1.Pushing the Point: Integrating Acupressure &Oriental Medicine inPsychiatric Nursing Practice Jaclyn Engelsher, DNPFamily & Mental Health Nurse Practitioner, Certified Acupuncturist Adam Margolis, DNPcAdult Nurse Practitioner, Licensed Acupuncturist

2. DISCLOSUREThere are no potential conflicts of interest with a commercial entity,a company, or a business. 3. Objectives Describe the theory and benefits of using TraditionalOriental Medicine techniques in the psychiatric andmental health setting Identify the functions of ten commonly usedacupoints that can be integrated into treatment plansof patients with psychiatric and mental healthdisorders Discuss methods for integrating TCM modalities withconventional PMH nursing practice. 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. 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 VariabilityParity states: MT, SC, HIMD/DOChiropractorsPhysician AssistantsDentistsPodiatristsNaturopaths 7. BASIC THEORY & HISTORY 8. Yin and Yang 9. Qi 10. Meridians 11. Meridians(Acupuncture Media Works, 2012) 12. Statement of Fact Yibing tongzhi, tongbing yizhiSame disease different treatment. Different disease, same treatmentStahl: Dimensional Diagnosis 13. Acupuncture Assessment & Diagnoses An individuals patterns andtheir unique set of signs andsymptoms are treated, nottheir disease (nursingdiagnosis) Four examinations Looking - inspection withtongue diagnosis Listening/Smelling mental status exam Asking CC, HPI, 10questions (ROS) Feeling meridians andpulse(Acupuncture Media Works, 2012) 14. Treatment 3 Free TherapiesNutritionMovementRest (Mental and Physical) Acupuncture Moxibustion Cupping Tui Na/Acupressure Herbal Therapy Energy Work Tai Chi, Qi Gong 15. Treatment ProgressionIndividualized treatment planSymptomatic improvements often experienced within the first few sessionsLong-term abatement after 1 or more courses of treatment (antibiotic resistance)Treatments generally weekly, then prn once patterns resolved/managed 16. RESEARCH 17. Conditions Treated May work in conjunction with western medicine or, commonly,when other options have failed and/or have undesirable sideeffects. World Health Organization Pain of any kind from any cause Psychological conditions depression, anxiety, insomnia Womens 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. Effectiveness of acupressure for residents of long-term care facilities with insomnia: Arandomized controlled trial n=50 randomized to real acupressure or shamacupressure (single blinded) at point Shen Menon wrist Five minute administration by trained assistantsat bedtime for 5 consecutive weeks Athens Insomnia Scale Taiwan form (AIS-T)administered weekly at baseline, during 5 weekintervention, and after intervention 0-24 scale, >6 indicates insomnia(Sun, Sung, Huang, Cheng, & Lin, 2010) 19. True v. Sham Acupressure252015True Acupressure10Sham Acupressure50 Week Week Week Week Week Week Week1234567(Sun, Sung, Huang, Cheng, & Lin, 2010) 20. The effect of acupressure on quality of sleepin Iranian elderly nursing home residents N=90 randomized to acupressure (n=25), shamacupressure (n=26), and control/SOC (n=26) Mean ages: Acupressure: 75 Sham: 74 Control: 77 Acupressure administered 3 times/week for 4 weeks atpoints Nei Guan, Shen Men, ear Shen Men, YongChuan, 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. Global PSQI1412108Acupressure6 Sham AcupressureControl420 Pre-intervention Post-intervention(Reza, Kian, Pouresmail, Masood, Bagher, & Cheraghi, 2009) 22. The effect of acupressure on sleep quality in hemodialysispatientsN=48 participants randomized to acupressure and control (SOC)Fifteen minute intervention starting one hour after beginning hemodialysis 3 days per week for 4 weeksShen Men, He Gu, San Yin JiaoPSQI (Shariati, Jahani, Hooshmand, & Khalili, 2012) 23. Global PSQI121086Acupressure Control420 Pre-intervention Post-intervention (Shariati, Jahani, Hooshmand, & Khalili, 2012) 24. Effect of acupressure onpreoperative anxiety: A clinicaltrialN=70 randomized to true (n=35) or sham (n=35) acupressureYin Tang and ear Shen Men v. non- traditional points on the forehead and ear10 minutes of stimulationAnxiety VAS, BP, HR, RR measured before and after the intervention (Valiee, Bassampour, Nasrabadi, Pouresmaeil, & Mehran, 2012) 25. Anxiety Scores (VAS)7654 Acupressure3Sham Acupressure210Pre-intervention Post-intervention(Valiee, Bassampour, Nasrabadi, Pouresmaeil, & Mehran, 2012) 26. Effect of acupressure onnausea, vomiting, anxiety, and pain among post- cesarean section women in TaiwanN=104 participants assigned to treatment (acupressure) or control (SOC) groupsTwenty minutes digital stimulation of point Nei Guan administered the night before CS, 2-4 hours post CS, and 8-10 hours post CSVisual Analog Scale for Anxiety (VASA) and State-Trait Anxiety Inventory (STAI) 27. VASA7654Acupressure3 SOC210Preop 2-4h postop 8-10h postop (Chen, Chang, & Hsu, 2005) 28. STAI60504030AcupressureSOC20100 Preop 2-4h postop 8-10h postop(Chen, Chang, & Hsu, 2005) 29. Challenges in AcupressureResearchStandardized treatments v. heterogeneity of practiceAlternative diagnostic approachesControls/blindingFunding 30. APPLICATION 31. Acupressure TechniqueLocate the pointThumb/finger, pencil eraser, dowel, piezo, moxa warmer, tuning forkPress, tap, or massage point 30-60 seconds 32. (Acupuncture Media Works, 2012) 33. Anmian & Feng Chi(Acupuncture Media Works, 2008) 34. Jian Jing(Acupuncture Media Works, 2008) 35. Tan Zhong 36. Nei Guan 37. He Gu(Acupuncture Media Works, 2008) 38. Shenmen(Acupuncture Media Works, 2008) 39. Shao Chong (Acupuncture Media Works, 2008) 40. Zu San Li(Acupuncture Media Works, 2008) 41. San Yin Jiao (Acupuncture Media Works, 2008) 42. TaixiLocation: In the depressionbetween the tip if the medialmalleolus and Achilles tendonFunctions: Insomnia, agitation,back pain, headache, dizziness.(Acupuncture.com, 2010) 43. Tai Chong 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. Qi Gong Exercises 46. Food Therapy 47. Lung 48. Spleen (Acupuncture Media Works, 2008) 49. Heart 50. Kidney (Acupuncture Media Works, 2008) 51. Liver(Acupuncture Media Works, 2008) 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. References Acupuncture Media Works, (2008). Patient education. Retrieved fromhttp://www.acupuncturemediaworks.com/category_s/144.htm Acupuncture.com, (2010). Acupuncture point location. Retrieved fromhttp://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-cesareansection 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 ofsleep 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 hemodialysispatients. Complementary Therapeutics in Medicine. Sun, J., Sung, M., Huang, M., Cheng, G, & Lin, C. (2010). Effectiveness of acupressure for residents of long-term carefacilities 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 preoperativeanxiety: 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.