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.
Unit I herbs as raw materials, biodynamic agriculture.ppt
Pushing the Point: Integrating Acupressure & Oriental Medicine in Psychiatric Nursing
1. Pushing the Point:
Integrating Acupressure &
Oriental Medicine in
Psychiatric Nursing Practice
Jaclyn Engelsher, DNP
Family & Mental Health Nurse Practitioner, Certified Acupuncturist
Adam Margolis, DNPc
Adult Nurse Practitioner, Licensed Acupuncturist
2. DISCLOSURE
There are no potential conflicts of interest with a commercial entity,
a company, or a business.
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. DISCLAIMER
This session introduces basic evidenced-based Traditional Chinese
Medicine (TCM) theory and techniques with practical application
demonstration for informational and educational purposes. Please
check with your individual state to determine what aspects are
covered in your scope of practice and seek NCCAOM certified
practitioners in your area for acupuncture referral.
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. Scope of Practice Variability
Parity states: MT, SC, HI
MD/DO
Chiropractors
Physician Assistants
Dentists
Podiatrists
Naturopaths
15. Statement of Fact
Yibing tongzhi, tongbing yizhi
“Same disease different treatment. Different
disease, same treatment”
Stahl: Dimensional Diagnosis
16. 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)
17. Treatment
3 Free Therapies
Nutrition
Movement
Rest (Mental and Physical)
Acupuncture
Moxibustion
Cupping
Tui Na/Acupressure
Herbal Therapy
Energy Work – Tai Chi, Qi Gong
18. 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
20. 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)
21. 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)
23. 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)
25. 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)
26. Global PSQI
12
10
8
6 Acupressure
Control
4
2
0
Pre-intervention Post-intervention
(Shariati, Jahani, Hooshmand, & Khalili, 2012)
27. 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)
29. 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)
32. Challenges in Acupressure
Research
Standardized treatments v.
heterogeneity of practice
Alternative diagnostic approaches
Controls/blinding
Funding
45. 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)
47. 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)
58. 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
59. 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.
Hinweis der Redaktion
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