Culture and CAM (Complementary and Alternative Medicine) by thegza

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									Culture and CAM
(Complementary and
Alternative Medicine)


        Dr. Norma Cuellar
       Assistant Professor
        School of Nursing
    University of Pennsylvania
What is difference?
   Complementary
   Alternative
       What is CAM? (1997)
   “A broad domain of health resources that
    encompass health systems, modalities, and
    practices and their accompanying theories and
    beliefs, other than those intrinsic to the dominant
    health system of a particular society or culture in a
    given historical period.”
   “CAM includes all practices and ideas self-defined
    by their users as preventing or treating illness or
    promoting health and well-being.”
   “The CAM domain is not always sharp and fixed.”
        5 Domains from NCCAM
Alternative        Ayurveda, Chinese, Native American, Aboriginal, African,
Medical            Middle Eastern, Tibetan, Central and South American cultures,
Systems            Homeopathy, Naturopathy

Mind-Body          cognitive-behavioral approaches, meditation, hypnosis, dance,
Interventions      music, art therapy, prayer, mental healing
Biological         dietary supplements, herbs, orthomolecular (varying
Based              concentrations of chemicals, such as, magnesium, melatonin, and
Therapies           mega-doses of vitamins), individual biological therapies (use of
                    laetrile, shark cartilage, bee pollen).
Manipulative       chiropractic, osteopathic, manipulation, massage
And Body-
Based Methods
Energy Therapies   Qi gong, Reiki, therapeutic touch, bioelectromagnetic-based
                   therapies (pulsed fields, magnetic fields, or alternating current
                   or direct current fields)
1800 different CAM
modalities
Who is using CAM?
   Eisenberg Study in 1998
       42.1% us some form of CAM
           Women
           Well educated
       46.3% use an alternative practitioner
       Spend $21.2 billion dollars out of
        pocket
           This exceeds out of pocket expenses for
            hospitalizations!
Why are people using
CAM? (Stephen Strauss)
   PUSH
       Dissatisfaction with health care providers
        and medical outcomes
       Side effects of drugs and treatments
       High health costs
       Technology
       Lack of control in their own health care
        practices
       Time spent with practitioner
PULL Factors
   Looking for “cures”
   Want to use “natural” products
   Patient feels empowered
   Focus on spirituality and emotional
    well-being
   Health Care Provider provides the
    3 T‟s (Dr. Strauss): touch, talk,
    time
        Why should nurses care?
   Nurses generally have little knowledge
    about CAM
       Not included in health education
   A more culturally diverse population
    will bring in different/alternative
    health care practices
   Outcomes of CAM with conventional
    treatments
20th century
   The “science” of medicine
   Cultural practices and CAM have
    become secondary to new antibiotics
    and technological accomplishments
    that could cure and heal acute
    conditions
   CAM practices put on back burner
        Why is it difficult to incorporate CAM
        into Conventional Medicine?

   Medical model (does not focus on
    prevention or promotion)
     Acute care
     Treat disease

     Reductionism

     Causality with linear thinking

    This model has done a very good job in extending
      our lifespan, aging population, and increased
      quality of life (contributing to chronic illness)
Model for Health Promotion
and Prevention?
   CAM practices
       Health promotion
       Prevent disease (?)
           Do you ever know what has been
            prevented?
       Holistic approach
       Models to manage chronic disease
        (using CAM)?
Nursing models can be
integrated in CAM
   Nursing theories and context can
    be used in CAM
   Can direct our practice
   Can provide direction by using
    assessment, diagnosis,
    interventions, and evaluations in
    nursing practices
        Example:
        Therapeutic Touch
                                                 Nursing
                                                  diagnosis:
                                                  impaired comfort
                                                 Intervention:
                                                  therapeutic touch
                                                 Outcomes:
                                                  document
Delores Krieger and Doris Kunz                    subjective and
Therapeutic Touch co-founders                     objective data
Pumpkin Hollow Farm (http://www.therapeutictouch.org/)
   Health care providers who
    discredit CAM use can no longer
    deny the benefits
       need to respond to the challenges
        evolving from issues related to the
        use of CAM
       It is here to stay……
        Cultural influences in our
        country


   Different values and beliefs with every
    different culture
   Cultural competence in CAM
       Have to have a knowledge base about the
        varying modalities with the skills and abilities to
        provide culturally competent care including
        respect, compassion and dignity
        Impact of Culture and CAM
        use in Health Care
   Every culture has it‟s own beliefs
    on how or what cures and heals.
   It is impossible to understand what every culture
    does use.
       It is important as healthcare providers that we respect the
        wishes of different cultures when they come in to the
        healthcare arena – wherever it may be birthing rooms, long
        term care facilities, acute care settings, or the home
        environment.
   Health care providers should only intervene if there
    is a life or death situation that may arise.
   At this point in time, it is still up to the patient,
    based on personal cultural beliefs, to determine
    their own personal choice for health care.
“Culture” and CAM
   “isms”
       Culture and the use of CAM can be
        related to age, gender, sexuality,
        disabilities, among many other
        things.
   Every culture may use special CAM
    in their own personal experience.
        Commonalities
   Treatment of the whole person (mind, body, spirit,
    and community)
       Original forms of health practices: Ayurvedic, Chinese,
        Alaska Native and American Indian Traditional healing,
        Shamanism, to name a few.
       The community and family were always part of the
        healing process.
   Herbal medications, manipulations (forms of massage
    and spinal adjustment) and dietary practices
   Spiritual practices
       May be in the form of energy healing, meditation, prayer,
        imagery, story-telling, ceremony, ritual, or cleansing
        practices that were unique to that culture
Differences
   Depends on
    where the culture
    resides
       some herbal
        treatments might
        be more popular
        than others
       what is naturally
        available
        Traditional Healers in Cultures
   Traditional healing
       “Called” to be a healer.
            It is not a situation where you can just receive education in how to be
             a traditional healer.
            You may be born with a gift.
            You may undergo a life transitioning experience (near-death, for
             example) that prepares you to be a healer.
            You will most often apprentice for many years with another recognized
             healer.
       True traditional healers are recognized by the elders to be healers.
       Some tribal governments have incorporated traditional healers into
        their conventional medical care systems with title of Tribal Doctor.
            Being designated a tribal doctor does not mean you are always an
             accepted traditional healer.
       Community elders must recognize and validate the healer.
Original forms of medicine:
Folk Medicine, Faith Healing, and
Herbal Medicine
   Folk medicines
        forms of healing used before conventional medicine practices.
        often practiced by wise women
        In some countries, these healers were called witches and killed for
         their healing practices.
   Faith healing
        a powerful form of medicine
        psychoneuroimmunology and the studies of religious practices that
         faith can alter your immune and physiological responses.
   Herbal medicines
        a mainstay of cultural healing practices
        our first medicines
        many of our current-day pharmaceuticals evolved from the study of
         plants and their constituents.
       Spirituality
   As our western society became highly scientific and
    technically oriented, it lost much of its spiritual roots.
   We need a spiritual belief system and spiritual practices and
    beliefs to be healthy and whole as human beings.
   Culture, and the spiritual expressions embedded in each
    cultural system, provides us with a framework for religious
    and spiritual expression.
   Today, these belief systems overlap between cultures.
   The United States was founded on the principles of freedom
    of religion, but that religious freedom was originally framed
    within Christian traditions.
        Faiths within our cultures
   In our current world, acceptance of each other‟s
    spiritual freedom and quest for spirituality leads to
    peaceful coexistence.
       A clash of cultural forms of spiritual expression leads to
        terrorism and war.
   In many ways, CAM helps us to come together in
    relationship to cultural differences.
   Learning how other cultures view healing reveals
    how they express their spiritual side.
   Understanding leads to acceptance of diversity and
    acceptance of individual differences.
   Acceptance of individual differences can lead to
    healing and to peace.
Barriers related to culture
and CAM use
   lack of knowledge
   fear and disgust
   bias
   ethnocentrism
   stereotyping
   ritualistic behaviors by nurses
   language barriers
   differences in perceptions and
    expectations
        Can we merge CAM, Culture and
        Allopathic Medicine?
   “Integrative Medicine”
       Are we really merging?
       ? Allopathic physicians utilizing some small, but fractured
        part of a cultural practice in their own medical practice.
   A cultural healing system is meant to treat the
    whole person and no „piece‟ should be isolated
    from the rest of the healing components of that
    system.
       In Western medicine, the approach is to deal with
        „pieces‟—organs, symptoms, surgical procedures
        (reductionist approach)
   Utilization studies of CAM clearly demonstrates
    that patients do not pick CAM over
    conventional care.
       Patients utilize conventional care alongside other
        forms of treatment (complementary instead of
        alternative).
   Since there is the potential for adverse
    reactions between these systems,
    conventional and nonconventional
    practitioners alike must ask their patients
    what types of treatments and products they
    are using and prescribe accordingly.
   In our country (and in other
    countries), a new medical „culture‟
    is arising, where conventional
    medicine and nonconventional
    medicine must come to terms with
    each other.
       Consumers will not allow one to win
        out over the other; they insist on
        having access to all forms of healing.
          What can we do?
   Avoid offending patients by being respectful to them (and their family
    members).
   Remember to be respectful, not condescending of elders in each society.
   Ask your patient about what cultural practices they might be using.
   Demonstrate by your attitude and your concern that you will not look
    down upon, nor be critical of, their cultural ways of healing.
        If you succeed in doing this, you will be able to work with patients of all
         cultures without offending them.
   Remember that in many cultures, family members speak for an ill elder
    or child.
        Do not dismiss the input of family members who can be very helpful in this
         regard.
   It is important to understand the history and philosophy specific to a
    culture and the practice forms of healing.
       Ethical Issues related to
       Culture and CAM use
   Safety
      Positive and negative benefits (?)
          Cost, clinical effectiveness, usefulness

   Scope of Practice
      Boundaries of nursing practice – i.e. “licensed” to do guided
       imagery, dementia and hypnosis
   Informed Consent
      Fully informed consent – give both allopathic and CAM
       treatments?
   Cultural Issues
      Religiosity and spirituality issues
      Do we impose beliefs on subjects (when we do this research)?
   Justice
      Do al patients truly get to use CAM? Some are very expensive.
      What happens if we take some of the folklore traditions and
       “regulate” them? Then the culture who used them cannot afford
       them anymore?
      Health Policy
   National Plan to Advance Integrated Health
    Care
   White House Commission on CAM Policy
   National Policy Dialogue to Advance
    Integrated Health Care
   The Integrative Health Care Policy
    Consortium
   White House Committee on Integrative
    Medicine

								
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