Convergent Points for Conventional Medicine and Whole Systems Research: A User's Guide

Scoping review meets expert interviews: Key issues of multimodal programs for workplace health promotion in long-term care facilities - "We can't just run a standard program"

Background

Long-term care facility employees' workload escalation intensifies negative risk for (nursing) staff health, residents, and the economy. Workplace health promotion (WHP) has emerged as a vital approach with positive impacts on employee well-being. This Scoping Review focuses on multimodal WHP programs in long-term care facilities, emphasizing barriers, facilitators, and the integration of complementary and integrative medicine (CIM).

Methods

Following the PRISMA-ScR guidelines, a systematic search strategy from February to April 2023 in Medline (PubMed), EMBASE (Ovid), and CINAHL (EBSCOhost) yielded 506 hits. Findings were enriched through semi-structured expert interviews. All data were analyzed with a deductive-inductive qualitative content analysis.

Results

Eleven publications met inclusion criteria and eight experts were interviewed based on key topics of the included publications. The integration of the results showed that primary obstacles highlight structural challenges (time, finances, hierarchies) and team dynamics (lack of support, communication issues, low motivation), while effective communication, support from the management, and participatory engagement enhance program success. CIM approaches are not explicitly referenced as such, despite widespread use.

Conclusion

An exclusive CIM-focus, with multimodal WHP programs for long-term care facilities is missing and should highlight the necessity of a multimethod approach intervention. While the need for further research about the specific topic of multimodal, CIM-based WHO programs in long-term care facilities - including cross-cultural and international comparisons - is apparent, an appropriate evaluation of complex interventions is challenging given the nature of multimodal WHP programs. A multi-method approach is therefore recommended as standard for further research in this area.

A Patient-Centered Integrative Approach Improves Visual Field Defect: A Case Report

We present a case involving a patient with a complicated visual field defect preventing her from renewing her driver license. It highlights the underappreciated role of chronic stress in the genesis and perpetuation of ill health and the potential of Chinese medicine (CM) to complement biomedicine in the treatment of an intractable visual disorder. The patient experienced impaired vision from age 15, and ophthalmologists considered various diagnoses including optic neuritis and acute zonal occult outer retinopathy (AZOOR)-complex disorder with acute macular neuroretinopathy. She was treated with an integrative East-West medical approach incorporating acupuncture, cupping, trigger point injections, guidance on self-care and lifestyle modification. Although the eye disorder was not cured, there was visual improvement as demonstrated by various objective ophthalmologic tests, and the patient was able to renew her driver license. Visual improvement remained stable upon follow-up examination three years after the treatment intervention. Other concomitant health issues reported by the patient also improved including amelioration of neck pain, a more regular menstrual cycle, and decreased anxiety. This case demonstrates how a patient with an intractable complex eye disorder can have objective visual improvement when treated with an integrative patient-centered approach.