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Fifth Edition

Complementary
& Integrative
Therapies for
Nursing Practice
Karen Lee Fontaine
 CONTENTS

Preface   xi
Acknowledgments   xv

UNIT 1 Healing Practices: Complementary and

Integrative Therapies for Nurses    1
Chapter 1 Integrative Healing    3
Chapter 2 Basic Concepts Guiding Integrative Therapies    19
Chapter 3 The Role of Evidence-Based Health Care in
Complementary and Integrative Therapies    37

UNIT 2 Systematized Health-Care Practices    47

Chapter 4 Traditional Chinese Medicine    49
Chapter 5 Ayurvedic Medicine    70
Chapter 6 Native American Healing and Curanderismo    92

UNIT 3 Botanical Healing    111

Chapter 7 Herbs and Nutritional Supplements    113
Chapter 8 Aromatherapy   133
Chapter 9 Homeopathy   149
Chapter 10 Naturopathy   161

UNIT 4 Manual Healing Methods    169

Chapter 11 Chiropractic   171
Chapter 12 Massage   183
Chapter 13 Pressure Point Therapies    203
Chapter 14 Hand–Mediated Biofield Therapies    218
Chapter 15 Combined Physical and Biofield Therapy    232

UNIT 5 Mind–Body Techniques    239

Chapter 16 Yoga   241
Chapter 17 Meditation   256
Chapter 18 Hypnotherapy and Guided Imagery    271
Chapter 19 Dreamwork   289

vii
viii Contents

Chapter 20 Intuition   305

Chapter 21 Music as a Therapeutic Tool    315
Chapter 22 Biofeedback   325
Chapter 23 Movement-Oriented Therapies    333

UNIT 6 Spiritual Therapies    347

Chapter 24 Shamans   349
Chapter 25 Faith and Prayer    360

UNIT 7 Other Therapies    375

Chapter 26 Bioelectromagnetics   377
Chapter 27 Animal-Facilitated Therapy    388

Appendix Complementary Therapies for Common Health Problems  405

Index   431
 TRY THIS*

Energy   35 Loving Kindness Meditation    267

Massage   88 Renovating Your Day    285
Positive Thoughts    109 Shrinking Antagonistic Forces    285
Herbal Remedies    129 Improving Dream Recall    302
Soothing Potions    144 Positive Affirmations    312
Top 10 Remedies and Bach Flower Practice Intuition    313
Essences   157 Music for Stress Reduction    320
Pet Remedies    158 Mind Control of Muscular
Visualization   167 Strength   330
Energy Boosters    181 Feel Your Qi    343
Massage   199 Wave Hands Like Clouds (Water
Foot Massage    214 T’ai Chi)    343
Experience Your Energy Field    229 Shamanic Journey    358
Emotional First Aid    237 Absorbing Earth Energy    385
Redirecting the Flow of Energy    238 Going to the Mountains    385
Heart Breathing    253 Interacting with Your Pet    400

*
“Try This” features throughout the chapters, provides you with examples of how you can integrate
these practices into your own life, and also gives you ideas for client education. A list of resources is
also included in every chapter.

ix
This page intentionally left blank
 PREFACE

The profession of nursing has advanced beyond the Western biomedical

model to incorporate many healing tools used by our Asian, Latino, Native
American, African, and European ancestors. We are rapidly rediscovering
that these ancient principles and practices have significant therapeutic value.
Some see this movement as a “return to our roots.” Others believe it is a
response to runaway health-care costs, growing dissatisfaction with high-tech
medicines, and increasing concern over the adverse effects and misuse of medi-
cations and other treatments. The growth of consumer empowerment also
fuels this movement.
As nurses, how do you begin to assimilate thousands of years of healing
knowledge? How do you begin this journey of integrating practices into your
own lives? In your professional practice, how do you model healthful living?
How do you help clients choose their own healing journeys? How do you
break down the barriers between conventional and complementary and inte-
grative therapies? Learning about these practices, like anything else, is a slow
process involving a steady accumulation of bits of information and skills that
eventually form a coherent pattern called knowledge. Although it is possible to
learn a great deal about healing practices from reading, thinking, and asking
questions, you must in the long run learn about healing through participation.
Without hands-on experience, you can be a good student, but you can never
be a great nursing practitioner of the healing arts. I trust this book will be one
step in a lifelong exploration of and experiences with healing practices.
Consumers do not wish to abandon conventional medicines, but they do
want to have a range of options available to them including herbs and nutri-
tional supplements, manual healing methods, mind–body techniques, and
spiritual approaches. Some practices, such as exercise, proper nutrition, medi-
tation, and massage, promote health and prevent diseases. Others, such as herbs
and homeopathic remedies, address specific illnesses. Many other practices
do both. The rise of chronic disease rates in Western society is increasingly
motivating consumers to consider self-care approaches. As recently as the
1950s, only 30% of all diseases were chronic, and curable—largely infectious—
diseases dominated, for which medical interventions were both appropriate
and effective. Now, 80% of all diseases are chronic. Western medicine, with its
focus on acute disorders, trauma, and surgery, is considered to be the best
high-tech medical care in the world. Unfortunately, it is not responding
adequately to the current epidemic of chronic illnesses.
Ethnocentrism, the assumption that one’s own cultural or ethnic group is
superior to others, has often prevented Western health-care practitioners from
learning “new” ways to promote health and prevent chronic illness. With con-
sumer demand for a broader range of options, we must open our minds to the
idea that other cultures and countries have valid ways of preventing and cur-
ing diseases that could be good for Western societies. Although the information

xi
xii Preface

may be new to us, many of these traditions are hundreds or even thousands of
years old and have long been part of the medical mainstream in other cultures.
I have titled this book Complementary & Integrative Therapies for Nursing
Practice because I believe we need to merge complementary approaches with
Western-based nursing practices resulting in integrative therapies. I have
tried to provide enough information about these therapies to help guide prac-
tice decisions. This text, as an overview and practical guide for nurses, does
not pretend to be an exhaustive collection of all the facts and related research,
nor does it offer meticulous documentation for all claims made by the various
therapies. The goal of the text is to motivate you, the reader, to explore these
approaches, increase your knowledge about factors that contribute to health
and illness, and expand your professional practice appropriately.
It is possible to classify alternative practices in any number of ways. I have
chosen to present more than 40 approaches categorized into seven units. In Unit 1,
I introduce the philosophical approaches to both Western biomedicine and
complementary and integrative medicine, as well as evidence-based health care
in these therapies. Concepts common to many approaches are defined and
discussed, such as energy, breath, spirituality, and healing. Unit 2 presents a
number of health-care practices that have been systematized throughout the
centuries worldwide. These typically include an entire set of values, attitudes,
and beliefs that generate a philosophy of life, not simply a group of remedies.
The chapters cover Traditional Chinese medicine, Ayurvedic medicine, and
Native American healing and curanderismo. Unit 3 comprises chapters relating
to botanical healings used by 80% of the world’s population. Chapters cover
herbs and nutritional supplements, aromatherapy, homeopathy, and naturopa-
thy. Unit 4 presents manual healing methods—some from ancient times and
some developed in the latter half of the 20th century. The chapters discuss chi-
ropractic, massage, pressure point therapies, hand-mediated biofield therapies,
and combined physical and biofield therapies. The chapters in Unit 5 cover
types of mind–body techniques for healing and include yoga, meditation, hyp-
notherapy and guided imagery, dreams, intuition, music as a therapeutic tool,
biofeedback, and movement-oriented therapies. Unit 6 presents two spiritual
approaches to therapeutic intervention: working with shamans and the use of
faith and prayer. Unit 7 includes two chapters on miscellaneous practices: bioel-
ectromagnetics and animal-facilitated therapy.
The appendix provides specific information on managing the types of
common health problems that respond well to alternative therapies and life-
style modification.
This book does not recommend treatments but, rather, describes alterna-
tive practices, their backgrounds and claims, preparation of practitioners, con-
cepts, diagnostic methods, treatments, and evidence from research studies.
“Integrated Nursing Practice” is an important section of every chapter
designed to help you, the nurse, expand your practice by providing you with
specific information and suggestions.
In this fifth edition, I have continued the “Considering the Evidence”
feature with all new research relating to the chapter topic. Seven of these
 Preface xiii

features present a systematic review of randomized control trials, while three

present primary research. “Considering the Evidence” boxes not only present
current studies but also are designed to further critical thinking and perhaps
inspire you to design studies to answer your own questions. Each study
answers the following questions: What was the approach of the research?
What was the aim/purpose/objective of the research? How was the study
done? What were the significant findings of the research? What additional
questions might I have? What is the clinical significance of this study?

NEW TO THIS EDITION

• Updated all research sections and increased the number of systematic
reviews of randomized controlled trials
• Increased emphasis on integrative nursing practice
• Expanded the lists of resources to include more international resources
• Expanded the appendix by including nine additional common health-
care problems
• Added material on:
∘∘ African healing
∘∘ Forest bathing
∘∘ Health disparities
∘∘ Health literacy
∘∘ Native American sacred land
∘∘ Precision Medicine Initiative
∘∘ Low-level laser therapy
∘∘ Watsu®
Nurses are in a unique position to take a leadership role in integrating
complementary healing methods into Western health-care systems. Nurses have
historically used their hands, heart, and head in more natural and traditional
healing interactions. By virtue of their education and relationships with clients,
nurses can help consumers assert their right to choose their own healing
journey and the quality of their life and death experiences.
My dear friend and colleague has written the following letter to you
about her lived experience uniting biomedicine with complementary and
integrative approaches.
Dear Reader,
It is both a pleasurable and enlightening experience for me to contribute
to your text, Complementary & Integrative Therapies for Nursing Practice,
through the development of the “Considering the Evidence” feature. I
approach this work hopeful that it may inspire you, the reader, to engage
in critical thinking, assist in your understanding of the significance of
research to inform your nursing practice, and, perhaps, propose future
studies to answer your own researchable questions. While I am very
committed to the importance of nursing research, I have asked Karen Lee
xiv Preface

Fontaine to allow me the privilege of sharing my anecdotal experience

with you as it relates to my personal journey with complementary and
integrative therapies. I hope my story and insight can inspire you to
reflect on and embrace the important content of this text in your nursing
practice. After learning of my diagnosis of bilateral breast cancer, I
actively participated in a myriad of Western medicine therapies while
integrating complementary and integrative therapies. Although the
chemotherapy experience was both emotionally and physically taxing, I
considered the massage therapist as part of “my team,” and I looked for-
ward to this dimension of comfort during this challenging time. Engag-
ing in yoga enhanced “restful sleep” as a response to the overwhelming
fatigue that frequently accompanies Western therapies such as chemo-
therapy and radiation and just the daily awareness that “you have cancer.”
Acupressure relieved uncomfortable postoperative symptoms. T’ai chi
continues to be an opportunity to focus on myself and reflect on the posi-
tives associated with this journey. Reiki and reflexology is my specified
“me time.” As I continue to engage in the associated deep breathing exer-
cises, it stimulates my mind to drift to affirmative thoughts and so many
positive memories from my life. For me, “living with cancer” is more of
an “inconvenience” in my life’s journey. I can appreciate this may not be
the experience for everyone, but I can personally assure you that integrat-
ing many of the therapies discussed in this text allows me a “quality of
life” while simultaneously working with conventional medicine’s goal
for a “quantity of life.” With the combination of both, even after some
time, I feel I have been given the power to survive and, perhaps, make a
difference in the lives of those currently living this journey!
While it has been several years since my original diagnosis and initiat-
ing the “cancer treatment path,” I am unwavering in my belief of the
POWER of complementary and integrative therapies in enhancing one’s
quality of life. I frequently share my story with women recently diag-
nosed with cancer and just embarking on their “new reality” and encour-
age them to integrate these therapies in their treatment plan. I hope my
story gives you a sense of hope and empowerment in caring for persons
both professionally and personally who are partaking on a strenuous
journey related to their health. I can recall in my own nursing practice
experiencing feelings of helplessness when caring for persons undergo-
ing complex treatments with so many uncertainties related to their health
outcome. I can attest that your understanding, knowledge, and support
in the implementation of complementary and integrative therapies can
significantly affect their “quality of life” and allow you the privilege of
making a difference in their health journey.
Dolores M. Huffman, RN, PhD
Professor Emeritus, College of Nursing
Purdue University Northwest, IN
 ACKNOWLEDGMENTS

I would like to express thanks to the many people who have inspired, com-
mented on, and in other ways assisted in the writing and publication of the
fifth edition of this book. On the publishing and production side at Pearson, I
was most fortunate to have an exceptional team of editors and support staff.
My thanks go to Julie Levin Alexander, Publisher, and Neha Sharma, Content
Producer, who provided support and guidance throughout this project.
Sadika Rehman, Project Manager, kept this book on schedule and dedicated
her time and skills to its completion.

Previous Edition Contributors

Dolores M. Huffman, PhD, RN
Professor Emeritus
College of Nursing
Purdue University Northwest
Hammond, IN
Sheila Lewis, BScN, MHSc
Associate Lecturer
Department of Nursing, Faculty of Health
York University
Toronto, ON, Canada
Leslie Rittenmeyer, PsyD, CNS, CNE, RN
Professor
College of Nursing
Purdue University Northwest
Research Associate: Northwest Indiana Center for Evidence Based Practice:
A Joanna Briggs Institute Collaborating Centre
Hammond, IN

xv
 REVIEWERS

Carol Athey, MA, MSN,RN, Teresa Johnson, DCN, RD, LD

CNOR, CCAP Associate Professor
Clinical Instructor Troy University
Stephen F. Austin State School of Nursing
University Troy, Alabama
DeWitt School of Nursing Dr. Kim Link, DNP, PMHNP
Nacogdoches, Texas Assistant Professor
Karen Avino, EdD, MSN, RN, Western Kentucky University
AHN-BC, HWNC-BC School of Nursing
Assistant Professor Bowling Green, Kentucky
University of Delaware Dr. Dawn Garrett Wright, PhD,
School of Nursing CNE
Newark, Delaware Associate Professor
Lori A. Edwards, DrPH, MPH, Western Kentucky University
RN, PHCNS-BC School of Nursing
Assistant Professor Bowling Green, Kentucky
University of Maryland
School of Nursing
Baltimore, Maryland

xvi
 1
UNIT

Healing Practices:
Complementary
and Integrative
Therapies for
Nurses

Happiness, grief, gaiety, sadness are by nature contagious.

Bring your health and your strength to the weak and sickly,
and so you will be of use to them. Give them, not your
weakness, but your energy, so you will revive
and lift them up.
Henri-Frederic Amiel
This page intentionally left blank
1
Integrative Healing
Time is generally the best doctor.
Ovid

M
ost of nursing education in the United States, Canada, the
United Kingdom, Europe, and Australia—often referred
to as Western countries—has been under the umbrella of
biomedicine, and thus Western nurses are familiar and comfort-
able with its beliefs, theories, practices, strengths, and limitations.
Fewer nurses have studied alternative medical theories and prac-
tices and as a result may lack information or even harbor misinfor-
mation about these healing practices. Unlike the profession of
medicine in general, however, the profession of nursing has tradi-
tionally embraced two basic concepts embodied by alternative
therapies—holism and humanism—in its approach with clients.
Nurses have long believed that healing and caring must be
approached holistically and that biological, psychological, emo-
tional, spiritual, and environmental aspects of health and illness
are equally important. This humanistic perspective includes prop-
ositions such as the mind and body are indivisible, people have the
power to solve their own problems, people are responsible for the
patterns of their lives, and well-being is a combination of personal
satisfaction and contributions to the larger community. This theo-
retical basis gives nurses a solid foot in each camp and places them
in the unique position to help create a bridge between biomedicine
and alternative medicine (Buchan, Shakeel, Trinidade, Buchan, &
Ah-See, 2012; Dossey & Keegan, 2016; Peplau, 1952; Quinn, 2000).

BACKGROUND
Many interesting exchanges around the world have debated the
appropriate terminology of various healing practices. Some peo-
ple become vested in the use of particular terms and have diffi-
culty getting past the language limitations. For example, many
3
4 Unit 1 • Healing Practices

people view the term alternative medicine as being too narrow or misleading
and are concerned that the term lacks a full understanding of traditional heal-
ing practices. It would be helpful for a common language to be developed
without these constraints. As language evolves, the terms used today may be
quite different from those that will be in use 20 years from now. For consistency,
the terms chosen for this text are conventional medicine or biomedicine to
describe Western medical practices, and the terms alternative medicine or
complementary medicine to describe other healing practices. Traditional
medicine refers to indigenous medical systems such as Traditional Chinese
Medicine (TCM). Integrative medicine embodies conventional and comple-
mentary and alternative medicine. There are no universally accepted terms.
The following list presents commonly used words and their counterparts:
Mainstream Complementary/Alternative
Modern Ancient
Western Eastern
Allopathic Homeopathic; holistic
Conventional Unconventional
Orthodox Traditional
Biomedicine Natural medicine
Scientific Indigenous healing methods
The line between conventional medicine and complementary and alter-
native medicine is imprecise and frequently changing. For example, is the use
of megavitamins or diet regimens to treat a disease considered medicine, a
lifestyle change, or both? Can having one’s pain lessened by massage be con-
sidered a medical therapy? How should spiritual healing and prayer—some
of the oldest, most widely used, and least studied traditional approaches—be
classified? Although the terms alternative and complementary are frequently
used, in some instances they represent the primary treatment modality for an
individual. Thus, conventional medicine sometimes assumes a secondary role
and becomes a complement to the primary treatment modality.

Conventional Medicine
Biomedical or Western medicine is only about 200 years old. It was founded
on the philosophical beliefs of René Descartes (1596–1650)—that the mind and
body are separate—and on Sir Isaac Newton’s (1642–1727) principles of physics—
that the universe is like a large mechanical clock in which everything operates
in a linear, sequential form. This mechanistic perspective of medicine views
the human body as a series of body parts. It is a reductionist approach that
converts the person into increasingly smaller components: systems, organs,
cells, and biochemicals. People are reduced to patients, patients are reduced
to bodies, and bodies are reduced to machines. Health is viewed as the absence
of disease or, in other words, nothing is broken at present, and sick care is
focused on the symptoms of dysfunction. Physicians are trained to fix or
 Chapter 1 • Integrative Healing 5

repair broken parts through the use of drugs, radiation, surgery, or replacement
of body parts. The approach is aggressive and militant—physicians are in a
war against disease, with a take-no-prisoners attitude. Both consumers and
practitioners of biomedicine believe it is better to
• do something rather than wait and see whether the body’s natural pro-
cesses resolve the problem.
• attack the disease directly by medication or surgery rather than try to
build up the person’s resistance and ability to overcome the disease.
Biomedicine views the person primarily as a physical body, with the
mind and spirit being separate and secondary or, at times, even irrelevant. It
is a powerful medicine in that it has virtually eliminated some infectious
diseases, such as smallpox and polio. It is based on science and technology,
personifying a highly industrialized society. As a “rescue” medicine, the
biomedical approach is appropriate. It is highly effective in emergencies,
traumatic injuries, bacterial infections, and some highly sophisticated sur-
geries. In these cases, treatment is fast, aggressive, and goal oriented, with
the responsibility for cure falling on the practitioner.
The priority of intervention is on opposing and suppressing the symp-
toms of illness. This approach is evidenced in many medications with prefixes
such as an- or anti-, as in analgesics, anesthetics, anti-inflammatories, and anti-
pyretics. Biomedicine characterizes each disease in terms of its mechanisms of
action, based on the belief that most individuals are affected in the same way.
There is minimal consideration for how the disease affects the person or how
the person affects the disease (Maitland, 2016). Thus, treatment is basically the
same for most people. Because conventional medicine is preoccupied with
parts and symptoms and not with whole working systems of matter, energy,
thoughts, and feelings, it does not do well with long-term systemic illnesses
such as arthritis, heart disease, and hypertension. Despite higher per capita
spending on health care in the United States than in all other nations, in 2013,
U.S. life expectancy ranked only 37th, and the infant mortality rate ranked 56th
among the 225 nations studied (World Factbook, 2013–2014; World Health
Rankings, 2016). In comparison of 19 developed countries, the United States
had the highest rate of preterm births. Sadly, the United States has failed to be
a world leader in providing a healthier quality of life (Raheim, 2015).

Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) is an umbrella term for as
many as 1,800 therapies practiced worldwide. Many forms have been handed
down over thousands of years, both orally and in written records. These thera-
pies are based on the medical systems of ancient peoples, including Egyptians,
Chinese, Asian Indians, Greeks, and Native Americans. Others, such as
osteopathy and naturopathy, evolved in the United States during the past two
centuries. Still others, such as some of the mind–body and bioelectromagnetic
approaches, are on the frontier of scientific knowledge and understanding.
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