Alternative Health Practitioner, Vol. I , No.

I , Spring 199s

A Theory for Alternative Health Practitioners

Carl 0. Helvie, RN, DrPH

Old Dontinion University
Norfolk, VA

All alternative health practitioners have in common the use of some aspect of energy
in their practice. For example, the acupuncturist works with blockages of energy,
the therapeutic touch therapist channels energy from the universe to the client, and
the nurse assists clients with their energy exchanges with the environmcnt.
The Helvie Energy Theory is useful for alternative health practitioners because
it is organized around the concept of energy. Organizing the theory around the
concept of energy facilitates learning and using in practice because all pieces of the
theory relate back to energy and energy is a familiar concept to most alternative
health practitioners.
With energy as a focus, the individual can be viewed as an energy field affecting
and being affected by all other energy fields in the environment (physical, biolog-
ical, chemical, psychosocial, and community subsystems) through exchanges.
These energy exchanges and individual success or failure in adaptation determine
placement (actual, potential) on an energy continuum and the need for assistance
from the health practitioner. This theory is applied in practice through a process of
assessing, planning, intervening, and evaluating.

What are alternate health practices? Under this umbrella is found a wide range of
therapies. These include such practices as massage, homeopathy, biofeedback, acu-
puncture, yoga, chiropractic, breathing, and therapeutic touch. These may or may not
be used in combination with traditional treatments.
What do all of these alternative health therapies have in common? They all involve
some aspect of energy. For example, those who practice acupuncture say there are
energy channels that run through the body that may become blocked and they work with
these channels, and those who practice therapeutic touch say the universe has unlimited
energy that can be channeled to clients to overcome an imbalance of energy. In addition,.
the intake of such substances as food, oxygen, medications, and love can be considered
to be energy. These are assessed and/or prescribed by health professionals when
appropriate. Whether therapy is directed toward removing blockages so energy can
flow through the body, or whether it is to correct an imbalance (treatment) or maintain
a balance (prevention), all treatments used by health practitioners involve energy.
Helvie’s Energy Theory is a useful theory for alternative health practitioners. This
theory uses a systems approach and is organized around the concept of energy. The

0 1995 Springer Publishing Company 15

16 C. 0. Helvie

systems approach requires the practitioner to assess the family and community as well
as the individual when working with individual clients. Organizing the theory around
the concept of energy facilitates learning and practice use because every aspect cf the-
theory relates to the concept of energy.
Riehl and Roy (1990) and Meleis (1991) say that theory can be a set of sentences that
conceptualize a practice area. The purpose of these sentences is to describe and predict
health care. The Helvie Energy Theory follows this definition.
The theory was applied to individuals, families, and communities for community
health nurses in the original sources (Helvie, 1981, 1991) but will be applied to
individuals in this article. This seems appropriate because the individual is the more
usual unit of service for alternative health practitioners.

THE THEORY

The theory can be outlined as follows:

1. Individuals are open energy systems.
2. The individual’s environment is energy.
3. Individuals exchange energy with the environment.
4. Individuals continually attempt to adapt holistically to energy exchanges.
5. Individual energy needs vary with time and situation.
6 . Adaptation to energy exchanges determines the individual’s level of health.
7. As individuals move toward the illness end of a healthhllness continuum, they
often require assistance from others.
8. Health practitioners assist high-risk individuals (actual, potential, poor adapters).
to maintain or regain efficient adaptation to energies.

Individuals Are Open Energy Systems

Individuals are open energy systems composed of three types of energy: bound, kinetic. and
potential. These constitute the internal environment. Bound energy is organized energy or
mass and includes cells, organs, or the whole body. Kinelic energy is energy in motion that
assists in meeting the needs of the bound energy and maintaining a homeo dynamic balance.
Kinetic energy relates to such processes as maintaining a steady blood sugar level, stable
vital signs, or movement of nerve impulses to and from the brain. Kinetic energy also
includes the energy that flows through the body in meridian pathways discussed by
acupuncturists, or through the zones discussed by reflexologists. Pofenfialenergy is stored
energy on which work has been done and which is available for future use. This includes
such energies as stored glycogen in the liverand stored knowledge,attitudes, rolebehaviors,
and defense mechanisms in the brain. All individuals are open systems because they
exchange energy with the environment.

The Environment Is Energy

The environment of individuals is energy, which can be internal or external. The
internal environment was discussed earlier. The external environment is all energy
beyond the individual’s bound energy (body) or energy field around the body. This can
be subdivided for purposes of study into chemical, physical, biological, or psychoso-
Alternative Health Theory 17

cial. In reality these are interrelated and overlapping. In addition, some environmental
energies such as humans, plants, and animals can be seen with the eye, whereas other
energy forms, such as bacteria, can only be seen with the microscope. Other types of
environmental energy cannot be seen, but register on other senses. For example, sound
and heat register on our auditory organs and skin, whereas energy generated by prayer
and laying-on-of-hands is in a grey area but can be felt by the sensitive individual.
Cizernical energies include objects such as food, oxygen, d r pollutants, cigarettes,
and medications. Physical energies include color, heat, light, sound, radiation, and
olhers. Biological energies include bacteria, fungus, virus, rabid animals. allergens,
plants, and insect bites. Psychosocial energies include anger, fear, love, and hate, as
well as nonverbal expressions, sociocultural values, prayer, healing, and physical
closeness or distance. Many of the psychosocial energies are supplied through the
family.
Another level of environmental energies exists in the community and can be
conceptualized as the services and resources available to individuals by economic,
health, education, legal, recreation, and sociocultural subsystems. For example, eco-
nomic services include employment availability, and health services include all health
services in the community.

Individuals Exchange Energy With the Environment

From the chemical environment, individuals select food and give off waste products or
breathe oxygen and exhale carbon dioxide. In addition, society has learned to convert
energy for future use (potential) in such forms as pesticides, antibiotics, and fuel for
automobiles. These affect exchanges and have both positive and negative consequences
for society. Exchanges between an individual and a bacterium (biological input) might
include an infection, symptoms of illness, and possible changes in the urine, vital signs,
and other measurable body indicators as output. For community exchanges, the
individual may pay taxes or a fee, and in return receive an education from the
educational subsystem or health care from Uie health subsystem. There are also
exchanges between the individual and sociocultural subsystem that influences values
and attitudes.
Inpzct varies from person to person and some input is more controllable than others.
For example, the oxygen-carbon dioxide and other autonomic exchanges are not under
the control of individuals, and unless there is damage to the bound energyresulting from
past energy exchanges, they usually remain fairly consistent from person to person. On
the other hand, food intake may vary from individual to individual in relation to amount,
type, and frequency. Individuals also make decisions about whether or not to smoke,
take drugs, eat candy, or drink alcohol.
Oirtpul may also vary from individual to individual. Input is transformed and the by-
product of what is used or stored is discarded. Physiological oirlpirl is usually fairly
consistent from person to person unless there are changes in the body resulting from past
energy excesses or deprivations. Thus, these outputs can be compared with standards
to determine normality. For example, normal feces have a certain consistency, color,
and frequency whereas normal urine has a certain specific gravity, volume, and color
and is free from sugar, acetone, blood, and other abnormalities. Output for the
chiropractor, acupuncturist, or massage therapist (in response to tension or disease in
clients) may be in the form of energy blockage or disrupted patterns of energy flow.
I8 C. 0. Helvie

Output in the form of behavior is less consistent from person to person because of the
transformation that combines the input with potential energy (knowledge, values,
attitudes). For example, one person who has a sore throat and fever as a result of an
exchange with a disease agent (biological energy) may consult a physician, whereas
another with the same symptoms may consult a nurse practitioner, herbalist, chiroprac-.
tor, or no one (Helvie, 1991).
Although the practitioner cannot always predict input and output, thereare standards
with which to compare assessment data. These data in combination with an assessment
of the basis for the observed behavior determine interventions.
Excesses and deprivations of energy from exchanges may lead to damage to the
bound, kinetic, and/or potential energies of the body. (See the discussion of entropy
below.)

Individuals Continually Attempt to Adapt

The ongoing exchanges (input, output) between the individual and the environment that
are necessary for life and growth require the individual to continually adapt.Adaptation
is the homeodynamic adjustment of the individual as the parts work together to keep the
parts and the whole system in balance when faced with internal and external energy
forces against this balance (Helvie, 1991, p. 13). Within the internal environment the
interrelated parts such as the heart, liver, and muscles work interdependently using
kinetic and potential energy to maintain the individual’s balance and purposeful
direction. For example, a reduction in blood sugar will trigger a conversion of glycogen
(potential energy) in the liver to glucose to maintain the blood sugar level. Likewise, a
change in environmental temperature will bring into play interrelated mechanisms to
maintain a steady body temperature. In addition, the brain assists in maintaining
balance by reasoning, problem-solving, and using knowledge (potential energy) to
influence exchanges, such as eating when hungry, or putting on acoat when cold. These-
and other processes that tend to maintain a steady physiological state are known as
negative feedback. The other type of feedback is positive feedback, which tends to
amplify change from a steady state, and leads to growth and learning.
Change that requires adaptation may be introduced by any variation in external
environmental energies. For example, a loss of health care, job, or spouse will all
require adjustment.
As change is introduced there is a need to reestablish a temporary balance. For
example, when individuals lose a job, there is no exchange with the economic
subsystem and they must look for another job, use savings, and/or apply to social
services for assistance. During this period they may have less money for food, shelter,
recreation, and other necessities. The ramifications of these changes will lead to a new
temporary balance that may move them toward or away from health.
Although responding to change (nonautomaticresponse) may vary from individual
to individual, it usually follows a specific pattern for an individual based on learned
behaviors (potential energies of knowledge, attitudes, values). For example, we learn
what to do and what is acceptable in our group when we lose a job. We also learn what
to eat, when to eat, whom to love, and so forth for nonautomatic behaviors. Responses
to change may also involve such concepts as bargaining,pressuring, and voting to arrive
at a consensus among factions such as family members who are for or against a specific
change.
Alternative Health Theory 19

Entropy is the energy lost during transformation and not available for use. An
example would be the loss of some energy when food is converted to a usable form by
the body. The subsystems (circulatory, nervous, respiratory) continually lose some
energy as they adjust to and transform external energies.This loss is not detrimental to
the individual when all parts are working efficienlly and there is enough additional
energy to meet needs for growth and movement toward a higher form of organization
(n eg en t ropy).
Harmful entropy results from a defect in a part of the system (bound, kinetic,
potential) usually resulting from previous excesses or deprivations of energy. This
breakdown of a part of the system will affect other parts and consequently decrease the
efficiency of the system. For example, emphysema, which may result from excess
chemical energy (cigarette smoking or polluted air), will affect the oxygen-carbon
dioxide exchange (because of the decreased lung capacity), and will subsequently
affect the circulatory and nervous subsystems, which will accommodate, but function
at a less efficient level. This makes it more difficult for the system to meet its goal of
maintenance and growth. Other examples include cancer, cardiovascular disease, and-
allergies.
All behavior is considered adaptive, but there is a range (efficienf adaptation)
beyond which there may be irreversible changes in the energy system (bound, kinetic,
potential) resulting from excessive or deprivation of energy. Efficient adaptation has
been defined as the “genetically/environmentally determined range of adaptability for
the specific individual in which changes in the bound, kinetic, and/or potential energies
may take place but are easily reversible and maintain the efficient functioning of the
system” (Helvie, 1991, p. 18). An example of efficient adaptation would be normal
weight loss. It is important to distinguish between reversible and irreversible changes
because they may dictate the need for outside assistance (see below). For example, the
loss of body protein when there is an inadequate intake of food is adaptive behavior by
the body but this change is probably not easily reversible.

Individual Needs Vary

Energy needs of individuals vary as they move through time depending upon such
factors as the rate of growth and the energy used for activities and with negative feelings
(worry, hate). The elderly person needs less chemical energy in the form of food than
a young active person, but may need more chemical energy in the form of medicines or
herbs. The pregnant woman may need different energies than a woman of the same age
who is not pregnant. Developmental and situational changes such as these have been
studied and the energy needs documented. Thus, it is possible to compare a specific.
individual’s needs with standards established using concepts and tools such as the
Denver Developmental Screening Test (Frankenburg. Goldstein. & Camp, 1971),
Piaget’s stages of cognitive development (Piaget, 1963), or Erikson’s stages of psycho-
social development (Erikson, 1959).

Adaptation Determines Level of Health

Health is “the adaptation of humans to the changing energies in the environment”
(Helvie, 1991, p.22). It can beconceptualizedon acontinuumfromanoptimum balance
of energies (high-level wellness) to a dissipation of energy (death). At the optimum
20 C. 0.Helvie

balance of energies end of the continuum are individuals who are within an efficient
range of adaptability regarding the intake and output of energiesappropriate for the age,
condition, and so forth. It also includes a balance in biopsychosocial and spiritual
dimensions.
As individuals experience excesses and deprivations of energies over a period of time
and move outside the range of adaptability, they move down the continuum. This
movement may be temporary or more permanent, depending whether or not the changes
from the energy excesses or deprivations are reversible. For example, the effect of an
excess of biological energy resulting in the common cold or influenza may move
individuals down the continuum temporarily until they recover from the illness.
However, a common cold or influenza in a person who has had previous excesses and
deprivations'of energy that have led to structural or process changes (bound, kinetic)
may produce a more permanent movement down the continuum.

Continuum Movement Usually Requires Assistance

Although individuals can use assistance to remain within an efficient range of adaptabil-
ity, when they move outside this range, ihey will require assistance from others: teaching
about wellness behaviors, healthy chiropractic adjustments, use of herbs for health.
Assistance may come from family members or from community resources (health
practitioners, social workers, or others), depending upon the results of an assessment.

Health Practitioners Assist High-Risk Individuals

Health practitioners help high-risk individuals maximize their efficient adaptation, that
is, they help individuals stay within the efficient range of adaptability by altering or
maintaining energy exchanges or help clients return as closely as possible to the efficient
range of adaptability by altering energy exchanges and/or working with the effects of
past energies on the bound, kinetic, or potential energies. A11 interventions are based
upon an adequate assessment or health history that may focus on all or selected aspects
of current energy exchanges andlor the effects of past energy exchanges.
'
Higli-risk individitals q e those individuals who are experiencing, have experienced,
or are likely to experience a developmental or situational change and who are deemed
least likely to adapt based upon epidemiological data about groups. These groups of
individuals comprise all who have experienced the effects of past excesses or depriva-
tions of energy, or who are currently experiencing or may experience excess or
deprivation of energies and thus may be considered to have actual or potential health
problems as a result of the energy exchanges.

PROCESS AND THEORY MODEL

The process used to apply this theory is known by various names. Nurses call it the
nirrsing process, consisting of assessing, planning. implemeniing, and evaluating.
Physicians have not named the process but identify components of taking a health or
medical history, developing a treatment plan, carrying out the plan, and evaluation.
Others call it the scienlific nteihod, problent-solvingprocess, research process, or some
other name. Each discipline, however, seems to include the four components identified
above.
Alternative Health Theory 21

In practice we apply the theory of energy through the process identified above. First,
we assess h e effects of past energies on the bound, kinetic, and/or potential energies of
the individual. If there have been excesses or deprivations of energy exchanges in the
past, there may be changes in the bound or other energies of the individual and often
movement outside the efficient range of adaptability. These changes are usually the
basis for an individual seeking assistance from a health practitioner. Some practitioners
such as the herbalist. massage therapist, acupuncturist, chiropractor, hospital nurses,
and physicians may work primarily with the effect of these past energy exchanges and
will obtain a health history as a basis for treatment.
The next step in Uie model is to assess the current energy exchanges between the
individual and environment. Here the practitioner assesses the chemical, physical,
biological, and psychosocial exchanges (including the family) and also exchanges with
the community subsystems such as health, social services, education, economic, and
others. Current exchanges will be compared with standards as a basis for identifying
excesses and deprivations that have the potential for causing changes in the bound,
kinetic, or potential energies of the individual.
Assessment tools specific to a discipline will be used, but all practitioners will
consider the person’s energy needs dependent upon time and situation. In addition.
some disciplines will assess a part of the exchanges whereas others may assess all
exchanges as a basis for treatment. For example, social workers may be more interested
in the exchanges with the economic or social subsystems of the community, whereas
community health nurses more often use a holistic approach to meet their goals. Other
practitioners may be less interested in assessing current exchanges than in assessing the
effects of past energy exchanges.
From the assessment of exchanges compared with standards, the practitioner makes
a determination about the energy exchanges. They may be adequate, excessive, or
deprived. The practitioner also determines the basis for the observed exchanges before
planning. For example, is the food deficit a result of a lack of knowledge, a lack of
income, a desire to lose weight, or some other factors? Different causal factors will
require different interventions.
A diagnosis is written in relation to the energy terminology. For example, inadequate-
food intake could be written: “A deficit in the chemical energy input of food (specify)
due to a lack of knowledge of proper nutrition.” A diagnosis related to the effects of past
energies on the body might be “blockage or imbalance of energies in bound energy
(specify area. e.g., neck) due to stress.”
After writing an energy diagnosis. a treatment plan is developed. Treatments will
involve some aspect of energy related to Lhe diagnosis. Goals, objectives. and planned
treatments may be identified in part or whole. Goals are broad and usually relate to an
increase, decrease, or maintenance of energy exchanges for exchanges between the
individual and environment. Goals for past energy exchanges that have affected the
bound or kinetic energy of the body may be written in terms of increasing, decreasing.
removing. or rebalancing energies. For example. a goal for the diagnosis above related
to nutrition might be “increase chemical energies of food (specify)”; and a goal for the
blockage identified above might be “remove the blockage of energies.”
Objectives relate to the expectations for the client in meeting the goal. These usually
have at least three components: Who is to carry out the activity (usually Uie client); wlio!
activity is to be carried out; and when the activity is to be completed. For example, an
objective to meet the goal of increasing the chemical energy of food might be: “Client
22 C. 0. Helvie
will eat three green leafy vegetables aday beginning 12/21/94” (if these vegetables had
been identified as the deficit energy in the diagnosis). Other related objectives would
also be written to meet the goal. A goal for the blockage diagnosis might be “Client will
practice stress management exercises for 10minutes nightly beginning 12/12/94.” This
would supplement the manipulations of the massage therapist or chiropractor and
would help prevent further blockage.
Treafrnenfsare identified and direct the interventions of the practitioner. These may
take many forms: increasing physical energy through such activities as manipulation by
the chiropractor or osteopath, massage therapy, giving a bath, or providing for olher
activities of daily living. They might involve increasing chemical energy by altering the
diet, providing oxygen therapy, teaching deep breathing exercises, or prescribing
medications, herbs, or other oral preparations. They might involve increasing sound
energy by teaching specific to the problem, increasing light energy through the use of
ultraviolet light, or decreasing these energies in a quiet, dark hospital room.
After planning is completed, the practitioner and client implement the plan, and with
the client’s assistance, the practitioner evaluates the effect of the treatment. Reassess-
ment and development of new plans or the end of treatment follows.

REFERENCES
Erikson, E. (1959). Identity and the life cycle. Psychological Issues (Vol. 1, No. 1).New
York: International Universities Press.
Frankenburg, W. K., Goldstein, A., & Camp, B. (1971). The revised Denver Develop-
mental Screening Test: Its accuracy as a screening instrument. Journal of Pediat-
rics, 79, 988-995.
Helvie, C. (1981). Communifyirealfh nursing, theory andprocess. New York: Harper
and Row.
Helvie, C. (1991). Corra,zrtnityhealth nursing, fireoryandpractice. New York: Springer
Publishing Company.
Meleis, A. (1991). TIIeoretical nursing: Developtnent andprogress. Philadelphia: J.B.
Lippincott.
Piaget, J. (1963). Tire child’s conception of the world. Totowa, NJ: Littlefield, Adams
& co.
Riehl, J., & Roy, C. (1990). Conceptual nzodels for nursing practice. Norwalk, CT:
Appleton-Cen tury-Crofts.

Biographical Data. Carl 0. Helvie, RN, DrPH, is a Professor of Nursing in the School
of Nursing at Old Dominion University in Norfolk, VA. Dr. Helvie is the author of
numerous articles as well as the text Conntunity Health Nursing: Tiieory and Practice,.
(1991, Springer Publishing), the earlier edition received a Book of the Year Award from
the Anzerican Journal of Nursing.

Offprinfs. Requests for offprints should be directed to Carl 0. Helvie. RN, DrPH, Old
Dominion University, School of Nursing, Norfolk, VA 23529-0500.