Pushing the Point: Integrating Acupressure & Oriental Medicine in Psychiatric Nursing


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With the rising costs of care, decreased
reimbursement for services, and shortage of
mental health clinicians, patients and
providers are increasingly researching and
incorporating integrative therapies as part of a
holistic care plan. A review of the literature
revealed a growing evidence base for the
integration of Traditional Chinese Medicine
(TCM) therapies with allopathic medicine. This
has prompted nursing schools across the
country to include education on TCM in their
curriculums, encouraged hospitals and clinics
to add TCM therapies to their list of
psychiatric services, and resulted in
development of new protocols for addiction,
PTSD, and pain management. Acupressure, a
component TCM, is a non-invasive, integrative
modality that can help alleviate common
symptoms such as stress, anxiety, depression,
mental fatigue, and insomnia, while reducing
barriers of cost, time, and deleterious
medication side effects frequently found in
PMH treatment. A basic understanding of TCM
theory is necessary for nurses to teach and
use acupressure effectively in the inpatient
and outpatient settings. The session will
review the function and energetics of common
acupoints easily integrated into
Psychiatric/Mental Health nursing practice,
provide a live demonstration of acupressure
techniques, and include supervised practice
time to develop beginning skills and
experience the benefits.

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  • Comprehensive training in traditional differential diagnosis and proper treatment methods requires that a Diplomate of Acupuncture (NCCAOM) completes three to four academic years of education at the master’s degree level in an acupuncture program accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). ACAOM is the only accrediting body recognized by the United States Department of Education as the authority for quality education and training in acupuncture and Oriental medicine. In addition to graduation from an ACAOM accredited program, a Diplomate of Acupuncture (NCCAOM) must demonstrate professional competency by passing NCCAOM certification examinations in Foundations of Oriental Medicine, Acupuncture, and Biomedicine.medical history gathering, safety, and ethics, and recognition of when to refer patients to other health care professionals or consult with other medical practitioners.
  • 42 states no requirement for practiceParity StatesPN (200),Maryland (250), LA, NJ & NY (300)American Board of Medical AcupunctureMD/DO only - 42 states no requirement for practice100 clinical hours, 200 class hours, 500 treatments, board examCertification not required to practice in any state10 year certification, 150 CEUs requiredBattlefield AcupunctureWeekend seminar Pain management, auricular(NADA)Addiction and emergency responseAuricularNurses mentioned in one state only
  • Loosely translated Qi is “life force energy” or “life activity”When Qi flows freely through the meridians, the body is healthy. Blocks or imbalance in the flow cause illness
  • Meridians are energy lines where Qi flows through the body similar to how blood flows through the cardiovascular system or electrical impulses are conducted through the brain
  • 7 EmotionsJoy (Over-excitement, Manic) - Heart and Fire ElementSlows the Qi
Fear controls Joy (Water controls Fire)PalpitationsInsomniaUnclear ThinkingMania, Disturbed Shen (possibly manic, risk-taking)Heart AttackExample:Migraine headache caused by sudden joy from receiving good news. Anger (Rage, Resentment, Frustration) - Liver and Wood ElementMakes Qi Ascend
Grief controls Anger (Metal controls Wood)Vertex HeadacheDizzinessBlurry VisionBlood Pressure is RaisedStrokeInternal Wind (trembling from anger or an onset of Wind symptoms such as a seizure)Pain in the Costal Region Especially in the LiverLiver attacks Spleen and StomachSpleen Qi XuRebellious Stomach QiBleedinga. Nosebleeds common because Qi is ascending
b. Vessels Burst Because Spleen is WeakLiver counterattacks LungAsthmaLiver Can harm Gall Bladder (Yin Yang paired Organ)Inability to make decisions (I'm so angry, I can't think straight) – stuck!Grief or Sadness - Lung and Metal ElementWeakens, Depletes, or Dissolves the Qi
Joy Controls Grief (Fire controls Metal)Tightness in the Chest (SOB)Excessive CryingAsthmaFrequent Colds and Flu (Wei Qi is weakened)Skin problemsGrief Affecting the HeartZong Qi is weakened affecting HeartMetal counterattacking FireCirculation Becomes Impaired – excema, superficial skin, dysthymia/eore, chronic immunity so being sick is a state of mind Worry and Pensiveness - Spleen and Earth ElementStagnates or Knots the Qi
Wood controls Earth (Anger controls Worry and Pensiveness)Harms the Heart (Son Depleting the Mother), and ultimately the ShenPalpitationsSpleen Qi DeficiencyHeart Blood Deficiency (GAD/Depression – “dia-depression”)Fright/Fear (Terror, Shock) - Gallbladder and Wood ElementFright Confuses or Scatters the Qi
Grief controls Fright (Metal controls Wood)Note: There is a difference between fear and fright: Fright: startling, scared by things that are present. Fear: deeper, more chronic; scared by things not presentIndecisiveConfusedLack CourageHarms the Kidneys (son depleting mother; Wood depleting Water)Long-term fright turns to fear (child abused once causes fright; ongoing abuse leads to fear of when it will happen again)Harms Liver (Gallbladder and Liver are Yin Yang paired organs)become angry at what frightened us (a mother becomes angry with a child that loves to startle her as a joke)Harms the Heart (Wood fails to nourish Fire)Fright unroots the ShenFear - Kidneys and Water ElementMakes Qi Descend
Concentration and thinking controls Fear (Earth Controls Water)Note: Less sudden, more chronic and internal than frightKidneys are weakened when living in fearmight lose bladder controlHarms Liver and Gallbladder (Water not nourishing Wood)DepressionIndecisiveConfusedLack CourageHarms the Heart (Water not controlling Fire)Heart Fire blazes out of controlanxiety, restlessness
  • Stahl SourceBranches may look the same, bu the roots are not
  • Phlegm misting heart orifice
  • Acupuncture styles:TCM, Japanese,Korean,5 elements - Wood, Fire, Earth, Metal, Water,Medical ,Auricular
  • http://psycnet.apa.org/journals/pst/47/3/385/
  • 40 conditions
  • No description of treatments other than points used
  • GB20/21 – Anmian
  • http://apps.who.int/medicinedocs/en/d/Js4926e/5.html
  • Pushing the Point: Integrating Acupressure & Oriental Medicine in Psychiatric Nursing

    1. 1. Pushing the Point: Integrating Acupressure & Oriental Medicine inPsychiatric Nursing Practice Jaclyn Engelsher, DNP Family & Mental Health Nurse Practitioner, Certified Acupuncturist Adam Margolis, DNPc Adult Nurse Practitioner, Licensed Acupuncturist
    2. 2. DISCLOSUREThere are no potential conflicts of interest with a commercial entity,a company, or a business.
    3. 3. Objectives Describe the theory and benefits of using Traditional Oriental Medicine techniques in the psychiatric and mental health setting Identify the functions of ten commonly used acupoints that can be integrated into treatment plans of patients with psychiatric and mental health disorders Discuss methods for integrating TCM modalities with conventional PMH nursing practice.
    4. 4. DISCLAIMERThis session introduces basic evidenced-based Traditional ChineseMedicine (TCM) theory and techniques with practical applicationdemonstration for informational and educational purposes. Pleasecheck with your individual state to determine what aspects arecovered in your scope of practice and seek NCCAOM certifiedpractitioners in your area for acupuncture referral.
    5. 5. Comprehensive Training Education  Masters degree program 3-4 yrs approved by Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM)  1490 hrs acupuncture/2050 comprehensive  Doctoral program available, not required Certification  National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM)  Clean Needle Technique  Biomedicine, Foundations, Point Location, Herbology Licensing  Title varies by state: DOM, LAc/Lic.Ac, CAc, RAc, DA, ADS, AP  No practice acts: AL, KA, ND, OK, SD, WY (NCCAOM, 2012)
    6. 6. Scope of Practice VariabilityParity states: MT, SC, HIMD/DOChiropractorsPhysician AssistantsDentistsPodiatristsNaturopaths
    8. 8. Yin and Yang
    9. 9. Qi
    10. 10. Meridians
    11. 11. Meridians (Acupuncture Media Works, 2012)
    12. 12. Statement of Fact Yibing tongzhi, tongbing yizhi“Same disease different treatment. Different disease, same treatment” Stahl: Dimensional Diagnosis
    13. 13. Acupuncture Assessment & Diagnoses An individual’s patterns and their unique set of signs and symptoms are treated, not their disease (nursing diagnosis) Four examinations Looking - inspection with tongue diagnosis Listening/Smelling – mental status exam Asking – CC, HPI, 10 questions (ROS) Feeling – meridians and pulse (Acupuncture Media Works, 2012)
    14. 14. Treatment 3 Free Therapies Nutrition Movement Rest (Mental and Physical) Acupuncture Moxibustion Cupping Tui Na/Acupressure Herbal Therapy Energy Work – Tai Chi, Qi Gong
    15. 15. Treatment ProgressionIndividualized treatment planSymptomatic improvements often experienced within the first few sessionsLong-term abatement after 1 or more courses of treatment (antibiotic resistance)Treatments generally weekly, then prn once patterns resolved/managed
    16. 16. RESEARCH
    17. 17. Conditions Treated May work in conjunction with western medicine or, commonly, when other options have failed and/or have undesirable side effects. World Health Organization  Pain of any kind from any cause  Psychological conditions – depression, anxiety, insomnia  Women’s Issues – fertility, pms, menstrual problems, cysts, fibroids, endometriosis  Immune/Respiratory Issues – allergies, asthma, common cold, recurrent infections  Gastro-Intestinal Issues – constipation, reflux, digestive issues, etc. (World Health Organization, 2003)
    18. 18. Effectiveness of acupressure for residents of long-term care facilities with insomnia: A randomized controlled trial n=50 randomized to real acupressure or sham acupressure (single blinded) at point Shen Men on wrist Five minute administration by trained assistants at bedtime for 5 consecutive weeks Athens Insomnia Scale – Taiwan form (AIS-T) administered weekly at baseline, during 5 week intervention, and after intervention 0-24 scale, >6 indicates insomnia (Sun, Sung, Huang, Cheng, & Lin, 2010)
    19. 19. True v. Sham Acupressure252015 True Acupressure10 Sham Acupressure50 Week Week Week Week Week Week Week 1 2 3 4 5 6 7 (Sun, Sung, Huang, Cheng, & Lin, 2010)
    20. 20. The effect of acupressure on quality of sleep in Iranian elderly nursing home residents N=90 randomized to acupressure (n=25), sham acupressure (n=26), and control/SOC (n=26) Mean ages:  Acupressure: 75  Sham: 74  Control: 77 Acupressure administered 3 times/week for 4 weeks at points Nei Guan, Shen Men, ear Shen Men, Yong Chuan, San Yin Jiao, and An Mian Sham group had stimulation at non-acupressure points Pittsburgh Sleep Quality Index (PSQI)  >5 indicates poor sleep (Reza, Kian, Pouresmail, Masood, Bagher, & Cheraghi, 2009)
    21. 21. Global PSQI1412108 Acupressure6 Sham Acupressure Control420 Pre-intervention Post-intervention (Reza, Kian, Pouresmail, Masood, Bagher, & Cheraghi, 2009)
    22. 22. The effect of acupressure on sleep quality in hemodialysis patientsN=48 participants randomized to acupressure and control (SOC)Fifteen minute intervention starting one hour after beginning hemodialysis 3 days per week for 4 weeksShen Men, He Gu, San Yin JiaoPSQI (Shariati, Jahani, Hooshmand, & Khalili, 2012)
    23. 23. Global PSQI121086 Acupressure Control420 Pre-intervention Post-intervention (Shariati, Jahani, Hooshmand, & Khalili, 2012)
    24. 24. Effect of acupressure on preoperative anxiety: A clinical trialN=70 randomized to true (n=35) or sham (n=35) acupressureYin Tang and ear Shen Men v. non- traditional points on the forehead and ear10 minutes of stimulationAnxiety VAS, BP, HR, RR measured before and after the intervention (Valiee, Bassampour, Nasrabadi, Pouresmaeil, & Mehran, 2012)
    25. 25. Anxiety Scores (VAS)7654 Acupressure3 Sham Acupressure210 Pre-intervention Post-intervention (Valiee, Bassampour, Nasrabadi, Pouresmaeil, & Mehran, 2012)
    26. 26. Effect of acupressure on nausea, vomiting, anxiety, and pain among post- cesarean section women in TaiwanN=104 participants assigned to treatment (acupressure) or control (SOC) groupsTwenty minutes digital stimulation of point Nei Guan administered the night before CS, 2-4 hours post CS, and 8-10 hours post CSVisual Analog Scale for Anxiety (VASA) and State-Trait Anxiety Inventory (STAI)
    27. 27. VASA7654 Acupressure3 SOC210 Preop 2-4h postop 8-10h postop (Chen, Chang, & Hsu, 2005)
    28. 28. STAI60504030 Acupressure SOC20100 Preop 2-4h postop 8-10h postop (Chen, Chang, & Hsu, 2005)
    29. 29. Challenges in Acupressure ResearchStandardized treatments v. heterogeneity of practiceAlternative diagnostic approachesControls/blindingFunding
    30. 30. APPLICATION
    31. 31. Acupressure TechniqueLocate the pointThumb/finger, pencil eraser, dowel, piezo, moxa warmer, tuning forkPress, tap, or massage point 30-60 seconds
    32. 32. (Acupuncture Media Works, 2012)
    33. 33. Anmian & Feng Chi (Acupuncture Media Works, 2008)
    34. 34. Jian Jing (Acupuncture Media Works, 2008)
    35. 35. Tan Zhong
    36. 36. Nei Guan
    37. 37. He Gu (Acupuncture Media Works, 2008)
    38. 38. Shenmen (Acupuncture Media Works, 2008)
    39. 39. Shao Chong (Acupuncture Media Works, 2008)
    40. 40. Zu San Li (Acupuncture Media Works, 2008)
    41. 41. San Yin Jiao (Acupuncture Media Works, 2008)
    42. 42. Taixi Location: In the depression between the tip if the medial malleolus and Achilles tendon Functions: Insomnia, agitation, back pain, headache, dizziness. (Acupuncture.com, 2010)
    43. 43. Tai Chong
    44. 44. Yong Quan Location: In the depression of the anterior third of the sole when the foot is in plantar flexion. Function: Loss of consciousness, headache, mania, dizziness, psychosis, insomnia (Acupuncture Media Works, 2008) (Acupuncture.com, 2010)
    45. 45. Qi Gong Exercises
    46. 46. Food Therapy
    47. 47. Lung
    48. 48. Spleen (Acupuncture Media Works, 2008)
    49. 49. Heart
    50. 50. Kidney (Acupuncture Media Works, 2008)
    51. 51. Liver (Acupuncture Media Works, 2008)
    52. 52. Important Links Finding a qualified acupuncturist: www.NCCAOM.org State Laws: https://www.acufinder.com/Acupuncture+Laws General acupuncture information: www.Acupuncture.com Research, news, CEUs: www.HealthCMI.com Reading List & Resources: www.OneDNP.com Supplies: www.lhasaoms.com
    53. 53. References Acupuncture Media Works, (2008). Patient education. Retrieved from http://www.acupuncturemediaworks.com/category_s/144.htm Acupuncture.com, (2010). Acupuncture point location. Retrieved from http://www.acupuncture.com/education/points/index.htm Chen, H., Chang, F., & Hsu, C. (2005). Effect of acupressure on nausea, vomiting, anxiety, and pain among post-cesarean section women in Taiwan. Kaohsiung J Med Sci, 21(8), 341-350. NCCAOM, (2012). NCCAOM certification in oriental medicine. Retrieved from http://www.nccaom.org/applicants/eligibility- requirements Reza, H., Kian, N., Pouresmail, Z. Masood, K., Bagher, M., & Cheraghi, M. (2009). The effect of acupressure on quality of sleep in Iranian elderly nursing home residents. Complementary Therapies in Clinical Practice, 16, 81-85. Shariati, A., Jahani, S., Hooshmand, M., & Khalili, N. (2012). The effect of acupressure on sleep quality in hemodialysis patients. Complementary Therapeutics in Medicine. Sun, J., Sung, M., Huang, M., Cheng, G, & Lin, C. (2010). Effectiveness of acupressure for residents of long-term care facilities with insomnia: A randomized controlled trial. International Journal of Nursing Studies, 47, 798-805. Valiee, S., Bassampour, S., Nasrabadi, A., Pouresmaeil, Z, & Mehran, A. (2012). Effect of acupressure on preoperative anxiety: A clinical trial. J Perianesth Nurs, 27(4), 259-266. World Health Organization (2003). Acupuncture: Review and analysis of reports on controlled clinical trials. Geneva.