Negotiating competency, professionalism and risk: The integration of complementary and alternative medicine by nurses and midwives in NHS hospitals

The bad expert

We focus on two cases in which participants narrate and perform a new culture of expertise by constructing a bad expert, a reviled or dangerous figure of scientific credibility gone wrong. We show that a key mechanism in the construction of expertise cultures is the use of antithesis performances, which are performances of scientific and professional credibility that rely on telling stories about a scientific enemy or ostracized Other. By performing the antithesis of the bad expert, actors help generate turning points in expertise, allowing new cultures of expertise to emerge. Our two case studies are: (1) feminist therapeutic expertise related to domestic violence, and (2) the revival of psychedelic medicine. In explicating these cases, we link the jurisdictional model of expertise (from the sociology of professions) with the network model of expertise (from science and technology studies): Cultural factors such as scientific narratives and embodied performances link together expert domains and forge new boundaries around expert practice.

Perspectives of physicians on medical acupuncture in Lebanon: a preliminary study

OBJECTIVES

There are no regulations governing the practice of acupuncture in Lebanon as it is not yet registered as a profession. To our knowledge, no studies have ever been conducted in Lebanon regarding the practice of acupuncture. The purpose of this preliminary study was to explore the knowledge of Lebanese physicians about acupuncture, with the intent of conducting larger scale studies and developing strategies aimed at refining this knowledge in the future, and the ultimate goal of setting guidelines for acupuncture practice in Lebanon.

METHODS

An online survey looking into physicians' knowledge of acupuncture, its mechanisms of action, effectiveness, indications and safety, and physicians' understanding of its concepts, was circulated to 4651 physicians registered in the Lebanese orders of physicians.

RESULTS

One hundred forty-nine physicians (3.2%) completed the survey. Most study respondents stated that they were unaware of the difference between traditional Chinese acupuncture (TCA) and Western medical acupuncture (WMA). Overall, 30% of respondents had personally used and/or referred patients for acupuncture. Physicians who had personally tried acupuncture were more likely to refer patients for acupuncture (p < 0.001). Those who know the difference between WMA and TCA were more likely to have tried or referred for acupuncture (p = 0.004). 72% believed that acupuncture and other integrative medicine modules should be introduced in medical curricula in Lebanon.

CONCLUSION

Interest in acupuncture among physicians in Lebanon appears to be limited, based on the low response rate. Among respondents, physicians who had tried or referred patients for acupuncture appeared to be more well informed about different acupuncture styles.

Navigating the path: a qualitative exploration of New Zealand general practitioners' views on integration of care with acupuncturists

BACKGROUND

Increasingly, many patients believe that a combined approach of complementary and alternative medicine (CAM), including acupuncture, and conventional medicine is better than either on its own, and more patients now have the desire to discuss CAM with well-informed general practitioners (GPs). However, to our knowledge, the interaction and collaboration between GPs and acupuncturists specifically in relation to shared care have not been investigated. This research explored interprofessional communication between GPs and acupuncturists in New Zealand. This article specifically reports the GPs' viewpoints.

METHODS

This study was part of a larger mixed-methods research project. Semi-structured interviews of 14 purposively sampled GP participants were conducted and analysed using thematic analysis.

RESULTS

The data analysis identified both facilitators of and barriers to integrative health care. Facilitators included the willingness of GPs to engage in communication and a recognition of the importance of patient choice. Barriers included the limited opportunities for sharing information and the lack of current established pathways for communication or direct referrals. GPs also highlighted the confusion around scopes of practice in terms of the different styles of and approaches to acupuncture.

CONCLUSION

This research contributes to the body of knowledge concerning interprofessional communication and collaboration between GPs and acupuncturists and suggests that while there are significant barriers to collaboration, there is also the potential to impact provider satisfaction and patient well-being. It provides context within a New Zealand health care setting and also provides additional insights regarding acupuncture, specifically through the disaggregation of specific CAM modalities.

Beyond the orthodox/CAM dichotomy: Exploring therapeutic decision making, reasoning and practice in the therapeutic landscapes of elite sports medicine

Elite athletes face extreme challenges to perform at peak levels. Acute and chronic musculoskeletal injuries are an occupational hazard while pressures to return to play post-injury are commonplace. Therapeutic options available to elite athletes range from novel 'cutting edge' biomedical therapies, established biomedical and surgical techniques, and physiotherapy, to a variety of non-orthodox therapies. Little is known about how different treatment options are selected, evaluated, nor how their uses are negotiated in practice. We draw on data from interviews with 27 leading sports medicine physicians working in professional football and cycling in the UK, collected 2014-16. Using idea of the 'therapeutic landscape' as a conceptual frame, we discuss how non-orthodox tools, technologies and/or techniques enter the therapeutic landscape of elite sports medicine, and how the boundaries between orthodox and non-orthodox therapy are conceptualised and navigated by sports medicine practitioners. The data provide a detailed and nuanced examination of heterogenous therapeutic decision -making, reasoning and practice. Our data show that although the biomedical paradigm remains dominant, a wide range of non-orthodox therapies are frequently used, or authorised for use, by sports medicine practitioners, and this is achieved in complex and contested ways. Moreover, we situate debates around nonorthodox medicine practices in elite sports in ways that critically inform current theories on Complementary and Alternative Medicine (CAM)/biomedicine. We argue that existing theoretical concepts of medical pluralism, integration, diversity and hybridisation, which are used to explain CAMs through their relationships with biomedicine, do not adequately account for the multiplicity, complexity and contestation that characterise contemporary forms of CAM use in elite sport.

Medical Pluralism, Mainstream Marginality or Subaltern Therapeutics? Globalisation and the Integration of ‘Asian’ Medicines and Biomedicine in the UK

Medical Pluralism refers to the coexistence of differing medical traditions and practices grounded in divergent epistemological positions and based on distinctive worldviews. From the 1970s, a globalised health market, underpinned by new consumer and practitioner interest, spawned the importation of ‘non-Western’ therapeutics to the UK. Since then, these various modalities have coexisted alongside, and sometimes within, biomedical clinics. Sociologists have charted the emergence of this ‘new’ medical pluralism in the UK, to establish how complementary and alternative medicines have fared in both the private and public health sectors and to consider explanations for the attraction of these modalities. The current positioning of complementary and alternative medicines can be described as one of ‘mainstream marginality’ ( Cant 2009 , The New Sociology of the Health Service, London: Routledge): popular with users, but garnering little statutory support. Much sociological analysis has explained this marginal positioning of non-orthodox medicine by recourse to theories of professionalisation and has shown how biomedicine has been able, with the support of the state, to subordinate, co-opt and limit its competitors. Whilst insightful, this work has largely neglected to situate medical pluralism in its historical, global and colonial contexts. By drawing on post-colonial thinking, the paper suggests how we might differently theorise and research the appropriation, alteration and reimagining of ‘Asian’ therapeutic knowledges in the UK.

Reasons for complementary therapy use by cancer patients, information sources and communication with health professionals

BACKGROUND

Cancer patients are known to commonly use complementary therapies (CT). However, it is emphasized that patients do not share sufficient information with health professionals about this subject and that the subject is ignored in oncology practice. The aim of the study is to assess cancer patients' reasons for using complementary therapy, information resources and communication with health professionals.

METHODS

The study is a descriptive, cross-sectional study. In this study, a questionnaire was used by the researchers. A questionnaire form consisting of 3 parts was used. In the first part of this form, there were questions about the gender, age and educational status of the patients (8 questions). In the second part, there were questions about disease and treatment information (3 questions), and the third part had questions about the use of complementary therapies (9 questions). To determine the use of complementary therapy, patients were asked 'Do you currently use complementary treatment?' (Yes or No). 183 patients included in the study completed the questionnaire about complementary therapies.

RESULTS

In this study, it was determined that 37.7% of the patients were using complementary therapies. The most commonly used complementary therapy was natural products (46.4%). The most common reason for using complementary therapy was to provide support for treatment. Almost half of the cancer patients (48.5%) did not talk about this issue with their physicians, and 41.1% of them did not talk about CT with their nurses. The study found that the most important reason why the patients did not talk about CT was that they were not asked about it by health professionals.

CONCLUSION

This study determined that almost half of patients could not receive information about CT from health professionals. Patients expect physicians and nurses to initiate communication on this subject. Providing healthcare professionals with evidence-based counseling about CT is essential for improving patient safety and patient outcomes.

The bargaining of professionalism in emergency care practice: NHS paramedics and higher education

Over the past 2 decades, as part of reforms to the National Health Service and with it organizational changes to ambulance work in the UK, paramedic education has undergone a process of academisation and a shift from in-house, apprenticeship weeks-long occupational training, to university-based undergraduate programs. While the professional regulation and standardization of Allied Health Professionals' education in high-income countries has captured scholarly attention, the study of paramedic practice is still in its infancy and there is a need to explore its evolvement in relation to the fluid societal-political circumstances affecting its provision and demand. Based on interviews with front-line paramedics, paramedic educators and paramedic science students in the South of England, this article examines how the reforms to paramedic education have impacted the professionalization of paramedics and their discourse of professionalism. Framed within to the 'new' sociology of professions, the case of British paramedics demonstrates the complex nature of the relationship between the university and professional practice. It appears that universities, the providers of paramedic education, are caught between two opposing discourses of professionalism: on the one hand, that of providing a platform for students' socialization and engagement with professionalism 'from within' practice which is based on students' common goals and mutual experiences, and, on the other hand, serving as a conduit for managerial/organizational strategies of professionalism which appear to undermine the role of university socialization.

Addressing holistic healthcare needs of oncology patients: Implementation and evaluation of a complementary and alternative medicine (CAM) course within an elective module designed for healthcare professionals

BACKGROUND

Patients, and especially oncology patients, increasingly demand information and application of complementary therapies to supplement their conventional medical treatment and follow-up care. Due to the widespread interest in holistic treatment opportunities in oncology populations, healthcare professionals need to be prepared in differentiating evidence-based methods of the complementary and alternative medicine (CAM) spectrum and how to consult with patients about it.

OBJECTIVE

This paper reports on the implementation and evaluation of a newly designed module "Complementary and Alternative Medicine in oncological healthcare" in the bachelor degree program Interprofessional Health Care (B.Sc.).

DESIGN

The study applied a developed evaluation questionnaire to capture students' perspectives on the CAM contents. This assessment instrument was administered pre and post the CAM teaching unit.

SETTING

Interprofessional medical education, University Hospital Heidelberg, Germany.

RESULTS

The integration of the CAM elective module was possible and was met by positive response. Students' interest was reflected in an increase of their self-reported knowledge gain and positive CAM attitude. Comparison of pre and post evaluation data demonstrate that, particularly, students' expectations on developing their own opinion about CAM, and getting an overview of the evidence-base of different CAM methods have been met.

CONCLUSIONS

Evaluation results indicate that the module content was in line with the students' expectations and may have positively impacted on their general CAM attitude. The results support us in continuing to offer this CAM course within the elective module to prepare today's healthcare professionals for patient-oriented healthcare delivery.

Challenges facing the farm animal veterinary profession in England: A qualitative study of veterinarians' perceptions and responses

The farm animal veterinary profession in the UK has faced a number of challenges in recent decades related to the withdrawal of government funding and a contraction of the agricultural sector. They have come under pressure to respond by developing skills and focusing on disease prevention advisory services. However, this puts veterinarians in competition with other providers of these services, and moves in this direction have only been partial. Failure to respond to these challenges puts the veterinary profession at risk of de-professionalisation-a loss of their monopoly over knowledge, an erosion of client beliefs in their service ethos and a loss of work autonomy. This paper explores how farm animal veterinarians in England perceive these challenges and are responding to them. Semi-structured qualitative interviews were carried out with 28 veterinarians from Royal College of Veterinary Surgeon farm accredited practices. Veterinarians were chosen from high, medium and low density cattle farming regions. Interviews were recorded, transcribed and themes identified through the constant comparison method. The majority of respondents recognised the challenges facing the veterinary profession. Most believed their role had changed, moving towards that of a disease prevention adviser who was part of the farm management team. In terms of maintaining and redefining their professional status, farm animal veterinarians do have a defined body of knowledge and the ability to develop trusting relationships with clients, which enhances their competitiveness. However, while they recognise the changes and challenges, moves towards a disease prevention advisory model have only been partial. There seem to be little effort towards using Farm accreditation status or other strategies to promote their services. They do not appear to be finding effective strategies for putting their knowledge on disease prevention into practice. Disease prevention appears to be delivered on farm on an ad hoc basis, they are not promoting their disease prevention services to farmers effectively or using their professional position to stave off competition. Farm animals veterinarians will need to realign their veterinary expertise to the demands of the market, work together rather than in competition, improve their skills in preventive medicine, consolidate information given by non-veterinary advisors, develop new business models appropriate to their services and develop entrepreneurial skills to demonstrate their market value if they are to avoid becoming marginalised.

What led health professionals to study and practise acupuncture in Spain?

Acupuncture is the most widespread practice of Traditional Chinese Medicine in the Western world. This confers special relevance to the experiences and circumstances of life to explain the health-illness process. Recent research has reported an increasing interest of Western health professionals in its practice. The aim of this study was to map and understand the motivation of health professionals to study and practise acupuncture in Spain. A total of 27 in-depth interviews were conducted with Spanish health professionals trained in acupuncture. Participants were selected following a theoretical sampling. Grounded theory dimensional analysis guided this research in order to obtain a theoretical explanation of the motivations of health professionals to study and practise acupuncture. Their motivations were focused on six categories: humanisation of medicine, acquiring additional therapeutic resources, efficacy and far-reaching healing potential of acupuncture, attraction to acupuncture philosophy, external influences (other professionals and relevant sources of information) and work-related motivation. Our results show that health professionals were attracted to acupuncture because of the Traditional Chinese Medicine worldview (a philosophical approach) and therapeutic benefits of acupuncture (a practical approach). Acupuncture offers the possibility to improve the healthcare assistance by transcending the reification of human beings resulting from the pre-eminence of the biomedical paradigm and facilitating cooperation between disciplines. Participants consider acupuncture as a complete medicine, not merely as a technique, and highlight the importance of traditional Chinese concepts to practise it.

Examination of the Perceptions of Registered Nurses Regarding the Use of Healing Touch in the Acute Care Setting

Given the current transformation of traditional health care to provide more integrative and complementary modalities, health systems are implementing new programs and services to meet consumer and provider needs. One such integrative modality, Healing Touch, with a foundation in holistic nursing, is a gentle therapy that uses touch to promote health and well-being by balancing the human energy system. This article describes the perceptions of registered nurses regarding the implementation of a Healing Touch training program at a multihospital health system. Five themes were identified: benefit to the patient, benefit to the nurse, holism beyond task orientation, integrating Healing Touch into acute care, and barriers and challenges. Nurses recognize the importance of creating caring-healing relationships and a holistic approach to care. Training in Healing Touch provides one avenue for nurses and health care providers to provide compassionate care.

Integration of acupuncture into conventional medicine from health professionals’ perspective: A thematic synthesis of qualitative studies

Acupuncture is a prominent Complementary Medicine. Although health professionals’ conceptions of acupuncture may affect its utilisation and integration within conventional medicine, these aspects have not been well studied. The aim of this review was to analyse the integration of acupuncture into conventional medicine from the perspective of health professionals.

We conducted a systematic review and a thematic synthesis of qualitative studies that analysed the integration of acupuncture into conventional medicine grounded in participants’ perspectives. A systematic search was undertaken in PubMed, Web of Science, the Cochrane Library Plus, Scopus and CINAHL.

This review included 18 articles: 6 analysed the viewpoint of physicians, 3 of nurses and 9 comprised different health-related professionals. Most of these studies included healthcare professionals practising acupuncture and took place in sites where the relation between acupuncture and biomedicine is favourable. The most used research techniques were convenience sampling, semi-structured interviews and interpretative approach. The holistic approach of acupuncture and its lack of adverse effects were highlighted by the analysed studies. This led to health professionals encouraging its integration into conventional medicine. The main obstacles perceived for the integration were lack of knowledge and institutional support. In general, acupuncture has been adapted to the biomedical model (often practised in an unsystematic and individual manner), and it is conceived as a supplement of Western medicine.

‘Working together’ and overcoming the biomedical model are recognised by the participants as key conditions for successful integration of acupuncture.

Traditional acupuncturists and higher education in Britain: the dual, paradoxical impact of biomedical alignment on the holistic view

Traditional acupuncturists' quest for external legitimacy in Britain involves the standardization of their knowledge bases through the development of training schools and syllabi, formal educational structures, and, since the 1990s, the teaching of undergraduate courses within (or validated by) Higher Education Institutions (HEIs), a process which entails biomedical alignment of the curriculum. However, as holistic discourses were commonly used as a rhetorical strategy by CAM practitioners to distance themselves from biomedicine and as a source of public appeal, this 'mainstreaming' process evoked practitioners' concerns that their holistic claims are being compromised. An additional challenge is being posed by a group of academics and scientists in Britain who launched an attack on CAM courses taught in HEIs, accusing them of being 'unscientific' and 'non-academic' in nature. This paper explores the negotiation of all these challenges during the formalization of traditional acupuncture education in Britain, with a particular focus on the role of HEIs. The in-depth qualitative investigation draws on several data sets: participant observation in a university validated acupuncture course; in-depth interviews; and documentary analysis. The findings show how, as part of the formalization process, acupuncturists in Britain (re)negotiate their holistic, anti-reductionist discourses and claims in relation to contemporary societal, political and cultural forces. Moreover, the teaching and validation of acupuncture courses by HEIs may contribute to broadening acupuncturists' 'holistic awareness' of societal and cultural influences on individuals' and communities' ill-health. This investigation emphasises the dynamic and context-specific (rather than fixed and essentialized) nature of acupuncture practice and knowledge.

The Sociology of Traditional, Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) and traditional medicine (TM) are important social phenomena. This article reviews the sociological literature on the topic. First, it addresses the question of terminology, arguing that the naming process is a glimpse into the complexities of power and history that characterize the field. Second, focusing on the last 15 years of scholarship, it considers how sociological research on users and practitioners of TM/CAM has developed in that time. Third, it addresses two newer strands of work termed here the 'big picture' and the 'big question'. The big picture includes concepts that offer interpretation of what is happening at a societal level to constrain and enable observed patterns of social practice (pluralism, integration, hybridity and activism). The big question, 'Does it work?', is one of epistemology and focuses on two developing fields of critical enquiry - first, social critiques of medical science knowledge production and, second, attempts to explain the nature of interventions, i.e. how they work. Finally, the article examines the role of sociology moving forward.

Performing ‘pragmatic holism’: Professionalisation and the holistic discourse of non-medically qualified acupuncturists and homeopaths in the United Kingdom

Complementary and alternative medicine practitioners have often utilised ‘holism’ as a key identification mark of their practice, distancing themselves from ‘the reductionist biomedicine’. However, the past couple of decades have witnessed increased engagement of several complementary and alternative medicines in professionalisation, which includes a degree of biomedical alignment while ‘reducing’ holistic claims in order to provide practice with a ‘credible outlook’ and move closer to the mainstream, a development which challenges the role of holism in complementary and alternative medicine practices. This article explores the strategies by which two groups of complementary and alternative medicine practitioners, namely, non-medically qualified acupuncturists and homeopaths in the United Kingdom, pragmatically accommodate holistic notions as a professional resource, a process of negotiation between maintaining their holistic premise, on the one hand, and the drive to professionalise and enhance their societal status, on the other. Based on in-depth interviews with non-medically qualified acupuncture and homeopathy practitioners and school principals, textual analysis of practitioners’ web sites and observation of practice, the findings demonstrate the dynamic approach to ‘holism’ in complementary and alternative medicine practice. This discourse, through which practitioners use a range of strategies in order to ‘narrow’ or ‘expand’ their holistic expression, can be described as ‘pragmatic holism’, by which they try to make gains from the formalisation/standardisation processes, without losing the therapies’ holistic outlook and appeal.

Governanca em enfermagem: revisao integrativa da literatura

O objetivo deste estudo foi identificar e caracterizar os tipos de governança em enfermagem, destacando seu impacto na prática dos enfermeiros e no cuidado em saúde. Trata-se de revisão integrativa a partir das bases de dados MEDLINE, CINAHL, LILACS e na biblioteca eletrônica SciELO, de 2007 a 2011, com os descritores Governança /Governance e Enfermagem/ Nursing, totalizando 25 artigos. Foram identificados três modelos de governança, estudados principalmente nos Estados Unidos e Inglaterra: governança compartilhada, governança clínica e governança pública. Entre os impactos desses modelos, destacam-se: melhoria da qualidade assistencial, maior autonomia profissional dos enfermeiros, melhoria da articulação entre os serviços de saúde e maior satisfação profissional entre enfermeiros. Pontua-se a necessidade da realização de estudos sobre a temática na América Latina, com o intuito de avaliar sua aplicabilidade em diferentes contextos.

Networks of knowledge or just old wives’ tales?: A diary-based analysis of women’s self-care practices and everyday lay expertise

Complementary and alternative medicine is increasingly popular in Australia and particularly among women. While existing research provides some understanding of women’s engagement with complementary and alternative medicine and biomedicine, there has been comparatively little examination of the day-to-day character of their experiences. In this study, we utilise solicited diaries with women aged 60–65 years drawn from the 1946–1951 cohort of the Australian Longitudinal Study on Women’s Health to capture the temporal dimension of their therapeutic engagement. Focusing on 30 active complementary and alternative medicine users, we explore women’s experiences of managing their health, illness and well-being over a 1-month period. The themes that emerge from their diaries illustrate the day-to-day enactment of lay expertise through informal knowledge networks, practices of self-trialling and experimentation and the moralities underpinning self-care. The diaries provide unprecedented temporal insight into the (often problematic) enactment of lay expertise at the nexus of complementary and alternative medicine and biomedicine. They also point to the value of longitudinal techniques of data collection for augmenting more traditional sociological ways of exploring therapeutic pluralism.

Holistic Pregnancy Care: Aligning Complementary and Alternative Medicine With Midwifery Practice

BACKGROUND:The use of complementary and alternative medicine (CAM) to manage pregnancy-related conditions is becoming increasingly popular. This article draws on a qualitative study that aimed to explain the processes midwives engaged when determining the role of these therapies for pregnancy care.

METHODOLOGY:Our study used grounded theory methodology. Twenty-five midwives, who were employed in metropolitan hospitals situated in Victoria, Australia, participated in the study. Data was collected from semistructured interviews and nonparticipant observation of a subgroup over an 18-month period.

RESULTS:Midwives’ attitudes and behavior toward the CAM was influenced by their professional ideology and knowledge. When participants considered the role of these therapies, they employed various strategies including aligning CAM with midwifery philosophy, using the therapies to increase women’s options, valuing diverse ways of understanding and seeking out professional knowledge.

CONCLUSIONS:Although midwives do not reject conventional medicine, many value the opportunity CAM offers to individualize care and promote natural childbearing.

Midwives' use of complementary/alternative treatments

BACKGROUND

in recent years, several surveys have suggested that many midwives use some form of complementary/alternative therapy (CAT), often without the knowledge of obstetricians.

OBJECTIVE

to systematically review all surveys of CAT use by midwives.

SEARCH STRATEGY

six electronic databases were searched using text terms and MeSH for CAT and midwifery.

SELECTION CRITERIA

surveys were included if they reported quantitative data on the prevalence of CAT use by midwives.

DATA COLLECTION AND ANALYSIS

full-text articles of all relevant surveys were obtained. Data were extracted according to pre-defined criteria.

MAIN RESULTS

19 surveys met the inclusion criteria. Most were recent and from the USA. Prevalence data varied but were usually high, often close to 100%. Much use of CATs does not seem to be supported by strong evidence for efficacy.

CONCLUSION

most midwives seem to use CATs. As not all CATs are without risks, the issue should be debated openly.