Nurses' attitudes and behaviour towards patients' use of complementary therapies: A mixed methods study

Traditional and complementary medicine perspectives of family physicians in Istanbul

Introduction: The World Health Organization, within the scope of the Traditional Medicine Strategy for 2014-2023, recommends the development of integrated health policies, particularly in the area of primary healthcare. However, family physicians often report feeling insufficiently trained to effectively integrate these practices into patient care. This study aims to assess the views, understanding, and experiences of family physicians regarding the utilization of Traditional & Complementary Medicine (T&CM).Methods: The family physicians employed by the Istanbul Health Directorate Public Health Services were solicited to participate in an 18-question online survey to assess their level of education in T&CM methods, their views on integration of T&CM into family medicine, and the impact of these practices on patient care.Results: A total of 324 family physicians took part in the survey; 12.0% were specialists, 64.5% had worked in primary care for over 10 years, and 59.6% were in the age range of 31-50 years. Among the physicians, the majority (70.1%) reported a preference for integrating T&CM practices with conventional medicine (ConvM). The majority of the participants (71.6%) had no formal T&CM training, and 66.4% reported inquiring about T&CM in their patient consultations. Over half of the physicians (56.79%) believed that T&CM methods should be used in preventive medicine. The most widely recognized T&CM technique was cupping therapy (18.5%), which was also the most frequently recommended method by physicians.Conclusion: Most of the family physicians who participated in the study expressed a desire for integrative medicine, despite acknowledging limited formal education in this field. Offering physicians training in evidence-based complementary medicine therapies could provide them with additional non-invasive treatment options. However, patients' diffidence to inform their family physicians about T&CM practices they undergo may pose significant risks. As a result, incorporating education on integrative medicine into formal medical education and residency training may be necessary.Keywords: Family physician, complementary medicine, integrative medicine, traditional medicine

Educational courses on non-pharmacologic complementary interventions for nurses across Europe: The INES mapping pilot study

BACKGROUND

Pharmacological interventions still form the mainstay of the management of pain, anxiety, sleep problems and discomfort. In Europe, an estimated 100 million people use complementary non-pharmacological interventions (NPIs) for these conditions. In their pre-registration education, nurses do not generally learn about the various types of NPIs and how patients and health care professionals can include NPIs complementary to their standard care. Some nursing schools in Europe offer elective courses on NPIs, often relying on individual initiatives. Little is publicly available about the content of these programmes and how they relate to the current nursing curriculum for EU countries.

OBJECTIVES

This pilot study aims to explore and map the field of nursing education with regard to complementary NPIs for nurses in Europe.

DESIGN

A web-based open-access questionnaire administered through the online survey tool LimeSurvey® was designed by the authors.

PARTICIPANTS

The questionnaire was sent to a purposive sample of 49 experts on nurse education and complementary NPIs from 16 European countries. All levels of education were eligible for inclusion.

METHODS

The questionnaire consisted of 35 items regarding course content, teaching material, teaching methods and methods of assessment. In addition, respondents were invited to perform a strengths, weaknesses, opportunities and threats (SWOT) analysis in relation to their education programme. Qualitative data was analyzed using a directive content analysis approach.

RESULTS

Between January and May 2020, thirty-one completed questionnaires from ten different countries were returned (response rate 63.3%). Massage, meditation, mindfulness and relaxation are the most taught interventions. Anxiety, stress, chronic pain, depression and sleep problems are the most common symptoms addressed.

CONCLUSIONS

Currently, a consistent and European approach to education for nurses on complementary NPIs and integrative nursing is lacking. Although taught at regular nursing educational institutes, the courses discussed here are not yet embedded in mainstream education for nurses.

Integrating Traditional Medicine and Healing into the Ghanaian Mainstream Health System: Voices From Within

In this study, I employed interpretive ethnographic qualitative design to explore perceptions of and proposals from traditional healers, biomedical practitioners, and health care consumers regarding integrating traditional medicine and healing in Ghana. Data were gathered through focus groups, in-depth individual interviews, and qualitative questionnaires and analyzed thematically. The results revealed positive attitudes toward integrating traditional medicine in Ghana and a discursive discourse of power relations. The power imbalance between biomedical and traditional practitioners regarding what integrative models to adopt is sanctioned by formal education and institutional structure. As a result, multiple approaches for integration were made, including patient co-referrals, collaborations between biomedical and traditional medical practitioners, and creating a unit for traditional medicine and healers at the outpatients' department for patients to choose either biomedicine or traditional medicine. Incorporating aspects of traditional healing in the training of biomedical practitioners and creating a space for knowledge sharing were also proposed. These integrative models reflected the distinctive interests of healers and biomedical practitioners. Considering these findings, I recommended policy options for consideration toward achieving an integrative health care system in Ghana.

MIXED METHODS APPRAISAL TOOL: STRENGTHENING THE METHODOLOGICAL RIGOR OF MIXED METHODS RESEARCH STUDIES IN NURSING

ABSTRACT Objective: to describe the use of the Mixed Methods Appraisal Tool to appraise and to strengthen the methodological rigor of mixed methods studies in nursing. Method: a theoretical essay was used to describe the application of Mixed Methods Appraisal Tool to support the development and assessment of mixed methods research in nursing. Four mixed methods articles in nursing were purposely chosen and evaluated based on the Mixed Methods Appraisal Tool criteria. Results: Mixed Methods Appraisal Tool is a tool for evaluating primary mixed methods studies based on five evaluation criteria: 1) justification for adopting mixed methods methodology; 2) integration between the quantitative and qualitative components; 3) interpretation of integrated findings of quantitative and qualitative data; 4) presentation of divergences between quantitative and qualitative results; and 5) compliance with the methodological rigor of each individual approach in mixed methods research. Conclusion: Mixed Methods Appraisal Tool is an instrumental resource that can be used to appraise mixed methods research and strengthen the methodological rigor in planning and conducting future mixed studies in nursing research.

The state of mixed methods research in nursing: A focused mapping review and synthesis

AIMS

To consider the scope and quality of mixed methods research in nursing.

DESIGN

Focused mapping review and synthesis (FMRS).

DATA SOURCES

Five purposively selected journals: International Journal of Nursing Studies, Journal of Nursing Scholarship, Journal of Advanced Nursing, Worldviews on Evidence-Based Nursing, and Journal of Mixed Methods Research.

REVIEW METHODS

In the target journals, titles and abstracts from papers published between 2015-2018 were searched for the words or derivative words 'mixed methods'. Additional keyword searches were undertaken using each journal's search tool. We included studies that investigated nursing and reported to use a mixed methods approach. Articles that met the inclusion criteria were read in full and information was extracted onto a predetermined pro forma. Findings across journals were then synthesized to illustrate the current state of mixed methods research in nursing.

RESULTS

We located 34 articles that reported on mixed methods research, conducted across 18 countries. Articles differed significantly both within and across journals in terms of conformity to a mixed methods approach. We assessed the studies for the quality of their reporting as regard the use of mixed methods. Nineteen studies were rated as satisfactory or good, with 15 rated as poorly described. Primarily, a poor rating was due to the absence of stating an underpinning methodological approach to the study and/or limited detail of a crucial integration phase.

CONCLUSIONS

Our FMRS revealed a paucity of published mixed methods research in the journals selected. When they are published, there are limitations in the detail given to the underpinning methodological approach and theoretical explanation.

Secondary Data Analysis in Nursing Research: A Contemporary Discussion

This editorial provides an overview of secondary data analysis in nursing science and its application in a range of contemporary research. The practice of undertaking secondary analysis of qualitative and quantitative data is also discussed, along with the benefits, risks and limitations of this analytical method.

Contextual factors triggering placebo and nocebo effects in nursing practice: Findings from a national cross-sectional study

AIMS AND OBJECTIVES

To describe contextual factors (CFs) used by nurses to increase placebo and to prevent nocebo effects.

BACKGROUND

Placebo effects have been studied in the nursing discipline, but nocebo effects still remain unexplored. Recently, a set of CFs functioning as triggers of placebo/nocebo effects has been described; however, its use in daily care has never been documented to date.

DESIGN

A national cross-sectional survey, according to the Checklist for Reporting Results of Internet E-Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was performed in 2016.

METHODS

A wide sample of Italian nurses belonging to four national associations was involved. A questionnaire based on CFs literature was developed and administered through the SurveyMonkey Software^® exploring: (a) CFs definition, (b) beliefs, (c) case-by-case frequency of use, (d) circumstances of application, (e) clinical conditions where participants perceived their potential beneficial effects, (f) ethical implications and (g) communication issues with the patient.

RESULTS

Out of 1,411 eligible nurses, 455 answered (32.2%) and 425 questionnaires (30.1%) were valid for the analysis. A total of 211 nurses (49.6%) defined the CFs as an intervention with a possible aspecific effect; participants believed in the CFs (2.91; 95%CI 2.88-2.94), using them >2 times/month, mainly in addition to a nursing intervention to optimise clinical outcomes (n = 79; 18.6%). Psychological and physiological therapeutic effects have been perceived mainly in chronic pain (n = 259; 60.9%) and insomnia (n = 243; 57.2%). According to participants, CFs have been reported as ethically acceptable when exerting beneficial psychological effects (n = 148; 34.8%); however, 103 (24.2%) of nurses did not communicate to the patient when CFs were used.

CONCLUSIONS

Nurses are aware of CFs as elements to increase the placebo and prevent the nocebo effects in concomitance with evidence-based nursing interventions.

RELEVANCE TO CLINICAL PRACTICE

The CFs valued by nurses and experienced as effective are mainly based upon the internal quality of the nurse and the quality of the relationship between the nurse and the patient. These qualities require a large personal investment; therefore, nurses should be supported in developing these qualities since their nursing graduation.

Unmasking the Practices of Nurses and Intercultural Health in Sub-Saharan Africa: A Useful Way to Improve Health Care?

In 2001 and 2013, the World Health Organization (WHO) published the WHO Traditional Medicine Strategy 2002-2005 and 2014-2023, respectively, to address policy, ethics, quality, and integration of complementary health therapies (CHT). Despite the adoption of these strategic frameworks, sub-Saharan African (SSA) countries largely run dualistic and inclusive health care system. A recent article published in Complementary Therapies in Clinical Practice analyzed the role of practicing nurses in CHT integration and intercultural health in an SSA country setting. Drawing on the Complementary and Alternative Medicine Health Belief Questionnaire, the study specifically examined nurses’ knowledge, practices, and attitudes toward CHT. The study revealed that nurses had low knowledge about CHT, which reflected in their ineptitude to engage in professional practices of CHT. In spite of the knowledge deficit, nurses generally held favorable attitudes toward CHT and the majority supported the need for “safe” and evidence-based integrative model. Efforts to improve CHT-related knowledge of nurses may enhance medical integration in SSA. This commentary proposes novel political will and investment in CHT education and research as well as an inclusion of CHT modules in the nurses’ training programs; viabilities to achieve intercultural health and improved care in SSA.