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CHAPTER
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C C C C Complementary and Alternative Approaches in
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C C C C Cardiovascular Disease
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Eleanor F. Bond / Shannon M. Latta
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Complementary and alternative medicine (CAM) health care ap- Al Alternaative meedicine approaches are those usedd in place off conven-
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proa hches are commo ly us ded by pa ients withh cardiiovasc lular ti tion lal health practicess.
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pr p oblems to promote health or to treat cardiovascular or other dis- Compplementary mediccine approaches are those used iin conjjunction
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eases or symptoms. Despite CAM’s substantial influence, much with conventional health practices.
remains unknown about the therapeutic efficacy of CAM meth- Holistic health care approaches emerge from viewing the patient’s
ods and interactions with mainstream clinical care. There is a need physical condition and emotional responses in the context of
for systematic investigation of the safety, efficacy, and interactions his environment and support system (family, home, commu-
of CAM with conventional therapies. It is important that scien- nities). Nursing models are typically holistic.
tists consider CAM issues when they design trials of conventional Integrative health care combines elements of CAM and allopathic
therapies. In the past, U.S. conventional health care profession health care.
schools such as nursing schools have given insufficient attention Traditional medicine denotes health behaviors and traditions of
to CAM. This pattern is changing as educators, researchers, care people indigenous to a particular region. Traditional health
providers, and patients become aware of CAM approaches. It is practices are typically based on experience and knowledge ac-
important that health care providers understand the power and cumulated over thousands of years. Traditional medical sys-
limitations of CAM approaches and integrate this information tems are typically based on cultural perceptions of the uni-
into their care delivery. verse, religious beliefs, and bodily function. In the United
This chapter describes some CAM therapies commonly used States, “traditional” sometimes is used to refer to allopathic or
to promote cardiovascular health and treat cardiovascular disease. conventional medicine (although that use will not be applied
It summarizes the evidence regarding efficacy, untoward effects, in this chapter). More commonly in North America the term
and interactions with conventional treatments. Included are sug- “traditional medicine” denotes the spiritual and health care
gestions regarding assessing a patient’s underlying health beliefs practices of American Indians, Alaska Natives, and Canada’s
and CAM use, and also suggestions relating to integration of First Nations people.
CAM into clinical nursing management. Whole (or alternative) medical systems are defined by NCCAM as
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being built on complete systems of theory and practice. Gen-
erally, these systems have evolved separately from conventional
CAM DEFINITIONS AND Western medicine. Some whole medical systems have evolved
CHARACTERISTICS in other cultures (Traditional Chinese Medicine [TCM],
Ayurveda); others have been developed within Western cul-
tures (naturopathy, homeopathy).
The National Institutes of Health’s National Center for Comple-
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mentary and Alternative Medicine (NCCAM) defines CAM as “a
group of diverse medicine and health systems, practices, and prod-
ucts that are not presently considered part of conventional medi- CAM DOMAINS
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cine.” Conventional health care, in turn, is defined by NCCAM as
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those practices currently used by medical doctors and other West- According to NCAAM, CAM practices can be categorized into
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ern health care providers. As evidence emerges regarding CAM, four major domains: mind–body interventions, biologically based
these practices and therapies are integrated into conventional practices, manipulative and body-based methods, and energy medi-
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Western health care approaches; they are then no longer consid- cine. These domains are described in Table 41-1. Whole medical
ered to be part of CAM. Thus, the categorization of practices and systems typically include treatment approaches from several of the
therapies as CAM continually evolves. For example, exercise pre- CAM domains.
scriptions, once considered an alternative approach, are now a
core element of conventional clinical management of diabetes
mellitus, heart disease, arthritis, cancer-related fatigue, and bone PREVALENCE OF CAM
health. In a similar way, cognitive-behavioral therapies, once part
of CAM, are now a component of allopathic care, for example, for
In all areas of the world, traditional healing systems compete with
irritable bowel syndrome.
the allopathic biomedical model. According to the World Health
Terms used in discussing g CAM include the following: 2 2
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Organization, at least 80% of the developing world uses tradi-
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Allopathic medicine denotes conventional health care approaches tional healing systems as their primary source of health care.
as taught in a country’s medical and nursing schools. While developing countries are striving toward improving health
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