Oncology nurses' perspectives on unconventional therapies

Experiences and Attitudes of Nurses Regarding Complementary Health Approaches Used by Themselves and Their Patients

Nurses' attitudes and experiences may affect the level of patient exposure to complementary health approaches (CHA), both now and in the future. The purpose of this study was to describe nurses' experience of CHA and their personal and professional attitudes to the use of CHA. The sample consisted of 220 nurses working at a university hospital in Antalya, Turkey. Data were collected using a questionnaire developed by the researchers. Nurses had a positive attitude toward CHA and reported mixed experiences of CHA for allergies, pain, and stress. This study may contribute to increased awareness of the potentially important role of nurses in delivery of CHAs. Hospital nurses should receive more training on CHA. Nurses should discuss the potential benefits and risks of CHA with patients.

Integrating complementary and alternative medicine into cancer care: Canadian oncology nurses' perspectives

The integration of complementary and alternative medicine (CAM) and conventional cancer care in Canada is in its nascent stages. While most patients use CAM during their cancer experience, the majority does not receive adequate support from their oncology health care professionals (HCPs) to integrate CAM safely and effectively into their treatment and care. A variety of factors influence this lack of integration in Canada, such as health care professional(HCP) education and attitudes about CAM; variable licensure, credentialing of CAM practitioners, and reimbursement issues across the country; an emerging CAM evidence base; and models of cancer care that privilege diseased-focused care at the expense of whole person care. Oncology nurses are optimally aligned to be leaders in the integration of CAM into cancer care in Canada. Beyond the respect afforded to oncology nurses by patients and family members that support them in broaching the topic of CAM, policies, and position statements exist that allow oncology nurses to include CAM as part of their scope. Oncology nurses have also taken on leadership roles in clinical innovation, research, education, and advocacy that are integral to the safe and informed integration of evidence-based CAM therapies into cancer care settings in Canada.

Nurses' experiences, expectations, and preferences for mind-body practices to reduce stress

BACKGROUND

Most research on the impact of mind-body training does not ask about participants' baseline experience, expectations, or preferences for training. To better plan participant-centered mind-body intervention trials for nurses to reduce occupational stress, such descriptive information would be valuable.

METHODS

We conducted an anonymous email survey between April and June, 2010 of North American nurses interested in mind-body training to reduce stress. The e-survey included: demographic characteristics, health conditions and stress levels; experiences with mind-body practices; expected health benefits; training preferences; and willingness to participate in future randomized controlled trials.

RESULTS

Of the 342 respondents, 96% were women and 92% were Caucasian. Most (73%) reported one or more health conditions, notably anxiety (49%); back pain (41%); GI problems such as irritable bowel syndrome (34%); or depression (33%). Their median occupational stress level was 4 (0 = none; 5 = extreme stress). Nearly all (99%) reported already using one or more mind-body practices to reduce stress: intercessory prayer (86%), breath-focused meditation (49%), healing or therapeutic touch (39%), yoga/tai chi/qi gong (34%), or mindfulness-based meditation (18%). The greatest expected benefits were for greater spiritual well-being (56%); serenity, calm, or inner peace (54%); better mood (51%); more compassion (50%); or better sleep (42%). Most (65%) wanted additional training; convenience (74% essential or very important), was more important than the program's reputation (49%) or scientific evidence about effectiveness (32%) in program selection. Most (65%) were willing to participate in a randomized trial of mind-body training; among these, most were willing to collect salivary cortisol (60%), or serum biomarkers (53%) to assess the impact of training.

CONCLUSIONS

Most nurses interested in mind-body training already engage in such practices. They have greater expectations about spiritual and emotional than physical benefits, but are willing to participate in studies and to collect biomarker data. Recruitment may depend more on convenience than a program's scientific basis or reputation. Knowledge of participants' baseline experiences, expectations, and preferences helps inform future training and research on mind-body approaches to reduce stress.

Oncology clinicians' accounts of discussing complementary and alternative medicine with their patients

The profile of complementary and alternative medicine (CAM) has risen dramatically over recent years, with cancer patients representing some of the highest users of any patient group. This article reports the results from a series of in-depth interviews with oncology consultants and oncology nurses in two hospitals in Australia. Analysis identifies a range of self-reported approaches with which oncology clinicians discuss CAM, highlighting the potential implications for patient care and inter-professional dynamics. The interview data suggest that, whilst there are a range of consultant approaches to CAM, ;risk' is consistently deployed rhetorically as a key regulatory strategy to frame CAM issues and potentially direct patient behaviour. Moreover, ;irrationality', ;seeking control', and ;desperation' were viewed by consultants as the main drivers of CAM use, presenting potential difficulties for effective doctor-patient dialogue about CAM. In contrast, oncology nurses appear to perceive their role as that of CAM and patient advocate - an approach disapproved of by the consultants on their respective teams, presenting implications for oncology teamwork. CAM education emerged as a contentious and crucial issue for oncology clinicians. Yet, while viewed as a key barrier to clinician-patient communication about CAM, various forms of individual and organizational resistance to CAM education were evident. A number of core issues for clinical practice and broader work in the sociology of CAM are discussed in light of these findings.

Complementary and Alternative Medicine: Oncology Nurses' Experiences, Educational Interests, and Resources

PURPOSE/OBJECTIVES

To describe oncology nurses' experiences with patients communicating interest in or use of complementary and alternative medicine (CAM) therapies along with oncology nurses' CAM resources and educational interests.

DESIGN

National mailed survey.

SETTING

A national medical center and research institute.

SAMPLE

A random sample of 850 Oncology Nursing Society (ONS) members who are RNs involved in direct patient care.

METHODS

Respondents completed a demographic questionnaire and the Nurse Complementary and Alternative Medicine Knowledge and Attitude Survey. Initial analysis compared the demographics of the sample to the ONS membership. Descriptive analysis was used to further describe nurses' experiences with patients communicating interest in or use of CAM, nurses' interest in CAM education, and nurses' use of CAM resources.

MAIN RESEARCH VARIABLES

Experiences, resources, interests, and CAM therapies.

FINDINGS

Oncology nurses reported their experiences with patients who communicated interest in or use of CAM therapies. Respondents demonstrated considerable interest in learning more about specific CAM therapies and used a variety of resources to find information on CAM therapies.

CONCLUSIONS

Assessing oncology nurses' experiences, resources used, and interest in learning about CAM therapies is the first step in determining the learning needs of oncology nurses in the direct patient care environment. The next step is to obtain baseline information on oncology nurses' CAM knowledge and attitudes for developing and providing appropriate education. CAM education will provide nurses with knowledge to support and advocate for their patients.

IMPLICATIONS FOR NURSING

Oncology nurses are the bridge to help patients safely integrate evidence-based CAM therapies into conventional treatment.

Nursing Students' Willingness to Use Complementary and Alternative Therapies for Cancer Patients: Istanbul Survey

It is important for student nurses to be knowledgeable of the complementary and alternative therapies and to provide accurate information to both cancer patients and other health care professionals. This study examined the nursing students' willingness to use these therapies, availability of sources of information, use of the therapies for self care, opinions about the integration of these therapies into nursing curriculum, and analyzed the differences among the responses. A self-administered questionnaire was offered to 640 nursing students in Istanbul, descriptive statistics were used, and comparisons among responses were made with chi-square test. Willingness to use for cancer patients was highest for nutritional therapy (76.1%), breathing therapies (74.5%), and massage and manipulation-Tui Na, in which pressure and touch are applied to the body (71.9%). Use of information sources was highest for nutritional therapy (75.6%), breathing therapies (71.9%), and massage and manipulation-Tui Na (62.3%). Over half of the nursing students used music therapy (54.2%), and massage and manipulation-Tui Na (53.6%) for self-care. Breathing therapies (87.2%) were the most desired therapy chosen to be included in nursing curriculum. The statistically significant differences were found among the responses related to use five therapies for care and related to desired three therapies to be included in nursing curriculum. Although students had not previously been exposed to these therapies use with oncology patients, many of students expressed a desire to integrate therapies learning into nursing curriculum. The more student nurses document high risk patients, the more effective strategies will be developed by other health care professionals.

'Thinking outside the box': complementary and alternative therapies use in paediatric oncology patients

The aim of this study was to determine the prevalence of complementary and alternative medicine (CAM) use among children with cancer who had received or were receiving treatment at a large hospital in the UK, including the identification of the most commonly used therapies and parental motives for doing so. Using a cross-sectional survey design, questionnaires were sent to parents of paediatric patients diagnosed with cancer. Of the 49 respondents, 32.7% reported using some type of CAM. The most commonly used therapies included multivitamins, aromatherapy massage, diets and music as therapy. Most children had used more than one therapy. Many of the factors that motivated parents to use CAM were related to helping or supporting their child's medical treatment. The main benefits identified from using CAM included increased confidence, pain relief and relaxation. The longer the time since diagnosis the more children tended to use CAM. The reasons for parents not using CAM included the child doing well and therefore not seeing the need for CAM use; not being aware of CAM; CAM not being offered and lack of information available. Parents identified a need for more information to be available both at ward level and for information about CAM to be discussed by medical staff, particularly at the start of treatment. The results indicate that CAM is frequently used by children and young people with cancer and that their use plays a substantial role in helping children through their conventional cancer treatment.

Complementary therapies and healing practices: faculty/student beliefs and attitudes and the implications for nursing education

The purpose of this study was to describe the knowledge and attitudes of nursing faculty and students (BSN and MS) regarding complementary/alternative therapies (C/AT) and their integration into nursing practice. Implications for curricular and faculty development were also identified. A cross-sectional survey (n = 170) of graduating BSN students (n = 73) and MS and PhD students (n = 47) and faculty (n = 50) was conducted in a university-based nursing program. The self-administered questionnaire contained 134 forced choice items. Questions assessed attitudes and knowledge about training in, personal use of, perceived barriers to, and intent to integrate C/AT into clinical practice. Over 95 percent of the students and faculty agreed that clinical care should integrate the best of conventional and C/AT practices. Few had received formal C/AT education; the highest number had received some education about massage, music, prayer/spiritual healing, and therapeutic/healing touch. They desired more education but not necessarily the skills to perform these therapies themselves. Faculty and students expressed positive attitudes about incorporating C/AT into curricula and nursing practice. Current knowledge lags behind interest, however, suggesting a situation ripe for change. The most important perceived barrier to incorporation was lack of evidence. Curricular change is needed to fully integrate C/AT in nursing programs at all levels; faculty development and nursing research is needed to facilitate these changes.

Complementary therapy practice: defining the role of advanced nurse practitioners

The purpose of the study was to identify the current and perceived clinical role functions of advanced nurse practitioners (ANPs) within the complementary health paradigm and their learning needs. Participants were asked to identify their referral practices to complementary practitioners, current and perceived clinical activities with respect to six most popular complementary therapies, learning needs and concerns regarding their use. A random sample of 389 ANPs registered with the College of Nurses of Ontario participated in a mailed survey using a modified Dillman approach, an established method for improving response rate through repeated mailings. An overall response rate of 55.3% (215 out of 389 eligible participants) was achieved. The results show that ANPs are currently engaged in clinical activities involving these therapies, with a trend towards more participation in assessing the need for them and counselling on the risks and benefits. ANPs are interested in validating the use of these therapies and acquiring more knowledge on the scientific principles, evidence of efficacy, pharmacology and potential interactions with conventional medicine.

Evaluation of a hospice based reflexology service: a qualitative audit of patient perceptions

Complementary therapies are being increasingly used in palliative care in the drive to improve patients' emotional, psychological and spiritual health, and enhance the quality of their lives. The importance of seeking the 'user' perspective when evaluating such services is becoming increasingly acknowledged. However, it is also extremely important that we elicit such perspectives in an ethically sensitive manner. This study used a simple semi-structured questionnaire to elicit the views of a convenience sample of 34 patients receiving palliative care at a specialist palliative core unit in the north of England who had completed a course of 4-6 sessions of reflexology. Patients' comments about the therapy and the service as a whole were overwhelmingly positive. They identified relaxation, relief from tension and anxiety, feelings of comfort and improved well-being as beneficial effects of their course of reflexology. Patients also spontaneously evaluated the experience holistically in terms of the wider therapeutic environment--the centre, the staff and the therapist as well as the therapy itself. The increasing demand for evidence based practice now challenges researchers to provide a relevant holistic assessment of complementary therapies using approaches that are both ethical and sensitive to the needs of this vulnerable patient population.

Knowledge levels and attitudes of staff nurses in Israel towards complementary and alternative medicine

AIMS

The purpose of this study was to determine the knowledge level and attitudes of Israeli nurses towards complementary and alternative medicine and what factors are related to these variables.

BACKGROUND

Over recent years there has been increased interest among the lay public and health care professionals in complementary and alternative medicine (CAM). Previous studies have shown that several variables such as education, income, age, perceived health status and satisfaction with medical therapy are associated with use of CAM. Conflicting reports were found with respect to the relationship between health locus of control and the use of CAM. Israel is a small country comprised mostly of immigrants from vastly differing cultures with differing beliefs about health and health care. Nurses whose origins are similar to the general population are also caregivers who are used to integrating diverse therapies into the plan of care devised with the client. No study was found which investigated these issues among Israeli nurses.

DESIGN/METHODS

A systematic random sample of 369 staff nurses working at a major academic medical centre in Jerusalem, Israel were invited to participate in the study. Informed consent was obtained. Four self-administered, pencil and paper, questionnaires were distributed to the study participants: a questionnaire designed by the authors to determine the level of knowledge and attitudes towards complementary and alternative medicine; a questionnaire which measured satisfaction with the patient-physician relationship; a questionnaire which measured health locus of control; and a demographic questionnaire. Participants received a packet containing the questionnaire and a note explaining the study. The anonymous questionnaires were collected by the ward secretaries and sent in bulk to the researchers.

RESULTS

Results demonstrated that nurses in this sample perceived that they had little knowledge of complementary and alternative medicine but were very interested in learning more. Few used complementary and alternative medicine in their nursing practice but levels of personal use were similar to that of the general population. Nurses who used complementary and alternative medicine were satisfied with their care.

CONCLUSIONS

In general, nurses tended to be wary of the use of complementary and alternative medicine. Nurses were also not satisfied with their relationships with their physicians. Those of middle age were more likely to use complementary and alternative medicine but no other demographic characteristics were associated with knowledge or attitudes towards complementary and alternative medicine. Nurses had higher levels of internal health locus of control which was associated with more positive attitudes and knowledge levels of complementary and alternative medicine.

Nurses' perceptions of complementary and alternative medical therapies

The purpose of this study was to identify the perceptions of nurses toward the effectiveness and safety, as well as their recommendations for and personal use of complementary and alternative medical therapies. A, random sample of 1000 nurses throughout the United States were surveyed using a three-wave mailing. About half of the respondents perceived there was conclusive evidence or preponderance of evidence that five therapies were effective: biofeedback, chiropractic, meditation/relaxation, multi-vitamins, and massage therapy. The same amount of nurses also perceived five therapies as definitely safe: hypnotherapy, chiropractic, acupressure, acupuncture, and healing touch. However, the nurses were most likely to recommend (regularly or periodically) four therapies: multivitamins, massage, meditation/relaxation, and pastoral/spiritual counseling. The vast majority (79%) of nurses perceived their professional preparation in this area to be fair or poor.