This document provides an overview of a seminar presentation on complementary and alternative medicine (CAM) and nursing practice. It defines CAM and discusses the most commonly used CAM therapies. It outlines safety concerns regarding regulatory issues and potential interactions. It also discusses nursing considerations for assessing CAM use, educating patients, and ensuring safety. Nurses need knowledge of CAM to understand their patients' health choices and provide guidance on reliable sources of information.

1. COMPLEMENTARY
AND ALTERNATIVE
MEDICINE (CAM) AND
NURSING PRACTICE
SEMINAR PRESENTATION
BY SAMBO,NICKY MARIAH
SPS/19/MNS/0012
MSC NURSING SCIENCE
BAYERO UNIVERSITY KANO

2. COUSRE OUTLINE
Introduction
Definition of terms
Why patients use CAM
The Most Commonly Used CAM
Safety concerns in the use of CAM
• Regulatory issues in the use of
CAM
• Nursing considerations in the
use of CAM
• Why Nurses need to learn about
CAM?

3. INTRODUCTI0N
• Complementary and alternative medicine (CAM) includes many
practices and products used to promote and maintain health and
wellness or treat human illness . “Patients are using them. Although
some healthcare providers specialize in CAM, individuals can buy and
use CAM treatments without medical advice or prescriptions .
• Intercultural exchanges and CAM use have increased worldwide.

4. CONT’D
• Time and time again, research finds that the majority of the
population is using integrative health products, and this rate is much
higher for patients with higher socioeconomic status and/or patients
who suffer from chronic health conditions,” says Jessie Hawkins.
“Without guidance from their care providers, patients are left to self-
educate through online sources. This results in reduced efficacy at
best and injury at worst.”

5. • All therapies were once considered alternative—even antibiotics.
• We know that there is far more to healing than just applying a
chemical compound or mechanical procedure to the human form—
that intrinsic mind and spirit aspect can be a real determining factor
in whether or not a patient gets better.

6. TRADITIONAL, COMPLEMENTARY AND
ALTERNATIVE MEDICINES IN NIGERIA
Traditional, Complementary and Alternative Medicines Department
came into being following the approval by the Head of Service in a
letter OHCSF/MSO/72/IV/132 dated 4th April, 2018. The activities of
the Traditional, Complementary and Alternative Medicines
Department commenced fully in July 2018 In Nigeria.

7. DEFINITIONS
• Complementary and alternative medicine (CAM): The National Center
for Complementary and Alternative Medicine (NCCAM) defines CAM
as "a group of diverse medical and healthcare systems, practices, and
products that aren't generally considered part of conventional
medicine." Sometimes called Western or allopathic medicine,
conventional medicine is that practiced by healthcare providers who
are medical doctors or nurses etc.

8. COMPLEMENTARY MEDICINE
• When a health care provider
uses complementary medicine,
it’s used in conjunction with
common Western medicine
• CAM may complement
conventional medicine when
they're used together.
When such a combination is
backed by high-quality
evidence, it's known as integrative
medicine.

9. ALTERNATIVE MEDICINE
• When the provider uses
alternative medicine, it’s used
in place of common, Western
medicine. CAM may be used as
an alternative to conventional
treatment
• Both words refer to non-
mainstream treatments such as
aromatherapy, meditation,
massage

10. WHY PATIENTS USE CAM
• Relieve symptoms
• Ease treatment side effects
• Improve quality of life
• Seem natural and non toxic
• Comfort and satisfaction from the touch, talk and time
• Might help control or cure their cancer

11. The Most Commonly Used CAM
-Acupuncture,
-Reiki
-Aromatherapy,
-Hypnosis, massage therapy,
-Meditation
-Therapeutic touch, and
-Vitamins/herbal
supplements.
-Tai Chi.

12. Reiki
• Reiki is a form of complementary
medicine; there’s evidence it can
reduce daily stress and help with
management of some chronic diseases.
Reiki is an energy healing
technique that involves a
Reiki master using gentle
hand movements to guide
the flow of healthy energy
through the body to reduce
stress and promote healing.

13. APPLICATIONS OF SOME OF THE CAMS
AROMATHERAPY OILS
• Aromatherapy oils are now used
post-op in some hospitals to
reduce anxiety and pain after
surgery so that patients will
require less pain medications.
Meditation
• Meditation has been used in
psychiatry through progressive muscle
relaxation, guided imagery, and
mindfulness meditation to augment
the practices of cognitive behavioral
therapy and dialectic behavioral
therapy.

14. TAI CHI
• Tai Chi has been shown to
improve balance and flexibility for
older adults and thereby reducing
falls in long-term care and
community settings,” explains
Baxter (2018).
HERBAL SUPPLEMENTS
• Herbal supplements such as CBD
oil have shown some efficacy in
reducing seizures, pain, and
anxiety.

15. HYPNOSIS
• Hypnosis is a treatment that is
offered for smoking cessation
and obesity treatment.
Massage therapy and
acupuncture
• Massage therapy and
acupuncture have been
demonstrated to be beneficial in
addiction treatment

16. Therapeutic touch
Therapeutic touch has
been demonstrated to
help with pain in some
instances by
manipulating the energy
fields that surround the
body.”

17. STEM CELL
• They have the potential to repair,
restore, replace, and regenerate
cells, But unproven stem cell
therapies can be particularly unsafe.
• Attendees at a 2016 FDA public
workshop discussed several cases of
severe adverse events. One patient
became blind due to an injection of
stem cells into the eye. Another
patient received a spinal cord
injection that caused the growth of a
spinal tumor.
stem cells are the cells
that develop into blood,
brain, bones, and all of
the body’s organs. Stem
cells have been called
everything from cure-alls
to miracle treatments.

18. SAFETY CONCERN 1.
New products may appear in a health food store without local
community understanding or guidelines for proper use. The nurse
acquiring knowledge about what's safe and effective presents an
ongoing challenge to practitioners everywhere. For this reason, the
World Health Organization (WHO) has encouraged national dialogue
and policy development to prevent misunderstandings, inappropriate
use, and harmful indications

19. SAFETY CONCERN 2
• 2. Very limited research on the use of herbs and dietary supplements such
as St. John's wort, gbogbonse, ciwo Tara, agbo, Echinacea, ginkgo biloba,
Stem Cell, glucosamine, chondroitin, and red yeast rice has produced
conflicting results.
• Examples of unsafe herbal supplements include comfrey, which can
damage the liver, and licorice root, which in large doses may alter Blood
Pressure

20. SAFETY CONCERN 3.
• Another safety concern is that some patients don't tell their
healthcare professional about their CAM therapy or fail to provide a
complete list . Consequently, they may experience unexpected
interactions with prescribed drugs or treatment failure. They may not
disclose CAM therapy because they don't consider these products to
be medications or they fear criticism or lack confidence in the
healthcare professional's knowledge about CAM

21. REGULATORY ISSUES
• The FDA approves an over-the-counter (OTC) drug only when it's
proven safe and efficacious for treating the indications for which it's
marketed. The container must display a prominent standardized label
with FDA-required product information and instructions for safe use.
• In contrast, most herbal products distributed in tablet or capsule form
lack similar controls and labels. Patients may assume they're safe
because they look like drugs and are often sold at pharmacies. Herbs
sold as dietary supplements are subject to alternative regulations, but
proof of efficacy or safety isn't required

22. REGULATORY ISSUES CONT…
• A therapeutic herbal supplement may be composed of a plant or botanical
or a portion of a plant's roots, leaves, flowers, or seeds. Although herbal
products are purchased OTC, their manufacture and delivery to the
consumer differ from that of other OTC drugs that are fully FDA-controlled.
According to federal regulations, herbs are considered dietary supplements
as defined by the Dietary Supplement Health and Education Act of 1994.
Companies are required only to follow good manufacturing practices and
to post a label stating that the product hasn't been evaluated by the FDA

23. REGULATORY ISSUES CONT…
• The NCCAM cautions consumers that a herbal supplement may
contain more or less than the labeled amount of its ingredient. It may
also contain many unexpected or unknown ingredients, including
other plant species, pesticides, metals, or prescription drugs.
Although the FDA doesn't routinely screen herbal supplements for
these ingredients, if any are reported, the FDA may issue a warning to
the manufacturer or in some cases ban the product's sale.

24. REGULATORY ISSUES CONT…
• In 2006, the U.S. Congress passed Public Law 109-462, known as the
Dietary Supplement and Nonprescription Drug Consumer Protection
Act. This act requires manufacturers, distributors, and importers to
self-report any adverse events to the FDA. Events such as related
injuries, hospitalizations, or birth defects traceable to a herb or
dietary supplement must also be reported.

25. REGULATORY ISSUES CONT…
Hospitalizations, or birth defects traceable to a herb or dietary
supplement must also be reported.
The NCCAM cautions consumers that a herbal supplement may contain
more or less than the labeled amount of its ingredient. It may also
contain many unexpected or unknown ingredients, including other
plant species, pesticides, metals, or prescription drugs

26. REGULATORY ISSUES
• FDA approves an over-the-counter (OTC) drug only when it's proven safe
and efficacious for treating the indications for which it's marketed. The
container must display a prominent standardized label with FDA-required
product information and instructions for safe use.
• In contrast, most herbal products distributed in tablet or capsule form
lack similar controls and labels. Patients may assume they're safe because
they look like drugs and are often sold at pharmacies. Herbs sold as
dietary supplements are subject to alternative regulations, but proof of
efficacy or safety isn't required.

27. NURSING CONSIDERATIONS
• During medication reconciliation, determine whether patients use or
intend to use CAM, including herbal supplements.
• Assess their knowledge of their health status, diseases, and
treatments.
• Identify any potential interactions of drugs and herbal remedies and
document them in the medical record, then follow up with the
patient and provider as indicated

28. NURSING CONSIDERATIONS
• Consider a patient's economic constraints and cultural preferences.
• Help educate patients about how to make informed choices. Evaluate their
understanding of the difference between OTC "drugs" and "food supplements,"
such as herbs provided in tablet or capsule form that are unregulated and lack
NAFDA approval.
• Caution patients about the potential for fraudulent advertising, especially on the
Internet.
• Warn patients that advertisers who lack scientific data to support their claims
often use testimonials from users.
• Encourage patients to fully disclose their CAM supplement use to their
healthcare providers.

29. NURSING CONSIDERATIONS IN THE USE OF CAM
• Encourage patients to share, question, and exchange ideas and
practices about their healthcare choices. Be prepared to help patients
express their beliefs and preferences, identify dependable
information, and avoid making uninformed decisions and purchases
• “Avoid a one-size-fits-all approach. Like medications, what works for
one person may not work for another

30. WHAT NURSES NEED TO KNOW ABOUT
CAM
• Patients are using alternative therapies, and that use is increasing
• Don’t be like your patients and simply look up information about CAM
online .
• If you want to implement it into your practice, it’s necessary for you
to get some kind of formal education
• Integrative health is a concept that is rapidly growing and expanding
worldwide
• “Continuing education in integrative health is one of the best career
investments a nurse can make

31. CARING FOR SPECIAL POPULATIONS
Older adults.
• Researchers assessed OTC medication and supplement use from
2005 to 2006 in community-dwelling residents ages 57 to 85. One out
of 25 older adults who combined prescription and nonprescription
medications was found to be at risk for major drug-drug interactions.
Supplements these older adults used included calcium, vitamin D,
glucosamine-chondroitin, omega-3 fatty acids, garlic, coenzyme Q,
and saw palmetto

32. CONT’D
• In a national health survey of adults over age 65, herbs were found to
be an important factor in self-managed healthcare. Predictors of
herbal use included gender, ethnicity, culture, and level of education.
Educate older adults about potential drug-drug interactions, including
those caused by mixing prescription or OTC drugs and herbs.

33. CONT’D
• However, they discovered that over half of the CAM users didn't
reveal their CAM use to their primary care providers. More research
needs to be done to predict which patients are less likely to disclose
their use of CAM. Always query older patients about their CAM use.

34. PREGNANT PATIENTS
The use of herbal preparations in pregnancy hasn't been directly measured and
isn't well understood, but an integrative literature review and meta-analysis from
1995 to 2006 found that pregnant women use a wide variety of OTC drugs and
herbal supplements.
More research is needed about the use of prescription and OTC drugs during
pregnancy, but clinical trials involving pregnant patients raise ethical considerations
due to fetal risks, making evaluation difficult. When a medication's safety during
pregnancy hasn't been established, a pregnant patient shouldn't use it unless its
benefit is clearly greater than any potential fetal risk

35. PEDIATRIC PATIENTS
• Oral CAM therapy in children also needs further study. Little research
supports the efficacy of herbs for chronic diseases such as asthma in
pediatric patients.
• CAM use might be high in children with asthma who have adverse
reactions to steroids, which drives their parents to seek CAM. Ask
parents if they administer any CAM products or supplements to their
children.
• Advise them to get their pediatric healthcare provider's advice before
doing so.

36. SUMMARY
• Medicine is evolving, as is the state of health. It’s critical to explore options
and be at the forefront of new therapies
• It is essential that nurses have knowledge about common CAM and obtain
information to elicit use of CAM therapies from the patient history.
• It’s important to help patients get information from reliable sources and to
know if a suggested alternative treatment, such as herbal supplements,
may interfere with the medications they are currently prescribed or may be
detrimental to their health.

38. RESOURCES FOR CAM
• Obtain information about potential interactions with CAM
at http://nccam.nih.gov/health/herbsataglance.htm.
• American Holistic Nurses Association
• Complementary and Alternative Therapies in Nursing (8th ed.), edited
by Ruth Lindquist, Mary Fran Tracy, and Mariah Snyder
• International Journal of Palliative Care Nursing
• Journal of Holistic Nursing
• National Center for Complementary and Integrative Health
• Therapeutic Touch International Association

39. REFERENCES
1. NCCAM. About dietary supplements.
2012. http://nccam.nih.gov/health/supplements/wiseuse.htm. [Contex
t Link]
2. World Health Organization. Guidelines on developing consumer
information on proper use of traditional, complementary and
alternative medicine.
2004. http://apps.who.int/medicinedocs/pdf/s5525e/s5525e.pdf.
3. U.S. Food and Drug Administration. About FDA. Drugs. FDA basics.
2012. http://www.fda.gov/AboutFDA/Transparency/Basics/ucm192696
.htm.

40. REFERENCES
• NCCAM. About dietary supplements.
2012. http://nccam.nih.gov/health/supplements/wiseuse.htm. [Cont
ext Link]
• Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST.
Use of prescription and over-the-counter medications and dietary
supplements among older adults in the United States. JAMA.
2008;300(24).
• Nigerian Institute of Medical Research (2018). Traditional,
complementary and alternative medicine.