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Awareness and practice of complementary therapies in hospital and community settings within Essex in the United Kingdom.
Enhanced public interest calls for integration of Complementary treatments within allopathic medicine. The Foundation of Integrated Medicine issued guidelines for the use of complementary therapies in June 2003. The National Institute of Clinical Excellence (NICE) backed the use of Alternative Therapies in a paper in November 2003. The nursing and midwifery council (NMC) issued a position statement (December 2000) advocating all nurses and midwives using complementary or alternative therapies must ensure that they are individually competent to practice. For the service user, the NMC stipulated that these therapies needed to be safe and used as part of the therapeutic process. This included the recipient consenting to treatment. This has enabled nurses to expand their practice to integrate Complementary treatments into nursing care within the National Health Service. High-quality care is focused on client's individualized needs, based on current government initiatives (Making a Difference, 2000; Government response to the House of Lords select committee's report on complementary and alternative medicine, CM5124, The Stationary Office, London) (NHS Choice Agenda 2004). Following the Patient's charter (DoH, 1991) and the more recent NHS Plan (2001), service users are no longer intimidated by the authority-based structure and speak out against various decisions and the right to take part in decision-making. This study investigated the awareness of complementary therapies by healthcare professionals currently employed by a local healthcare Trust. Data were also gathered on qualifications in complementary therapy and hospital and community sites of practice. We found a mismatch between the referrals staff recommended to clients and the treatment available within the practice areas. On the basis of our findings, we developed a new policy [Richardson J, Brennan AM. Complementary therapies in the N.H.S. service development in a local district general hospital. Complement Ther Nursing Midwifery 1995;1:89-92] for the provision of complementary therapies within the local health service.
Complementary therapies courses for the 21st century.
Over the past 5 years, an innovative portfolio of degrees in complementary therapies has been developed at the University of Westminster. Most of the degrees were the first of their kind in the UK, and the provision is now the widest range of complementary therapies courses in Europe. With an intake of 80 students in 1996, the provision has grown rapidly to a total of over 500 in 2000. The opening of the unique multidisciplinary Polyclinic in 1998 marked the beginning of an exciting clinical training and research dimension. The context that has lead to the growth of mainstream higher education provision of complementary therapies is explored. The current offer is reviewed, and criteria for degree provision and the role of the professional bodies discussed. The development of the University of Westminster's provision is described, including the early collaboration with established providers, design, influence of nursing and midwifery, experiences with the professional bodies, development of the unique Polyclinic and the plans for the future.
Alternative and complementary therapies in nursing curricula.
The growing interest in and use of alternative and complementary therapies by health care professionals and laypersons, the incorporation of these therapies in medical curricula and practice, and the greater acceptance of the legitimacy of such treatment methods require that nurse educators consider how this content may be incorporated into curricula. The authors propose that prelicensure students learn the premises that support such healing practices and develop skill in eliciting and evaluating patients' use of alternative therapies. In-depth study of one or more complementary therapies may be the focus of continuing education or elective courses. Students in graduate programs may investigate the safety and efficacy of nonorthodox therapies.
Complementary therapies and nursing models.
It is suggested that personal construct theory not only has the potential as a model for nursing, but also for complementary therapies, thus allowing complementary therapies or procedures from the therapies and nursing to blend, promoting a seamless integration that enables nurses to offer a wider range of interventions in their nursing care. By coming together in a therapeutic relationship using personal construct theory, it is possible for nurses to enhance the process of healing which is an integral part of nursing care.
Critical review of complementary therapies in haemato-oncology.
There is evidence of the increasing use of complementary and alternative medicine by Australians diagnosed with cancer. Given the increasing desire of cancer patients to use complementary and alternative medicine, it is important that clinicians have a good understanding of the evidence available in this field. This critical review aims to provide an overview of the current evidence pertaining to a range of complementary therapies that are used in a supportive role in the treatment of cancer patients. Treatment methods considered are acupuncture, music therapy, massage and touch therapies and psychological interventions. The efficacy of these complementary therapies in terms of improvement in symptoms and quality of life is examined. Evidence that relates to an effect on immune function and survival is also investigated.
Systematic reviews of complementary therapies - an annotated bibliography. Part 2: herbal medicine.
BACKGROUND: Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with herbal medicine. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of herbal medicines; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pre-tested form and summarized descriptively. RESULTS: From a total of 79 potentially relevant reviews pre-selected in the screening process 58 met the inclusion criteria. Thirty of the reports reviewed ginkgo (for dementia, intermittent claudication, tinnitus, and macular degeneration), hypericum (for depression) or garlic preparations (for cardiovascular risk factors and lower limb atherosclerosis). The quality of primary studies was criticized in the majority of the reviews. Most reviews judged the available evidence as promising but definitive conclusions were rarely possible. CONCLUSIONS: Systematic reviews are available on a broad range of herbal preparations prescribed for defined conditions. There is very little evidence on the effectiveness of herbalism as practised by specialist herbalists who combine herbs and use unconventional diagnosis.
Alternative and complementary therapies for labor and birth: an application of Kolcaba's theory of holistic comfort.
Although nursing has always used nonpharmacologic interventions for the relief of the discomforts of childbirth, alternative and complementary therapies are becoming more acceptable. Alternative and complementary therapies are based on a balance of body, mind, and spirit. Kolcaba's theory of holistic comfort is proposed as a framework for guiding nurses to use alternative and complementary therapies in the comfort care of laboring women.
Complementary therapies for cancer-related symptoms.
Relief of cancer-related symptoms is essential in the supportive and palliative care of cancer patients. Complementary therapies such as acupuncture, mind-body techniques, and massage therapy can help when conventional treatment does not bring satisfactory relief or causes undesirable side effects. Controlled clinical trials show that acupuncture and hypnotherapy can reduce pain and nausea. Meditation, relaxation therapy, music therapy, and massage mitigate anxiety and distress. Pilot studies suggest that complementary therapies may treat xerostomia, hot flashes, and fatigue. Botanicals or dietary supplements are popular but often problematic. Concurrent use of herbal products with mainstream medical treatment should be discouraged.
Issues that influence patient/physician discussion of complementary therapies.
This article explores what patients expect from physicians when discussing complementary therapies. Counsellors at four cancer centres, under the auspices of the British Columbia Cancer Agency, discuss their clinical observations in working with oncology patients. They present perspectives of factors that influence the patient/physician discussion of complementary therapies. Some of the common themes include desire for collaboration and control, need for understanding treatment information, maintenance of hope, and trust of the physician.
Complementary therapies: the position of the UKCC [practice guideline].
The Council receives many enquiries about its position in relation to the use of complementary therapies in the health services. The Council's position in relation to these therapies is such that it considers their safe inclusion in the care offered to patients and clients to be properly described in three of its publications. These are: the Scope of Professional Practice, the Code of Professional Conduct and the Council's Standards for the Administration of Medicines. In applying the principles in these documents, nurses, midwives and health visitors should not only be able to provide these therapies safely but they will also be acting in a proper manner should they be called to account by the Council. Finally, the Council has no plans to register complementary therapy qualifications, as such activity lies outside its legal remit. A Council position statement on complementary therapies was prepared in November 1994.
Relaxation training as complementary therapy for mild hypertension control and the implications of evidence-based medicine.
Relaxation therapy for the treatment of hypertension presented a number of challenges, in terms of conducting and using research as well as gaining the wider acceptance of this complementary therapy in common practice in Hong Kong. Two issues were central to the current implementation of complementary therapies: the evidence-based practice movement and the management of risk during the implementation of new therapies. A major concern was how to maximize the chance of inclusion of research on complementary therapies in evidence-based practice systematic reviews. This was thought to be achievable by making the data amenable to meta-analysis when small samples may be unavoidable. The empirical work examined the effects of three relaxation therapies for the reduction of high blood pressure in nine Chinese subjects. Subjects were randomly assigned to three groups: (a) progressive muscle relaxation, (b) stretch release relaxation and (c) cognitive imagery relaxation. Systolic, diastolic blood pressure and heart rate were assessed in a baseline session, the 8th post-treatment session, and a 30-days follow-up session. Datawere analyzed using ANOVA and Paired sample t-test. One-Sample Kolmogorov-Smirnov Tests for the normal distribution were performed among the three groups. The results verified that the normality assumption for the data had not been violated. Results revealed that in the context of the study all relaxation therapies can reduce blood pressure in Chinese subjects, but stretch release relaxation and progressive muscle relaxation therapies appeared to be more effective in lowering blood pressure compared to cognitive imagery relaxation. These data are in a form available for meta-analysis at a later date. The study also shows a degree of clinical significance and validation with respect to a Hong Kong population. It demonstrates ways in which the inclusion of research on complementary therapies in systematic reviews can be maximized.
Use of complementary therapies by patients attending musculoskeletal clinics.
Patients with musculoskeletal disorders commonly seek treatment outside orthodox medicine (complementary therapy). In patients attending hospital clinics we investigated the prevalence of such behaviour and the reasons for it. Patients attending rheumatology and orthopaedic clinics who agreed to participate were interviewed on the same day by means of a structured questionnaire in three sections: the first section about demographic characteristics; the second about the nature and duration of the complaint, the length of any treatment and whether the patient was satisfied with conventional treatment; and the third about the use of complementary medicine, the types of therapy that had been considered and the reasoning behind these decisions. The data were examined by univariate and bivariate analysis as well as logistic regression multivariate analysis. 166 patients were interviewed (99% response rate) and the predominant diagnosis was rheumatoid arthritis (22.3%). 109 patients (63%) were satisfied with conventional medical treatment; 63 (38%) had considered the use of complementary therapies, and 47 (28%) had tried such a therapy. 26 of the 47 who had used complementary therapy said they had gained some benefit. Acupuncture, homoeopathy, osteopathy and herbal medicine were the most popular types of treatment to be considered. Patients of female gender (P = 0.009) and patients who had expressed dissatisfaction with current therapies (P = 0.01) were most likely to have considered complementary medicine. These results indicate substantial use of complementary therapy in patients attending musculoskeletal disease clinics. The reasons for dissatisfaction with orthodox treatment deserve further investigation, as does the effectiveness of complementary treatments, which must be demonstrated before they are integrated with orthodox medical practice.
Use of complementary therapies in patients with Parkinson's disease in Singapore.
To determine the frequency and spectrum of complementary therapy (CT) use and its association with sociodemographic or disease-specific characteristics among Asian patients with Parkinson's disease (PD) in Singapore, we interviewed 159 patients using a structured questionnaire. Sixty-one percent (95% CI=55-67) of participants used at least one type of CT for PD, of which the most common were traditional medicine, acupuncture, and vitamins/health supplements. Among CT users, 40% (95% CI=32-48) subjectively reported some improvement of their symptoms. However, only 16% informed their physicians of their use of CT. Due to unequal follow-up times, a survival analysis approach was adopted for statistical analysis. The rate of starting CT use was 1.2/100 person months. At 3 years after PD diagnosis, 48% had started using CT. Among a subgroup of participants, those with a baseline Unified Parkinson's Disease Rating Scale motor score of more than 16 were 2.5 times more likely to use CT compared to those with a baseline score of 16 or less (P=0.031; 95% CI=1.1-5.8). CT use was not associated with age of onset of PD or other sociodemographic factors. The use of CT is high among Asian PD patients. Patients with more severe motor dysfunction at onset are more likely to use CT.
Questions and answers on the legal aspects of complementary therapies.
This paper discusses certain concerns which have worried United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) practitioners who have developed skills in complementary therapies. Some of the legal issues which are discussed are: the right of the employer to refuse to allow a practitioner to use his or her complementary therapy skills in the course of employment; the legal situation relating to the mentally incapacitated adult and the lack of consent to the use of complementary therapies; and the determination of competence for the practitioner. A strategy for UKCC practitioners is suggested.
Finding the right complementary therapies course.
Over the past 8 years the number of full time, Complementary Therapies degree courses provided within UK Universities has increased from less than five to currently almost one hundred. In addition, the developments within the Further Education and private sector have added to the increase in provision. With so many different courses on offer, finding the most suitable, quality course is becoming a challenge for applicants. Course titles provide little insight into the philosophy, nature and quality of provision while details within an institute's prospectus or web site frequently do not clearly identify distinguishing features. Key characteristics of quality provision to look for in a course in complementary therapies are discussed. Aspects considered include: the type of institute, modes of study, which therapy and its current regulation, the skills development and clinical experience opportunities, the balance of subjects within a course, the experience of the teaching team and their research activities. Discussion is included of the need for adequate quality assurance procedures to ensure courses evolve to continue to meet the needs of those entering the rapidly developing profession. The relationship of the provider and the appropriate professional bodies is also discussed. A summary of aspects to consider when looking for a comprehensive, quality course has been provided in Table 2.
Natural and complementary therapy utilisation on the north coast of NSW.
The use of natural and complementary therapies in Australia seems to be increasing. There is an emerging body of literature which describes the prevalence and patterns of usage of such therapies. This paper reports the findings of a telephone survey of 645 residents of the North Coast of New South Wales which set out to describe the prevalence and patterns of use of natural and complementary therapies in the region.
Complementary therapy and older rural women: who uses it and who does not?
BACKGROUND: Despite the growing use of complementary therapy by consumers in the United States, very little is known about the factors associated with the use of these therapies among older rural women. OBJECTIVE: The aim of this study was to answer the following research question using data from a portion of a larger study: What factors predict the use of complementary therapy among older rural women? METHODS: Data were collected by telephone interview from a random sample of older residents of 19 rural towns in Montana and North Dakota. Interviews were conducted using a guide that included questions about the use of allopathic and complementary healthcare and related issues such as health status, health problems, and reasons for seeking care. A direct logistic regression analysis was performed on the use of complementary or alternative medicine (CAM) as outcome and eight potential predictors. Data from 156 women were included in this analysis. RESULTS: A total of 25.6% (n=40) of the women reported using CAM in the recent past. Rural women most likely to use CAM were those who were fairly well educated, not currently married, and in their early older years. They had one or more significant chronic illnesses and lower health-related quality of life due to emotional concerns. DISCUSSION: By improving the existing understanding of who is or is not likely to use CAM, the results of this study can be used in giving comprehensive care for rural women, including all healthcare practices, self-care and practitioner provided, and complementary and conventional.