Integrative Therapies In Conjunction With The Conventional Therapies

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Integrative Therapies In Conjunction With The Conventional Therapies

 As a PMH-APRN, you may have clients who use integrative therapies in conjunction with the conventional therapies prescribed by the health care provider. Identify issues that are important to assess, and discuss how you would ask about the use of these non-conventional practices.

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Instructions:

Use an APA 7 style and a minimum of 200 words. Provide support from a minimum of at least three (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 years), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. Include the Doi or URL link.

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• Textbooks are not considered scholarly sources. 

• Wikipedia, Wikis, .com website or blogs should not be used

Complementary and Alternative Medicine (CAM) in Psychiatry

The revolution and re-conceptualization of health and healing that has occurred in the Western health care system in the last 20 years has given opportunity for a paradigmatic shift in health care education, research, and practice. More than one hundred years ago, the American health care system was dominated by the biomedical worldview. Today, this is no longer true. Support for complementary and alternative medicine (CAM), also called natural, alternative, and complementary (NAC) therapies, and holistic practices, has never been greater than at the present time.

CAM is a form of integrative care. Integrative care places the client at the center of care, focuses on prevention and wellness, and attends to the client’s physical, mental, and spiritual needs (Institute of Medicine [IOM], 2009). Integrative care is directed at healing and considers the whole person (mind, body, and spirit), along with the lifestyle of the person. Holism is described as involving (l) the identification of the interrelationships of the bio-psychosocial-spiritual dimensions of the person, recognizing that the whole is greater than the sum of its parts, and (2) understanding of the individual as a unitary whole in mutual process with the environment (American Holistic Nurses Association [AHNA], 2004). Because of growing interest in and use of holism and CAM in the United States, the National Institutes of Health (NIH) established the National Center for Complementary and Alternative Medicine (NCCAM) in 1998. The NCCAM supports fair and scientific evaluation of integrative therapies and dissemination of information that allows health care providers to make good choices regarding the safety and appropriateness of CAM. The holistic natural, alternative, and complementary (NAC) therapies that are commonly used today in the United States include: Integrative Therapies In Conjunction With The Conventional Therapies

  • Acupuncture
  • Ayurveda
  • Biofeedback
  • Chiropractic manipulation
  • Diet-based therapies
  • Deep-breathing exercises
  • Energy healing therapy/Reiki
  • Exercise therapy
  • Guided imagery
  • Hypnosis
  • Massage
  • Meditation
  • Herbal therapy
  • Aromatherapy
  • Reflexology
  • Yoga
  • Prayer and spiritual practices

Although research on the efficacy of CAM is increasing, studies in the field are minimal when compared to those of conventional medicine. According to Zahourek (2005), several reasons for CAM research challenges include:

  • The relatively recent use of some of these therapies in the United States
  • Individual, cultural, and environmental variables
  • Lack of or limited funding sources
  • Time as a variable to measure change
  • Interpretation and meaning of an experience
  • Impact of other intervening life experiences
  • Effect and timing of a specific intervention or approach on a particular problem, specifically placebo and experimental effects
  • Personality, belief systems, spiritual practices, and temperament of both the researcher and participants
  • Difficulty trying to standardize modalities, variations in methods, approach and skill of the researcher
  • Influence of studying a phenomenon or person within a naturalistic setting
  • Interpretation of results
  • The recognized value of both qualitative and quantitative results
  • Acknowledging the importance of the re he relationship between the healer and the one being healed

If a pharmaceutical company studies and patents a drug, it can reap considerable financial return; however, an herb cannot be patented and exclusively marketed, so there is little incentive to invest in researching its uses and effects. Governmental sources of funding such as the NCCAM and NIH, as well as nonprofit groups, are continuing to sponsor research that should contribute to further understanding of CAM. Nursing groups such as Healing Touch International and the American Holistic Nurses Association (AHNA) are emphasizing research and are beginning to catalogue research on their websites Integrative Therapies In Conjunction With The Conventional Therapies.

Consumers and Integrative Care

Consumers are attracted to integrative care for a variety of reasons, including:

  • A desire to be an active participant in one’s health care and engage in holistic practices that can promote health and healing
  • A desire to find therapeutic approaches that seem to carry lower risks than medications
  • A desire to find less expensive alternatives to high-cost conventional care
  • Positive experiences with holistic, integrative CAM practitioners, who tend to spend more time with and learn about their clients as a whole
  • Dissatisfaction with the practice style of conventional medicine (e.g., rushed office visits, short hospital stays)
  • A need to find modalities and remedies that provide comfort for chronic conditions for which no conventional medical cure exists, such as anxiety, chronic pain, and depression

The knowledgeable consumer, relying on health information available through public libraries, popular bookstores, and the Internet, may question conventional health care. It is essential that PMH-APRNs maintain up-to-date knowledge of these modalities, continue to evaluate the evidence supporting the effectiveness and safety of CAM, and be able to guide patients in their safe use of these treatments.

Safety and Efficacy – People who use CAM therapies often do so withoutinforming their conventional health care providers, which poses some risk. In the United States, there are no standards or regulations that guarantee the safety or efficacy of herbal products. Herbs and other food supplements do not have to undergo the same safety review as over-the-counter and prescription medications. Some consumers may believe that if they purchase a natural substance at a health food store, it must be safe and effective; however, “natural” does not mean “harmless.” Herbal products and supplements may contain powerful active ingredients that can cause damage if taken inappropriately. Furthermore, the consumer cannot be sure that the amount of the herb or other active ingredient listed on the label is actually the amount in the product.

Consumers may waste a great deal of money and risk their health on unproven, fraudulently marketed, useless, or harmful products and treatments. Another concern regarding CAM therapies is that diagnosis and treatment may be delayed while clients try alternative interventions, which is common with mental health symptoms such as major depression and anxiety.

The US Food and Drug Administration (FDA; 2009) offers seven warning signs of fraud:

  1. The product is advertised as a quick and effective cure-all for a wide range of ailments.
  2. The promoters use words like “scientific breakthrough, miraculous cure, exclusive product, secret ingredient, or ancient remedy.”
  3. The text is written using impressive terminology to disguise lack of good science.
  4. The promoter claims the government, the medical profession, or research scientists have conspired to suppress the product.
  5. The advertisement includes undocumented case histories claiming amazing results.
  6. The product is advertised as available from only one source, and payment is required in advance. ·
  7. The promoter promises a “no-risk, money-back guarantee.”

Cost – The growth in the use of CAM therapies is also linked to the rising cost of conventional medical care. There is mounting pressure to control health care spending in the United States and many other countries, and efforts are focused on the development of less expensive treatments. Before we can adopt alternative methods of treatment, however, even those that are less expensive, it is essential that we have reliable information about the clinical effectiveness of these treatment methods. Research on herbs such as St. John’s wort, valerian, and ginkgo biloba and mind-body interventions such as yoga and meditation is extensive, and results are available on the NCCAM website. These supplements and approaches may prove effective and less costly than prescription drugs that produce similar results; however, it is imperative that data be available to identify the desired and adverse effects of these treatments.

Reimbursement – Payment for CAM services comes from a wide array of sources, although third-party coverage is still the exception rather than the rule. Research in the 1990s revealed that more money was being spent out of pocket on CAM than on primary care visits (Eisenberg, 1993), and out-of-pocket payments remain the principal source of spending on CAM. Some health insurance companies include coverage for certain modalities, particularly chiropractic medicine, nutritional care, massage, mind-body approaches, and acupuncture (Dumoff, 2004). The covered benefits are quite narrowly defined, however. For instance, acupuncture can be used in some plans only as an alternative to anesthesia Integrative Therapies In Conjunction With The Conventional Therapies.