Implementation of complementary interventions in the Netherlands: experiences of pioneers

"The right thing for our patients": perspectives of physical therapists transitioning to a 7 day a week service in an urban acute care center in Canada

BACKGROUND

True seven day a week acute care physical therapy (PT) coverage is rare. Our facility is one of a few in Canada that has increased weekend PT coverage on medicine units to seven days of full PT staffing levels.

OBJECTIVE

This article investigates the perspectives of physical therapists involved in the change with the focus on the emotional experiences of those therapists.

METHODS

Thematic analysis of interview and focus group transcripts with 18 physical therapist and 2 manager participants were aligned with four themes of: 1) optimism, hope and excitement; 2) frustration, guilt, and resentment; 3) fear, anxiety, uncertainty, and vulnerability; and 4) ambivalence, neutrality, and impartiality.

RESULTS

Although there were several perceived benefits to quality of care and work/life balance, participants' comments also reflected: frustration, guilt, and resentment related to the rapid implementation of the change and the impact of altered work schedules.

CONCLUSIONS

Participants emphasized the need to discuss large changes with staff prior to implementation in order to prevent frustration and resentment. Participants also felt that increased acute care PT coverage over seven days is valuable, but other allied health professions also need a proportional increase in staffing to improve hospital flow.

Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis

BACKGROUND

Music is a non-invasive, safe, and inexpensive intervention that can be delivered easily and successfully. We did a systematic review and meta-analysis to assess whether music improves recovery after surgical procedures.

METHODS

We included randomised controlled trials (RCTs) of adult patients undergoing surgical procedures, excluding those involving the central nervous system or head and neck, published in any language. We included RCTs in which any form of music initiated before, during, or after surgery was compared with standard care or other non-drug interventions. We searched MEDLINE, Embase, CINAHL, and Cochrane Central. We did meta-analysis with RevMan (version 5.2), with standardised mean differences (SMD) and random-effects models, and used Stata (version 12) for meta-regression. This study is registered with PROSPERO, number CRD42013005220.

FINDINGS

We identified 4261 titles and abstracts, and included 73 RCTs in the systematic review, with size varying between 20 and 458 participants. Choice of music, timing, and duration varied. Comparators included routine care, headphones with no music, white noise, and undisturbed bed rest. Music reduced postoperative pain (SMD -0·77 [95% CI -0·99 to -0·56]), anxiety (-0·68 [-0·95 to -0·41]), and analgesia use (-0·37 [-0·54 to -0·20]), and increased patient satisfaction (1·09 [0·51 to 1·68]), but length of stay did not differ (SMD -0·11 [-0·35 to 0·12]). Subgroup analyses showed that choice of music and timing of delivery made little difference to outcomes. Meta-regression identified no causes of heterogeneity in eight variables assessed. Music was effective even when patients were under general anaesthetic.

INTERPRETATION

Music could be offered as a way to help patients reduce pain and anxiety during the postoperative period. Timing and delivery can be adapted to individual clinical settings and medical teams.

FUNDING

None.

Attitudes, Beliefs, and Practices of Integrative Medicine Among Nurses in the Netherlands

Purpose: This study assessed the attitude, beliefs, and practices of integrative medicine (IM) among nurses in the Netherlands. Design: Subscribers of a Dutch nursing journal were asked to fill in an anonymous, structured, online survey related to the topic under study. Results: A total of 355 people responded, of which 37% were familiar with the concept of IM in advance. On completion of the survey, the majority (83%) considered IM as a (very) important innovation in health care. Familiarity (odds ratio = 3.20; 95% confidence interval [1.48, 6.94]) and organization (nursing home compared to hospital (odds ratio = 5.98; 95% confidence interval [1.36, 26.23]) were characteristics associated with a positive attitude toward IM. Between 23% and 46% of respondents encountered obstacles regarding implementation of IM. The main obstacles were lack of support (69% to 78%), means (57% to 85%), and time (63% to 70%). Conclusions: Dutch nurses seem to have relatively positive attitudes and beliefs regarding IM. The outcome of this survey may contribute an increased awareness of the key role that nurses can play in the development and implementation of IM.

Accessibility and implementation in UK services of an effective depression relapse prevention programme - mindfulness-based cognitive therapy (MBCT): ASPIRE study protocol

BACKGROUND

Mindfulness-based cognitive therapy (MBCT) is a cost-effective psychosocial prevention programme that helps people with recurrent depression stay well in the long term. It was singled out in the 2009 National Institute for Health and Clinical Excellence (NICE) Depression Guideline as a key priority for implementation. Despite good evidence and guideline recommendations, its roll-out and accessibility across the UK appears to be limited and inequitably distributed. The study aims to describe the current state of MBCT accessibility and implementation across the UK, develop an explanatory framework of what is hindering and facilitating its progress in different areas, and develop an Implementation Plan and related resources to promote better and more equitable availability and use of MBCT within the UK National Health Service.

METHODS/DESIGN

This project is a two-phase qualitative, exploratory and explanatory research study, using an interview survey and in-depth case studies theoretically underpinned by the Promoting Action on Implementation in Health Services (PARIHS) framework. Interviews will be conducted with stakeholders involved in commissioning, managing and implementing MBCT services in each of the four UK countries, and will include areas where MBCT services are being implemented successfully and where implementation is not working well. In-depth case studies will be undertaken on a range of MBCT services to develop a detailed understanding of the barriers and facilitators to implementation. Guided by the study's conceptual framework, data will be synthesized across Phase 1 and Phase 2 to develop a fit for purpose implementation plan.

DISCUSSION

Promoting the uptake of evidence-based treatments into routine practice and understanding what influences these processes has the potential to support the adoption and spread of nationally recommended interventions like MBCT. This study could inform a larger scale implementation trial and feed into future implementation of MBCT with other long-term conditions and associated co-morbidities. It could also inform the implementation of interventions that are acceptable and effective, but are not widely accessible or implemented.

The role of health care communication in the development of complementary and integrative medicine

In recent years, complementary medicine (CM) approaches are integrated within a growing number of health care services worldwide. Implementation of CM within primary, secondary and tertiary settings of health care requires attention to a variety of communication challenges. In this special issue of Patient Education and Counseling 23 articles are presented about the patient-provider communication on complementary approaches, and the implementation and integration of CM in health care. Parallel to CM integration in the clinical arena, this special issue emphasizes the importance of two complementary axes: in medical education and in research, particularly on management of chronic illness and life-threatening diseases. The three legs of the integrative stool--research, education, and clinical practice--are perceived in the light of open, non-judgmental patient-health care provider-CM practitioner communication and a patient-centered bio-psycho-social-cultural-spiritual agenda.