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C HAPTER 41 / Complementary and Alternative Approaches in Cardiovascular Disease 917
as being able to teach. The nurse should proceed in an open,
nonjudgmental fashion, avoiding terms that suggest disapproval,
such as “unproven.” The nurse should ask the patient how well
the remedy has worked or not worked before stating an opinion.
It may be appropriate to ask the patient’s permission to coordi-
nate with the other therapists. Some suggested questions are as
follows:
1. What are your values and beliefs related to health and illness?
2. Are there health practices that are part of your cultural, spiri-
tual, or religious beliefs?
3.What therapies have you used to maintain or improve your
health?
4. Have you consulted with or been treated by a naturopathic,
acupuncturist, or homeopathic provider? (Elicit specific de-
tails.)
5. Have you consulted with any specialized healers, such as prac-
titioners of oriental medicine or Native American healing
practices?
■ Figure 41-6 Therapeutic touch. (From Lewis, S. M., Heitkem- 6. Do you meditate or practice yoga or tai chi?
per, M. M., & Dirksen. S. R. [2004]. Medical surgical nursing: Assess- 7. Have you used any herbal treatments?
ment and management of clinical problems [6th ed.]. St. Louis: Mosby; 8. Have you tried any dietary modifications such as increasing
used with permission.)
your consumption of vitamins or fish oils?
9. Have you consulted with a chiropractor or massage therapist?
10. Do you use magnets or crystals to alter your health status?
with a patient who is experiencing physical or psychological pain. 11. Why did you select this approach?
Nurses with specialized training sometimes practice this form of 12. What is your attitude toward conventional medical care?
energy therapy (Fig. 41-6). Healing touch could potentially im-
prove the provider–patient relationship, promote relaxation, re- Nursing Management Related
duce the stress response, or alter cardiac variables. More studies are to CAM
needed of the efficacy in cardiac diseases.
Some CAM approaches are within the scope of nursing practice
and can be integrated into the plan of care. Massage, relaxation
LEGAL ASPECTS OF CAM therapy, or music therapy may be useful adjuncts to the care plan.
Some nurses conduct reiki and therapeutic touch treatments. As
Most forms of CAM require specialized training and licensure. with any procedure, the nurse should acquire training in the cor-
Naturopathy, TCM, acupuncture, homeopathy, and chiropractic rect applications of the procedure, review the evidence that the
medicine all require years of training. Other therapies such as therapy is useful, devise a means to evaluate the efficacy of the
massage therapy, reiki, therapeutic touch, and yoga require some, treatment, and act in conjunction with institutional protocols and
but less, extensive training. License regulations vary from state to procedures. There is considerable need for patient education in re-
state. Nurses who are making referrals or assisting patients to eval- gard to CAM approaches. Patients often use products or ap-
uate various treatment approaches should become familiar with proaches that they learn about from laypeople, the Internet, or
the state regulatory statutes. television advertisements. The nurse can assist the patient with
weighing the risks and benefits of CAM treatment approaches and
help them identify licensed and certified providers of CAM ther-
INTEGRATION OF CAM INTO apies.
NURSING ASSESSMENT AND
CLINICAL MANAGEMENT
SUMMARY
It is important to specifically query patients regarding their CAM
usage. Metz et al. 102 evaluated the intake interviews of 196 cancer The widespread and increasing use of CAM by the consuming
patients. Each patient received a standard medical history and public amplifies the imperative for health care professionals to be-
physical examination including queries about over-the-counter come familiar with the range of CAM care options, the role CAM
treatments. After completion of the usual interview, patients were plays in health promotion, the interaction between CAM and
asked explicit questions about use of CAM treatments. Although conventional medicine and nursing, and the potential for adverse
only 13 patients (6.6%) initially disclosed CAM treatments; after outcomes. Unfortunately, nursing curricula traditionally have not
directed questioning, an additional 66 patients (36%) disclosed included CAM education. This breach in the education of direct
CAM treatments. Thus, CAM usage should be integrated into the care providers has obvious consequences in the care delivered to
health interview rather than relying on the patient to initiate it. patients. At the same time, there is a clear need for research into
The nurse or health care provider should approach the interview the efficacy of CAM practices either as sole therapies or as adju-
with an attitude of being willing to learn from the patient as well vant treatments in health promotion and disease management.