Healing the Heart: Integrating Complementary Therapies and Healing Practices Into the Care of Cardiovascular Patients Mary Jo Kreitzer, PhD, RN, Mariah Snyder, PhD, RN Prog Cardiovasc Nurs 17(2):73-80, 2002. © 2002 Le Jacq Communications, Inc. Abstract Complementary therapies and healing practices have been found to reduce stress, anxiety, and lifestyle patterns known to contribute to cardiovascular disease. Promising therapies include imagery and hypnosis, meditation, yoga, tai chi, prayer, music, exercise, diet, and use of dietary supplements. Many of these complementary approaches to healing have been within the domain of nursing for centuries and can readily be integrated into the care of patients with cardiovascular disease. While individual complimentary modalities hold considerable merit, it is critical that the philosophy underlying these therapies -- caring, holism, and harmony -- also be understood and honored. Introduction For many cardiovascular patients, stress and underlying lifestyle patterns are among the well documented risk factors known to contribute to both the development of cardiovascular disease and to recovery. These risk factors include anger,[1] hostility,[2] social isolation,[3] stress,[4] anxiety,[5,6] and depression.[7] In a review article on the influence of anxiety and depression on outcomes of patients with coronary artery disease, Januzzi et al.[7] conclude that anxiety is prevalent in patients with acute cardiac illness and triples the risk for mortality following a myocardial infarction, doubles the risk for reinfarction over 5 years, and increases the risk for sudden cardiac death by a factor of six. They further conclude that the incidence of major depression in patients with acute cardiac illness is approximately 25% and that major depression following a myocardial infarction has a devastating effect on both the quality of life and adherence to therapies, and quadruples the risk for mortality. Dean Ornish, MD, published numerous papers throughout the 1980s and 1990s, demonstrating that lifestyle changes, including low-fat diet, exercise, yoga, and group support, can impact the course of, and in many cases even reverse, severe coronary artery disease.[8-10] In his recent book Love and Survival: The Scientific Basis for the Healing Power of Intimacy,[11] Ornish notes that scientists and practitioners have long believed that the benefits of his program are due to diet and exercise changes. They have often overlooked the evidence that stress management techniques are as strongly correlated with changes in coronary artery disease as is adherence to diet. He goes on to note that as important as changes are in cardiac positron emission tomographic scans and arteriograms, there are even more important outcomes that patients and their families experience that are more difficult to quantify. These include: rediscovering inner sources of peace, joy, and well-being; learning how to communicate in ways that enhance intimacy with loved ones; creating a healthy community of friends and family; developing more compassion and empathy for themselves and others; and directly experiencing the transcendent interconnectedness of life. There is a growing body of empiric evidence that "healing the heart" requires care of the whole person -- the body, mind, and spirit. To effectively achieve this requires tapping into a broad array of healing options, including the best of high-technology biomedical care as well as complementary and alternative care options. The Growth of Complementary and Alternative Medicine Over the past 10 years, there has been tremendous growth in the field of complementary and alternative medicine (CAM). It is estimated that more than 40% of Americans use complementary therapies. This is thought to be a conservative estimate, as the survey conducted by Eisenberg et al.[12] inquired about the use of a limited number of therapies and obtained information only from English-speaking persons with a telephone. This has prompted some to refer to the field of CAM as "the invisible mainstream." The high use of complementary therapies has occurred despite the fact that the majority of costs have been paid out-of-pocket. Eisenberg et al. estimate that annual expenditures for CAM services exceed $27 billion. The growing interest in CAM prompted the National Institutes of Health to establish a center dedicated to CAM research. The National Center for Complementary and Alternative Medicine (NCCAM) is responsible for exploring complementary and alternative healing practices in the context of rigorous research, training CAM researchers, and disseminating authoritative information. Information on NCCAM can be obtained from the National Institutes of Health web site: http://www.nccam.nih.gov. Overview of CAM The field of CAM is large, complex, and diverse. It is estimated that there are over 1800 complementary therapies. Some of these therapies fall within an organized alternative system of care, such as traditional Chinese medicine or Ayurvedic medicine. Others, such as clinical hypnosis, meditation, and massage, are not unique to any one alternative system of care. The list of healing practices encompassed within CAM changes continuously. As research evidence accumulates supporting a particular CAM practice or therapy, it becomes more accepted as a "mainstream" health care practice. NCCAM has identified five major domains of CAM: alternative medical systems, mind-body interventions, biologically based treatments, manipulative and body-based methods, and energy therapies. Alternative Medical Systems Alternative medical systems are complete systems of care that have often evolved independently of and parallel to conventional biomedicine. While each of these systems is unique and distinct, there are commonalities in philosophies of health and illness, relationship to nature, and the role of the community. Examples of alternative medical systems include traditional Oriental medicine, Ayurvedic medicine, naturopathy, homeopathy, and other culturally based or indigenous systems of healing developed by Native American, Tibetan, Hispanic, African, and Aboriginal cultures. Alternative medical systems have their own theories about the causation of disease and ways to promote health and wellness. Traditional Oriental medicine is based on a belief that disease is caused by blockages or imbalances in qi (pronounced chi), or vital energy. Therapeutics such as acupuncture, acupressure, herbal therapies, and qi gong (described below) are believed to improve the flow or balance of qi. Ayurvedic medicine, India's traditional system of medicine, is more than 5000 years old. Ayurveda means the "science of life." Therapies are designed to restore the inner harmony of the individual and emphasize care of the mind, body, and spirit. Ayurvedic treatments include diet, exercise, meditation, herbs, massage, and controlled breathing. Homeopathy is a western system of care that is based on the belief that very dilute substances or remedies are able to stimulate a healing response. The system is based on the theory that "like cures like." The same substance that in large doses produces the symptoms of an illness, in very dilute doses is believed to cure it. Homeopathic preparations are derived from plants and minerals. Naturopathy emerged in the late 19th century in America. The underlying belief is that the body naturally heals itself. Naturopathic practitioners use a wide array of healing practices, including diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy, spinal and soft-tissue manipulation, and physical therapies, as well as modern conventional practices, such as surgery and drugs. Culturally based or indigenous healing practices vary considerably, although many hold in common the use of herbs, healing rituals and ceremonies, and other spiritual practices. Mind-Body Interventions Mind-body interventions include clinical hypnosis, guided imagery, biofeedback, meditation, dance, music and art therapies, prayer, and spiritual healing. They are based on an understanding that there is a strong mind-body connection and that our thoughts, feelings, and emotions impact our neurologic and immune systems. Psychoneuroimmunology, the study of the interconnectedness of the mind, nervous system, and immune system, provides a framework for understanding why and how mind-body interventions work. Biology-Based Therapies Biologically based therapies include herbal medicine, the use of essential oils (clinical aromatherapy), special diets, orthomolecular therapies (high-dose vitamins and use of minerals, such as magnesium), and use of biologic substances, such as shark cartilage and bee pollen. Herbs are the fastest-growing segment of the pharmaceutical industry. Sold as "dietary supplements," they may be purchased over the counter in health food stores, drugstores, supermarkets, and convenience stores. Although the research evidence is accumulating that demonstrates the therapeutic benefit of some herbs, there continues to be concerns about the lack of standardization of products and product purity. Manipulative and Body-Based Methods This domain includes chiropractic medicine, osteopathy, massage, rolfing (structural integration), and cranial-sacral therapy. Each of these approaches is based on manipulation and/or movement of the body. Energy Therapies The energy therapy domain includes both biofield therapy and electromagnetic therapy. Biofield therapies, such as therapeutic touch, healing touch, reiki, and qi gong, are intended to affect the energy fields that are believed to surround and penetrate the body. Bioelectromagnetic therapies include the use of magnets and pulsed fields. Use of CAM Therapies Within Nursing Use of complementary therapies in nursing extends back to the origins of modern nursing. Florence Nightingale described how the use of various therapies would improve the well-being of patients. For example, she suggested that music could be used to aid the recovery of the sick. Back rubs, a form of massage, were an integral part of all nursing care until recent years. Other therapies that have had wide use in nursing include imagery, prayer, reminiscence, active listening, presence, humor, and biofeedback. More recently, nurses have been leaders in the use of energy therapies, such as therapeutic and healing touch. A review of nursing journals, particularly clinically focused journals, reveals that nurses have conducted a considerable number of research studies to determine the efficacy of various complementary therapies. Although many of these studies have used small samples and may have other methodologic weaknesses, they provide direction for developing practice guidelines and for conducting future research. Nursing has documented that a number of complementary therapies are an integral part of nursing's body of knowledge. Considerable attention has been given to the multitude of complementary therapies that exist. Health professionals sometimes become overwhelmed with the variety and diversity of these therapies. What is critical is attention to the philosophy that underlies the majority of these therapies: holism and harmony. If a nurse approaches the use of complementary therapies as just adding another modality to one's armamentarium, the true value of complementary therapies is lost. What is needed is for practitioners to become immersed in the holistic, caring philosophy and administer complementary therapies from this perspective. Two therapies that have been used extensively in nursing and that characterize the holistic/caring philosophy are presence (being there for the person) and active listening. No clear directives are available that prescribe which of the complementary therapies should be taught in schools of nursing or continuing education programs. No health profession or discipline owns specific complementary therapies. An overarching guideline may be that if a therapy that falls within the scope of nursing assists a nurse to accomplish a patient outcome, then the therapy can be used.[13] The American Holistic Nurses' Association (AHNA) has developed a position paper on the role of nurses in the practice of complementary and alternative therapies. An excerpt of the position statement succinctly describes nurses' potential roles and responsibilities: The AHNA believes that although selected CAM therapies are appropriate interventions for use by nurses, the use of these interventions must be integrated into a comprehensive holistic nursing practice. Practicing within a holistic nursing framework does not imply competency in effectively and safely utilizing CAM therapies and practices. Nurses must be responsible for seeking, when necessary, additional education and experience and demonstrating clinical competency in all interventions used in their nursing practice. A nurse practicing as a therapist of a specific conventional or CAM therapy must have the education, skills and credentials ascribed for that therapy. The nurse also must operate within the legal scope of practice of the nurse's licensure and jurisdiction.[14] Medscape, 7/02 Integrating CAM for Heart Patients Nurses Perspective, 8/02 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.