reduction in these individuals. A critical review of literature together with a personal trial of these therapies were used to evaluate their definition, mechanism of action, practice implementation practicality, and effectiveness. Individuals who benefit from receiving these therapies were also recognized. The literature and personal assessment of these therapies provides robust evidence to support the effectiveness and use of these therapies for stress reduction. The type of evidence obtained included qualitative and quantitative research studies. Additional benefits demonstrated by these therapies were also identified. Recommendations for nursing practice implementation include education of therapy methods and effectiveness on stress reduction in combination with nursing practice integration strategies. Patient recommendations include teaching complementary therapy benefits and efficacy to reduce stress through relaxation.

Objectives: After participating in this presentation, the learner will be able to:

1. describe complementary therapy methods, mechanisms of action, effectiveness, and individual benefits.

2. apply complementary alternative modality practice integration strategies to promote stress reduction.

3. educate patients on the benefits and effectiveness of complementary therapy.

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Prayer, Guided Imagery and Music Therapies for Control of Pain or Stress

Peter Nurse, RN

P[email protected]

Minnesota State University, Mankato

NURS382 Holistic Nursing Assessment and Practice

Dr. Laura Schwarz, DNP, RN, CNE

Date

Abstract

Pain and stress are problems that are common among hospitalized patients. These problems are also common among hospital nursing staff. Prayer, guided imagery and music therapies are some complementary and alternative medicine (CAM) therapies that may provide relief from pain and stress. These treatments were studied using literature research and personal implementation to determine their potential efficacy. Numerous peer-reviewed studies were reviewed supporting the use of all these therapies for stress and/or pain management, either alone or as adjuncts. Personal experience also recommends the use of these therapies. These therapies are easily implemented by the nurse and deliver benefit to patients at low cost. These therapies may improve overall patient satisfaction with hospital services.


Objectives, after participating in this session, the learner will be able to

1. Describe selected CAM therapies, indications for use, and potential benefits.

2. Provide patients with practical strategies for implementation of selected CAM therapies for use in the hospital setting.

Complementary Alternative Medicine

Nancy Nurse, RN

Minnesota State University: Mankato

Nursing 382

Holistic Nursing Assessment and Practice

Dr. Laura Schwarz, DNP, RN, CNE, AHN-BC

Month, day, year

Definition of CAM Therapy

No one single definition of CAM (Gadboury, April, & Verhoef, 2012).

Best definition found: A group of therapies, products, or procedures that are present outside conventional medicine.

Used in addition to, not instead of traditional medicine.

China is largest user of CAM, but on the rise in the USA.

Used increasingly by traditional providers and practitioners, including nurses (Li et al., 2011).

CAM Therapies Researched

MASSAGE

YOGA

MEDITATION

Massage Figure 1. Photo of massage. Massage
Envy Spa. www.massageenvy.com.

Definition: Use of hands to touch or rub the skin and muscles of another to create a positive effect.

Technique examples: kneading, skin rolling and gliding.

One of the fastest growing CAM therapies in USA.

Usually not covered by insurance.

(Smith et al., 2010)

Massage

Wellness paradigm: Massage attends to the person’s physical, emotional and psychological needs.

Benefits: lowers muscle tension, lowers blood pressure, improves mood, pain management, improves pain threshold and reduces fatigue.

Contraindications: burns, skin injuries and DVT.

(Smith et al., 2010)

Who benefits from massage?

Patients with neck, back and shoulder problems, muscle pain, fatigue, anxiety and depression, non-ill people looking for wellness, pregnancy and headaches (Smith et al., 2010).

Improves lung function in children with asthma (Abdel Fattah & Hamdy, 2011).

Immediate results with ill hospitalized psychiatric patients. Reduces anxiety and aggression (Garner et al., 2008).

My experience with massage

I used a gift card from my 40th birthday for a massage. It was wonderful! I got the massage with hot rocks (as pictured).

I felt relaxed and refreshed.

I would not have gone without

the gift card, and I am very

thankful. Courtesy of Microsoft Office PPT

The feelings of well being lasted for 2 days. I choose the hot rocks to work on some tense spots in my upper back and it worked.

Massage as a nursing tool

Almost any of our patients could benefit from massage. In most inpatient or nursing home settings, the nurse can give a patient a massage, with their permission. A neck or hand massage would be a great way to reduce anxiety about an upcoming procedure. In the psychiatric setting it could help with the stress of a commitment hearing.

If the nurse is not able to give a massage, a referral to a local massage therapist is ideal.

Yoga Figure 2. Photo of Yoga. Yoga Journal.
http
://
blogs.yogajournal.com/slideshows/better-bone- health

Definition: A practice of physical postures, breathing techniques and mind control.

Mind-body form of CAM.

Encourages proper body alignment and awareness.

Yoga breathing is a stress reliever.

Teaches good posture, (not just on the mat) but all the time.

(Krucoff, 2011)

Yoga

Used by many for overall health and fitness.

Also used as a CAM therapy for specific aliments: physical and emotional.

In USA, usually taught in a group class

(Kaley-Isley et al., 2010)

Yoga

Dates back 4000 years and has evolved.

Increases flexibility and strength.

Enhances muscle function.

Very few drawbacks, but must be done correctly to avoid injury (Hart, 2008).

“Pay attention to what their own bodies are saying” (Hart, p. 31, 2008).

Who benefits from Yoga?

Patients with anxiety, depression, ADHD, obesity, eating disorders, pain, injury, asthma and irritable bowel syndrome (Kaley-Isley et al., 2010).

Patients with chronic neck and shoulder pain (Krucoff, 2011).

Patients with back pain, arthritis, fatigue, coronary artery disease, hypertension and carpal tunnel syndrome (Hart, 2008).

My experience with Yoga

I have some old Yoga DVDs that I have not used it a while. I pulled them out and did one each day for 4 days. It felt great. My favorite pose is downward facing dog (pictured here).

I could feel it strengthening and

stretching my muscles. I feel that

if I continue with Yoga, it will

lessen my back pain. I also felt

reduced stress those days. Courtesy of Microsoft Office PPT.

Yoga as a nursing tool

Some simple Yoga postures and stretches could be taught to patients by nurses. Yoga videos could be viewed in a patient room or in a general area of the healthcare intuition. With a small investment, Yoga mats could be provided.

If Yoga instruction is not possible, the nurse could make a referral to local Yoga classes.

Meditation Figure 3. Photo of meditation.
www.themeditationcenter.org.

Definition: The act of sitting up, focusing on your breath. When your mind wanders from breath, re-focus on breath and being in the present moment.

Apply techniques to daily life. For example, mindful eating or driving (Brady, O’Connor, Burgermeister, & Hanson, 2012).

Actually increases cerebral blood flow (Moss, Wintering et al., 2012).

Meditation

Practical and low-cost CAM.

Techniques focus on management of attention and emotion.

Spiritual element: improves feelings of well-being and spirituality.

(Moss et al., 2012)

Meditation training

Mindfulness-based Stress Reduction (MBSR)

Training done in various institutions.

Group sessions and discussions.

Guided sitting meditation.

Numerous body postures.

(Olivio et al., 2009)

Who benefits from meditation?

Anyone feeling stressed or emotionally exhausted (Brady et al., 2012).

Patients with anxiety, fatigue, anger, confusion along with memory loss or cognitive problems (Moss et al., 2012).

Patients at risk for coronary artery disease, substance abuse, eating disorders and hostility (Olivio et al., 2009).

My experience with meditation

I am in a book club where 2 of the members meditate on a regular basis. I asked them for guidance. One of the women brought a guided meditation for the whole group to our meeting. We did it together, and I really liked it. I feel that focusing on the present moment lessens the stress of daily life. Meditation brings us to a place of realization that we can handle all that comes along in life. It will also take practice, but it’s worth it.

Meditation as a nursing tool

The first step would be for the nurse to educate about and encourage meditation to their patients. Written information can be distributed or left in common areas. Nurses could also keep a simple meditation card in their pocket to give to interested patients. The nurse can guide patients through a simple meditation of focusing on their breath. If that is not possible, a community referral could be made.

Conclusion

Many CAM therapies are meant to reduce stress and anxiety. This is true for massage, Yoga and meditation. Almost anyone can benefit from all three.

Massage is more expensive and requires another person, but Yoga and meditation can be done low-cost and alone if need be.

There is evidence to back up the many health benefits of these and other CAM therapies.

References

Abdel Fattah, M., & Hamdy, B. (2011). Pulmonary Functions of Children with Asthma Improve Following Massage Therapy. Journal of Alternative & Complementary Medicine, 17(11), 1065-1068. https://doi.org/10.1089/acm.2010.0758

Brady, S., O’Connor, N., Burgermeister, D., & Hanson, P. (2012). The Impact of Mindfulness Meditation in Promoting a Culture of Safety on an Acute Psychiatric Unit. Perspectives In Psychiatric Care, 48(3), 129-137. https://doi.org/10.1111/j.1744-6163.2011.00315.x

Gaboury, I., April, K., & Verhoef, M. (2012). A qualitative study on the term CAM: is there a need to reinvent the wheel? BMC Complementary & Alternative Medicine, 12(1), 131-137. https://doi.org/10.1186/1472-6882-12-131

Garner, B., Phillips, L., Schmidt, H., Markulev, C., O’Connor, J., Wood, S., & McGorry, P. (2008). Pilot study evaluating the effect of massage therapy on stress, anxiety and aggression in a young adult psychiatric inpatient unit. Australian & New Zealand Journal Of Psychiatry, 42(5), 414-422.

Hart, J. (2008). An overview of clinical applications of therapeutic yoga. Alternative & Complementary Therapies, 14(1), 29-32.

References

Kaley-Isley, L., Peterson, J., Fischer, C., & Peterson, E. (2010). Yoga as a complementary therapy for children and adolescents: a guide for clinicians. Psychiatry (1550-5952), 7(8), 20-32.

Krucoff, C. (2011). Yoga for Neck and Shoulder Pain: As a mind-body practice, yoga offers powerful tools for physical and emotional relief. IDEA Fitness Journal, 8(6), 88-90.

Li, X., Tao, K., Zhou, Q., & Ling, C. (2011). Scientific Publications from Mainland China, Taiwan, and Hong Kong in Integrative and Complementary Medicine Journals: A Ten-Year Literature Survey. American Journal Of Chinese Medicine, 39(4), 639-649.

References

Moss, A., Wintering, N., Roggenkamp, H., Khalsa, D., Waldman, M. R., Monti, D., & Newberg, A. B. (2012). Effects of an 8- Week Meditation Program on Mood and Anxiety in Patients with Memory Loss. Journal Of Alternative & Complementary Medicine, 18(1), 48-53. doi:10.1089/acm.2011.0051

Olivo, E., Dodson-Lavelle, B., Wren, A., Fang, Y., & Oz, M. (2009). Feasibility and effectiveness of a brief meditation-based stress management intervention for patients diagnosed with or at risk for coronary heart disease: a pilot study. Psychology, Health & Medicine, 14(5), 513-523. doi:10.1080/13548500902890087

Smith, J., Sullivan, S., & Baxter, G. (2010). Massage therapy: more than a modality. New Zealand Journal Of Physiotherapy, 38(2), 44-51.

Yoga Journal. (2008). Ahimsa. [photograph]. Retrieved from
http://blogs.yogajournal.com/slideshows/better-bone-health on March 2, 2014.

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Complimentary
Alternative
Modalities
Nursing 382
Holistic Nursing Assessment and Practice
Dr. Laura Schwarz, DNP, RN, CNE, AHN-BC
Mavis maveric
Month, Date, Year

A comprehensive approach used to address health care needs to include the physical, emotional, psychological & spiritual aspects of a person (Blais & Hayes, 2011)

Practices or products used in addition to, or

as an alternative to, traditional Western

medicine. Not widely taught in medical schools

or readily available in heath care settings

(Dossey et al., 2015)

Becoming more popular, patients are more

aware

What is cam therapy?

Photo courtesy of Microsoft Office PPT

Biological-Based Therapies – Herbals medicine

– Vitamin supplements

– Whole, organic foods

Manipulative Body Therapies – Cranial-sacral therapy

– Massage therapy

– Osteopathic manipulation – Chiropractic therapy

Energy Therapies – Magnet therapy

– Therapeutic / healing touch

– Reiki

– Qi Gong

Mind-based Therapies – Prayer

– Guided self-healing

– Meditation

– Art, music and dance

(Blais & Hayes, 2011, p. 370)

Examples of CAM

Aromatherapy

Massage Therapy

Yoga / Meditation

Three Therapies experienced

Photo courtesy of Microsoft Office PPT

Photo courtesy of Microsoft Office PPT

Photo courtesy of Microsoft Office PPT

The use of essential oils, derived from plants, thought to work at the psychological, physiological and cellular levels in the body

Stimulants travel through the nose and

nerve impulses, to the limbic system of brain,

evoking an emotional response

May also be absorbed through the skin &

into blood stream through massage oils

bath salts

One of the oldest forms of CAM, dating back 6000 years

(Novey, 2000)

Aromatherapy – What is it?

Photo courtesy of Microsoft Office PPT

WHY:

I chose aromatherapy because we have started to use on my Mother Baby unit (nasal inhalers, oils & bath salts). I wanted to see if it would help me manage my stress, relax & sleep

HOW:

I used a lavender oil inhaler stick every day before bed (for 15 min) & used lavender bath salts 2 times a week for 2 weeks

RESULTS:

My tension, anxiety, stress level decreased & I was able to fall asleep faster. I was able to focus on my breathing, clear my mind and relax.

Aromatherapy – My experience

Patients experiencing pain, stress, anxiety, depression, insomnia, cancer treatment or in critical care

“Patients in the lavender group had less postoperative pain” after cesarean section (Olapour et al., 2013, p. 203)

“Aromatherapy in cancer patients suggests a short-term benefit to reduce anxiety and depression, improve sleep and increase overall wellbeing” (Boehm et al., 2012, p. 508)

Aromatherapy reduced anxiety, improved sleep, and stabilized the blood pressures of patients in the

ICU (Cho et al., 2013)

Aromatherapy – Who would benefit?

Photo courtesy of Microsoft Office PPT

We recently started using aromatherapy on our unit. I will now offer this to every patient by sharing what is available, how it works & how they could benefit. However, I will respect those who chose not to use it

Share research that post-op pain scores decreased for cesarean section patients who used aromatherapy, in addition to standard meds

Communicate how easy, cost effective, and empowering aromatherapy can be for use in the hospital or at home

A significant and increasing number of pregnant women use CAM, as if offers them greater control and choice in their holistic care (Hall et al., 2011)

Aromatherapy – How nurses could incorporate?

A systematic form of touch and pressure that manipulates soft tissues of the body to promote comfort and healing

Stimulates the circulation of blood &

lymph, to help remove metabolic

wastes and promote relaxation

Often used with aromatherapy, oils,

and music

Widely available, many different types,

prices vary

(Novey, 2000)

Massage Therapy – what is it?

Photo courtesy of Microsoft Office PPT

WHY:

I often have tight muscles, especially in my back and hamstrings. With work, exercise and a busy lifestyle, I often feel stressed. My doctor and others have recommended massages to me. I have had had one years ago, but can be expensive.

HOW:

I had a deep tissue (myofascial release) massage. The room was dimly lit, with soft music. I was on a comfortable table, with a sheet covering me, face down in a “donut”. The therapist used oil, heat packs and deep stroking pressure for 60 min.

RESULT:

After my session, my tension, knots, stress and muscle aches were relieved. The area under my eyes were swollen and I was very thirsty. I was told to drink lots of water. I felt absolutely fabulous. I vowed to schedule monthly appointments!

Massage Therapy– My experience

Patients experiencing pain, stress, anxiety, depression, pregnancy or chronic illness

For low back pain, “although traditional therapy showed slightly greater pain relief, the decline in pain using massage therapy was significant” (Melancon & Miller, 2005, p. 120)

“Back massage significantly reduced anxiety” in CHF patients (Chenet al., 2013, p. 464)

Massage therapy with pregnant women lowered anxiety and depression and women were less likely to deliver prematurely (Field et al., 2012)

Positive effects are seen on full term and preterm infants experiencing massage therapy (Abdallah et al., 2013).

Massage Therapy – Would would benefit?

Our hospital has an “Integrative Medicine” group that we can put a “consult” in for them to see our patient. Most patients do not stay long enough to have an IM massage, except for antepartum (bed rest) patients.

Encourage patients to utilize if they

have an extended stay.

Give hand, foot or neck massages

to patients or show their caregiver.

Offer aromatherapy oils to use

Encourage people to use at home, in

addition to traditional medication, heat and ice.

Practice what I preach and make appointments for monthly massages! Already found “Groupons” for cheaper options.

Massage Therapy– How nurses could incorporate?

Photo courtesy of Microsoft Office PPT

Consciously controlling breathing, while moving through a series of postures or asanas (Dossey et al., 2005)

“Control of the body through correct posture and breathing, control of the emotions and mind, and meditation and contemplation” (Novey, 2000, p. 141)

Involves mind, body and spirit in a relaxation response mechanism, by increasing blood flow and oxygen use, while reducing carbon dioxide and

respiration rate (Novey, 2000)

Popular activity, especially

among women

Widely available, prices vary

Various types & levels offered,

something for everyone

Yoga / Meditation – What is it?

Photo courtesy of Microsoft Office PPT

WHY:

I already run and strength train, but have never done yoga consistently or tried different types. My doctor & others have encouraged yoga to increase my flexibility, promote relaxation and manage my stress.

HOW:

Participated in five Bikram and five Hatha yoga sessions since January.

Bikram yoga is done in a 105 deg F room with 40% humidity. The 26 poses were very intense and invigorating. I felt detoxified due to the exorbitant amount of sweating. Sessions are 90 min and I need shower after. I had mild headache after one (perhaps dehydration?).

Hatha yoga was done in a dimly lit room, with soft music. The session was 60 min, with simple poses, done in a relaxing, calming manner. I did at night, then went straight to bed.

RESULT:

I enjoyed both, but liked to alternate depending upon my time & mood. Both offered the opportunity to “stretch, relieve stress, open the lungs, relax the heart, and clear the mind” (Novey, 2000, p. 146).

Yoga – My expereince

Patients experiencing pain, anxiety, stress, pregnancy, cancer treatment or chronic illness. Check with your doctor, as not all yoga is safe for everyone (i.e. Bikram)

Prenatal yoga provided optimism, power and well-being, while helping to relieve musculoskeletal issues during pregnancy (Reis & Alligood, 2014)

Systematic reviews show yoga to be beneficial for reducing fatigue in cancer patients (Sadja & Mills, 2013)

“Eight weeks of Bikram yoga improved mindfulness, perceived stress, cardiorespiratory endurance, flexibility and balance” (Hewlett al., 2011, p. 87)

Regular daily yoga improved sleep and quality of life in the elderly (Bankar et al., 2013)

Yoga – would would benefit?

Encourage patients to do yoga, offer resources, classes in area, as there are many offerings, including at our hospital

Share research that indicates yoga may help patients with relaxation, flexibility and stress relief.

Share my experiences and answer

patient questions (i.e. many post partum

patients ask about mom baby yoga classes)

I will continue to do yoga at least once a

week, and vary the type of yoga, depending

upon my time and mood

Yoga – How nurses could incorporate?

Photo courtesy of Microsoft Office PPT

CAM is becoming more mainstream – patients are more aware and asking about

Nurses need to be educated regarding options, benefits and be able to answer patient questions

Aromatherapy is a safe, effective addition

to traditional medication for pain control,

relaxation and sleep

Massage promotes relaxation, stress

reduction and muscle tension relief

Yoga can help improve meditative breathing,

flexibility and overall well-being.

All are cost effective, empowering and easy to offer patients

conclusion

Photo courtesy of Microsoft Office PPT

Abdallah, B., Badr, L. K., & Hawwari, M. (2013). The efficacy of massage on short and long term outcomes in preterm infants. Infant Behavior and Development, 36(4), 662-669.

Bankar, M., Chaudhari, S., & Chaudhari, K. (2013). Impact of long term Yoga practice on sleep quality and quality of life in the elderly. Journal of Ayurveda and Integrative Medicine, 4(1), 28.

Blais, K., & Hayes, J. S. (2015). Professional nursing practice: concepts and perspectives (7th ed.). Pearson.

Boehm, K., Bussing, A., & Ostermann, T. (2012). Aromatherapy as an Adjuvant Treatment in Cancer Care – A Descriptive Systematic Review. African Journal of Traditional, Complementary and Alternative Medicines, 9(4), 503-518.

References

Chen, W., Liu, G., Yeh, S., Chiang, M., Fu, M., & Hsieh, Y. (2013). Effect of Back Massage Intervention on Anxiety, Comfort, and Physiologic Responses in Patients with Congestive Heart Failure. The Journal of Alternative and Complementary Medicine, 19(5), 464-470.

Cho, M., Min, E. S., Hur, M., & Lee, M. S. (2013). Effects of Aromatherapy on the Anxiety, Vital Signs, and Sleep Quality of Percutaneous Coronary Intervention Patients in Intensive Care Units. Evidence-based Complementary and Alternative Medicine, 2013, 1-6.

Dossey, B. M., Keegan, L., & Guzzetta, C. E. (2005). Holistic nursing a handbook for practice (4th ed.). Jones and Bartlett.

Field, T., Diego, M., Hernandez-Reif, M., Medina, L., Delgado, J., & Hernandez, A. (2012). Yoga and massage therapy reduce prenatal depression and prematurity. Journal of Bodywork and Movement Therapies , 16(2), 204-209.

REFERENCES

Hall, H. G., Griffiths, D. L., & McKenna, L. G. (2011). The use of complementary and alternative medicine by pregnant women: A literature review. Midwifery, 27(6), 817-824.

Hewett, Z. L., Ransdell, L. B., Gao, Y., Petlichkoff, L. M., & Lucas, S. (2011). An Examination of the Effectiveness of an 8-week Bikram Yoga Program on Mindfulness, Perceived Stress, and Physical Fitness. Journal of Exercise Science & Fitness, 9(2), 87-92.

Melancon, B., & Miller, L. H. (2005). Massage Therapy Versus Traditional Therapy for Low Back Pain Relief. Holistic Nursing Practice, 19(3), 116-121.

Novey, D. (2000). Clinician’s complete reference to complementary & alternative medicine. St. Louis: Mosby.

REFERENCES

Olapour, A., Behaeen, K., Akhondzadeh, R., Soltani, F., Razavi, F.A., & Bekhradi, R. (2013). The Effect of Inhalation of Aromatherapy Blend containing Lavender Essential Oil on Cesarean Postoperative Pain. Anesthesiology and Pain Medicine, 3(1), 203-7.

Reis, P. J., & Alligood, M. R. (2014). Prenatal Yoga in Late Pregnancy and Optimism, Power, and Well-Being. Nursing Science Quarterly, 27(1), 30-36.

Sadja, J., & Mills, P. J. (2013). Effects of Yoga Interventions on Fatigue in Cancer Patients and Survivors: A Systematic Review of Randomized Controlled Trials. EXPLORE: The Journal of Science and Healing, 9(4), 232-243.

References

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Complementary Alternative Modalities

Nursing 382 – Holistic Nursing Assessment and Practice

Dr. Laura Schwarz, DNP, RN, CNE, AHN-BC

Student Name

March, 17th 2020

Complementary Alternative Modalities

Complementary Alternative Modalities (CAM) are holistic health promoting therapies used in conjunction with conventional medicine. (National Institutes of Health. 2013).

Conventional medicine consists of traditional, mainstream medical treatment such as surgeries, procedures or medications. (National Institutes of Health. 2013).

Holistic health embraces one’s spiritual, emotional, and psychological well-being.

Image Courtesy of Microsoft Office Clip Art.

Examples of Complementary Alternative Modalities:

Images Courtesy of Microsoft Office Clip Art.

Acupuncture

Guided Meditation

Yoga

Aromatherapy

Healing Touch

Music Therapy

Massage

Vitamins/Herbal Supplements

Holistic Nursing Practice

“Holistic nursing practice takes into account the interconnectedness of body, mind, emotion, spirit, social/cultural, relationship, context, and environment and its impact on health and healing”(Blais & Hayes, 2011, p. 364).

Patient Well-being

Spiritual

Emotional

Cultural

Environmental

Physical

Physiological

Therapies Personally Experienced

Aromatherapy

Hand Massage

Guided Meditation

5

Aromatherapy

Stimulation of the basic sense of smell is used to promote feelings of well-being, relaxation, and connection.

(Liwidjaja-Kuntaraf et al.., 2011)

Figure 1: Photograph of Aromatherapy. Achieving Health.
http://www.achievinghealth.com.au/change-mood-aromatherapy

Mechanisms of Action:

“Aromatherapy is the use of essential oils from plants for healing. In general, it seems to relieve pain, improve mood, and promote a sense of relaxation” (University of Maryland Medical Center, 2013).

“Aromas hit the nose and go directly to the most primitive parts of the brain, effecting our emotions and nervous system before our higher cortex is even aware of them” (Kemper, 2010).

“The scent of essential oils from flowers, herbs, and trees is inhaled to promote a sense of health and well-being” (Liwidjaja-Kuntaraf et al., 2011).

“A systematic review of the use of aromatherapy and massage for symptom relief in patients with cancer revealed some support for the relief of both physical and psychological symptoms” (Williams et al. 2009).

Essential Oils

Can be applied to skin or inhaled by diffuser.

Essential oils that help achieve a state of relaxation include:

Chamomile

Jasmine

Lavender

Rose

(University of Maryland Medical Center, 2013)

Essential Oil Contraindications

Contraindicated for patients with:

Asthma

Heart conditions

Hypertension

Epilepsy

Allergic reactions

Avoid using essential oils on anyone less than 5 years of age.

(University of Maryland Medical Center, 2013)

Why Aromatherapy?

I enjoy the scent of essential oils and feel they are complimentary to other CAM’s.

I have previously taken a day course on massage with essential oils called the Raindrop Technique by Young Living Essential Oils.

I wanted to find out if I could incorporate this therapy into my everyday routine to help balance stress and anxiety for both myself and my patients.

Need to include how/why these were chosen.

10

Aromatherapy Experience

Description

Using Young Living Essential oils nightly for one week, I diffused the scent of lavender to relax and unwind before I went to bed.

I also applied lavender infused lotion to my hands and feet before going to sleep.

Additionally, I included aromatherapy during my hand massage experience.

Thoughts

Many times after a long day of work, I find myself continually thinking about what I need to get done the next day.

After the first night of using aromatherapy, I found that I was able to clear my mind and relax before bed.

I also had an easier time falling asleep without my mind racing about my work.

Describe experience, including what I thought

11

Practice Implementation

Who would Benefit?

Nursing Application Strategies:

Offer lavender essential oil patches to patients who would benefit from this therapy.

Educate patients about the benefits of aromatherapy.

Take breaks in the staff renewal room.

Use the essential oil diffuser to create a sense of relaxation and well-being during my breaks.

What patient’s will benefit?? Use peer reviewed sources to back up information Include how nurses could incorporate this into practice

12

Aromatherapy

Cancer Patients

Dementia Patients

Patients with insomnia

Patients with chronic illness

Nurses

Patients with Anxiety or Depression

Hand Massage

Light pressure on the soft tissues of the hands is used to promote relaxation, along with a sense of well-being and connection. Hand massage can also be used in conjunction with aromatherapy.

Figure 2: Photograph of Hand Massage. Tips for Massage. http://www.tipsformassage.com/hand-and-arm-massage-techniques/

(Liwidjaja-Kuntaraf et al. 2011)

Mechanisms of Action:

“Massage therapy encompasses many techniques, using oil or lotion to reduce friction on the skin while the therapist presses, rubs, and otherwise manipulates the muscles and other soft tissue of the body” (Liwidjaja-Kuntaraf et al. 2011).

Hand Massage helps relieve muscle tension, reduce stress, and evoke feelings of calmness. (University of Maryland Medical Center, 2013)

“Hand massage helped to reduce stress and anxiety in terminally ill patients, based on psychological and endocrinological measurements”(Osaka et al., 2009).

Massage Contraindications Include:

Inflammation

Bruising

Skin conditions

Burns

Cancer

Blood clots

Image Courtesy of Microsoft Office Clip Art.

(University of Maryland Medical Center, 2013)

Why Hand Massage?

Massage is one of the most easily applied CAM therapy for nursing.

To assess a simple massage type’s effectiveness on reducing stress.

I am uncomfortable getting a massage at a spa; with hand massage I could test the benefits of this therapy without feeling self-conscious.

Hand Massage Experience

Description

Through our spiritual care department I trialed hand massage and aromatherapy from the healing services menu.

This menu is offered to patients and staff from 8am to 8pm Monday – Friday.

I made two 15 minute appointments with a therapist to receive hand massage supplemented by aromatherapy.

Thoughts

I was much less apprehensive and self-conscious with hand massage and felt able to relax.

During the massage I felt calm and with less tension.

The addition of the essential oil tangerine helped stimulate my senses and reduce my nervousness.

Describe experience, including what I thought

17

Practice Implementation

Who would Benefit?

Offer hand massage to hospitalized patients in pain or feeling anxious.

Review the benefits of massage with patients and help them develop additional coping skills to decrease stress and anxiety outside of the hospital.

Utilize our healing services menu offered through our spiritual care team.

Nursing Application Strategies:

Hand Massage

Pregnant Women

Patients with Anxiety or Depression

Hospice Patients

Elderly

Patients with Chronic Pain

Nurses

Guided Meditation

Relaxation of the mind and body through focused concentration to promote mental, emotional, and physical healing in addition to stress relief.

Figure 3: Photograph of Meditation. Corporate Wellness Magazine. http://www.corporatewellnessmagazine.com/article-detail.php?issue=issue-15&article=focus-on-fascia-

(University of Maryland Medical Center, 2013)

Mechanisms of Action:

“The goal of mind-body techniques is to get the body and mind to relax and to reduce the levels of stress hormones in the body, so that your immune system is better able to fight off illness”(University of Maryland Medical Center, 2013).

“Meditation is a method of relaxation that has been associated with a number of positive effects and shown to decrease pain and other symptoms such as anxiety and pain” (Williams et al., 2009).

“It is designed to guide patients toward a relaxed state of mind and to promote gentle, hypnotic-like suggestions to bring the resources of the relaxed mind back to daily life” (Toth et al., 2007, p.197).

Why Guided Meditation?

I can remember being a child and my mother using this to help me fall asleep. With her voice she would soothingly stimulate my imagination by saying “pretend that you are on a soft cloud, floating high up in the air”. I remember feeling so comforted, peaceful, and able to relax my mind.

I wanted to try this therapy with the help of a trained coach.

The goals of this trial were to assess it’s effectiveness on stress reduction and the efficacy of using this in nursing practice.

Need to include how/why these were chosen.

21

Guided Meditation Experience

Description:

Every Tuesday and Thursday spiritual services offers guided meditation from 12:00 to 12:15.

I attended both days during one week in our hospital chapel.

During this session, you are guided through your imagination to places of tranquility and relaxation.

Thoughts:

Both times I left feeling relaxed, centered, and less anxious.

I was able to return to work feeling less emotionally fatigued and more mentally focused.

This experience was very helpful to reduce stress through meditation.

Describe experience, including what I thought

22

Practice Implementation

Who would Benefit?

Educate patients on the benefits of guided meditation and services offered while in the hospital.

Utilize guided meditation for patients in pain or having anxiety.

Call a “Code Lavender” for patients or family in emotion or spiritual distress.

Nursing Application Strategies:

Guided Meditation

Nurses

Patients with Anxiety or Depression

Pregnant Women

Patients with Chronic Conditions

Patient with Insomnia

Patients Experiencing Pain

Calling a “Code Lavender”

Courtesy of Park Nicollet Spiritual Care Services, 2013.

Conclusion

CAM therapies are beneficial for both nurses and patients in any stage of health promotion.

Teaching patients about CAM therapy provides additional coping mechanisms to help support primary health promotion.

“With proper advice and an open approach towards its usage, CAM can safely and effectively complement conventional medicine” (Buchan et al. 2012, p.675).

Review’s major points

25

Conclusion

My research findings have shown me that holistic patient care involves treating patients entire state of well-being.

Implementing CAM therapy into nursing practice promotes holistic nursing care.

CAM therapies together with Traditional Medicine form a holistic treatment plan for patients.

Conclusion

I truly enjoyed my experience with these CAM therapies and found that I felt less stress and anxiety.

I plan to incorporate CAM therapies into my current nursing practice by learning more about hand massage techniques and providing patients with the spiritual care healing services menu.

I also plan to make time to utilize our Staff Renewal Rooms and educate other staff members on the benefits to CAM therapy.

In the future, I would personally like to try other CAM therapies such as Yoga or Acupuncture.

References

Blais, K. & Hayes, J.K. (2015). In Pearson (Ed.), Professional nursing practice: Concepts and perspectives (7th Edition ed.). New Jersey: Prentice Hall, Inc.

Blythman, R., & Vialls, K. (2012). Relaxation and conventional medicine go hand-in-hand. Australian Nursing Journal, 19(8), 44-45.

Buchan, S., Shakeel, M., Trinidade, A., Buchan, D., & Ah-See, K. (2012). The use of complementary and alternative medicine by nurses. British Journal of Nursing, 21(11), 672-675.

Corporate Wellness Magazine. (2010). [Photograph of Meditation]. Retrieved from
http
://
www.corporatewellnessmagazine.com/article-detail.php?issue=issue15&article=focus-on- fascia-

Cleveland Clinic. (2014, January). Health Hub. Retrieved from Cleveland Clinic:
http
://
my.clevelandclinic.org/wellness/integrative-medicine

References

Kemper, K. J. (2010). How aromatherapy works. Nutrition Health Review: The Consumer’s Medical Journal, (102), 3-3.

Liwidjaja-Kuntaraf, K., Handysides, A., & Landless, P. (2011). Your guide to complementary alternative medicine. Vibrant Life, 27(5), 30-35.

National Institutes of Health. (2013, May). Retrieved from National Center for Complementary and Alternative Medicines: http://nccam.nih.gov/health/whatiscam

Osaka, I., Kurihara, Y., Tanaka, K., Nishizaki, H., Aoki, S., & Adachi, I. (2009). Endocrinological evaluations of brief hand massages in palliative care. Journal of Alternative & Complementary Medicine, 15(9), 981-985. https://doi.org/10.1089/acm.2008.0241

Schwantes, M. (2011). DETOX your mind. Vibrant Life, 27(5), 16-19.

Toth, M., Wolsko, P. M., Foreman, J., Davis, R. B., Delbanco, T., Phillips, R. S., & Huddleston, P. (2007). A pilot study for a randomized, controlled trial on the effect of guided imagery in hospitalized medical patients. Journal of Alternative & Complementary Medicine, 13(2), 194-197. https://doi.org/10.1089/acm.2006.6117

Williams, A. M., Davies, A., & Griffiths, G. (2009). Facilitating comfort for hospitalized patients using non- pharmacological measures: Preliminary development of clinical practice guidelines. International Journal of Nursing Practice, 15(3), 145-155. https://doi.org/10.1111/j.1440-172X.2009.01739.x

University of Maryland Medical Center. (2013, May). Medical Reference Guide.
http
://
umm.edu/health/medical/altmed/treatment/aromatherapy

University of Maryland Medical Center. (2013, May). Medical Reference Guide.
http://
umm.edu/health/medical/altmed/treatment/mindbody-medicine#ixzz2vntOlNK9

University of Maryland Medical Center. (2013, May). Medical Reference Guide. http://umm.edu/health/medical/altmed/treatment/massage

References

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