Knowledge, attitude and use of complementary and integrative health strategies: a preliminary survey of Iranian nurses

Complementary and alternative medicine in oncology: knowledge, attitude and practice among Tunisian healthcare workers

PURPOSE

Over the past years, there has been a considerable increase in complementary and alternative medicine (CAM) use among cancer patients. However, guidance from health care workers (HCWs) is not always provided. We aimed to determine the knowledge, attitude and practice of Tunisian HCWs regarding the use of CAM in cancer patients.

METHODS

We conducted a multicenter cross-sectional study over 5 months from February to June 2022 among HCWs caring for cancer patients in the Tunisian center region. Data were collected using a self-administered questionnaire developed by our investigators.

RESULTS

The level of knowledge about CAM was declared limited by 78.4% of our population. The best known CAM therapies were herbal medicine and homeopathy while chiropractic and hypnosis where the least. HCWs who had sought information on CAM represented 54.3% of our sample and the main source of information was the Internet (37.1%). A positive attitude towards the use of CAM was found in 56% of HCWs. The integration of CAM into supportive care in oncology was approved by 78% of HCWs. Concerning training on CAM, 78% declared its necessity for HCWs and 73.3% expressed a desire to have it. A personal use of CAM was found in 53% of HCWs while 38.8% had previously used CAM in the treatment of their cancer patients.

CONCLUSION

The majority of HCWs had a positive attitude towards the use of CAM in oncology despite their poor knowledge about it. Our study emphasizes the need to train HCWs dealing with cancer patients on CAM.

The effectiveness of teaching complementary and alternative medicine based on the components of theory of planned behavior on nutrition students: multicenter research study

OBJECTIVE

Safe and beneficial use of complementary and alternative medicine (CAM) modalities results from integrating CAM education into curricula and increasing CAM knowledge. We sought how much teaching CAM procedures in a virtual environment can influence the components of the theory of planned behavior (TPB), including knowledge, attitude, behavioral intention, and behavior of nutrition students.

METHODS

This cross-sectional descriptive-analytic study was conducted on 162 undergraduate nutrition students were selected through convenience sampling based on inclusion criteria in 2021-2022. Data were collected through a validated researcher-made CAM questionnaire that was designed based on TPB questionnaire that consisted of four constructs (knowledge, attitude, behavioral intention, and behavior). The content validity index and content validity ratio of the questionnaire were evaluated.

RESULTS

Our results revealed that students who significantly scored the highest scores in attitude, behavioral intention, and behavior constructs were the students who claimed that "teaching two credits of CAM for nutrition students is not enough" (p. value =  < 0.001, < 0.001, and 0.005, respectively). In addition, these students used treatment methods of CAM for themselves, suggested treatment methods of CAM to others, and followed the recommendations of the CAM specialists (for three pairwise comparisons: p. value =  < 0.001, < 0.001, and < 0.001, respectively). The attitude could predict 70% of behavioral intention. However, attitude and behavioral intention could predict 90% of behavior.

CONCLUSION

Attitude was the most critical determinant influencing behavioral intention and behavior. CAM teaching using evidence-based CAM-ITM principles with a succinct, concerted, and collaborative curriculum, integration of CAM into continuing education, and integration of educational CAM programs continuously for several years into the academic curriculum in the actual setting influence the success of the educational CAM program.

Use and perception of complementary and alternative medicine among Iranian psychologists

OBJECTIVES

The seeking and use of Complementary and Alternative Medicine (CAM) modalities by people to treat mental disorders has increased and it is necessary for psychologists to have the necessary information in this field. This study aims to evaluate the use and perception of CAM by Iranian psychologists.

METHODS

This cross-sectional study was conducted on 100 psychologists selected by the census in 2019. Data collection tools consisted of four sections of the demographic section, the CAM questionnaire for psychologists, awareness of CAM, and use of CAM. The validity and reliability of this questionnaire were confirmed.

RESULTS

The mean (standard deviation) scores of attitude and educational needs were 40.45 (11.36) and 33.93 (5.96), respectively. Only 19.25% of psychologists had sufficient knowledge of CAM, and most of them (56.34%) reported that there is an educational need for CAM. In this study, 64% of psychologists used CAM for themselves. There was a significant relationship between the attitude toward CAM modalities and the suggestion of CAM to the clients (p=0.025). There was also a significant relationship between the use of CAM by psychologists and the suggestion of these modalities to their clients (p<0.001).

CONCLUSIONS

Psychologists had not sufficient awareness about CAM and had a moderate attitude. Most of the psychologists reported that there is educational need for CAM. Therefore, it is necessary to design and implement appropriate training courses for psychologists toward CAM modalities.

Iranian healthcare professionals' knowledge, attitudes, and use of complementary and alternative medicine: a cross sectional study

Background

The present study aims to investigate the knowledge, attitude, and performance of Iranian Healthcare Professionals (HP) about Complementary and Alternative Medicine (CAM) modalities.

Methods

This cross-sectional study was carried out on 210 HP in 2019. Samples were selected from healthcare centers, clinics, and hospitals using census sampling. Data collection tools included demographic information, attitude, knowledge, and the amount of use of CAM modalities. Data analysis was performed using SPSS ver. 24.

Results

In this study, the response rate was 85.3% (n=209). A majority of respondents had a positive attitude toward CAM (n=166, 79%), but their level of knowledge was limited (n=154, 73.6%). The most commonly used CAM modalities were herbal medicine (93.2%), exercise therapy (75.4%), and hydrotherapy (75.2%), respectively, and the least commonly used ones were magnetic therapy (2.9%) and hypnosis (4.8%). The most important reasons for the use of CAM modalities by HP included fewer side effects than medical treatments (57.4%), its lowest cost than medical treatments (34.9%), non-serious disease with no need for referral to a clinic (32.1%), and its more convenient access than medical treatments (30.6%). The results showed that there was a significant relationship between the education level and the use of CAM modalities (p<0.05). There was also a significant relationship between the suggestion of CAM modalities and the amount of use of these modalities, and those who used these modalities would also have recommended them to their clients more frequently (p<0.05).

Conclusion

The results showed that most of HP used at least one of the CAM modalities and had a positive attitude towards CAM. As the level of knowledge was limited, training courses should be implemented to increase health practitioner’s level of knowledge on CAM.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-021-03421-z.

Effects of Meridian Acupressure on Stress, Fatigue, Anxiety, and Self-Efficacy of Shiftwork Nurses in South Korea

Shiftwork nurses experience physical and psychological health problems related to shift work. This study aimed to examine the effects of Meridian acupressure on stress, fatigue, anxiety, and self-efficacy of shiftwork nurses in South Korea. A quasi-experimental pretest-posttest control group design was employed. Study participants were a total of 59 shiftwork nurses (intervention group: n = 29, control group: n = 30) in S hospital, Seoul, South Korea. The study was conducted at nurse stations in S hospital. Meridian acupressure as intervention was conducted for a total of 15 min on six Meridian acupressure points (GV 20, GB 12, GB 21, LI 11, SI 3, KI 1), 2 min 30 s (10 times for 15 s at a time) on each Meridian point. Measures were the stress scale, fatigue scale, State Anxiety Inventory, and self-efficacy scale, in Korean. Data were collected from July to August 2018. There were significant differences in the degrees of stress, fatigue, and anxiety of shiftwork nurses between the two groups. Meridian acupressure significantly decreased stress, fatigue, and anxiety of shiftwork nurses. This study provides preliminary evidence that Meridian acupressure was an effective intervention. Meridian acupressure could be applied to shiftwork nurses in various clinical situations.

Integrative therapies in intensive care units: A scoping review

AIM

We reviewed literature describing the incorporation of integrative therapies in intensive care units. We aimed to elicit an overall picture of research and find existing knowledge gaps on this topic.

DESIGN

We conducted a scoping review guided by Arksey and O'Malley's methodological framework and were guided by the PRISMA-ScR Checklist.

METHODS

Various databases were searched for relevant literature. English language articles published between 1999 and 2019 were retrieved. Data were extracted based on sample, sample size, methodology, findings and implications for practice.

RESULTS

From 275 studies retrieved, 30 were included, based on the inclusion criteria. Three key themes related to integrative therapies in intensive care units emerged from the literature: 1) general information on integrative therapies; 2) interventions using integrative therapies; and 3) perceptions and attitudes of nurses on integrative therapies. Positive outcomes were observed in ICUs, and nurses showed positive attitudes towards using integrative therapies.

Potential therapeutic effect of Chrysopogon zizanioides (Vetiver) as an anti-inflammatory agent

Vetiver has a broad history of traditional medicinal uses, but only a handful of research article has reported its utility in treating diseases. But unfortunately, no work has been reported on the anti-inflammatory activity of its plant extract and inflammatory-linked diseases. Hence, the present review focuses on investigating the several presumptions which can be put forward to explain its anti-inflammatory property. Thus, for ensuring the same, all the databases like science direct, PubMed, book chapters, and other authenticated papers were thoroughly studied to present a connection between inflammation and the plant potential. After gaining enough knowledge on pathogenesis of inflammation, it has been observed that the release of mediators from the arachidonic acid metabolism pathway and generation of oxidative and nitrogen species are presented as the main reason for the occurrence of inflammation condition. The stimulation of antioxidant enzyme system network by the plant extract reduces the level of oxidative stress, creating a balance between oxidant and antioxidant system. Moreover, its antimicrobial activity will prevent the biological source of stimulation towards injury and the CNS depressant effect will subside the pain of inflammation. Amalgamating all the factors together, the plant can be utilized as anti-inflammatory can be and also can be proved as a beneficial perspective in the treatment of inflammation-linked disorders.

Nurses' use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study

BACKGROUND

Pain is a common and unpleasant feeling among patients in intensive care units. Therefore, the use of proper pain management methods, such as non-pharmacological interventions, is a priority in intensive care units.

OBJECTIVE

This study aimed to ascertain the extent of the use of non-pharmacological pain management methods by intensive care unit nurses in Iran and to identify the obstacles that hindered the use of these methods.

MATERIAL AND METHODS

This study used a descriptive cross-sectional design which involved a convenience sample of 224 nurses who worked in 16 intensive care units across northern Iran. Data were collected using the non-pharmacological pain management questionnaire and a researcher-developed checklist of the obstacles that hindered the use of non-pharmacological pain management methods.

RESULTS

A moderate number of ICU nurses used non-pharmacological pain management methods (55.8 %). The most common method used by nurses was repositioning (M = 2.72), while methods such as acupuncture and reflexology were used less frequently. Furthermore, the most common obstacles to the use of non-pharmacological pain management methods were nurses' fatigue (M = 2.92) and multiple responsibilities (M = 2.91). Demographic variables such as age, gender, educational level, and work experience were not significantly associated with the use of non-pharmacological pain management methods.

CONCLUSIONS

Due to factors such as fatigue, multiple responsibilities, a heavy workload, and an insufficient number of nurses per shift, the rate of utilization of non-pharmacological pain management methods among intensive care unit nurses in Iran was low. Furthermore, most of the participants in this study had not attended courses on non-pharmacological pain management.

Knowledge and attitudes towards complementary medicine by nursing students at a University in South Africa

Background

The increased popularity of complementary medicine has created the need for patients to receive accurate information from nurses who are front-line healthcare providers. Studies have demonstrated that patients are more likely to discuss other medication and therapy use with nurses, rather than with general practitioners or other health professionals. It is, therefore, important to determine nurses’ knowledge and attitudes towards complementary medicine.

Aim

The aim of this study was to determine nursing students’ knowledge and attitudes toward the use of complementary medicine.

Setting

The study was conducted with Baccalaureus Curationis (nursing) students registered at a large public university in Gauteng, South Africa.

Methods

This research utilised a quantitative approach with a prospective, descriptive survey design. A convenience sample comprising registered Baccalaureus Curationis nursing students (n = 202) was utilized. Participants completed a 34-item, paper-and-pencil questionnaire to determine their knowledge, personal use and attitude toward complementary medicine modalities.

Results

Questionnaires were completed by 126 nursing students with 119 questionnaires included for analysis. Despite a reported lack of knowledge regarding complementary medicine and limited personal use, participants had an overall positive attitude towards complementary medicine. Almost half of the participants reported enquiring about its use in history taking and were willing to refer patients to a complementary medicine practitioner.

Conclusion

A positive attitude towards complementary medicine modalities might suggest a willingness from students to improve their knowledge of the various modalities and to refer to a complementary medicine practitioner when indicated.

Effect of aromatherapy on cancer complications: A systematic review

PURPOSE

The aim of this study was to determine the effect of aromatherapy on cancer complications.

METHODS

In this systematic review, international (PubMed, Web of Science, Scopus, EMBASE and CENTRAL) and national databases (SID and Magiran) were searched from inception of the databases to April 31, 2019. JBI and Jadad scales were used to assess the quality of the studies included.

RESULTS

of 43 Studies conducted on 3239 cancer patients in 13 countries from 1995 to 2019, entered the final stage. The results showed that the aromatherapy improves the various physical and psychological complications, although few studies have shown that aromatherapy had no effect on skin reactions.

CONCLUSION

Considering the various complications and costs in cancer patients, it seems that the aromatherapy can be used as a proper supplemental treatment to improve complications, although further studies are needed to determine the protocol and the standard dosage.

The necessity for integrating traditional, complementary, and alternative medicine into medical education curricula in Iran

BACKGROUND

The use of traditional and complementary medicine (T&CM) is increasing in both developed and developing countries. The school of Persian medicine (PM) in Iran is a comprehensive medical school that is rich in history and has its own special principles, elements, philosophy, and diagnostic and treatment options. Many complementary therapy modalities are also popular and in demand among patients and physicians. The aim of this paper is to provide logic for the policymakers in Iranian medical education to make changes in medical education curricula, particularly on integrating T&CM.

METHODS

We reviewed the global experience in teaching T&CM to medical students, and highlighting the strengths of PM, described why it is necessary to integrate T&CM into general medicine curricula in Iran.

RESULTS

PM is a traditional system of medicine that dates back about 7000 years. Although there are few studies about the safety and effectiveness of PM, research into it has recently been accelerated. There is a suitable opportunity for integrating T&CM with conventional medicine. Physicians should be familiar with T&CM to avoid any contraindications, interactions, and unwanted effects.

CONCLUSION

Traditional medicine is part of Iran's heritage and, thus, needs special attention. Familiarization of physicians with T&CM can help them choose the best treatment options for their patients. To integrate T&CM into the medical education curricula of Iran, a two-credit course has been proposed for implementation across the country.

Do complementary and integrative medicine therapies reduce healthcare utilization among oncology patients? A systematic review of the literature and recommendations

PURPOSE

Complementary and integrative medicine (CIM) is frequently used by oncology teams for reducing physical and emotional side-effects related to cancer treatment. In light of the changing healthcare system, evidence is needed regarding the economic implications of these interventions. The purpose of this study was to: (1) systematically examine the literature for links between CIM interventions and healthcare utilization (2) provide recommendations for growing this area of research.

METHOD

PubMed and EBSCO databases were reviewed for articles reporting on healthcare utilization associated with CIM therapy use in oncology populations. CIM intervention characteristics and healthcare utilization were extracted and summarized from 7 articles meeting inclusion criteria.

RESULTS

Studies included various CIM modalities. Most studies targeted physical symptoms (i.e., pain, infection, nausea/vomiting; n = 4). Healthcare utilization included medication use/cost (n = 4) and hospitalization length/cost (n = 5). All four studies (prospective/retrospective between-group, n = 2; within-subject pre-post, n = 1; RCT, n = 1) examining medication reduction noted decreased medication costs or use. Mixed findings emerged for studies examining hospitalizations (retrospective between-group, n = 2; within-subject pre-post, n = 1; RCT, n = 2), with only one study (retrospective between-group) indicating lower hospitalization duration in the CIM group.

CONCLUSIONS

Findings indicate the potential for CIM therapy to reduce healthcare utilization in oncology populations, particularly medication use. However, this research is limited both in size and quality. To increase the uptake of these interventions and to advocate for insurance coverage of CIM interventions, high quality economic evaluations are needed.

New candidates for treatment and management of carpal tunnel syndrome based on the Persian Canon of Medicine

Carpal tunnel syndrome (CTS) is defined as a compressing median mononeuropathy. CTS is one of the major costly debilitating diseases of the hand. Although CTS is a relatively recent concept in current medicine, some evidences show that medieval physicians in Persian medicine (PM) such as Avicenna were familiar with it. The PM textbook written by Avicenna, the Canon of Medicine, defines the anatomy of carpal tunnel and median nerve, as well as mononeuropathy; it also offers suggestions for the prevention and treatment of carpal tunnel syndrome (called as Vaja al-asab and Khadar) in the chapter of nerve diseases. The book describes not only symptoms including pain, paresthesia, hypoesthesia, tingling, and numbness, but also its etiology such as nerve compression (entrapment neuropathy); nonphysical reasons such as disturbed balance among the four body humors; alteration in the nerve's temperament (Mizaj) that prevents the transmission of nerve impulses; and the others such as nutrition, mental condition, sleep, weather condition, body movements, and proper disposal of body waste. Furthermore, the book suggests a lifestyle modification method based on six factors and 10 prescriptions composed with 85 natural products that are not actively used for CTS treatment in modern times. The medicinal suggestions for CTS in the Canon of Medicine will be good candidates for discovering new treatments besides providing historical significance to the various insights considered 1000 years ago.

Perspectives of Oncology Nurses on Complementary and Alternative Medicine in Turkey: A Cross-Sectional Survey

In Turkey, between 22.1% and 84.1% of patients with cancer use complementary and alternative medicine (CAM). However, few CAM-related studies have focused on the perspective of oncology nurses. This study aimed to determine the knowledge, attitudes, and practices of Turkish oncology nurses regarding CAM. A descriptive cross-sectional survey of 127 participants was conducted in Ankara, Turkey. A semistructured questionnaire including characteristics, knowledge, attitudes, and practices of oncology nurses toward CAM was administered to participants. We found that more than half of nurses (54.0%) surveyed had no information on CAM modalities. Most oncology nurses (81.1%) used audiovisual media sources to obtain CAM information. Many nurses (81.3%) reported not using any CAM in cancer care, and only 26.8% recommended CAM to patients. Most nurses used CAM to accelerate wound healing (19.7%) and to manage symptoms, including constipation and diarrhea (8.8%) and anxiety (7.9%). Music (52.8%), massage (49.6%), and exercise (48.8%) were stated to be beneficial. Important barriers to use CAM for patients with cancer involved a lack of knowledge (60.6%); needing physician approval to apply any CAM methods to patients (52.1%); legal and institutional issues (47.2%); and limited educational, training, or certificate programs (44.1%). There is a need for increased knowledge about CAM by oncology nurses, considering their vital role in symptom management of patients with cancer. This can be achieved through solving legal and institutional problems, structured and comprehensive education/training programs, and the integration of CAM therapy into cancer care guidelines.

Complementary Medicine and the Role of Oncology Nurses in an Acute Care Hospital: The Gap Between Attitudes and Practice

PURPOSE/OBJECTIVES

To describe hospital nurses' knowledge, attitudes, and practices regarding complementary medicine (CM); to compare the knowledge and attitudes of nurse managers to staff nurses with diverse oncology experience; and to assess attitudes toward integrating CM into the role of the hospital oncology nurse. 
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DESIGN

Descriptive, cross-sectional study.
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SETTING

Rambam Health Care Campus in northern Israel.
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SAMPLE

A convenience sample of 434 hospital nurses with varied oncology experience.
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METHODS

Nurses completed a knowledge and attitude questionnaire developed for the current study. Data were analyzed using parametric and nonparametric statistical tests. 
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MAIN RESEARCH VARIABLES

Hospital nurses' knowledge of and attitudes toward CM, and attitudes toward integrating CM into the role of the hospital oncology nurse.
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FINDINGS

Nurses lack knowledge and are unaware of the risks associated with CM. However, they believe this approach can improve the quality of life of patients with cancer; 51% expressed an interest in receiving training. Oncology nurses were ambivalent about the feasibility of applying an integrative approach, whereas nurse managers expressed significantly more positive attitudes toward integrating CM within the scope of nursing practices.
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CONCLUSIONS

A large discrepancy remains between nurses' strong interest in CM and awareness of associated benefits, and their ambivalence toward its integration in their nursing practice. 
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IMPLICATIONS FOR NURSING

Although improving nurses' knowledge should be mandatory, it remains insufficient; a shift in the approach to integrating CM into conventional health care is needed, from practitioners' responsibility to healthcare policymakers' responsibility. Legislations and policies are necessary, along with providing respectable infrastructures.

Indonesian provisional clinical psychologists' knowledge, attitudes, and behaviours towards complementary-alternative medicine (CAM)

Sixty provisional clinical psychologists in Indonesia were emailed to seek their participation in an online-questionnaire that reflected: CAM knowledge, attitudes CAM, and CAM behaviours. Of the 60 participants approached, 44 with majority of female (95%) completed the questionnaire. The mean age of participants was 25 years. Overall, participants reported low knowledge of CAM and attitudes towards CAM were positive. While 73% reported having recommended CAM to their clients, only 39% had ever made referral. Most of the participants (98%) had used CAM personally but just over half (59%) had ever used it in clinical practice. It was found that knowledge and attitudes towards CAM did not predict CAM recommendation, personal use, nor professional use among the participants. However, CAM knowledge was found to predict CAM referrals. It is assumed that positive attitudes towards CAM integration among participants has been conflicted with their concern for CAM safety.

Complementary and alternative medicine (CAM) among Australian hospital-based nurses: knowledge, attitude, personal and professional use, reasons for use, CAM referrals, and socio-demographic predictors of CAM users

OBJECTIVE

This study was intended to examine CAM among Australian hospital-based nurses, identifying their knowledge, attitude, personal and professional use, reasons for use, CAM referrals, and socio-demographic predictors of CAM users.

METHODS AND MATERIALS

Nurses holding a qualification in nursing and working in surgical wards were included using a convenience sampling technique. A self-complete questionnaire was developed to achieve the aims of the study. Descriptive and non-parametric statistics were calculated to describe and analyse data.

RESULTS

Overall, 95.7% and 49.7% of nurses reported personal and professional use of CAM, respectively. The most popular CAM/CAM domain personally and professionally used by nurses was massage therapy and mind-body therapies. The primary reason for personal use of CAM was "[it] fits into my way of life/philosophy". Furthermore, massage therapists were the most commonly recommended CAM practitioners to patients. Only 15.8% of nurses would always ask patients about use of herbal medicines as part of nursing history taking. Over one-fifth (22.4%) of nurses rated their attitude as having a very positive, and 60.3% rated themselves as having very little or no knowledge of CAM. A positive correlation was also found between knowledge and attitude about CAM. Positive attitude and higher knowledge about CAM were positively correlated to CAM referrals. Several socio-demographic factors predicted personal and professional use of CAM.

CONCLUSION

This study revealed that nurses generally believe not to have sufficient knowledge of CAM but are open to use CAM with patients. Nurses' positive attitude toward and personal use of CAM could be an indication that they are poised for further integration of evidence-based CAM into nursing practice to treat whole person.

Effects of Storytelling-Based Education in the Prevention of Drug Abuse among Adolescents in Iran Based on a Readiness to Addiction Index

INTRODUCTION

One of the most effective strategies in the prevention of addiction is increasing awareness among young people, towards the tendency for taking drugs their physical, mental and social side effects. Storytelling is effective for increasing characteristics of happiness and resilience. This study uses storytelling, a common and popular method to increase awareness among adolescents.

AIM

To examine the effect of storytelling-based education on the prevention of drug abuse, based on a readiness to addiction index.

MATERIALS AND METHODS

This quasi-experimental study was conducted on 136 high school students (grade one), selected by a cluster sampling procedure from May 2014 to February 2015 in Zabol, Iran. The instrument for gathering data was a readiness to addiction questionnaire. This questionnaire included 41 items for which the scoring of each item followed the Likerts format. The data gathered was analysed using SPSS version 21 with descriptive statistics and inferential statistics.

RESULTS

The results revealed that the mean of the readiness to addiction index in the case group fell from 75.66±19.99 to 69.57±21.83 (paired t-test; p =0.02); in the control group the same index changed from 103.01±21.88 to 93.98±27.70 (paired t-test, p = 0.775). That is, the index decreased for both groups, but the reduction was statistically significant only for the case group (p =0.02).

CONCLUSION

This suggests that the narrative method is effective in reducing adolescents readiness to addiction. Storytelling is an effective way to raise awareness among young people about addiction and its detrimental impacts on health. Therefore, such a technique can be taken into consideration in teaching principles of prevention.