Traditional Surgery Jeanne Hately, RN, MSN, Phd
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You may raise an eyebrow upon hearing about the use of comple- mentary alternative medicines (CAMs) in the OR. You may ask, “What are some CAMs that have been used in the OR?” or “How can a practitioner who performs YCAMs be permitted in the OR, when in the past only the surgical team involved in the procedure was permitted in the OR?” There’s a common misconcep- tion that “CAM” and “alternative medicine” are the same; in fact, you may hear the terms used syn- onymously. According to the National Center for Complement- ary and Alternative Medicine, however, CAMs are therapies used together with conventional medi- cine.1 For example, music therapy Complementing traditional surgery Jeanne Hately, RN, MSN, PhD delivered through earphones to lessen a patient’s Acupuncture discomfort during and following surgery. Originating in China more than 2,000 years ago, acu- Alternative medicine is used in place of conven- puncture is one of the oldest, most commonly used tional medicine. For example, a special diet to treat therapies in the world. Acupuncture uses thin needles cancer rather than undergoing surgery, radiation, or to stimulate anatomical points on the body. The practi- chemotherapy.1 tioner inserts the needles and either a manual or elec- trical technique is used in key areas. Key areas are Various CAMs often determined according to symptoms described by CAMs include a long list of therapies or modalities, the patient.3 such as acupuncture, aromatherapy, guided imagery, herbalism, homeopathy, hypnosis, massage, music, Aromatherapy Qigong, Reiki, and therapeutic touch (TT). Many Aromatherapy is the practice of using volatile plant CAMs are natural modalities that were commonly oils, including essential oils, for psychological and used for hundreds of years but were discontinued with physical well-being. Essential oils are the pure essence the development of antibiotics and other medications.2 of a plant, not to be confused with perfumed oils, www.ORNurseJournal.com July/August OR Nurse2008 39 Complementing traditional surgery and have been found to provide both Essential oils and effects psychological and physical benefits Essential oil Effect when used correctly.4 (See Essential Basil Uplifting, refreshing, clarifying, aids oils and effects.) concentration Bergamot Refreshing, uplifting Guided imagery Chamomile Refreshing, relaxing, calming, soothing, Guided imagery is an effective visualiza- balancing Cedarwood Sedating, calming, soothing, strengthening tion technique sometimes referred to as Clary sage Warming, relaxing, uplifting, calming, a focused daydream. This method helps causes euphoria patients to focus on positive images to Cypress Relaxing, refreshing, provides astringent heal their bodies. Guided imagery prac- qualities titioners instruct patients in general Eucalyptus Head clearing, provides antiseptic and relaxation exercises and help patients decongestant properties, invigorating create detailed images in their minds. Fennel Provides carminative properties, eases A commonly used method of guided indigestion imagery is the Simonton Method, devel- Frankincense Relaxing, rejuvenating, eases breathing, oped by oncologist Dr. O. Carl Simon- dispels fears ton. The Simonton Method was devised Geranium Refreshing, relaxing, balancing Hyssop Provides decongestant properties to help patients undergoing cancer treat- Jasmine Relaxing, soothing, builds confidence ments to imagine their immune system Juniper Refreshing, stimulating, relaxing, promotes eating up and destroying cancer cells diuresis during treatment, thus freeing them of Lavender Refreshing, relaxing, provides therapeutic cancer.5 qualities, calming, soothing Lemon Refreshing, stimulating, uplifting, motivating Herbalism Lemongrass Toning, refreshing, fortifying Herbalism is the practice of prescribing Marjoram Warming, fortifying, sedating or making herbs for certain medical Melissa Uplifting, refreshing conditions, such as recommending black Myrrh Toning, strengthening, rejuvenating, cohosh for the treatment of hot flashes. provides expectorant properties Neroli Relaxing, dispels fears Many herbalists revert only to herbs for Orange Refreshing, relaxing the treatment of all conditions. Some Patchouli Relaxing, enhances sensuality caution must be used as individuals may Peppermint Cooling, refreshing, head clearing misuse and overdose or have sensitivi- Petigrain Refreshing, relaxing ties to an herb or compound.6 Pine Refreshing, provides antiseptic properties, invigorating, stimulating Homeopathy Rose Relaxing, soothing, enhances sensuality, A German physician in the late 18th builds confidence century, Samuel Hahnemann, is the Rosemary Invigorating, refreshing, stimulating, founder of homeopathy. Hahnemann clarifying worked on the premise of treating “like Sandalwood Relaxing, warming, builds confidence, grounding with like.” He studied patient symptoms Tea tree Acts as an antiseptic, strengthens immune and determined that symptoms were the system body’s way of fighting disease. Homeo- Thyme Acts as an antiseptic, refreshing, pathy practitioners encourage the symp- strengthens immune system toms seen and prescribe a remedy in Ylang ylang Relaxing, soothing, enhances sensuality small doses that in larger doses would produce the same symptoms displayed Source: Thomas DV. Aromatherapy: Mythical, Magical, or Medicinal? Holist Nurs in the patient. According to homeopa- Pract. 2002; 17(1): 10. thy, this method stimulates the immune system to help cure the illness.7 40 OR Nurse2008 July/August www.ORNurseJournal.com Hypnosis eratively report a decrease in stress and pain postop- Clinical hypnosis is a technique used by a qualified eratively.11 health professional or therapist who give patients carefully worded instructions intended to guide the Reiki patient into a state of deep relaxation. In this relaxed Reiki is based on the belief that when energy is chan- state, the patient is aware of everything that’s occur- neled through a Reiki practitioner, the patient’s spirit is ring but, at the same time, becomes increasingly healed, which in turn heals the body and contributes absorbed in using her imagination as directed by the to an overall feeling of well-being.12 Reiki is practiced clinician. The clinician monitors the patient through- by placing the hands on or above the patient in vari- out the session and is able to reverse the hypnotic ous positions. A state of deep relaxation and a general state.8 feeling of well-being is usually one of the most imme- diate effects of the treatment. Reiki practice is based Massage on the concept that an unseen life force energy flows Massage is the manipulation of through all people. If one’s life connective tissues and muscles force energy is low, that person to stimulate circulation and is more likely to get sick or feel enhance the function of those stress; if the life force energy is tissues to promote relaxation high, that person is more capa- and well-being. Massage thera- ble of being happy and py can be highly effective for healthy.13 reducing the symptoms of arthritis, back pain, carpal tun- Music therapy has been Therapeutic touch nel syndrome, and other disor- used in the OR to Reiki and TT are often con- ders of the muscles and ner- decrease postoperative fused, but in essence work on vous system.9 the same principles. TT is a rel- pain and anxiety. atively modern therapy with Music therapy origins in ancient healing prac- According to the American Music Therapy tices, and is a technique used to balance and restore Association, “Music therapy is the clinical and evi- the flow of human energy.14 TT was developed in dence-based use of music interventions to accom- the early 1970s by Dora Kunz, a natural healer, and plish individualized goals within a therapeutic rela- Dolores Krieger, RN, PhD, Professor Emerita of tionship by a credentialed professional who has com- Nursing at New York University and author of sever- pleted an approved music therapy program.”10 Music al books on the topic. therapy is designed to uplift physical and emotional health through the use of music. It’s often used in CAMs at work in the OR stress management programs or in conjunction with Some anesthesia providers use aromatherapy in the exercise. Music therapy is used in a variety of health- form of essential oils in the OR to promote relax- care settings with positive results in both short-term ation (lavender) and reduce nausea or perceptions of and more serious long-term conditions.10 smell (peppermint). Dr. Mehmet Oz, in his book Healing from the Heart, Qigong discussed his belief in the value of aromatherapy. He Qigong, similar to Tai Chi is an energy-producing stated that when patients were given a whiff of a Chinese movement technique that many healthcare flowery scent, their pain was lessened compared with providers now recommend for relaxation, stress when they sniffed spices, which made the patient reduction, and an overall feeling of well-being. more sensitive to pain. Dr. Oz also suspected that Qigong combines focused concentration with move- aromatherapy could be used to help surgical patients ments and balanced breathing in a controlled way. by inducing a relaxation response. Dr. Oz stated that The movements are simple, making the technique aromatherapy is very appealing because the emotion- easy to learn and easy to perform for most patients. al center of the brain is profoundly affected by Many patients who practice this technique preop- smell.15 www.ORNurseJournal.com July/August OR Nurse2008 41 Complementing