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FRAMEWORK
INTRODUCTION
Society and its healthcare needs always evolving as a result, healthcare faces many
challenges, including rising costs, shortage of professionals, an ageing population, the
introduction of new technologies and difficulties with access to care. The demand for
collaborative, innovative clinical practitioners to act as a leader in healthcare has never been
stronger. Nurses in advance nursing practice are well positioned to respond to the evolution
of healthcare. In particular advance nursing plays a key role in meeting the health needs, by
building the nursing knowledge, advancing the nursing profession and contributing to a
sustained and effective healthcare system.

DEFINITION OF NURSING PRACTICE
Advance nursing practice is an umbrella term describing an advance level of
clinical practice that maximizes the use of graduate educational preparation, in depth nursing
knowledge and expertise in meeting the health needs of the individual, families, group,
communities and population. It involves
Analyzing and synthesizing knowledge.
Understanding, interpreting and applying nursing theory and research.
Developing and advancing nursing knowledge and the profession as the whole.
OR
Nursing practice is an act of providing care to the patient. In providing care to the patient the
nurses implement a nursing care is based on initial condition of the patient. It is based on
specific nursing theory following nursing theory and nursing practice research side by side is
must for patient care and nursing practice.

CHARACTERSTICS OF ADVANCED NURSING PRACTICE:-
In advance nursing practice nurses builds on their expertise in a specially area, integrating
and consistently displaying the following feature and characteristics:
Provision of effective and efficient care, delivered with a high degree of autonomy.
Demonstrate of leadership and initiation of change to improve client, organization and
system outcomes.
Deliberate, purposeful and integrated use of in-depth nursing knowledge, research and
clinical expertise.
Depth and breadth of knowledge that draws on a wide range of strategies to meet the
needs of client and to improve access to and quality of care.
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Ability to apply and explain the theoretical empirical, ethical and experiential
foundation of nursing practice.
Demonstration of advance judgment and decision making skills.
Critical analysis of and influence on healthy policy.

DEVELOPMENT OF THE FRAMEWORK:-
One of the first priorities of the vice president and CNO (Chief Nursing Office) of the
Calgary Health Region was to developmental of this vision, it became apparent that a
mission for nursing was also essential. As this work progressed, an evident need emerged
to establish a definition of professional practice and a guideline or framework that nurses
could utilize on daily basis to achieve the vision and mission of nursing in the region.

APPROVAL OF THE FRAMEWORK:
After several month of consultation with nurses across the region, discussion at regional
nursing council and numerous revisions, the final draft of professional practice
framework was approved by Nursing Council and distributes during nurse week 2003.
The professional nursing practice framework for the Calgary Health Region.

The framework is congruent with the value of the Calgary Health Region.
(Honesty, integrity, dignity, trust, respect, responsiveness, creativity and hearing). It
reflects elements that are common to other professional practice frameworks describe
in the literature.
The framework reinforces the prerequisites for the promotion of safe, competent and
ethical nursing practice that are inherent; in the standards of practice and the
professional body that regulates the practice of registered nurse in the province.
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The framework logo depicted in the model was design by one of the members of
regional nursing council is an expression of her belief that the nurses cap has
traditionally been an important symbol of professionalism in nursing.
Implementation Of The Framework:-
Numerous sessions were held to familiarize nursing staff with the framework
when it was first launched.
Introduction to the framework is now routinely incorporated into the orientation of
all new nurses who join the region
The framework also gives the development preceptors and change nurses.
The major element of the framework next have been linked to the expected RN
and RPN competencies articulated in job description, and application of the
nurses ongoing professional development and continuing education plan.
Evaluation and Research:-
Now that the professional practice framework has been articulated, it will be
important to determine the effectiveness with which it is being implemented across
the many sites and setting in this large regional health authority and measures is
impact on practice and patient outcomes. Over the course of the next several years,
specific implementation initiative will be targeted for evaluation and research. An
over changing framework will be developed to guide the evaluation of specific
initiatives. Answer will be sought to such questions as:-
What facilitate internalization of the professional practice framework?
Did its implementation change nursing practice of select units?
Did changes in nursing practice affects the role of other members of the
health care team/ what difference if any?
Did implementation of a professional practice framework make in job
satisfaction and patient outcomes?
What went well in implementing the framework? What could have been done
differently?







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SCOPE OF NURSING PRACTICE
Nursing practice today is composed of a wide variety of roles and responsibilities
necessary to meet the health care needs of the society. Nurses are the front line professional
of health care. Nurses are the front line professional of health care. Nurses of the skilled care
to those recuperating from illness or injury, advocate for patient right, support patient at
critical times. The framework provides principles which should be used to review, outline ad
expand the parameters of practice for nurses. It is appropriate for nursing practice should
develop to meet the ever changing needs of the population and the health services.

Nursing is responsible for articulating and disseminating clear definition of the roles
nurses engage in, professions scope of practice. National professional organization bear the
responsibility for defining nursing and nurse role that are consistent with accepted
international definition articulated by the International Council Of Nurse, and relevant to
their Nations health care needs. While nurses, through professional, labour relation and
regularly bodies, bear primary responsibility for defining, monitoring and periodically
evaluating roles and scope of practice the views of other in society should be sought and
considered in defining scope of practice.

The scope practice is not limited to specific tasks, functions and responsibility but
include direct care giving and evaluation of its impact, advocating for patients and for health,
supervising and delegating to other leading- managing, teaching undertaking research and
developing health policy for health care systems. Furthermore, as the scope of practice is
dynamic and responsive to health needs development of knowledge and technological
advances, periodic review is required to ensure that it continue to be consistence with current
health need and supports improved health outcomes.

National Nurse Association has a responsibility to seek support for legislation which
recognize the distinctive and autonomous nature of nursing practice, including a defined
scope of practice.

Definition:-
The scope of nursing practice is the range of roles, functions, responsibilities and activities
which a registered nurse is educated, competent and has the authority to perform. This
definition of the scope of nursing practice must be understood in context of the following
definition of nursing which is based on the definition provided by the WHO 1996, and ICN
1987. Nursing is both an art and science. It requires the understanding and applications of
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specific knowledge and skills and its draws on knowledge and techniques drive from the
humanities and the physical, social, medical and biological science.
Principles:-
The following are the basis for making decision with regards to the scope of practice for an
individual nurse:-
The primary motivation for expansion of practice must be the best interest of
patient/clients and the promotion and maintenance for the best quality health services
for the population.
Expansion of the practice must be made in the context of the definition of nursing and
the values that underpin nursing practice.
Expansion of practice must only be made with due consideration to legislation
National policy, local policy and guidelines.
In determining of his or her scope of practice the nurse/midwife must make a
judgment as to whether he/she is competent to carry out the role function.
The nurse/midwife must take measures to develop and maintain the competence
communications and evaluations.
Expansion of the practice must be based on appropriate assessment, planning,
communication and evaluation.
The nurse who is delegating a particular role/function (the delegator) is accountable
for the decision to delegate. This means that the delegator is accountable for ensuring
that the delegate role/function is appropriate and that support and resources are
available to the person to whom it has been delegated.
The individual nurse is accountable for his/her practice this means that he/she is
accountable for decision he/she makes in determining his/her scope of practice that
included decision to expand or not to expand his/her practice.
Values :-
The following values are mentioned below:-
In making decision about an individuals nurses scope of practice, the best interest
of the patient/client and the importance promoting and maintaining the highest
standards of quality in the health services should be foremost.
Nursing care should be delivered in a way that respects the uniqueness and dignity
of each patient/clients regardless of culture and religion.
Fundamental nursing practice is the therapeutic relationship between the nurse and
the patient/client that is based on trust, understanding and support and serve to
empower the patient/client to make life choice.
Key Components:-
The key determining factors that must be taken into account in deciding on the scope of
nursing these include:-
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Competency
Accountability and autonomy
Continuing professional development
Support for professional nursing practice
Delegation

The Scope Of Nursing Practice:-
Nursing profession is accountable for ensuring that its member act in the public
interest and provide the unique service that has been designated to them by society.
This process is called professional regulation
The profession of nursing regulates itself through defining practice, establishing and
developing the public standard of practice and a code of ethics.
In turn, the state through statues, attests to the public that registered nurses meet
minimal standards for practice and prohibits unlicensed individual from practicing as
registered nurse.
Since each state has legal authority for the regulation of nursing, the definition and
therefore the scope of nursing practice may vary from state to state.
However the laws remain consistent to protect the public.
The Nursing Practice Act:-
The nurse practice act was enacted by the legislature to regulate the practice for the
purpose of protecting the public.
The act does not designed to protect the public from incompetent nursing, not to
protect nurses from discriminatory or questionable employment practice.
Each nurse is responsible and accountable for making decision and practicing in
accordance with the individuals educational background and experience in nursing.

NURSING PRACTICE IN DIFFERENT SETTING:-
Individual RNs :-
The registered nurse is responsible and accountable, professionally and legally for
determining his/her professional scope of nursing practice.
Since the role and consequently the scope of nursing practice, is ever changing and
increasing in complexity. It is important that the nurse makes decision regarding
his/her own scope of practice.




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The Nurse Manager And Nurse Executive:-
The nurse executive in a changing and complex health delivery system is
knowledgeable regarding change in rules and regulation accreditation standards and
standards for care and practice in addition to evaluation of boundaries specified in
nurse practice act.
The nurse executes and/or the nurse manager facilitates changes to assure quality
patient care outcomes and develop mechanism that will promote the same.

Mobile Nursing Practice:-
In 1984 a need was seen to offer more extensive home health care for local residents
who preferred to receive needed care in own homes.
This enabled many to reduce costs and remain in their homes, at least for a longer
period of time.
This organization become known as mobile health care Ltd, and was later changed to
mobile nursing services ltd. This was the area first private home health care delivery
system.
It was the first to offer such services at all time of the day and night. Previously such
care was available only during regular business hours.
Mobile nursing service has been a leader and innovator in the field of home health
care and has transformed this important method of health care delivery in the
southeast area.
It is the largest and oldest home health care system in the area, except for public
organization and it has had a favourable competitive effect on those, resulting in
overall improved care for the area residents from a variety of public and private
sources.
Mobile introduces many innovations into the local home health care market and
continues to do so.

Mobile Nursing Services:-
These services provide home teaching and care for patient with varied needs and
health problem:-
Patient discharge early from hospital
Patient suffering from chronic and acute medical problems
Surgical patient.
Patient requiring I.V. therapy.
The elderly.
Respiratory patients.
The seriously ill.
Patient in need of medication management
Hospice concept
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Ventilator dependent
(Assistance) with bathing, dressing, meals, transportation, light housekeeping
Service may be covered by Medicare, medical private insurance, private
payment.
Military Nursing Services:-
First World War:-
The military nursing services has its origin from the Army Nursing Service formed
in 1881 part of Royal army. The Army Nurses served in Flanders the Mediterranean the
Balkans, the Middle East and onboard hospital ships. After the war on 1 October 1926 the
nursing services was granted permanent status in Indian Army. This date is formally
recognized as the information day of military nursing service, though in actual its origin
occurred 45 years before.
Second World War:-
With the outbreak of second world war, nurses once again found themselves serving
all over the world.
During the middle of the war in 1943, the Indian army of the nursing services was
separated through Indian Military Nursing Services ordinance, 1943 and redesignated
it. There by constituting the Military Nursing Service (MNS) in its present form.
The Military Nursing Service stands out as one of the oldest services where women
have contributed directly to the nations war effort by providing care to the sick and
wounded soldiers; this is true for all the armed forces of the world.
The army nurses have made a permanent place in every Nations heart by nursing
million of sick and wounded soldiers back to health.
The officers of Military Nursing Services had distinguished themselves in the Second
World War, through the care of the sick and wounded soldiers in India and also at
many foreign threats of war.
Post independence, the nursing officers cared for the wounded soldiers in five major
bloody conflicts with the neighboring countries.
Rank structure;- the various rank of the Military Nursing Services are listed below in
descending orders
Commissioned officers
Major- General
Brigadiers
Colonel
Lieutenant Colonel
Major
Captain
Lieutenant
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Tele Nursing:-
Refers to the use of telecommunication and information technology for providing
nursing services in health care whenever a large physical distance exists between
patient and nurse, or between any numbers of nurses
As a field it is part of tele health and has many points of contacts with other medical
and non medical application, tele monitoring etc.
Tele nursing is achieving large number of growth in many countries, due to several
factors, the preoccupation in driving down the costs of health care, an increase in the
number of aging and chronically ill, population and the increase in coverage of health
care to distant, rural or small populated region.
Among its many benefits, tele nursing may solve increasing shortages of nurses; to
reduce distance and save travel time and to keep patient out of hospital. A greater
degree of job satisfaction has been registered among tele nurses
The Nursing Robots:-
The development of nursing robot system included the development of a mobile robot
system to help physically handicapped people.
Completed in 1986, the nursing Robot was one of the first fully functioning mobile
robots equipped with a manipulators arm, also integrated with seven different sensor
systems.
The system was controlled by four networked on board Sinclair spectrum computer
and on off board IBM-PC.
The nursing robot system comprises their major components; a self propelled vehicle,
a robotic arm mounted on it, and a communication post next to the disabled persons
bed.
Onboard the mobile robot low cost micro-computers are interconnected as a
hierarchical network in order to control a variety of activities, sensor data processing
motion control, path planning, communication and others.
The vehicle can move autonomously in a room with unexpected obstacles.
Nursing in Occupational Health:-
Occupational health nurses (OHN):-
OHNs are registered nurses who independently observe the assess the workers health status
with respect to job tasks and hazards, using their specialized experience and education, these
registered nurse recognize and prevent health effects from hazardous exposure and treat
workers injuries/illness
Scope
OHNs bring their nursing expertise to all industries such as meat packing, manufacturing,
construction as well as the health care industry, OHNs have:-
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Have special knowledge of work place hazards and the relationship to the employee
health status.
Understand industrys hygiene principles of engineering controls, administrative
controls, and personal protective equipment.
Have knowledge of toxicology and epidemiology as related to the employee and the
work site.
School Health Nursing:-
School nurses are primary care nurses for school children. They work with individual
children young people and families, schools and communities to raising educational
standards.
A school nurse is qualified, experienced professional and the only trained nurse working
across health and education boundaries, they also provide the link between school, home and
the community
Responsibilities of School Health Nurse:-
Promoting healthy life style and school
Child and adolescent mental health.
Chronic and complex health care need in children and young people
Vulnerable children and young people
Activities of school health nurses:-
Health assessment for children at entrance to the school when required.
Individual health interviews offered to young people aged 13 -14 years.
Immunization programme.
Child protection.
Health education.

TRENDS IN NURSING PRACTICE
Trends in nursing care closely tied to what is happening to health care in general. Trends are
fascinating phenomena, but they do not existing in vacuums; Most are interrelated; one trend
often spawns another, although trends are more than fads, they are far from money back
guarantees. We watch to anticipate the direction that particular trends will take us, to remove
the elements of surprise, when we look back on trends, however, some will have permanent
changes, but other might have been no more than blips on the radar screen.


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Broadening focusing:-
The focus of nursing has broadened from the care of the ill person to the care of the
people in illness and from care of only the patient to care of the clients, the family,
and in some instance the community.
In the past, nursing like medicine was oriented towards disease and illness.
Today there is increasing recognition of people needs for health care as distinct from
illness care and of the nurses independent functions in this area.
Another aspect of the broader nursing focus is to the movement of nursing practice
into the community. In a sense there is a return to the beginning of nursing that is
before it becomes a recognized occupation.
Throughout most of this century however nurse worked only in institution,
increasingly nursing services are provided in community often in homes and clinics.
The nursing activity not only assists those who are ill but also helps those who are
healthy to maintain or continue their health.
Scientific Basis:-
In the past nursing largely was either intuitive or relied on experience or observation rather
than on research, through trial and error the individual nurses discovered with measures that
would assist the client and many nurses become highly skilled in providing care through
experience.
Technology:-
Technology or mechanization is being applied in the health field extensively. Certain areas of
a hospital care most technologic than others. Nurses find themselves in the midst of rapidly
changing, increasingly technologic environment in hospital and in clients homes.
Indication Of Increasing Technology:-
a) The proliferation of the technologic equipment used in case of client in hospitals and
homes.
b) The increasing home and self care equipment.
c) Use of computers in many areas of health care.
Many nurses feel they need more education to obtain the knowledge and skills
necessary to use the new technology. High technology has enabled nurse to gather client
assessment data through non-invasive techniques (eg:- pulse oxymetry) rather than the
costly invasive procedure.

Expansion of employment opportunities:-
Nursing practice trends include a growing variety of employment setting in which nurses
have greater independence, autonomy and respect as member of the health care team.
Nursing role continue to expand and develop broadening the focus of nursing are and
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providing a more holistic and all encompassing domain. Nursing therapies are not only
drawing from traditional nursing and medicine, spiritual and emotional realms, but also
expanding into alternative therapies such as healing touch, massage therapy and use of
natural herbs and vitamins.
Nursing Public Perception:-
Any member of the society who has been ill, hospitalized or visited an emergency
department has experienced nursing campaign, noted that everybody need a nurse. The
Johnson Foundation has developed compelling, attention getting media campaign on nursing
profession. This media clips show nursing practice, and the nurses featured in the
advertisement and described their satisfaction in the profession, nursing is a pivotal health
care profession, as frontline health care providers, nurses practice in all health care setting
and constitute the largest number of professionals. Nurses are essential to provide skilled,
specialized knowledgeable care, to improve the health status of the public and to ensure safe
effective quality care; in addition, the American Public rated nurses high in honesty and
ethics in their professional role.
Nursing Impact on Politics and Health Policy:-
The ability to influence or persuade an individual holding a government office to exert the
power of that office to affect a desired outcome is known as Political power or influence.
Nurse involvement in politics is receiving greater emphasis in nursing curricular professional
organization and health care setting.
Professional nursing organizations have employed lobbyists to urge state legislature and the
US congress to improve the quality of health care.

CHANGING TRENDS IN NURSING
Nursing has originated from the word nurturing which means nourishing, helping in
growth and development of a human being, in the past nursing was family based
work.
Modern nursing began in the 19
th
century under the leadership of Florence
Nightingale.
The aim of nursing was only to promote the recovery of patients. Even now the
central concern of nursing is nurturing the human beings.
The present day nurse provides care for the people in health services and illness.
Nursing is one of the health services which contribute to well being of an individual,
family and community. Therefore, nursing is defined as a humanistic science
dedicating to maintain and promote health preventing illness care for and
rehabilitation of the sick and disabled person.
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Nursing process includes doing, thinking and interaction component. It is mainly and
basically a problem solving approach of nursing cares. The nursing process consists
of five steps
- Assessment
- Nursing diagnosis
- Planning
- Implementation
- Evaluation.
Each step of a nursing process leads to the next one, which makes it a continue cyclic
process.

MORDEN TRENDS IN NURSING PRACTICE
The public perception of alternative, complimentary treatment method has been changing
over the past few decades. In the late 1960s and early 1970s, Natural New Age Self Help
Movements begin to attract followers, first among consumers and later among health care
practitioners. During that time provide, there was a growing trends towards the rejection of
traditional medicine because it was perceived invasive, painful, cost and ineffectiveness. A
Rekindled interest in Eastern Religion, lifestyle and medicine has fueled the development of
complementary holistic, alternative complementary modalities. Client are seeking out
alternative/complementary therapies because most such therapies are non invasive, holistic
and in many instance less expensive than going to a physician.
In 1993 a landmark survey found 1/3 of the US population had used some
nontraditional alternative method of treatment in addition to the standard medical treatment.
In 1993 the US Government established an Office of Alternative Medicine at the
National Institute of Health. One of the reason for the OAMs creation was the US citizens are
pursuing alternative methods of health care with unpredicted enthusiasm.
In 1992, the OAMs was allocated 2 million to investigate the use of nontraditional
treatment methods.
A few therapies investigated by the OAMs -1995:-
Biofeedback to control pain
Acupuncture to relieve depression
Imagery to control Asthma
Ayurvedic medicine to treatment to treat parkinsons disease
Music therapy to treat brain injured client
Shark cartilage to treat cancer


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ALTERNATIVE MODALITIES OF CARE
ALTERNATIVE SYSTEM OF HEALTH
COMPLIMENTARY THERAPEUTIC

Alternative modalities of care, system of health and complimentary therapies includes various
healing process an approaches that originate from around the world and that are not based on
conventional western medicine. These therapies are called alternative medicine, when they
are used alone and complementary therapy when they are used with conventional medicine.
Alternative medicines include therapies and health care practice not widely taught in most
medical school however, many such practices are popular and some are used in hospitals.
Although the distinction between conventional and alternative medicine is not always easy to
determine, a basic philosophic difference exists. Alternative medicine often defines health
has a balance of body system physical, emotional and spiritual involving the whole patient
i.e. the approach is holistic. Conventional medicine generally defines health as the absence
of disease; disease is usually thought to result from isolated factor (e.g. Pathogens,
biochemical balance and treatment often involve drugs or surgery. Disease is thought to result
from isolate factor (e.g. pathogens, biochemical imbalance) and treatment often involves
drugs or surgery. Disease is thought to result from disharmony of the imbalances between
body systems. Treatment often involves strengthening the bodys often own defenses and
restoring these balance and energy flows.
Patients are most likely to seek alternative medicines for conditions such as chronic low back
pain, stress, and arthritis. Some patients seek alternative medicines when conventional
medicines offer little hope especially at the end of the life.
TERMINOLOGIES
HOLI SM- the idea that the whole of the sick person including their body, mind and way of
life, should be considered when treating them and not just the symptoms of the disease.
HUMANI SM- a symptom of thought that considers the solving of human problems with the
help of religious beliefs, it emphasizes the fact that the basic nature os human is good.
BALANCE- a situation in which different thing exist in equal correct or good amount.
ENERGY- the ability to put effort and enthusiasm into an activity work etc.
HEALI NG- the process of returning to normal function after a period of disease or injury.

DEFINITIION-
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Complementary and alternative medicine is a group of diverse medical and health care
system, practices and products that are not generally considered part of conventional
medicines.
Basic concepts
Several concepts are common to most alternative practices. These holism, humanism,
balance, spirituality, energy and heating environments.
Types of complementary and alternative medicines
1) Alternative medical system
2) Biologically based treatment
3) Mind body technique
4) Manipulative and body based method
HEALING MODALITIES
1) ALTERNATIVE MEDICAL SYSTEMS
a) Ayurveda
Definition:-
Ayurveda is system of healing based on homeopathy and naturopathy with an extensive
use of herbs
Ayurveda (devanagri the science of life) is a system of traditional medicine native into
Indian sub continent originated, 5000 year a ago and practiced in other parts of the world
as a form of alternative medicine. In Sanskrit. The word Ayurveda consist of the word
Ayur meaning life and Veda meaning related to knowledge or science. Evolving
throughout its history, Ayurveda remains an influential system of medicine in South
Asia. The earliest literature of ayurveda appeared during the vedic period in India.
The Sushrita Samhita and the charaka samhita were influential works on traditional
medicine during this era. Ayurvedic practitioners also identified a number of medicinal
preparation and surgical procedures for curing various ailments and diseases.
In ayurvedic system, the prevention of all types of disease has a prominent place in
treatment including restructuring a patients life style to align with the course of nature
and the four seasons to guarantee complete wellness.
The aim is to remove the cause of disorder prevenr illness and hamonise body mind and
consciousness. Ayurveda aids in maintaining good health, increasing longevity and
overall quality of life.

Alternative ayurvedic treatments and self help regimens include:-
Nutrition
Herbal remedies
Aromatherapy
Life style recommendation
Massage treatment
Color / sound therapy
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Meditation
Panchkarma (detoxificaton)
Yoga
Rejuvinaton therapies
Ayurveda empowers the individual to take control of their own health and wellbeing.
Forexample:-
1. Terminalia arjuna :- is useful in alleviating the pain of angina pectoris and in treating
heart failure and coronary artery disease. Terminalia may also be useful in treating
hyper cholesterolemis.
2. Black pepper:- are combined with ginger to form the traditional trikatu mixture in
ayurveda. This mixture increases appetite, promotes the secretion of digestive juices
and cures certain gastric disorders particularly achlorhydria and hypochlorhydric.
b) Siddha
The siddha medicine is a form of south Indian tamil traditional medicine and part
of the trio Indian medicines ayurveda siddha and unani. This system of medicine was
popular in ancient india, due to the antiquity of this medical system, the siddha system of
medicine is believed to be the oldest medical system in the known universe. The system is
believed to be developed by the 9 nath and 84 siddhas in the north and 18 siddhas in the south
called siddhas. They are the ancient supernatural spiritual saints of India and the Sidhas
system is believed to be handled over to the Siddhas by the Hindu God-lord Shiva and
Goddess Parvati, so are the Siddhas the followers of Lord Shiva.
Shiddharas were of the concept that healthy soul can only be developed through a healthy
body so they developed method and medication that are believed to strengthen their physical
body and there by their souls. Men and women who dedicated their lives into developing the
system were called SIDDHARAS. They practiced intense yogic practice, including year of
fasting and medication and believed to have achieved super natural power and gained the
supreme wisdom and overall immortality.
It is assumed that when the normal equilibrium of three humors (vatha, pitha and kapha) is
distributed, disease is caused. The factors which assume to affect this equilibrium are
environment climate condition, diet, physical activities and stress, according to the siddha
medicine system diet and life style play a major role not only in health but also in curing
disease.
The treatment in siddha medicine is aimed at keeping the three humors in equilibirium and
maintenance of seven elements. So proper diet medicine and a disciplined regimen of life are
advised for a healthy living and to restore equilibrium of humors in disease condition.
Saints Thiruvalluvar explain four requisites of successful treatment. These are:-
o Patient
o Attendant
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o Physician
o Medicine
When the Physician is well qualified and the other agent passes the necessary qualities, even
severe disease can be cured easily. The treatment should be commenced and early as possible
after assessing the course and cause of the disease. The treatment is classified into three
categories:-
Devmuruthuvam (divine method)
Manuda Muruthuvam (rational method)
Asura muruthuvam (surgical method)
In divine method medicine like parpam chendooram, guru, kuligai made of mercury sulphur
are used.
In the rational method medicine made of herbs like churanum, kudinur, vadagam are used. In
surgical method incision, excision hear application, leech application are used.
According to therapies the treatments of siddha medicine could be further categorized
into following categories such as purgative therapy, emetic therapy, fasting therapy, steam
therapy, oleation therapy, physical therapy, solar therapy and bloodletting therapy, yoga
therapy etc.
c) Unani and Tibbi:-
As an alternative form of medicine, Unani has found favours in Asia, especially India. In
India these Unani practitioners can practice as qualified Doctors, as the Indian Government
approves their practice. Unani medicine is very close to Ayurveda. Both are based on theory
of the presence of the elements (in Unani, they are considered to be fire, water, earth and air)
in the human body. (The elements attributed to the Philosopher Empedocles determined the
way of thinking in Medieval Europe).
According to followers of Unani Medicine These elements are presents in different fluid and
their balance leads to health and their imbalance leads to illness.
All these elaborations were built on the basic Hippocratic theory of the four Humors.
The theory postulates the presence in the human body of blood phlegm, yellow bile and black
bile. Each persons unique mixture of these substances determines his temperament a
predominance of blood gives a sanguine temperament a predominance of phlegm makes one
phlegmatic; yellow bile, bilious and black bile, Melancholic. As long as these humors are in
balance, the human system is healthy; it is imbalance can result in disease.
d) Homeopathy:-
It is a system of therapy based on the concept that disease can be treated with drugs (in
minute doses) which are capable of producing the same symptoms in healthy people as the
disease itself.
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Homeopathy developed in Germany in the late 1700s homeopathy is based on the principle
that like cures like. A substance that, when given in large doses, causes a set of symptoms is
believed to cure the same symptoms when it is given in minute dose.
Remedies used in homeopathy are derived from naturally occurring substance such as plant
extract and minerals, extremely low concentration are prepared in a specific way. The more
dilute the homeopathic medicine, the stronger it is considered to be.
Homeopathic remedy Rhustoxicodendrone delivered from poison substance prepared with
particular procedure and intended for treating patient. Example include Arsenicum album
(arsenic oxide), Natrum muriaticum (sodium chloride or table salt) and thyroidinum (thyroid
hormone).
Homeopaths also use treatments called Nosodes (from the Greek nosos, disease) made from
diseased or pathological products such as fecal, urinary and respiratory discharges, blood and
tissue, homeopathic remedies prepared from specimens are called sarcodes.
e) Naturopathy:-
It is a system of therapy based on preventative care, and on the use of heat, water, light, air
and massage as primary therapies for disease.
This therapy began as a formal health care system in the US during the early 1900s. founded
on the healing power of nature, natural healing abilities. This system also focuses on finding
the cause of a disease rather than merely treating symptoms, some of this systems principles
are not that different from those of modern Western Medicine.
In treating the whole patient the naturopathic practitioner searches for causes at many levels,
and attempts to eliminate the fundamental causes of illness not simply to remove symptoms.
The following therapies are considered to be of primary importance in the naturopathic
treatment of disease.
i. Nutrition and Dietetic:- this includes the prescription of a balanced wholesome,
natural diet, based on the principles advocated by naturopathic practitioners.
ii. Fasting:- the controlled abstinence from food has been used therapeutically for over
2000 years, it was advocated by Hippocrates as a treatment for many diseases because
it allowed the body to concentrate its resources processes of digestion, although
largely ridiculed by orthodoxy for many years. Fasting has recently begun to gain a
reputation as an excellent and safe treatment for conditions such as obesity, high
blood pressure, arthritis and rheumatism, various allergies and some psychiatric
disorders.
iii. Structural adjustment:- by such methods as osteopathy, chiropractic neuromuscular
technique, postural re-education and remedial exercise, the naturopathic practitioner
seeks to balance and integrate the spine, muscles, ligament and joints of the whole
body.
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iv. Hydrotherapy:- this is the use of water both internally and externally in the form of
baths, packs, compresses, sprays and douches. Hydrotherapy is of value in most
conditions and rightly applied can give remarkable results in the treatment of both
acute and long-standing conditions.
v. Healthy life style:- this includes the general care of ones body, the use of moderate
physical exercise, the cultivation of a positive approach to life and health, relaxation
technique.
vi. Education:- it naturopathic philosophy it is just as important, if not more so, to
explain to the patient why disease occur and what the patient can do for him or herself
to maintain the new, improved level of health given to them by naturopathy treatment.
In this way the patient is given responsibility for his/her health.
Naturopathy is based on the belief that the body is self healing. The body will
repair itself and recover illness spontaneously if it in healthy environment.

2) BIOLOGICALLY BASED TREATMENT:-
i) Herbal Medicine:-
Herbal medicine has always attracted some scientific interest and many known
drugs are plant derived for examples Digoxin from foxgloves and Morphine from poppie.
The following are some of the herbs commonly thought to e effective.
St John Wort (hypericum perforatum) is a safe and effective treatment for mild to
moderate depression. It may also help fatigue possibly because fatigue is a common
aspect of depression.
Ginkgo Biloba may be effective in relieving the symptoms of dementia and it may
also support memory in all older people.
Ginger is an effective remedy for nausea and vomiting.
Tea tree oil may be effective against fungal infection such as athletes foot.
Vegetables from the allium family (onion and garlic may protect against certain
cancers if eaten regularly especially cancer of the digestive tract, through further
studies need to be done.
ii) Nutritional Therapy:-
Nutritional therapy is a system of healing based on the belief that food as nature
intended, provides the medicine we need to obtain and maintain a state of health: our food
is our medicine, and our medicine is our food. Although some health problem requires
specific medication, much condition can be relieved effectively with nutritional therapy.
These include disorder ranging from chronic fatigue, energy loss, insomnia and
depression to backache, asthma and headache.
Nutritional therapy will also benefit you if you have specific illness but want to
maintain a state of optimum health. It is safe for babies and children as well as adult, and
the change of eating pattern that is typically prescribed usually has far fewer side effects
than synthetic medicines.
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Nutritional therapy is holistic discipline nutrition is the key to good health is the all
embracing fundamental principle used since the time of the famous Greek Doctor/founder
of western medicine.

3) MIND BODY TECHNIQUE:-
Mind body technique are based on the theory that mental and emotional factors can
influence physical health, behavior, psychology, social and spiritual method are used to
preserve health ad prevent or cure disease.
Because of the abundance of scientific evidence backing the benefit of mind body
techniques. Many of the approaches are now considered main stream, methods include the
following:-
Meditation
Hypnotherapy
Biofeedback
Relaxation technique
Guided imagery.
Mind body technique can be used to treat the anxiety and panic disorder, chronic pain,
coronary artery disease, depression, headache, difficulty sleeping and loss of urinary control,
mind body methods are used as an aid in child birth, in coping with the disease related and
treatment related symptoms of cancer and preparing people before surgery.
Meditation: - in meditation people regular focus their attention or systematically
focus on particular aspect of inner or outer experience. Meditation usually involves
sitting or resting quietly, often with the eyes closed. Sometimes it involves the
repetitive sounding of a phrase (a mantra) meant to gain the person focus.
Relaxation Technique:- relaxation techniques are practices specifically designed to
relieve tension and strain. The specific techniques may be aimed at reducing activity
of the nervous that control the stress response, lowering blood pressure, easing muscle
tension, slowing metabolic process, or altering brain wave activity. Relaxation
technique may be used in combination with other techniques, such as meditation,
guided imagery or hypnotherapy.
Guided imagery:- it involves the use of mental image to promote relaxation and
wellness, reduce pain or facilitate healing of the particular ailment, such as cancer of
psychological trauma. The image can involve any of the sense and may be self
directed or guided by a practitioner.
Hypnotherapy:- this alternative therapy is derived from the Western practice. In
hypnotherapy people are guided into an advanced state of relaxation and heightened
attention. Hypnotized people become absorbed in the images suggested by the
hypnotherapist and are able to suspend disbelief. Because their attention is more
focused and they are more open to suggestion, hypnotherapy can be used to help
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people change their behavior and thus improve their health. Hypnotherapy also may
be helpful in treating many condition and symptoms in which psychological factors
can influence physical symptoms:-
Phobias
Certain pain syndrome
Smoking cessation
Conversion disorder
Irritable bowel syndrome
Headache
Asthma
Some skin disorder
High blood pressure
Nausea and vomiting caused by chemotherapy
Anxiety
Biofeedback :-
Biofeedback is method of bringing unconscious biologic process under conscious
control, biofeedback involves the use of electronic devices to measure and report back to
the conscious mind information such as heart rate, blood pressure, muscle tension and
brain surface electrical activity.
With the help of a therapist or with training, people then can understand why these
functions change and can learn how to regulate them.
Biofeedback typically used to treat pain including headache and chronic abdominal
pain stress, insomnia, facial or urinary incontinence, attention deficit disorder and can mild
cognitive impairment and tinnitus.
4) MANIPULATIVE AND BODY BASED METHOD:-

i. Yoga:- the fundamental idea behind the practice of yoga is to unite the individual self
(jiva) with the supreme or pure consciousness (Brahama). The factual connotation of
yoga is unification.
Merging in this realism liberates the spirit from all sense of separation. It liberates the
mind from the ignorance of time, space and causation.
In he present view yoga is one of the most helpful and healthy forms of experience
to manage the influence of thin king by turning psychological and physical forces into
spiritual energy. Yoga therapy eases oneself from the cramped tension. Concentration
is enhanced by yoga. Yoga therapy cures all disease and controls the aging process its
daily practice is often seen as a way of gaining control over your health.
The main aim of yoga therapy is the mind body integration, which strike into
the normal healing properties of the body and helps to restore function of your body
and health.
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Yoga therapy consists of three basic parts of your body which work together.
Physical posture- it helps to stretch and strengthen your muscles. It also improves
mobility, flexibility and balance. The proper posture enhances bodys natural
functions of circulation, elimination, respiration and digestion.
Breathing techniques- it mainly focuses on awareness of breath and helps promote
calm focus the mind and relieve stress and fatigue.
Relaxation Technique- it mainly helps you to recharge and ease tension.
Benefits of yoga therapy:-
Yoga therapy shows positive result in treating depression.
Deep breathing associated with yoga is beneficial in controlling premature ventricular
complexes.
Yoga therapy is beneficial in post treating strategy, breast cancer and other survivors.
Yoga therapy shows significant benefits that includes emotional functions, fitness
variation and psychological benefit. it also shows variation in tension, mood
disturbance, cognitive function and gastrointestinal disturbance.
Practice of regular yoga exercise increases your bodys ability in using antioxidants.
This is beneficial in the prevention of cancer.
In diabetic patient yoga therapy improves nerve function and lower blood sugar.
If you are suffering from rheumatoid arthritis the practice of yoga increases your had
grip strength.
Yoga helps in treating some problems like asthma, respiratory problem, back pain
etc.It helps in weight reduction
Criticism of yoga therapy:-
The practice of yoga therapy is impossible if you have limited mobility and flexibility.
While attempting some of the postures of yoga without any pre-exercise preparation
then there is a possibility of getting injured.
iii) Chiropractics:-
In chiropractic, the relationship between the structure of the spine and function of the
nervous system is thought to be the key in maintaining or restoring health. The main method
for achieving balance is spinal manipulation.
Chiropractic is often useful in treating low backache, headache and nerve impingement
syndromes. Generally however, the effect of manipulation on condition not directly related to
the musculoskeletal system has not been established. Serious complication resulting from
spinal manipulation. (eg:- low back pain, damage t cervical nerves, damage to arteries in the
neck) are rare.
5) ENERGY THERAPY:-
i. Massage Therapy:- body tissue are manipulated to promote wellness and reduce pain
and stress. The therapeutic value of massage for many musculoskeletal symptoms and
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stress is widely accepted. Massage has been shown to help relieve muscle soreness
pain due to back injury and fibromyalgia and to help relieve anxiety in cancer
patients. Massage therapy is also effective in treating low birth weight infants.
Preventing injuries to the mother genitals during child birth relieving chronic
constipation and controlling asthma.
ii. Acupuncture:- a therapy within traditional Chinese medicines is one of the most
widely accepted alternative therapies in the western world. Specific points on the
body are stimulated usually by inserting thin needles into the skin and underlying
tissue. Some time additional stimulation is added by using a very low voltage
electrical current, by twisting the needle, or by warming the needle. Stimulating these
specific points is believed to unlock the flow of qi along energy pathway and these
restore balance between yin and yang. This procedure is not painful but may cause a
tingling sensation.
A variation in of acupuncture is called accupressure; uses localize massage
instead of needles to stimulate acupuncture points. Adverse effects are rare if the
procedure is done correctly, worsening of symptoms (usually temporary) and fainting
are the most common. Infection is extremely rare, most practitioner use disposable
needles.
iii. Reflexology:-a variant of massage therapy, relieve on manual pressure applied to
specific areas are believed to correspond to different organs or body systems via
meridians. Stimulation of these areas in believed to eliminate the blockage of energy
responsible for pain or disease in the corresponding body part.
iv. Hand Mediated Biofield Therapies:- therapeutic touch is mostly secular variant of
faith healing, started by Dolores Krieger in the early 1970s. The Therapeutic touch
practitioner moves his hand over the patients body, specifically the affected area,
without actually touching the patient. The practice is based on the belief that living
beings have an energy field or aura which extends beyond the surface of the body that
can be manipulated by the therapist, no evidence of effectiveness has been found.
v. Other therapies:-
Traditional chinese medicine:- traditional Chinese medicine, originating > 2000
years ago, traditional Chinese medicine is based on the theory that disease results
from improper flow of the life forces (qi). Qi is restored by balancing the
opposing forces of Yin and Yang which manifest in the body as heat and cold,
external and internal and deficiency and excess. Various practices (eg:-
acupuncture, herbal, remedies, massage medication) are used to preserve and
restore health.
Curanderism:- it is a cultural healing tradition found in latin America and among
many latinos in the United states. Although it is a traditional healing system, it
utilizes western biomedical belief, treatment and practices. Three levels of care
are practiced among curanderos and curanderas (women) the material level. The
majority of healer work at the material level and most combine spiritual healing,
herbal and first aid techniques.
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Aroma therapy:- aroma therapy is based on the healing power of plants oil which
may be massaged into the skin in haled or used in the bath. Anecdotally it is said
to induce a feeling a feeling of well being.
Aromatherapy massage relieves tension and improves circulation and can reduce
anxiety in short term setting such as intensive care. A trial of Melissa (lemon
balm) aroma therapy shows highly significant effect in reducing agitation and
increasing social interaction in dementia patients.
Spiritual therapy:- spiritual therapy is regimen to designed to heal ones spirit and
psyche as well as the body. In many tradition, it is believed if ones spirit is ailing
ones whole being suffers. This is where spiritual therapy comes in. It treats the
whole being, especially the spirit to promote a healthy whole person.
Music therapy:- it is an interpersonal process in which a trained music therapist
uses music and all of its facets physical emotions, mental, social aesthetic and
spiritual to help clients to improve or maintain their health, in some instances the
clients need are addressed directly through music, in other they are addressed
through the relationship that develop between the client an therapist.
Music therapy is used with individual of all ages and with a variety of
conditions, including :- psychiatric disorder, medical problems, physical
handicaps, sensory impairments, developmental disabilities, substance abuse,
communication disorders, interpersonal problems and aging. It is also used to:-
- Improve learning
- Build self esteem
- Reduce stress
- Support physical exercise and
- Facilitate a host of other health related activities
Humour and Laughter:- laughter is found to lower blood pressure, reduced stress
hormones, increase muscle flexion and boost immune function by raising level of
infection fighting T-cell, disease fighting proteins called Gamma interferon and
Beta cells, which produce disease destroying antibodies, laughter also triggers the
release of endorphins, the bodys natural painkiller and produces a general sense of
well being.
Laughter is infections. Hospitals around the country are incorporating formal and
informal laughter therapy programme into their therapeutic regimens.
Benefits of laughter:-
- Laughter activates the immune system.
- Laughter decreases stress hormones.
- Laughter brings in positive emotion that can enhance well being but cannot
replace conventional treatment. Hence it is another tool available to help fight
the disease.
Humaour:- humour is the tendency of particular cognitive experience to provoke
laughter and provide amusement. Humour is a universal language. It is a contagious
emotion and natural diversion. It brings other people in and breaks down barriers.
Best of all it is free and has no known side reaction.
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Bioelectromagnetic Therapy:- bioelectromagnetic therapy is the application of
electromagnetic field to treat and prevent disease and promote health and longevity.
Electromagnetism is a powerful clinical tool, simple to apply yet complex in this
biological effects.
Whenever current (I) passes through a wire, it induces a magnetic field.
Although the electricity itself remains confined within the wire, the magnetic field
induced moves outside.
What makes this treatment so remarkable is that living tissue is essentially
transparent to magnetic field, when a varying electromagnetic field is placed close to
a conductive medium such as the human body. It will induce electrical currents.

Photo energy therapy:- photo energy therapy devices emit near infrared light (NIR
Therapy) typically at a wavelength is believed to stimulate the release of Nitric Oxide
an Endothelium derived relaxing factor into the blood stream, thus vasodilating the
capillaries and venules in the microcirculatory system. This increase in circulation has
been shown effective in various clinical studies to decrease pain in diabetic and non
diabetic patient. Photo energy therapy devices seem to address the underlying
problem of neuropathies, poor microcirculation, which leads to pain and numbness in
the extremities.
Detoxification Therapy:- detoxification therapy involves the removal of toxic
substances. Our body naturally eliminates or neutralizes toxins. But due to industrial
revolution the accumulation of toxins (food additives, chemicals, anesthetics and
residue of pharma drugs, pesticides and heavy metals) surpasses its elimination.

Detoxification therapy treatment:-
There are a number of methods of detoxification.
Firstly a brief physical checkup is made, x-ray is taken, urine and blood
samples are sent for analysis sometimes sweat and hair may be analyzed.
Colonic irrigation, fasting, special diets, hyperthermia other hydrotherapy
treatment lymphatic stimulation and nutritional supplements are some methods
of detoxification.
Nutritional supplements:- intake of massive quantities of vitamin (a
recommended for people undergoing detoxification treatment). Vitamin A,
Vitamin B and Vitamin E and minerals like Magnesium, potassium, selenium
and zinc are also suggested. Herbs such as cayenne, Echinacea and garlic are
also included.

Benefits of Detoxification Therapy:-
Food additives preservatives, environmental pollutants and many synthesis
chemicals have bad effects and interfere with normal functioning of our
bodies and cause serious damage to adrenal glands, liver, kidney and thyroid.
A chemical fee home and workplace and healthy diet in insufficient to fully
undo the damage caused by years by years of toxic build up.
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Only detoxification programme are found beneficial in these cases, but some
experts argue that many of the recommended treatment are ineffective and
dangerous as well.

Avoid detoxification therapy when:-
Weak r under weight, elderly, pregnant and nursing mothers; people suffering
from ulcers and diabetes should avoid all forms of detoxification.
Ulcerative colitis , crohns disease, any other type of bowel inflammation or
hemorrhoids diverticulitis, tumor of the large intestine or rectum.
Liver or kidney problem.
High or low B.P. heart disease, epilepsy multiple sclerosis or asthma.
Lung problem or tuberculosis, heart problems, advanced cancer or diabetes.
People with history of blood clots

Animal assisted therapy:- (AAT) Is a type of therapy that involves an animal with
specific characteristics become a fundamental part of a persons treatment. Animal
assisted therapy is designed to improve the physical, social, emotional and/or
cognitive functioning of the patient, as well as provide educational and motivational
effectiveness for participants. AAT can be provided on an individual or group basis.
During AAT, therapists document records and evaluate the participants progress.

Many kinds of animals are used in therapy, including dogs, cats, elephants,
birds, insects like bees, dolphins, rabbits, lizards and other small animals. Such
animals are referred to as comfort animals. AAT with horses is known specifically as
equine- assisted psychotherapy (EAP). Equine assisted creative living (EACL)
Equine assisted personal development (EAPD) or hippo therapy.
BENEFITS
People who have pets benefits in various ways, foe example, the comfort of
physical contact with animals, reducing loneliness and increased opportunities
of meeting other, via the pets.
In addition caring for pets encourage nurturance, responsibility and adherence
to a daily schedule.
PHYSICAL
Improve fine motor skills
Improve wheel chair skills
Improve standing equilibrium (balance). May lower blood pressure, risk for
stroke or heart attack and decrease depression.
MENTAL
Increased attention skills
Develop leisure / recreation skills
Increased self esteem
Reduce anxiety
Reduce loneliness
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CRITICISM
The practice of capturing dolphin can leave more injured or even dead.


Horticulture therapy:-It the practice of horticulture as therapy eo improve human well
being.
According to the American horticultural therapy association:-
It is defined as a process utilizing plants and horticultural activities to improve social
educational psychological and physical adjustment of persons thus improving their body
mind and spirit.
Horticultural therapist are specially educated and trained members of rehabilitation
teams ( with doctors, psychiatrist, psychologists, occupational therapists and others) who
involve the client in all phases of gardening propagation to selling products as a means of
bringing about improvement in their life.

CONCLUSION
A lot of research is being done in this field and new drugs for treating more illness, are being
explore the side effects and resistance to allopathic, drug is becoming a human concern, so
people are turning to alternative approaches, so the people prospects of alternative
approaches in the future is bright.
SUMMARY
The topic includes framework, scope and trends in nursing practice. Frame work is important
to build the knowledge advancement of a profession. Which helps in broadening the scope of
practice continuous change in trends improves the level of the profession and provides the
wide working field for the nurses. It also helps in update the new knowledge regarding
alternative nursing care, health system and complementary therapy. The alternative
modalities of health care and system give client a better option to choose and go for that
according to their benefits and positive effects.





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BIBLIOGRAPHY
Kozier, Fundamental Of Nursing 5
th
Edition, page no. 18-21, 40-41.
Lois While Fudamental of Nursing Mosby Publication, Page No.85, 224.
Patricia A. Potter, fundamental Of Nursing 3
rd
edition, Mosby Publication, Page
no.- 29-31
Potter and Perry, fundamental Of Nursing, 5
th
edition Mosby publication.
Shabeer P. Basheer, A Concise Book of Advanced Nursing Practice 1
st
edition,
2012, Emmss medical publishers, page no. 648-675.

Internet:-
www.wikepedia.com
www.ncbi.com
www.pubmed.com
www.scribd.com
www.slideshre.com
www.sparknotes.com
www.ACN.org.com