While health care providers continue to pursue elusive magic pills to counter diseases and all of their negative effects, many nurses are opting for another approach. This growing group focuses on the body’s own ability to repair itself after injury or surgery, integrating complementary health care practices to support their own human healing capabilities into their overall treatment plan. When people take responsibility for their own participation in the healing process, they feel more in control of their disease outcome. Many hospitals, managed care plans, and conventional practitioners are now incorporating CAM therapies in their practices, and schools of medicine, nursing, and pharmacy are beginning to teach about CAM.¹ Patients report that they feel CAM would improve their health when used in combination with conventional medical treatments; when conventional medicine has no answers, they turn to CAM for new possibilities. As conventional medical practitioners become more comfortable with CAM, they often refer patients to selected CAM providers.²

Common popularity

Total visits to CAM providers each year now exceed those to primary care physicians! The Americans’ Use of Complementary and Alternative Medicine report indicates that 76% of adults have used some form of CAM when prayer, specific for healing, and megavitamin therapy are included as forms. When subsets of CAM domains were broken out, 22% of people felt that biologically based practices were preferred, while 17% preferred mind-body medicine.² The annual out-of-pocket costs for CAM are estimated to exceed $27 billion.¹

Difficulties with supporting research

Despite the popularity of complementary therapies, researchers have difficulty documenting their efficacy because of unique characteristics that do not lend themselves to traditional, Western research. For example, these therapies are not aimed at a single pathologic process; they do not focus on average responses; and they place more emphasis on the individual’s validation of treatment effectiveness.³ Many complementary therapies are tailored to the individual. For instance, there are no standard protocols for many homeopathic, guided imagery, and self-hypnosis treatments. And not many complementary practitioners in the U.S. are well-versed in traditional research methods.¹

Western researchers’ usual methods of validating techniques are biased toward quantifiable, objective measures that overlook the sometimes subtle changes that can only be verified by the subjective response of the benefactors.³ That may be why most funding sources do not support complementary research, which restricts studies to small-scale trials that often lack statistical significance.¹ Entrepreneurial companies that have the resources to study complementary methods also have little incentive for providing funds for studies that will not result in profit-generating products.^3,4

Are you ready?

Because of consumers’ heightened interest in complementary treatments and their widening use, anecdotal efficacy, and growing supportive research evidence, nursing and medical schools across the country now offer complementary health care courses.^1,5 Hospitals are including CAM departments and nurses can expect questions from their patients about these complementary therapies, so they need to be informed and comfortable enough to discuss these unique approaches. In fact, as more complementary practices become integrated with allopathic procedures, nurses must learn to provide effective complementary treatments.^5,6

Complementary therapies to consider

Out of hundreds of complementary therapies, here are 10 practices that with extra study and practice, some nurses have integrated into their practice.

Acupressure, dating back 5,000 years, is based on the concept of chi (sometimes spelled qi), the essential life force. Chi is believed to flow through the body like blood or nerve impulses, circulating through invisible passageways or meridians. According to this theory, when chi is balanced and evenly flowing, health ensues. When chi is stagnant, unbalanced, or overstimulated, illness occurs. Practitioners use finger pressure at points (acupoints) on the skin to access and guide the flow of chi. Once balance is restored by pressing the appropriate point, self-healing capacities are believed to take over.

Four major systems of acupressure — shiatsu, tsubo, jin shin jyutsu, and jin shin do — use different amounts of pressure, lengths of application, and acupoints. Acupressure is used to treat just about everything from allergies, the common cold, and headaches, to sport injuries and toothaches. Acupressure may also hasten recuperation from strokes and surgery. At some hospitals, nurses use elastic acupressure wristbands, specially designed to relieve motion sickness, to quell anesthesia-induced nausea.⁷

Aromatherapy uses essential plant oils to promote well-being. Its use may date back as far as 40,000 BC to the Australian aborigines. By the Middle Ages many people recognized the antiseptic and bactericidal properties of certain oils and alleged their positive effect on the immune system. Today, many household cleaning and disinfecting products use aromatherapy scents, such as pine, citrus, tea tree, or eucalyptus oils. Eucalyptus is also found in medicinal inhalations and liniments, and lavender and tea tree oils are added to antiseptic creams.

Although the exact mechanism of aromatherapy has not been determined, liquid gas chromatograph has identified many of the chemical components of essential oils, including alcohols, esters, ketones, oxides, aldehydes, coumarins, lactones, terpenes, and phenols. Some scientists hypothesize that inhaled essential oil particles are picked up by tiny cilia located at the roof of the nose. A message about the essential oil odor is then transported to the brain where the limbic system translates the communication and influences metabolic, stress, emotional, and hormonal responses.

Aromatic oils are used to treat a variety of physical conditions. Nurses in the United Kingdom and Australia use aromatherapy in a wide variety of treatment settings, and nurses in the U.S. can now take certificate programs in aromatherapy, which have been endorsed by the American Holistic Nurses Association. Chamomile, lavender, marjoram, and ylang ylang are hypnotics used to induce calm and restful sleep. Bergamot, frankincense, sandalwood, rose otto, geranium, orange, or patchouli evoke a calming and sedative effect on the nervous system. Blends of essential oils can create a state of relaxation.

Except for lavender, which doesn’t irritate the skin, essential oils are diluted in a carrier oil. The patient’s verbal and nonverbal response or a patch test may be the best indicators of whether an individual can comfortably use a specific oil or blend. Oils can be inhaled via fragrancers similar to vaporizers or applied topically during massage. In shared hospital rooms, oils for one individual can be placed on a handkerchief, tissue, or pillow, or in a vaporizing disc that is worn as a necklace. In private rooms, a few drops of an oil can be placed in a light bulb ring burner. In pregnancy, many oils are contraindicated due to toxic risk, and pregnant clients should be referred to a certified aromatherapist.⁸

Feng Shui (pronounced fung shway), a Chinese term that means “wind and water,” is the art of placement. Objects are positioned in the environment to induce harmony with chi. The practice predates Confucianism and Taoism and has been practiced for more than 3,000 years in China. Feng Shui practitioners translated the language of mountains, valleys, and meadows so that local villagers could strategically place their habitats above flood plains, below strong winds, and safely in the embrace of land blessed with harmonious chi. A harmonious plot of land was shaped like an armchair, surrounded and protected in back and on both sides by mountains, hills, or a forest. The preferred land then descended to a lower level where a pond, stream, river, or lake was located.

Practitioners used every physical feature from dead trees and animal bones to vibrant foliage and meandering streams to assess the quality of the surrounding chi.

One tenet of Feng Shui theory is that everything is alive and able to carry chi. Items that bring unhappy memories are sold, given away, or thrown out. Another tenet is that chi connects every physical thing, creating an interconnected web of life. Thus, the chaotic chi in a crowded hospital room can ripple out through the rest of the unit and have a negative effect on the whole hospital. Likewise, the soothing, nurturing chi generated by a beautiful entrance to a unit can pulse through the whole, creating a vibrant positivity. A joyful memory can be evoked by a treasured item, empowering it with vital chi that is re-experienced. By providing patients with a sniff of a remembered odor, the sound of a seashell, or a picture of a loved one, chi can be enhanced.

Feng Shui tries to strike a balance between the two extreme forces in the universe — yin (dark, wet, round, earthy, or cool) and yang (light, hot, straight, hard, angular, or dry). To balance a very yang room, nurses can add a soft blanket, or a dark, rich-colored rounded pillow. When a room has no windows, it may feel devoid of chi. Nurses could add a mirror, a soft light, or a bright-colored or natural object to help attract more chi. Placing an inviting banner, logo, or bright-colored object at the entrance to a unit or clinic can have the effect of friendly hands beckoning patients to enter. A simple practice such as keeping a drain closed and the toilet seat down in a patient’s room can keep vital chi flowing, rather than being drawn down into the openings.^9,10

Guided imagery uses consciously chosen positive and healing images, along with deep relaxation to reduce or manage stressors, prevent illness, and help people deal with the effects of disease. It can also be used to change negative emotions into positive ones and to enhance problem-solving. Images use all the senses — visual, aural, olfactory, gustatory, and tactile. In inducing imagery, a nurse asks a patient to imagine seeing, hearing, smelling, tasting, and/or touching something in the image.¹¹ Positron emission tomography (PET) has demonstrated that the same parts of the cerebral cortex are activated whether imagining something or actually experiencing it.¹²

Guided imagery has also been successfully used to relieve chronic pain and nausea and vomiting associated with chemotherapy, reduce allergic responses, lower blood pressure and control irregular heartbeat, relieve distressing gastrointestinal symptoms, and generally contribute to patients’ well-being.¹¹ It has even been shown to positively affect the immune system.^12,13 A certificate program for nurses is offered through endorsement by the American Holistic Nurses Association.⁵

Hypnosis is a relaxed, yet heightened state of awareness during which individuals are more open to suggestion. Relaxation therapy generally precedes hypnosis to prepare the person. Most people have experienced a trance state at one time or another. Daydreaming or concentrating intently on a book, movie, television program, or work project can bring on a hypnotic state.

All hypnosis is really self-hypnosis because no one will accept a suggestion unless he or she is willing. The self is always in control. Suggestions are most effective when positively phrased. Some people respond best to permissive suggestions, such as “I can feel more relaxed and refreshed,” while others respond best to commands, such as “I will feel more relaxed and refreshed.”

With training, nurses can use hypnosis to reduce stress and change behaviors related to smoking, drinking, overeating, or taking harmful drugs. It can also be used to treat destructive anger, timidity, anxiety, allergies, itching, asthma, study problems, and pain.¹⁴

Massage encompasses several methods of hands-on healing. For example, the simple backrub traditionally provided by nurses is a method of massage that enhances circulation, induces rest and relaxation, and provides healing touch. Ironically, the backrub — initially taught as a basic nursing skill — has been phased out of some settings’ nursing care, just as the public is seeking out massage therapy.¹⁵ In many countries, massage therapists work alongside physicians as partners in a health care team covered by national health insurance.

Traditional European massage includes the soft tissue manipulation techniques of effleurage (stroking), petrissage (kneading), vibration, and tapotement (tapping). Swedish massage uses a system of long, gliding strokes, friction techniques, and kneading of the more superficial layers of muscle. Esalen massage is more slow, rhythmic, and hypnotic, focusing on the whole mind and body. Neuromuscular massage is a form of deep massage, often used in pain control. Concentrated finger pressure is applied to individual muscles, enhancing blood flow, releasing trigger points that cause pain, and loosening knots of muscle tension. Deep tissue massage uses slow strokes, direct pressure, or friction with movement directed across the grain of the muscles. Fingers, thumbs, or elbows can be applied, often focusing on one problem pain area. Sports massage uses portions of other types of massage as part of an athlete’s training regimen and injury-healing approach. Manual lymph drainage massage uses light rhythmic strokes to improve poor lymph flow, such as edema.¹⁵

Structural massage, known as bodywork, organizes and integrates the body in relationship to gravity through manipulating soft tissues and/or correcting inefficient patterns of movement. Structural, functional, or movement approaches to bodywork include Rolfing, Hellerwork, Rosen method, Trager, Feldenkrais, Alexander technique, and OrthoBionomy. In craniosacral therapy, the practitioner applies very light corrective pressure to the head, spinal column, and sacrum to reestablish efficient functioning of the entire nervous system.¹⁵

Massage has been shown to stimulate the body’s ability to control pain naturally by stimulating the production of endorphins and other pain-controlling chemicals. In controlled studies, it has produced relaxation in elderly participants, reduced traumatically induced spinal pain, controlled lymphedema from radical mastectomy, diminished pain and disability from inflammatory bowel disease, helped premature infants gain weight and leave the hospital sooner, increased natural killer cells in patients with HIV, and reduced depression.^16-18

Meditation can be defined as the intentional self-regulation of attention, a systematic focus on particular aspects of the inner or outer experience.¹⁹ Two basic forms are concentration and mindfulness. Concentration is done usually with the eyes closed, and focuses on a single thought, allowing other intruding ideas to float past. A mantra — a special word or phrase — can help some people meditate, while others find counting breaths or steps when walking to be just as effective. Anything that focuses and quiets the mind can work, including breathing or chanting.¹⁹ One of the most famous and most studied forms of meditation is transcendental meditation (TM), which employs a Buddhist technique known as “mindfulness” to focus a person on the present moment.

Meditation has successfully countered chronic pain, hypertension, stress, panic disorders, headaches, and respiratory problems. It is recommended for the reduction of stress and anxiety and the treatment of high cholesterol and substance abuse. Advocates claim that meditation can enhance wellness and expand awareness.^19-22 Nurses are increasingly using this modality with their patients, although a supporting research base within nursing is sparse.²²

Reflexology uses deep massage on identified points on the foot or hand to scan and rebalance body parts that correspond with each point. For example, reflexology points on the feet are arranged so that the big toe represents the head. The practice has roots in ancient China and Egypt. William H. Fitzgerald, an American physician who worked with European reflexologists, introduced the practice to the U.S. in the early twentieth century as “zone therapy.” By manipulating a particular zone on the foot, practitioners claim to affect corresponding organs. Nurses in many settings have used foot massage to relax and promote comfort, and it is particularly useful for elders with dementia.

Practitioners have treated such ailments as anemia, arthritis and back problems, carpal tunnel syndrome, gout, high blood pressure, motion sickness, thyroid problems, and headaches. One controlled clinical study of 38 women with premenstrual syndrome showed a significantly greater reduction in symptoms for the reflexology-treated group.^23,24

Relaxation therapy is a structured way of releasing muscle tension by concentrating on body parts. One form, called progressive muscle relaxation (PMR), was introduced by Edmund Jacobson, MD, in 1938. In PMR, successive muscle groups are progressively tensed and relaxed. With continued practice, subjects learn to sense muscle tension without having to progress through the PMR relaxation. Subsequent studies have supported Jacobson’s early claims that PMR can reduce oxygen consumption, metabolic rate, muscle tension, respiratory rate, premature ventricular contractions, and systolic and diastolic blood pressure, while increasing alpha brain waves.^25-29

Nurses can use other forms of relaxation therapy that use a focus word, deep breathing, and/or relaxing imagery. For example, patients may be asked to repeat the words “peace” or “love,” or a short prayer, or picture themselves in a comfortable and safe place where they feel relaxed. Another form of relaxation called autogenics combines relaxation with self-hypnosis and guided imagery. The procedure involves the repetition of meaningful phrases, such as “It breathes me,” “My forehead is cool,” or “My legs are heavy” while focusing on a sense of heaviness and warmth in the limbs or other body parts and breathing calmly.¹⁰

Therapeutic touch is a contemporary interpretation of several ancient healing traditions. The method includes balancing energy by centering (a relaxed, meditative state), invoking an intention to heal, and moving the hands from the head to the feet several inches from the skin.¹⁰ Therapeutic touch was developed by Dolores Krieger, RN, PhD, a nursing professor at New York University, and Dora Kunz, a natural healer. The practitioner serves as a conduit for universal energy working with the patient’s energy field. The method is currently taught in more than 80 universities and 30 countries.

The results of many studies of therapeutic touch since the 1970s have been mixed, often due to the nature of the research design. More recent studies have used randomized designs. A single-blinded randomized study of therapeutic touch for osteoarthritis of the knee in 25 individuals found significant improvement in function and pain for participants receiving treatment.³⁰ Another research team examined the effect of therapeutic touch in burn patients and found that those who received therapeutic touch reported greater reduction in pain and anxiety than those in a control group without the treatment.³¹

With the rise of consumer interest in complementary therapies, nurses must be able to answer questions about their use. These approaches may require a reevaluation of values and beliefs; complementary modalities are based on a health and wellness paradigm, not a traditional medical model. An increasing number of nursing and medical schools are providing courses on these methods, and the integration of complementary with conventional therapies is becoming a common practice. Additional continuing education about complementary procedures can prepare nurses to integrate them into practice. More important, nurses need to be critical sources of information and evaluation. The American Holistic Nurses’ Association can provide additional education and contact people for integrating complementary therapies into nursing practice.