Nurses’ communication regarding patients’ use of complementary and alternative medicine

Background

: Many people integrate complementary and alternative medicine (CAM) into their health care. Nurses potentially play a significant role in communicating with patients about their CAM utilisation.

Do nurses’ personal health behaviours impact on their health promotion practice? A systematic review

BackgroundThere is a growing expectation in national and international policy and from professional bodies that nurses be role models for healthy behaviours, the rationale being that there is a relationship between nurses’ personal health and the adoption of healthier behaviours by patients. This may be from patients being motivated by, and modelling, the visible healthy lifestyle of the nurse or that nurses are more willing to promote the health of their patients by offering public health or health promotion advice and referring the patient to support services.MethodsAn integrated systematic review was conducted to determine if nurses’ personal health behaviour impacted on (1) their health promotion practices, and (2) patient responses to a health promotion message. Medline, CINAHL, SCOPUS, and PsycINFO databases were searched. A narrative synthesis was conducted.Results31 studies were included in the review. No consistent associations were noted between nurses’ weight, alcohol use, or physical activity level and their health promotion practice, although smoking appeared to negatively impact on the likelihood of discussing and engaging in cessation counselling. Nurses who reported confidence and skills around health promotion practice were more likely to raise lifestyle issues with patients, irrespective of their own personal health behaviours. The two studies included in the review that examined patient responses noted that the perceived credibility of a public health message was not enhanced by being delivered by a nurse who reported adopting healthy behaviours.ConclusionsAlthough it is assumed that nurses’ personal health behaviour influences their health promotion practice, there is little evidence to support this. The assertion in health care policy that nurses should be role models for healthy behaviours assumes a causal relationship between their health behaviours and the patient response and adoption of public health messages that is not borne out by the research evidence.     

Alternative,complementary or concurrent health care? A critical analysis of the use of the concept of complementary therapy

In this paper I critically address what is becoming the wholesale adoption of the concept of complementary medicine in researchers' analyses of lay participation in alternative therapies. This paper emerged out of a qualitative study of 21 Canadians who use and/or practice alternative therapies. I found that only seven informants used the term 'complementary' in describing their use of alternative therapies. Of those seven who did, five were alternative practitioners. I discuss the variability of meaning of the concept of 'complementary' and I argue that alternative practitioners have a professional interest in using the concept to avoid seeming in competition with medical professionals and to reduce the likelihood of being labelled 'quacks'. I conclude with a plea for researchers to define their terms in analyses of individuals' use of alternative and/or their dual use of alternative and allopathic health care.     

Does workplace violence,empathy, and communication influence occupational stress among mental health nurses?

Workplace violence is a major cause of occupational stress among mental health nurses, particularly those working in acute care. This study investigated the occurrence of occupational stress among mental health nurses in psychiatric hospitals and explored whether workplace violence, empathy, and communication skills influenced occupational stress levels in this population. A socio‐demographic questionnaire and the Chinese Nursing Work Stress Scale, Workplace Violence Scale, Jefferson Scale of Empathy – Health Professions version, and Nurses’ Clinic Communication Competence Scale were administered to 539 mental health nurses from three top‐grade tertiary research hospitals in the Beijing–Tianjin–Hebei region. The analysis revealed a high level of job stress (3.06 ± 0.69) and a moderate prevalence of workplace violence (6.21 ± 2.94) existed among participants when compared with among other nurses. Meanwhile, participants’ empathy (114.78 ± 15.99) and communication (4.31 ± 0.60) abilities were similar to or higher than those of other nursing populations. Mental health nurses with varying years of practice experience distinct levels of job stress. A linear regression analysis revealed that, while practice years (β = 0.104; P < 0.05) and workplace violence (β = 0.264; P < 0.01) aggravated occupational stress levels, empathy (β = ?0.147; P < 0.01) facilitated reductions in stress. Results suggest that reducing workplace violence and improving empathy in therapeutic relationships can limit the pervasiveness of occupational stress among mental health nurses. Having both psychological support and organizational support after a violent incident is essential, and the importance of professional education should be stressed.     

Natural,complementary, alternative: which term to use?

Although natural therapies are slowly infiltrating Australian nursing practice, there is still no consensus over which term to use and what these terms actually denote and infer. This article will address these concerns to reduce the confusion and misperception that currently surrounds the terminology currently in use.     

Push or pull? Relationships between lung cancer patients’ perceptions of quality of care and use of complementary and alternative medicine

Little is known about relationships between quality of care (QoC) and use of complementary and alternative medicine (CAM) among patients with lung cancer (LC).

Purpose

This study examines CAM-use among patients with LC in Sweden, associations between QoC and CAM-use among these patients, and reported aspects of LC-care perceived as particularly positive and negative by patients, as well as suggestions for improving QoC.

Methods

Survey data from 94 patient members of the Swedish LC patient organization about CAM-use and QoC as measured by the instrument “Quality from the patient’s perspective” were analyzed.

Results

Fifty (53%) LC-patients used CAM, with 40 of the CAM-users reporting that CAM helped them. The most common CAMs used were dietary supplements and natural remedies, followed by prayer. Significantly more patients reported using prayer and meditation for cure than was the case for other types of CAM used. Less than half the CAM-users reported having spoken with staff from the biomedical health care system about their CAM-use. Patients provided numerous suggestions for improving LC-care in a variety of areas, aiming at a more effective and cohesive care trajectory. No differences in QoC were found between CAM-users and non-CAM-users, but differences in CAM-use i.e. type of CAM, reasons for using CAM, and CAM-provider consulted could be associated with different experiences of care.

Conclusions

It is important to recognize that CAM-users are not a homogeneous group but might seek different types of CAMs and CAM-providers in different situations depending on experiences of care.     

Mental health nurses,promoters of inclusion or perpetuators of exclusion?

The literature identifies that mental health services and those individuals working within them have the potential to facilitate inclusion for their client group, because of their power to initiate potential inclusive opportunities. However, evidence suggests that service users themselves perceive many aspects of mental health services as contributing to the problem of exclusion. This has been attributed to an accumulation of messages, attitudes and disempowering practices that have emanated from mental health care providers over a long period. This study employs focus group methodology in a residential rehabilitation unit in an industrial city in the UK. Discussion of the findings highlight how, in spite of alleged inclusive practices, the attitudes held by members of the unit team could impede the clients' opportunities to become socially included, as a result of defensive practice, paternalistic attitudes, expectations of the local community upon the team and the stagnant views that are embedded in the culture of mental health services. While mental health nurses may see themselves as promoting inclusion, the reality may be quite different.     

Does experience of the 'occult' predict use of complementary medicine? Experience of, and beliefs about, both complementary medicine and ways of telling the future

This study looked at the relationship between ratings of the perceived effectiveness of 24 methods for telling the future, 39 complementary therapies (CM) and 12 specific attitude statements about science and medicine. A total of 159 participants took part. The results showed that the participants were deeply sceptical of the effectiveness of the methods for telling the future which factored into meaningful and interpretable factors. Participants were much more positive about particular, but not all, specialties of complementary medicine (CM). These also factored into a meaningful factor structure. Finally, the 12 attitude to science/medicine statements revealed four factors: scepticism of medicine; the importance of psychological factors; patient protection; and the importance of scientific evaluation. Regressional analysis showed that belief in the total effectiveness of different ways of predicting the future was best predicted by beliefs in the effectiveness of the CM therapies. Although interest in the occult was associated with interest in CM, participants were able to distinguish between the two, and displayed scepticism about the effectiveness of methods of predicting the future and some CM therapies.     

Do patients’ expectations influence their use of medications?: Qualitative study

OBJECTIVE

To investigate whether patients’ expectations influence how they take their medications by looking at the expectations patients have of their medications and the factors that affect these expectations.

DESIGN

Qualitative study using in-depth interviews and a grounded-theory approach.

SETTING

A large city in Ontario.

PARTICIPANTS

A total of 18 community-dwelling adult patients taking medication for at least 6 months.

METHOD

Both purposive and convenience sampling techniques were used. The initial strategy comprised stratified, maximum variation, and typical case sampling. The research team developed a semistructured interview guide after a preliminary review of the literature. Individual, face-to-face, in-depth interviews were conducted and audiotaped. At the end of the interviews, basic demographic information was collected. Interviewers were debriefed following each interview and their comments on relevant contextual information, general impressions of the interview, and possible changes to the interview guide were audiotaped. Audiotapes of each interview, including the debriefing, were transcribed verbatim, cleaned, and given a unique identifying number. At least 2 team members participated in analyzing the data using an operational code book that was modified to accommodate emerging themes as analysis continued.

MAIN FINDINGS

Patients’ expectations were more realistic than idealistic. Many participants acted on their expectations by changing their medication regimens on their own or by seeking additional information on their medications. Expectations were affected by patients’ beliefs, past experiences with medications, relationships with their health care providers, other people’s beliefs, and the cost of medication. Patients actively engaged in strategies to confirm or modify their expectations of their medications.

CONCLUSION

A range of factors (most notably past experiences with medications and relationships with health care providers) influenced patients’ expectations of their medications. More comprehensive discussion between patients and their health care providers about these factors could affect whether medications are used optimally.     

How frequently do patients with multiple sclerosis use complementary and alternative medicine?

OBJECTIVE: The purpose of the study was to examine the prevalence and characteristics of the utilisation of complementary and alternative medicine (CAM) by patients with multiple sclerosis (MS). DESIGN: Cross-sectional study using a semi-structured interview. SETTING: One hundred and fifty-four MS patients were examined by interview to collect sociodemographic and disease-related variables as well as aspects of their usage of CAM. The investigation was completed by data from neurological examination. MAIN OUTCOME MEASURES: Reported utilisation of CAM by MS patients. RESULTS: At the time of the investigation 61.7% (n = 95) of the MS patients reported that they were currently using CAM. Most of the therapies utilised (90.3%; n = 205) were complementary and only 9.7% (n = 22) were alternative choices. Users of complementary medicine were more severely affected by the disease than non-users, but no sociodemographic differences between users and non-users were found. Concerning the efficacy of CAM, 65.8% (n = 146) of MS patients reported improvement, 32.9% (n = 73) no influence, and 1.3% (n = 3) worsening of their condition. 4.5% (n = 10) of the CAM therapies were accompanied by slight side-effects. CONCLUSION: A large proportion of MS patients use unconventional treatments, yet clinical studies on the efficacy of CAM in these cases have not been undertaken. Therefore, further research on their motivation and on objective effects of CAM is required.     

The impact of occupational stress on nurses’ caring behaviors and their health related quality of life

Background

Nursing is perceived as a strenuous job. Although past research has documented that stress influences nurses’ health in association with quality of life, the relation between stress and caring behaviors remains relatively unexamined, especially in the Greek working environment, where it is the first time that this specific issue is being studied. The aim was to investigate and explore the correlation amidst occupational stress, caring behaviors and their quality of life in association to health.

Methods

A correlational study of nurses (N?=?246) who worked at public and private units was conducted in 2013 in Greece. The variables were operationalized using three research instruments: (1) the Expanded Nursing Stress Scale (ENSS), (2) the Health Survey SF-12 and (3) the Caring Behaviors Inventory (CBI). Univariate and multivariate analyses were performed.

Results

Contact with death, patients and their families, conflicts with supervisors and uncertainty about the therapeutic effect caused significantly higher stress among participants. A significant negative correlation was observed amidst total stress and the four dimensions of CBI. Certain stress factors were significant and independent predictors of each CBI dimension. Conflicts with co-workers was revealed as an independent predicting factor for affirmation of human presence, professional knowledge and skills and patient respectfulness dimensions, conflicts with doctors for respect for patient, while conflicts with supervisors and uncertainty concerning treatment dimensions were an independent predictor for positive connectedness. Finally, discrimination stress factor was revealed as an independent predictor of quality of life related to physical health, while stress resulting from conflicts with supervisors was independently associated with mental health.

Conclusion

Occupational stress affects nurses’ health-related quality of life negatively, while it can also be considered as an influence on patient outcomes.

     

Trick or treat? Australian newspaper portrayal of complementary and alternative medicine for the treatment of cancer

Purpose  

Many cancer patients within developed nations cite the media as informing their decisions to use complementary and alternative medicine (CAM). The present study describes (1) Australian newspaper coverage of CAM use for cancer between 1998 and 2007; (2) trends in reporting frequency and characteristics; and (3) how the Australian press framed stories on CAM use for cancer.     

Are users of complementary and alternative medicine sicker than non-users?

Higher utilization of complementary and alternative medicine (CAM), both in cross-sections and over time, is commonly related to better socioeconomic status and to increased dissatisfaction with conventional medicine and its values. Little is known about health differences between users and non-users of CAM. The objective of the paper is to explore the difference in health measured by the SF-36 instrument between users and non-users of CAM, and to estimate the relative importance of the SF-36 health domains scales to the likelihood of consulting CAM providers. Interviews were used to collect information from a sample of 2000 persons in 1993 and 2500 persons in 2000, representing the Israeli Jewish urban population aged 45-75 in those years. Bivariate and logistic regression analyses were used to explore the above associations. The results show that while users of CAM enjoy higher socioeconomic status and younger age, they tend to report worse health than non-users on the eight SF-36 health domains scales in both years. However, controlling for personal characteristics, lower scores on the bodily pain, role-emotional and vitality scales are related to greater likelihood of CAM use in 2000. In 1993, no scale had a significant adjusted association with the use of CAM. The conclusions are that CAM users tend to report worse health. With CAM becoming a mainstream, though somewhat luxurious, medical practice, pain and affective-emotional distress are the main drivers of CAM use.