Mental Health: Integrative Care
Lauren Lane & Katie Palmer
Integrative care encompasses the nursing practices of alternative medicine. This includes acupuncture, aromatherapy, guided imagery, and many more types of therapies. These therapies are usually centered on the individual patient, and holistically address their variety of needs, including physical, mental, and spiritual foci (Halter, 2014, p 637). We will address nonconventional treatments and explore the different approaches, safety, and nursing care associated with integrative care practices.
It is only recently that the United State’s western views of medicine have expanded to include complementary medicine. Western medicine is based on a more scientific approach with highly controlled experiments and research. Complementary medicine comes from mostly non-western sources and is based on nature and its interplay with energy (Halter, 2014, p 638). There was two billion dollars awarded to complementary research in 2011 and the studies results showed that we could neither prove nor disprove complementary medicines worth as a healing tool. There are many who do believe that complementary and alternative medicine (CAM) helps them. According to halter, 38% of adults and 12% of children use some type of CAM therapy (Halter, 2014, p 639). It is more widely used among women and mostly used for musculoskeletal problems. We have yet to discover the full effects and responses to CAM, which is still a complicated and controversial matter for the healthcare field.
Some of the reasons patients are so attracted to CAM is that it allows them to take action in their own care. CAM also has lower risks than many therapeutic approaches and drug regimens. It is less expensive and provides an alternative to conventional medicine when they are out of options or may have previously had negative experiences with western medicine.
As nurses, we can be informed about CAM and help consumers to make smart decisions to complement or give alternatives to routine therapeutic approaches. Our biggest concerns are safety. CAM is still unregulated and not guaranteed to work. Many consumers believe what they read on the Internet even though it may not be accurate information. Just because a supplement is natural or organic doesn’t mean that it is harmless. These natural supplements need to assessed and monitored just like a medication. We also face patients that put off treatment and self treat with alternative therapies that may or may not help their conditions, especially in cases of mental health issues (Halter, 2014, p 640).
As costs rise for conventional medicine in the United States, more and more consumers are moving toward alternative therapies. Only some of the alternative therapies are covered by insurance, and this is going to depend on what type of insurance the patient has, or if they have insurance at all. There is a large claim that CAM’s proposed effects are only due to the placebo effect (Halter, 2014, p 640). This is when a type of therapy works for an individual to some degree when the therapy is actually nothing; a placebo. Many believe this is due to the optimism and positive approach to CAM that can often occur.
The American Nurses Association (ANA) recognizes integrative care in the profession of holistic nursing. This is an approach that involves the person as a whole, and their biocultural influences. It allows the nurse to view the patient as more than a sum of their parts and all the dimensions that can affect that individuals well being (Halter, 2014, p 642).
Nutrition is a very big part of a person’s well being, and has been widely researched. Many people with illnesses can benefit from diet and nutrition changes; research shows that a diabetic patient benefits from a diabetic diet and lower glycemic index foods. Alternative therapies involving nutrition take this same approach to aid in treatment for a variety of disorders. For example, many people believe gluten free diets help children diagnosed with autism, but there has been no concrete evidence to support that claim. There are a lot of diet therapies associated with depression and other psychiatric disorders. Vitamins, supplements, and herbs are some examples of potential alternative therapies one might chose. Many of these can interact with medications and should be initially assessed in every patient. The patient may not recognize that they need to tell the healthcare provider or nurse that they are taking these alternative supplements and need to be asked specifically.
There are many common types of integrative therapy that are common to society today. Herbal therapy includes the uses of herbs like St. Johns wort, which is used for pain and mood stabilization. Ginkgo biloba is another common herb that is used for memory. Many of these have side effects and interactions just like any other medication and should be treated as such. Meditation is a mind and body therapy that involves focusing and deep breathing, which is used to help calm the person. Acupuncture uses needles at pressure points to relieve pain and many other disorders (Halter, 2014, p 644).
Aromatherapy is a popular therapy using essential oils on the skin or with a diffuser to target senses that results in a variety of effects such as calming, sleep, energizing and so on. Energy therapies such a Reiki are an expanding alternative therapy that nurses can take classes in. This requires energy manipulation and therapeutic touch as a means to heal and bring wellness to a person depending on their chief complaints.
There are many different patients that can benefit from these therapies. Dominantly, psychiatric patients seem to use alternative therapies more than those of any other disorder or illness (Halter, 2014, p 644-645). Depression and anxiety are the main focus. When caring for these patients we would want to make sure we assess the patient for use of alternative therapies, this includes supplements, herbs, and other preferred methods of therapy. This may include doing a cultural assessment of our patient, who may prefer or already be performing alternative therapies based on their beliefs of medicine and health.
Diagnosis for this patient might consist of cultural implications like the balance and harmony of nature with the body. In planning and implementing our patient’s care we will want to be sensitive to their preferences of therapy and their cultural values. This could entail a patient with different religious values, like a Jehovah witness who does not accept blood products. When western interventions are not accepted due to religious values, alternative therapies could ne used when planning their care. Alternative therapy may also not be the only therapy being implemented. It can complement medication regimens or other types of western-based therapies, such as the patient undergoing cancer treatment and also taking part in meditation and yoga.
Nurses need to assess patients for interactions and different side effects when a patient is using integrative therapies. Not only do nurses need to assess the medication effects but they also need to evaluate for patient outcomes. Is the alternative therapy helping the patient? How does the patient perceive the therapy? Is this therapy safe? These are important aspects to think about when undergoing the nursing process with alternative therapy practices.
Overall, alternative therapies are becoming more widely popular due to rising costs and limits of western medicine. Alternative therapy has become a common aspect of the nursing assessment and may coincide with cultural or religious views. Psychiatric patients tend to most use alternative therapies and should be considered along with their care (Halter, 2014, p 647). By being aware, informed, and knowledgeable of integrative care nurses can best serve patients holistically and maximize their safety and wellness.
Halter, M. J. (2014) Varcarolis, Foundations of psychiatric mental health nursing: A clinical
approach, 7th ed. St. Louis: Saunders Elsevier.