Definitions

1
Definitions Trends in Complementary
TherapeuticsUsing Research Findings

• NRSG 809
• MODULE 7

2
Contemporary Biomedicine

• 200 years old
• Based on scientific ways of knowing

3
Scientific Way of Knowing

• Objectivism
• Observer separate from observed
• Reductionism
• Complex explained by simpler parts
• Positivism
• Info from physically measurable data
• Determinism
• Predict from knowledge of science baseline
  conditions

4
Views about Health

• Cure
• Focus on diagnosis, fighting disease
• Body passive recipient of treatments
• Uses drugs, surgery
• Caring as means to an end

• Heal
• Focus on meaning, restoring harmony
• Body capable of self-healing
• Uses diet, stress management
• Caring as end in itself

5
Healing the Body

• The body heals itself
• The body has its own energy
• The body is uniquely individual

Holism in nursing practice
Complementary systems therapies
Allopathic medicine
6
Whats in a word?

• Alternative
• Complementary
• Integrative
• Enlightened
• CAM - CAT
• Schroeder Likkel (1999) Public Health Nursing,
  16
• Refers to hundreds of therapies, perhaps most
  useful in health promotion, disease prevention,
  chronic illness

7
Common Characteristics of CAM

• Emphasis on individuality whole systems
• Wellness orientation
• Reliance on self-healing
• Bioenergetic mechanisms involved
• Use of nutrition natural products
• Represents primary care strategies for 80 of
  world population (WHO, 1998)

8
Therapies used in NursingSnyder Lindquist
(2001) Online Jnl of Issues in Nsg, 6

• Active listening
• Animal-assisted therapy
• Aromatherapy
• Healing touch
• Humor
• Imagery
• Journaling

• Massage
• Meditation
• Music therapy
• Prayer
• Presence
• Progressive muscle relaxation
• Therapeutic touch

9
Popularity of CAM, CAT

• Use of CAT increasing
• 34 Americans used some therapy in 1990
• to 42 in 1997 spent 27 billion
• Herbal medicine, massage, megavitamins, self-help
  groups, folk remedies, energy healing
• Used for chronic conditions back pain, HA
• Eisenberg et al., JAMA, 280(18), 1569-75
• Use CAM, CAT because it mirrors own values
  beliefs about health not due to dissatisfaction
  with conventional
• Astin JAMA, 270(19)

10
Competing Paradigms?

• Biomedical Approach
• Oriented to disease
• Separate mind (psych) body (physical) systems
  for treatment
• Double-blind studies imply single causality
• Paternalism

• CAM Approach
• Oriented to whole person, restoration of balance
• Integration of mind body
• Multi-causality, non-linearity
• Partnership with patient

11
Questions for Researchers and Practitioners

• How do CAM practices work?
• Do CAM practices
• Lead to positive clinical outcomes?
• Improve quality of life?
• Provide safe, effective treatment?

12
National Center for Complementary and Alternative
Medicine (NCCAM) http//nccam.nih.gov/

• supports research on CAM practices products
• provides public with reliable info re safety
  effectiveness of CAM therapies
• Funding from 2 million (1993) to 68.7
  million (2000)

13
Domains of CAM Practices, NCCAM

• Alternative medical systems
• Mind-body interventions
• Biologically-based treatments
• Manipulative body-based methods
• Energy therapies

14
1. Alternative Medical Systems complete systems
of theory practice independent of conventional
Western biomedical approach

• Traditional Chinese medicine proper flow
  balance of qi (vital energy) uses massage,
  acupuncture, herbal medicine
• Ayurveda (India) equal emphasis on body, mind,
  spirit to restore innate harmony uses diet,
  exercise, meditation, herbs, massage
• Homeopathy like cures like, i.e., substance
  in large dose causes symptoms (attempt to cure
  self) substance in tiny dose will cure illness
  uses plant extracts minerals

15
2. Mind-Body Interventions help mind to affect
body function symptoms

• Meditation
• Hypnosis
• Dance
• Music
• Art therapy
• Prayer
• Patient education now well documented

16
3. Biological-based Therapies natural
interventions and products

• Herbal therapies
• Diet therapies
• Mega-dose vitamins
• Aromatherapy
• Others shark cartilage, bee pollen

17
4. Manipulative Body-based Methods movement of
the body

• Chiropractic spinal structure function
• Massage therapy manipulate soft tissues

18
5. Energy Therapies energy within body or from
other sources

• Therapeutic touch healing force of therapist
  affects patients recovery, healing promoted
  through balance of bodys energies
• Qi Gong movement, meditation, and regulation of
  breathing used to enhance flow of vital energy
  (qi), improve circulation, improve immune
  function
• Electromagnetic therapies EM fields used to
  treat asthma, cancer, manage pain

19
Systems of Healing (Micozzi, 2001)

• Homeostatic to support homeostasis
• Environment, diet, physical circumstances
  supporting normal function of body mind
• Treatment to restore function
• Diagnosis therapy after breakdown in
  homeostatic system
• Mind-body to expand personal resources
• Persons attitudes lifestyle r/t health (PNI)
• Spiritual to attain wholeness balance
• Meaning and purpose in life
• Health as a lifetime journey or process, optimal
  development not just a goal to achieve

20
Integrated Model of Healing Systems (Micozzi,
2001)
21
Advantages of an Integrated System

• Eliminates either/or distinction between
  conventional complementary
• More functional way of categorizing therapeutic
  practices
• Inclusive, not exclusive
• Systems approach could be used in initial triage
• MI involves all systems, a cold wouldnt
• Spiritual system not a focus for very young

22
Using Research Findings

• if nurses advise about CT, they should also be
  aware of the evidence for the effectiveness of
  the treatment
• Richardson (2000) Jnl Adv Nsg, 32, 399
• What matters is whether a treatment does more
  good than harm, and not how it happens to be
  categorized.
• Vickers (2000) BMJ, 321, 683-86

23
Quantitative Research

• Systematic, formal process
• Describe phenomena
• Relationships between phenomena
• Cause effect relationships between variables
• Use numerical indicators

24
CT Rating ScaleBennett Lengacher, IN State Univ

• Use Intent Subscale (5 pt scale, 14 items)
• currently doing -- definitely wouldnt try
• Attend exercise group
• Use of humor
• Hypnosis
• Massage
• Effectiveness Rating Subscale (4pt, 14 items)
• Very helpful -- not helpful

25
Randomized Clinical Trials Application of an
experimental design

• Test clinical treatment or intervention
• Random assignment of subjects to experimental
  control conditions
• Often use double blinding
• neither researchers nor subjects know who is in E
  C groups
• limits influence of beliefs, expectations
• Collect outcome data
• Often large sample size, diverse sites

26
Using RCTs for CT research

• Clinical vs statistical significance?
• Use of active placebos in CT research?

27
Placebos

• Healing capacity
• Communication link between mind and body
• Positive emotions and attitudes
• Art and science of healing

28
Questions to Ask

• Is there a control or comparison group?
• Was there random assignment?
• Are the measures of change reliable valid?
• Are appropriate statistics used?
• Are limitations identified?
• Any ethical principles violated?

29
Where to look in research article

• Abstract
• Introduction background purpose
• Methods how study conducted
• Results to whom results apply
• Discussion conclusions r/t purpose, data
• References

30
Qualitative Research

• Describe human experiences
• Context meaning
• Promotes understanding of the whole

31
Valuing Both Approaches
QuantitativeMethods
QualitativeMethods

• Need for multiple approaches in holistic research

More Complete Representation
32
Research findings decision making Albers (2001)
Jnl of Midwifery Womens Health, 46

• Evidence-based care (use of research findings) as
  a paradigm shift from personal experience, expert
  opinion, tradition
• Need to consider
• Study sample
• Study design appropriate for question
• Quantity quality of available information
• Clinical relevance of findings

33
NIH Technology Assessment Panel

• Chronic Pain
• Use of relaxation, meditation, hypnosis
  beneficial in treatment
• Insomnia
• Use of meditation, progressive muscle relaxation
  beneficial in treatment
• JAMA (1996), 276, 313-318

34
Outcome Criteria in CAM Eval

• Energy activity levels
• Functional abilities
• Ability to work, employment
• Sleep eating behaviors
• Disease symptoms
• Health status

• Satisfaction with health or life
• Sexuality
• Psychological effect (self-esteem, stress,
  anxiety)
• Happiness, well-being
• Economics (cost-effectiveness)

35
Research Needs

• Appropriateness of CAT in different populations
  or settings
• What conditions, for which therapies, for which
  patients what problems
• Outcome studies for usefulness, effectiveness,
  indications, contraindications, dangers
• Issues related to dosing

36
Cochrane Library

• http//www.update-software.com/ cochrane
• network of persons and institutions who prepare,
  maintain, disseminate systematic reviews of
  health related research

37
Creating Healing Environments

• Heal making whole, restoring balance harmony
• Nursing uses hand, heart mind to provide
  holistic care
• Empower others through knowledge, skills, support
  
• Use balance between technology compassion
• Fontaine (2000) Healing Practices