Chinese medicine and supportive cancer care: a model for an evidence-based, integrative approach

Traditional Chinese medicine (TCM) may be integrated with conventional Western medicine to enhance the care of patients with cancer. Recent evidence confirms a scientific basis for the use of acupuncture, herbs, diet and energy therapies. We suggest a holistic care plan based on the concepts of biological response modification, enhancement of psychoimmunological function, better symptom control and improvement of psychospiritual wellbeing. There is enough preliminary evidence to encourage good quality clinical trials to evaluate the efficacy of integrating TCM into Western cancer care.     

Use of electronic personal health records (PHRs) for complementary and alternative medicine (CAM) disclosure: Implications for integrative health care

ObjectivesTo test a hypothesis that patients' use of Internet-based personal health records (PHRs) will be positively related to their disclosure of their CAM use to medical doctors, controlling for covariates' effects (e.g., health, human capital, and demographics), and to examine the factors influencing patients' CAM use disclosures.DesignCross-sectional survey.MethodsWe analyzed data in a subsample of CAM users who used both the internet and healthcare services (n = 1457) from the Health Information National Trends Survey, a nationally representative study of U.S. adults (≥18), by using a multivariate logistic analysis.ResultsAmong the subsample, 52.7% disclosed their use of CAM to their doctors and 19.3% used PHRs. Both the bivariate (64.1% vs. 35.9%, p < 0.01) and multivariate (β = 0.558, SE = 0.220, OR = 1.75, p < 0.05) analyses revealed a positive relationship between PHR use and CAM use disclosure. Other significant factors for CAM use disclosure included being older, being a female, having insurance, and having regular source of care. Particularly, foreign-born adults had significantly lower odds of disclosing their CAM use than U.S.-born adults.ConclusionsWe found that patients' PHR use facilitated their disclosure of CAM use to medical doctors. To ensure integrative healthcare and integrative medicine in the healthcare sector and optimum care for patients, education for CAM users regarding PHR adoption is encouraged. Next-generation PHR designs should consider incorporating domains for CAM data that allow patients to store CAM data and also incorporating ‘intelligent' PHRs, whose contents can be converted into the patient's first language.     

SUN program: an approach to the health care personnel shortage

Nursing educational institutions have been challenged to find innovative alternatives to recruit and train individuals for the nursing profession. The shortage of nurses, as well as most health care personnel, is acute and increasing exponentially. Over the past three semesters, this community college has met the challenge by offering a step format program. Students progress through the various steps of unit clerk, nursing assistant, licensed practical nurse, and registered professional nurse, based upon their interests and abilities.     

Acknowledging communication: a milieu-therapeutic approach in mental health care

Title. Acknowledging communication: a milieu‐therapeutic approach in mental health care Aim. This paper is a report of a study to develop milieu therapists’ acknowledging communication in their relationships with patients. Background. Gunderson’s therapeutic processes in milieu therapy have come into use in a broad range of mental health contexts in many countries. Research in nursing indicates that validation needs a more concrete development for use in clinical work. Methods. Schibbye’s theory, ‘Intersubjective relational understanding’, formed the theoretical foundation for a participatory action research project in 2004–2005. The data comprised the researcher’s process notes written during participation in the group of group leaders every second week over a period of 18 months, clinical narratives presented by participants in the same group, and eight qualitative interviews of members of the reflection group. Findings. The core concept in acknowledging communication, mutuality, was described as inter‐subjective sharing of feelings and beliefs in a respectful way. Participants presented their process of development as a movement from knowing what was best for the patient (acknowledging patients as competent persons, a milieu‐therapy culture based on conformity), to appreciating diversity and stubborn talk, to reflective wondering questions. Misunderstanding of acknowledgement occurred, for instance, in the form of always being supportive and affirmative towards patients. Conclusion. The concrete approaches in acknowledging communication presented in this article could be a fruitful basis for educating in and developing milieu therapy, both for nursing and in a multi‐professional approach in clinical practice and educational institutions. Future research should focus on broader development of various areas of acknowledging communication in practice, and should also include patients’ experiences of such approaches.     

Critical interactionism: an upstream-downstream approach to health care reform

Currently, per capita health care expenditures in the United States are more than 20% higher than any other country in the world and more than twice the average expenditure for European countries, yet the United States ranks 37th in life expectancy. Clearly, the health care system is not succeeding in improving the health of the US population with its focus on illness care for individuals. A new theoretical approach, critical interactionism, combines symbolic interactionism and critical social theory to provide a guide for addressing health care problems from both an upstream and downstream approach. Concepts of meaning from symbolic interactionism and emancipation from critical perspective move across system levels to inform and reform health care for individuals, organizations, and societies. This provides a powerful approach for health care reform, moving back and forth between the micro and macro levels. Areas of application to nursing practice with several examples (patients with obesity; patients who are lesbian, gay, bisexual, and transgender; workplace bullying and errors), nursing education, and research are also discussed.     

Patient-centred care as an approach to improving health care in Australia

Patient-centred care (PCC) has emerged as a primary approach to health care. This approach emphasises partnerships in health between patients and healthcare professionals, acknowledges patients’ preferences and values, promotes flexibility in the provision of health care and seeks to move beyond the traditional paternalistic approach to health care. Thus, in addition to the physical aspects of health care, the PCC approach acknowledges a patient's beliefs and values towards wellbeing. One advantage of the PCC approach is its focus on enhanced patient satisfaction; however, recently, concerns have been raised as to the effects of the PCC on the evidence-based care approach, as the two approaches are viewed as mutually exclusive rather than complementary. The paper discusses the concept of PCC and considers its benefits both in relation to patients and health care organisations. It also considers the contribution of nurses to PCC and in the enhancement of service delivery.