Complementary and Integrative Therapies | Chapter 32 – Fundamentals of Nursing (11th)

Summary

The video explains how complementary, alternative, and integrative therapies can fit into holistic nursing care. These approaches may help address stress, chronic symptoms, and emotional or spiritual needs that conventional biomedical care may not fully meet. Nurses should discuss them openly with patients, use evidence and clinical judgment, and prioritize safety.

Key terms

• Conventional (allopathic or biomedical) medicine: Standard Western medical care, particularly effective for acute conditions such as infections, trauma, and surgical emergencies.
• Complementary therapies: Used alongside conventional medical treatment.
• Alternative therapies: Used instead of conventional treatment. A therapy’s category depends on how it is used: yoga for symptom relief alongside prescribed care is complementary; using it in place of prescribed treatment is alternative.
• Integrative health care: A coordinated, evidence-informed approach that combines conventional medicine with appropriate complementary therapies and considers the whole person—including mind, body, spirit, and community.
• Integrative nursing: A holistic approach grounded in caring, healing relationships and evidence-guided care for individuals, families, and communities.

Evidence is still developing for many therapies. Nurses should consider potential benefits and risks, the quality and history of the evidence, the patient’s circumstances, and cultural background.

Therapies discussed

Nursing-accessible approaches

These approaches may be taught or supported by nurses, but still require assessment, clinical judgment, and follow-up. They work best when patients participate and practice regularly.

Relaxation therapy

The relaxation response counteracts the stress response. It can lower heart rate, breathing rate, blood pressure, muscle tension, and oxygen consumption. The video associates chronic stress with physical effects such as headaches and digestive problems.

Two techniques are described:

• Progressive relaxation
  • Guide the patient to tense a muscle group, hold briefly, and then release it.
  • Move systematically through areas such as the face, arms, hands, abdomen, legs, and feet.
  • Encourage slow, deep abdominal breathing and noticing the difference between tension and relaxation.
• Passive relaxation
  • Quiet the mind and focus on slow breathing, without tensing muscles.
  • The patient may imagine warmth or heaviness moving through the body.
  • This may be more suitable when tensing would be tiring, such as for some patients with advanced illness.

Potential uses include easing anxiety, pain, muscle tension, treatment-related distress, and symptoms associated with chronic illness. The video also notes possible benefits for depression, shortness of breath, and nurses’ workplace stress. If relaxation intensifies symptoms or brings up new ones, stop, assess the patient, and notify the health care provider.

Meditation and breathing

Meditation focuses attention on one thing—such as the breath, a sound, an object, or a word—to quiet the mind and increase self-awareness. The four elements described are:

• A quiet place
• A comfortable position
• A receptive or passive attitude
• A focus of attention

The video reports possible benefits for blood pressure, anxiety, depression, distress, chronic pain, PTSD, mood, and quality of life. Regular practice requires self-discipline. Nurses should monitor patients taking antihypertensive, thyroid, or psychotropic medications, since meditation may increase medication effects and a prescriber may need to review doses.

Guided imagery and creative visualization

Imagery uses mental pictures to support well-being and may affect physical responses. A typical guided-imagery sequence is:

1. Begin with slow, deep abdominal breathing.
2. Have the patient picture a peaceful place or image.
3. Invite them to engage their senses: what they see, hear, smell, and feel.
4. They may imagine warmth entering with each breath and tension leaving.
5. Tailor the image to the patient and avoid images that could evoke negative memories.

Creative visualization is more self-directed: patients create and repeatedly picture a positive image related to a goal, sometimes pairing it with affirmations. The video describes uses for pain, stress, sleep, and symptoms associated with conditions such as asthma, cancer, sickle cell anemia, migraines, IBS, and rheumatoid arthritis. Monitor patients with asthma or COPD because imagery may occasionally increase airway constriction.

Therapies requiring specialized training

Nurses may need additional education or certification to provide these therapies. They should still understand them well enough to discuss options, screen for safety concerns, and refer appropriately.

Biofeedback

Electronic instruments give real-time visual or auditory feedback about processes such as muscle tension, skin temperature, heart rate, or brain waves. With coaching and practice, patients learn to influence these processes voluntarily. The video notes possible uses for headaches, urinary incontinence, fecal incontinence, and stroke recovery.

Consistent practice matters. Emotional distress may arise during sessions, and long-term practice may lower blood pressure or heart rate; monitor as appropriate.

Traditional Chinese medicine (TCM)

TCM views health as balance and harmony. Its concepts include yin and yang, opposing but interconnected forces, and qi (also rendered “chi”), a vital energy said to flow through pathways called meridians. TCM practitioners may use observation, questioning, listening, pulse palpation, and tongue examination.

Modalities mentioned include acupuncture, Chinese herbal formulas, tuina massage, moxibustion, cupping, tai chi, qigong, and dietary or lifestyle recommendations. The video notes evidence for tai chi improving balance and reducing falls in older adults, and some evidence for symptom relief in fibromyalgia.

A major concern is herbal-product quality and drug interactions. The video says Chinese herbs are generally sold as dietary supplements in the United States rather than regulated as drugs, so safety, purity, potency, and dosage may not be assured. Contamination and interactions with medicines—including anticoagulants and cardiovascular drugs—are concerns. Nurses should ask specifically about herbs and supplements.

Acupuncture

Acupuncture uses fine, sterile needles placed at specific points along meridians. Needles may be stimulated with heat or mild electrical current. The video reports evidence for certain kinds of pain and chemotherapy-related nausea and vomiting, as well as use for tension headaches and migraine prevention.

When performed by a well-trained, licensed practitioner using sterile, single-use needles, it is generally described as safe. Complications can include infection, faintness, bruising, nerve injury, or—rarely—organ puncture. Cautions include pregnancy, seizure or bleeding disorders, anticoagulant use, and skin infection near treatment points. Electroacupuncture is described as unsuitable for people with pacemakers, certain heart rhythm problems, epilepsy, or pregnancy.

Therapeutic touch (TT)

TT is an energy-based practice in which a practitioner uses their hands, often without touching the patient, with the intention of influencing an energy field. The five phases described are:

1. Centering: Become calm, present, and focused.
2. Assessing: Scan the area around the patient, often with palms held a few inches from the body, for perceived sensations such as warmth, coolness, pressure, or tingling.
3. Unruffling: Use downward strokes over or just above the body to “clear” or smooth the perceived energy field.
4. Treating or modulating: Direct energy toward areas perceived as depleted or rebalance areas perceived as excessive.
5. Evaluating: Reassess and ask the patient about their experience.

The video characterizes the research as mixed and inconclusive, with methodological criticisms, while noting some studies suggesting possible benefits for pain, anxiety, dementia-related function, or trauma symptoms. Assess for trauma history and sensitivity to touch—even noncontact gestures may feel threatening. Use particular caution with pregnant patients, newborns, and people with significant cardiovascular or neurological instability.

Pilates

Pilates is a mind-body movement system emphasizing core strength, posture, and controlled movement. Its six principles are centering, concentration, control, precision, flow, and breathing. It may improve strength, flexibility, coordination, balance, and functional status. The video mentions potential benefits for chronic back and neck pain and fall-prevention programs.

Chiropractic therapy

Chiropractic care focuses on the relationship between body structure—especially the spine—and function. Practitioners may use spinal manipulation or adjustments and may also recommend heat, ice, massage, exercise, or lifestyle changes. The video describes its use for back and neck pain and headaches, and notes research support for acute and subacute low back pain.

Contraindications include certain infections, spinal conditions, fractures, dislocations, inflammatory arthritis, and severe osteoporosis. Possible effects range from temporary headache or soreness to rare serious complications, such as vertebral artery dissection or a herniated disc. Patients should verify a practitioner’s credentials and discuss risks and benefits.

Natural products and herbal therapies

The video stresses that “natural” does not necessarily mean safe. In the United States, many supplements are sold as dietary supplements and are not subject to the same premarket drug regulation for safety and effectiveness. Ingredients and concentrations may vary; contamination or undeclared pharmaceuticals may occur.

Examples discussed include fish oil, glucosamine, probiotics, melatonin, echinacea, cranberry, garlic, ginseng, and ginkgo. Specific examples and cautions include:

• Aloe vera: Used topically for burns or skin inflammation; oral use may act as a strong laxative and interact with other laxatives.
• Garlic: Used for cholesterol or blood pressure; may inhibit platelets and increase bleeding risk with warfarin, aspirin, clopidogrel, and other blood thinners.
• Valerian: Used for sleep or mild anxiety; may cause central nervous system depression and should not be combined casually with sedatives, alcohol, or some antihistamines.
• Calamus and comfrey: Identified as unsafe because of risks including carcinogenic compounds and organ damage.
• Ephedra (ma huang): Described as a potent stimulant with serious risks, particularly for people with hypertension, heart disease, diabetes, or thyroid conditions. The video says it has been banned from supplements by the FDA.

The video recommends that consumers:

• Choose reputable manufacturers that provide the plant’s scientific name, manufacturer details, lot number, and expiration date.
• Look for third-party verification, such as a USP Verified mark.
• Tell their doctor and pharmacist about every supplement or herb they use.
• Remember that supplements are chemicals and may interact with prescription medicines.

Nursing responsibilities and clinical application

Nurses are well positioned to support informed decisions because of their frequent contact with patients and the trust they build. Key responsibilities include:

• Ask directly and routinely about complementary therapies, including herbs, supplements, yoga, meditation, and chiropractic care—not only prescription medications.
• Find reliable evidence about potential benefits, risks, precautions, and which patients may be appropriate for a therapy.
• Explain benefits and risks in plain language, understand practitioner credentials, and make referrals when appropriate.
• Help patients distinguish situations requiring conventional medical evaluation—such as acute chest pain or a suspicious lump—from situations where a complementary therapy may be used as an adjunct for symptom management.
• Follow the state nurse practice act and remain within legal scope.

The case example concerns Carmen, a 48-year-old with stage III breast cancer hospitalized with a suture infection. She is fatigued, fearful, and worried about drowsiness from pain medication. The suggested approach is to assess her physical and emotional needs, then consider less strenuous options such as passive relaxation, guided imagery, breathing exercises, or brief mindfulness. The nurse should tailor the approach to her condition, involve her in the choice, and use it to support comfort and coping—not replace needed medical care.

Speakers and sources featured

• Speakers: Two unnamed presenters in a conversational, podcast-style format.
• Primary source identified: Fundamentals of Nursing, 11th edition, by Potter, Perry, Stockert, and Hall.
• Other organizations or references mentioned: American College of Physicians; The Joint Commission; the U.S. Food and Drug Administration (FDA); and the USP Verified dietary supplement mark.