HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Take the CE Test Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tracy, M. F. Articles by Berman, B. Search for Related Content PubMed PubMed Citation Articles by Tracy, M. F. Articles by Berman, B.

CE Article and Journal Club Feature

Use of Complementary and Alternative Therapies: A National Survey of Critical Care Nurses

	Abstract

Top Abstract Definition of CAT Review of the Literature Methods Results Discussion Conclusions and Recommendations References

 
• Background Demand for complementary and alternative therapies is increasing and is affecting all healthcare settings, including critical care.

• Methods A random sample of members of the American Association of Critical-Care Nurses was surveyed to determine the members’ attitudes, knowledge, perspectives, and use of complementary and alternative therapies.

• Results Most of the 726 respondents were using one or more complementary and alternative therapies in practice. The most common therapies used were diet, exercise, relaxation techniques, and prayer. A majority of the nurses had some knowledge of more than half of the 28 therapies listed on the survey, and a majority desired additional training for 25 therapies. Respondents generally required more evidence judged as essential to use or recommend conventional therapy than to use or recommend complementary and alternative therapies. Nurses viewed complementary and alternative therapies positively overall, were open to use of the therapies, and perceived them as legitimate and beneficial to patients. Nurses judged the therapies helpful for treatment of a variety of symptoms. A majority of nurses desired an increase in the availability of the therapies for patients, patients’ families, and nursing staff. Nurses’ professional use of the therapies was related to having more knowledge of them, perceiving benefits of them, total number of therapies they recommended to patients, personal use, and affiliation with a mainstream religion.

• Conclusions Educational programs that provide information about use of complementary and alternative therapies and the underlying evidence base most likely will increase the appropriate use of the therapies to achieve desired outcomes.

	Definition of CAT

Top Abstract Definition of CAT Review of the Literature Methods Results Discussion Conclusions and Recommendations References

 
CAT are generally defined as the use of nonallopathic remedies that typically fall outside traditional formal healthcare practices; however, many CAT are well-accepted nursing interventions.³ CAT are often supplementary to mainstream healthcare, and often the aim is to provide comfort or care rather than to cure. CAT may induce a feeling of well-being or relaxation; they may enhance a person’s quality of life.

We use the term CAT to refer to nontraditional therapies in the broadest sense. This term is used instead of complementary and alternative medicine to acknowledge the use of these therapies by multiple diverse professionals and to avoid associating the therapies with a single profession (ie, medicine). Indeed, CAT have been used historically by nurses and members of other disciplines for thousands of years.³

The critical care environment has long been associated with stress.⁴ Many CAT can alleviate stress and contribute to the well-being of critical care patients and their families and also to the well-being of critical care nurses and other staff working in intensive care environments. CAT may be used to soften the harsh edges of the high-tech environment and provide low-tech, high-touch solutions to the problems of intensive care patients. However, the types and amounts of CAT used in intensive care units (ICUs) are largely unknown. Therefore, in this article, we describe critical care nurses’ use of and attitudes toward CAT.

	Review of the Literature

Top Abstract Definition of CAT Review of the Literature Methods Results Discussion Conclusions and Recommendations References

 
Use of CAT by the Public
The groundswell of public interest in CAT was captured in a report¹ of the results of a 1990 national survey of the use of unconventional therapies by adults in the United States. Eisenberg et al¹ noted that 1 in 3 Americans reported using one or more unconventional therapies within the preceding year, at an annual estimated expenditure of $13.7 billion.

The results of a follow-up survey published in 1998 indicated that use of these therapies had significantly increased, from 33.8% of American adults to 42.1%,² with an estimated $21.2 billion in expenditures. Eisenberg et al² concluded that the increase in costs was due to an increase in the number of persons who used the therapies rather than to an increase in the number of visits per person. In both surveys, approximately 72% of those who used the therapies reported that they did not tell their healthcare providers about the use of unconventional therapies.^1,2

Approximately 72% of persons who use unconventional therapies do not tell their healthcare providers.

 

Use of CAT by the public is wide and is increasing. Therefore, health providers most likely will encounter an increasing number of patients who are using CAT or who have questions about CAT. In addition, the number of patients who experience side effects from poorly advised use of CAT (eg, interactions with allopathic medicine or effects associated with overuse) may increase. Because of the limited or erroneous information many patients may have about CAT, nurses may encounter patients who are not using CAT, even though the therapies are judged potentially beneficial by nurses. Therefore, health professionals should be knowledgeable about CAT.

In the late 1990s, 42% of Americans reported having used at least 1 unconventional therapy in the past year.

 

Use of CAT by Health Professionals
Although studies of the use of CAT by health professionals have been done, little is known specifically about critical care nurses’ use of and receptivity to CAT. Available studies include investigations of a population of primary care physicians⁵ and of 3 select groups of non–critical care nurses,^6–8 a general survey of personnel in critical care settings,⁹ and a small local study of critical care nurses at 2 institutions.¹⁰

In a study of primary care physicians, Berman et al⁵ found that a majority of respondents had training in the CAT of behavioral medicine, counseling, diet, exercise, and relaxation. These therapies were the same ones viewed by the physicians as having the most legitimacy. Therapies considered to have only moderate legitimacy included hypnotherapy, massage, therapeutic touch, acupuncture, meditation, and prayer. Less than 15% of respondents viewed traditional Oriental medicine, electromagnetic therapy, and Native American medicine as legitimate therapies. Many of the physicians used some CAT in their own practice or would recommend the therapies to patients. Actual use was associated with the physicians’ knowledge of and attitudes toward CAT rather than by years of experience in practice. Those physicians who had been in practice more than 22 years tended to least accept and use CAT.

Similar findings were obtained in a small survey of critical care nurses at 2 local hospitals.¹⁰ More than 90% of the respondents in the survey viewed diet, exercise, relaxation, massage, counseling, and prayer as legitimate therapies. CAT that were frequently used by survey participants included those therapies that the nurses had knowledge of and training in, those they used personally, and those viewed as beneficial and legitimate. A total of 87% of the nurses were open or eager to use CAT in the critical care setting. Again, therapies identified as least legitimate were qi gong, electromagnetic therapy, traditional Chinese medicine, Native American medicine, and environmental medicine.

In a statewide study of registered nurses in Ohio, King et al⁸ found that reported knowledge of CAT was highly associated with reports of perceived efficacy. Similar therapies were most often used personally, in care of patients, and for referrals: diet, prayer, imagery, meditation, and massage. A total of 93% of the respondents reported that they used at least 1 therapy personally.

In a telephone survey of critical care units in London,⁹ more than 50% of the respondents reported that they used CAT in their setting, although not on a consistent basis.⁹ The most consistent use of CAT was in neonatal ICUs, particularly baby massage.

Oncology nurses reported clear perspectives on the importance of communication when working with patients on the use of CAT.⁷ Communication was identified as key to incorporating CAT into care based on the wishes of patients and providers. Also key was collaboration between conventional providers and nonconventional providers. These nurses viewed their role in the use of CAT with patients as one of providing and facilitating access to information and helping patients evaluate therapy options, including both conventional and nonconventional therapies.

These studies indicate that healthcare providers are interested in and have some limited training in use of CAT. Many study participants reported using the therapies personally and professionally or referring patients to CAT providers. Issues identified across studies that hindered integrating therapies into practice were lack of knowledge, lack of training, and lack of time. Many of the more commonly used therapies in these studies are psychobehavioral and lifestyle therapies that are often viewed as mainstream now (eg, diet, exercise, counseling, prayer). Although the findings across the studies were similar, they cannot be generalized to the practice and perspectives of critical care nurses across the United States.

Studies show that healthcare providers are interested in and have some limited training in the use of complementary and alternative therapies.

 

CAT for Critical Care Patients
Certain CAT may be helpful in the treatment of stress, anxiety, and other signs and symptoms, particularly in an ICU environment where patients may be in an unstable condition and have less tolerance for traditional pharmacological agents. Appropriate use and timely administration of CAT can help soften the edges of the high-tech environment and aid in creating a more humane context of care. Many of these therapies have been in the purview of nursing care for hundreds of years but have not always been recognized for their usefulness in effectively treating patients’ symptoms.¹¹

Although many CAT have high potential for efficacy, most do not have well-specified indications. Many have not been rigorously scrutinized for use in critically ill patients by means of scientific methods such as randomized, controlled, double-blind clinical trials. However, scientific scrutiny of therapies for use with hospitalized acute care and critical care patients has been increasing. For example, massage,¹² aromatherapy,¹³ music,¹⁴ imagery,¹⁵ and prayer¹⁶ have been or are currently under investigation in hospitalized patients with various acuities and conditions.

Although CAT are thought to be beneficial, and few reports of ill effects have been noted, they are not without potentially adverse consequences.¹⁷ Efforts to enlarge the knowledge base for practice are needed so that optimal benefits from CAT can be safely achieved.

Critical Care Nurses and Use of CAT
Many factors may influence critical care nurses’ use of CAT in practice. For example, nurses’ personal use of CAT may influence their attitudes toward CAT in general, and may increase or decrease their use of CAT with critically ill patients and the patients’ families.¹⁸ Nurses’ perceptions of legitimacy, efficacy, and benefits may also be factors in their decisions to use CAT for critically ill patients. Likewise, nurses’ knowledge of CAT may affect their use of these therapies in practice; if therapies are unknown to them or are therapies with which they have little experience, the nurses may be reluctant to use the therapies or to make a referral to practitioners who could administer CAT to critically ill patients. On the other hand, if the therapies are those with which the nurses are familiar, or that they use in self-care, they may be more likely to administer these therapies to patients or to seek a referral to a specialized CAT provider for their patients.¹⁹

Lack of knowledge about CAT may be a barrier to use of these therapies in practice. However, nurses who have the knowledge may face other barriers to the use of CAT in practice, including reluctance on the part of peers or physicians—or even the nurses’ own reluctance to use CAT. Nurses may face ethical issues in facilitating use of CAT when no scientific evidence supports the use of the therapies. Further, qualified providers may be unavailable or equipment, time, or training may be lacking. In addition, a lack of reimbursement or concerns about legal issues related to CAT use may be a barrier.

Nurses’ stress and environmental stressors may be associated with use of CAT. Stressful ICU environments may not be conducive for nurses to find the time or frame of mind to therapeutically listen or to provide soothing imagery. Also, general openness toward therapies may influence the use of the therapies. Nurses’ age, ethnic background, religious affiliation, and other sociodemographic factors may also be associated with their use of CAT.

Summary
In summary, CAT, as part of practice, potentially can increase patients’ satisfaction and bring about desired outcomes. CAT also are potentially useful as part of nurses’ regimen of self-care. Important to the integration of CAT are the willingness and receptivity of nurses to deliver, allow, or facilitate the administration of selected therapies.

	Methods

Top Abstract Definition of CAT Review of the Literature Methods Results Discussion Conclusions and Recommendations References

 
A national survey of critical care nurses was done to determine the nurses’ use of CAT and correlates of the use. The survey protocol was reviewed and approved by the institutional review board of the University of Minnesota.

Design
A descriptive exploratory correlational design was used.

Sample
A random sample of 2000 nurses was drawn from the membership data base of the American Association of Critical-Care Nurses to receive the survey. No restrictions on respondents or their work settings were made.

Instrument
A survey was modified (with permission) for use with critical care nurses from a survey developed by Berman et al⁵ to determine use of CAT among physicians. The survey for nurses was piloted, pretested, and sent to a random sample of members of the American Association of Critical-Care Nurses. Nurses were asked to provide their perspectives on 28 selected therapies that represented the main categories of CAT as defined by the National Center for Complementary and Alternative Medicine.¹⁰ The survey comprised 7 content areas:

1. demographic information,
   
2. professional and work setting information,
   
3. type of evidence required to recommend or use conventional therapy or CAT,
   
4. attitudes toward therapies (legitimacy, perceived benefit vs harm, openness to use, desire to increase availability of, and helpfulness),
   
5. current and desired knowledge or training,
   
6. personal and professional use (including recommendations and referrals), and
   
7. characteristics of the environment (barriers to CAT, stress, and sources of CAT information).
   

Analyses
Descriptive statistics were used to describe demographic, professional, and work setting characteristics of the sample and nurses’ personal use of CAT. Summary scores were created in 2 ways. Mean ratings were computed to describe the evidence needed, knowledge of CAT, desire for training, and attitudes (legitimacy and benefit); simple totals were used for barriers, recommendations, and personal and professional use. Nonnormally distributed ranked data were further categorized for analyses. The McNemar test was used to compare evidence required for use of conventional therapies with that required for use of complementary therapies. Associations between demographics, professional information, clinical setting, perceived barriers, attitudes, knowledge, and personal use of CAT with professional use of CAT were assessed by using the Pearson correlation and ² tests of association; t tests or nonparametric equivalents were used to examine differences. Variables associated at P .10 in bivariate analysis were included as candidates in multivariate stepwise linear regression analysis (significance for inclusion in final model, P.05). Appropriate regression diagnostics were examined for any indication of violation of assumptions.

	Results

Top Abstract Definition of CAT Review of the Literature Methods Results Discussion Conclusions and Recommendations References

 
Demographic, Work Setting, and Professional Data
A total of 726 surveys were returned (a response rate of 36.3%) after the initial survey mailing and a reminder postcard 2 weeks later. Characteristics of the sample and settings of employment are summarized in Table 1. Most respondents were female (90.8%) and white (89%). They ranged in age from 22 to 76 years (median 42). They had a median of 17 years in nursing and 13.1 years as critical care nurses. A majority of the nurses perceived their work environments as stressful (moderately stressful 62.3% and extremely stressful 23.7%).

Type of Evidence Required
Respondents were asked to rate (on a scale of unimportant to essential) how important it was to have certain types of evidence available to consider when recommending either conventional therapies or CAT. The percentage of respondents who rated evidence (including proven mechanisms, published case studies, epidemiological studies, proposed mechanisms, clinical trials, and successful use in their own practice) as essential for recommending conventional therapies was significantly greater than the percentage who rated such evidence as essential for recommending CAT (Table 3).

Knowledge and Training
A range existed in the numbers of therapies for which the nurses reported having some or a lot of training. More than 75% of respondents reported having some or more knowledge of 7 of the 28 therapies included in the survey (Table 5). Diet and exercise were the therapies for which most nurses reported knowledge of or training (98.6% and 98%, respectively). Many nurses reported that they had no knowledge or training for a significant number of therapies, including Native American medicine, traditional Chinese medicine, and qi gong. A majority of respondents wanted additional knowledge or training for most therapies, even respondents who had already stated that they had some or a lot of knowledge of CAT.

Helpfulness of CAT for Symptoms and Groups
Respondents were asked to report whether they perceived CAT (in general) to be helpful (by responding yes, no, or don’t know) for the treatment of each of 9 symptoms commonly encountered in working with critically ill patients (Table 7). A majority reported that they perceived CAT as helpful in the treatment of all symptoms presented in the survey except for vomiting, which 46.2% considered helpful.

Correlates of Professional Use
Survey variables were examined to determine their correlation with overall numbers of CAT used in practice. As anticipated, we found a positive significant association between the total numbers of CAT used by nurses personally and professionally (r = 0.58, P < .001). Moreover, we found a positive association between personal and professional use of each of the 28 therapies considered. However, of those respondents who used a therapy personally, the percentage who also used the therapy in practice varied from 22% to 96% (Table 8). For example, of the 609 nurses who personally used diet, 96% of them also used diet in their practice. At the other extreme, of the 18 nurses who used qi gong, only 22% recommended this therapy to their patients.

	Discussion

Top Abstract Definition of CAT Review of the Literature Methods Results Discussion Conclusions and Recommendations References

The therapies included in the survey were not specifically defined in order to avoid limiting the CAT interpretations by potentially not including a respondent’s personal or emerging definition of the therapy. For example, many would now consider diet a mainstream therapy if this therapy were defined as following a low-sodium, low-fat, or controlled-carbohydrate diet. However, diet therapies continue to emerge that could more likely be viewed as CAT than traditional. In addition, what one respondent might consider an unconventional therapy, another might view as mainstream, depending on the respondent’s cultural or religious background. Although the lack of definitions makes interpreting the survey results more difficult, it allowed the survey respondents to define the CAT as they use and identify the therapies.

A majority of nurses also reported that patients and patients’ families were requesting many of the commonly known CAT as well as some that are less well known. This report was based on nurses’ memories. Also, requests by patients and their families may be affected by how approachable or open the patients and their families perceived the nurse.

When respondents were asked to rate the perceived legitimacy of each of the 28 therapies, the question was not specifically anchored to legitimacy in critical care. The goal was not to link legitimacy of a therapy to a setting per se, but rather to ascertain the nurses’ perspectives of legitimacy of these therapies and the corresponding use in practice. Most CAT were viewed as legitimate therapies. In addition, if respondents did not respond that they viewed a therapy as legitimate, they tended to respond that they did not know rather than to label the CAT as not legitimate. When few respondents considered a therapy as legitimate, a majority still reported maintaining at least neutrality on perceived effects of harm versus benefit. For example, although only 21.2% of the respondents viewed electromagnetic therapy as legitimate, with 49.9% responding don’t know, 82.9% still viewed the effects of this therapy as neutral or beneficial. Thus, it appears that respondents were willing to keep an open mind about potential benefits of therapies for which they have little knowledge.

As indicated by the respondents, the ICU environment is still perceived as stressful. This finding underscores the potential importance of the use of CAT for relieving the stress of patients, staff, and patients’ family members. CAT have other uses as well. A majority of nurses thought the therapies were helpful in treating anxiety, pain, headache, and insomnia.

More than 90% of respondents were open or eager to use CAT in their practice despite the number of barriers they perceived existed in their work settings. Many reported that they wanted additional education and training for most therapies and wanted to increase availability of CAT in their settings not only for patients and patients’ families but also for nurses.

The vast majority of critical care nurses were open to using or eager to use complementary or alternative therapies in their practice.

 

Our results are similar to the research findings outlined in the literature review. Healthcare providers are reporting increases in the knowledge of and training in CAT and an openness to recommending and using these therapies with patients. The therapies used most often are those that respondents had knowledge of and training in, those the respondents used personally, and those the respondents viewed as legitimate and beneficial. The therapies used most often, as indicated in previous studies, were consistently those that tend to be viewed as mainstream therapies.

In addition, respondents in this and previous studies reported that they needed more scientific evidence in order to recommend conventional therapy than they did to recommend CAT. This finding is particularly noteworthy because many of today’s conventional therapies have little scientific evidence to support their use.

Although in the study of primary care physicians, Berman et al⁵ found that physicians with more than 22 years of practice experience were least accepting of CAT, in our study, we found no correlation between either age or years of practice in nurses’ professional use of CAT. Perhaps nurses in a critical care environment are more accustomed than primary care physicians to changes in practice over time and have a willingness to explore complementary therapies when pain and suffering are most likely to be acute.

A limitation of our study is a potential response bias; possibly only nurses supportive of CAT returned the survey. Even with this potential bias, a significant number of nurses reported that they are open to using CAT and are interested in gaining additional knowledge and training in these therapies. Future studies with large samples or samples specifically representative of nurses who are unfamiliar with or opposed to the use of CAT are needed to address the present, potential nonrespondent bias in this study.

	Conclusions and Recommendations

Top Abstract Definition of CAT Review of the Literature Methods Results Discussion Conclusions and Recommendations References

 
Critical care units are high-tech, stimulating environments that provide fertile contexts for delivery of CAT and are ripe for the benefits of CAT. Our findings indicate that critical care nurses are using CAT in practice and for personal use. These nurses are open and eager to increase their knowledge and use of CAT. Although the use of CAT in critical care is not without risks, clearly critical care health providers need to become more knowledgeable about CAT because patients and patients’ families are requesting the therapies. CAT may have a unique place for use in ICUs where critically ill patients may not be able to physiologically tolerate some conventional therapies.

Our survey did not include an exhaustive list of the CAT that are currently being practiced. However, this national survey of CAT use by critical care nurses is an important step in determining the general attitudes of critical care nurses toward CAT. In order to begin incorporating CAT into critical care despite barriers of time and stress, it may be worthwhile to initially promote the more commonly known CAT that do not require extensive training or the therapies already being taught in basic nursing education. Finally, research on the use of CAT in critical care should be encouraged to evaluate the benefits and risks of CAT in critically ill populations.

	ACKNOWLEDGMENTS

 
This research was funded by the Densford Scholar Program, the Katharine J. Densford International Center for Nursing Leadership, University of Minnesota, and the Genentech Research Award, the Greater Twin Cities Area Chapter of the American Association of Critical-Care Nurses.

To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints{at}aacn.org.

Commentary by Mary Jo Grap (see shaded boxes).

	REFERENCES

Top Abstract Definition of CAT Review of the Literature Methods Results Discussion Conclusions and Recommendations References

 

1. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkings DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Engl J Med. 1993;328:246–252.[Abstract/Free Full Text]
2. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine in the United States, 1990–1997: results of a follow-up national survey. JAMA. 1998;280:1569–1575.[Abstract/Free Full Text]
3. Snyder M. An overview of complementary/alternative therapies. In: Snyder M, Lindquist R, eds. Complementary/Alternative Therapies in Nursing. 4th ed. New York, NY: Springer Publishing Co; 2002:3–15.
4. Vreeland R, Ellis GL. Stresses on the nurse in the intensive care unit. JAMA. 1969;208:332–334.[Medline]
5. Berman BM, Singh BB, Hartnoll SM, Singh BK, Rielly D. Primary care physicians and complementary-alternative medicine: training, attitudes, and practice patterns. J Am Board Fam Pract. 1998;11:272–281.[Medline]
6. Hayes KM, Alexander IM. Alternative therapies and nurse practitioners: knowledge, professional experience, and personal use. Holist Nurs Pract. April 2000;14:49–58.[Medline]
7. Fitch MI, Gray RE, Greenberg M, Labrecque M, Douglas MS. Oncology nurses’ perspectives on unconventional therapies. Cancer Nurs. 1999; 22:238–245.[Medline]
8. King MO, Pettigrew AC, Reed FC. Complementary, alternative, integrative: have nurses kept pace with their clients? Medsurg Nurs. 1999;8:249–256.[Medline]
9. Hayes JA, Cox CL. The integration of complementary therapies in North and South Thames Regional Health Authorities’ critical care units. Complement Ther Nurs Midwifery. August 1999;5:103–107.[Medline]
10. Tracy MF, Lindquist R, Watanuki S, et al. Nurse attitudes towards the use of complementary and alternative therapies in critical care. Heart Lung. 2003; 32:197–209.[Medline]
11. Kreitzer MJ, Jensen D. Healing practices: trends, challenges, and opportunities for nursing in acute and critical care. AACN Clin Issues. 2000;11:7–16.[Medline]
12. Richards K, Nagel C, Markie M, Elwell J, Barone C. Use of complementary and alternative therapies to promote sleep in critically ill patients. Crit Care Nurs Clin North Am. 2003;15:329–340.[Medline]
13. Keegan L. Alternative and complementary therapies for managing stress and anxiety. Crit Care Nurse. June 2000;20:93–96.[Medline]
14. Chlan L. Effectiveness of a music therapy intervention on relaxation and anxiety for patients receiving ventilatory assistance. Heart Lung. 1998;27:169–176.[Medline]
15. Tusek D, Church JM, Fazio VW. Guided imagery as a coping strategy for perioperative patients. AORN J. 1997;66:644–649.[Medline]
16. Krucoff MW. The MANTRA Study Project [interview by B. Horrigan]. Altern Ther Health Med. May 1999;5:75–82.
17. Eliopoulos C. Using complementary and alternative therapies wisely. Geriatr Nurs. 2002;20:139–142.
18. Tracy MF, Lindquist R. Nursing’s role in complementary and alternative therapy use in critical care. Crit Care Nurs Clin North Am. 2003;15:289–294.[Medline]
19. Lindquist R, Tracy MF, Savik K. Personal use of complementary and alternative therapies by critical care nurses. Crit Care Nurs Clin North Am. 2003;15:393–399.[Medline]

Journal Club Article Discussion Points

When critically appraising this issue’s AJCC journal club article, "Use of Complementary and Alternative Therapies: A National Survey of Critical Care Nurses," consider the questions and discussion points listed below.

Study Synopsis: This study reports the results of a national survey of critical care nurses’ attitudes, knowledge, perspectives, and use of complementary and alternative therapies (CAT). A total of 726 nurses responded to a mailed survey assessing perspectives on 28 selected CAT representing the main categories of CAT, as defined by the National Center for Complementary and Alternative Medicine. The results indicated that a large majority of these nurses (98.3%) reported using 1 or more CAT in clinical practice. The most common therapies used were diet (94.2%), exercise (92.7%), relaxation techniques (79.9%), and prayer or spiritual direction (73.1%). More than half of the respondents reported that patients and families also requested the use of these CAT as well as massage, music therapy, pet therapy, and others. Most respondents indicated a positive view of CAT, openness to use of CAT, and perceived CAT as legitimate and beneficial to patients. Factors that influenced professional use of CAT included knowledge of CAT, perceiving benefits of CAT, total number of CAT recommended to patients, personal use, and belonging to a mainstream religion. Lack of training and lack of knowledge were identified as the most frequently perceived barriers to the use of CAT.

1. Description of the Study
   • What was the purpose of the research?
     
   • What are potential effects of CAT relevant to the critical care environment?
     
   
   
2. Literature Evaluation
   • What previous research has been conducted on the use of CAT in critical care?
     
   
   
3. Sample
   • How was the study sample selected?
     
   
   
4. Methods and Design
   • What type of study design was used?
     
   
   
5. Results
   • What were the findings of the study?
     
   • How did patients’ and family members’ ratings of CAT compare with ratings of critical care nurses?
     
   
   
6. Clinical Significance
   • What are implications of the study for clinical nursing?
     
   
   

Information From the Authors: Mary Fran Tracy, RN, PhD, CCRN, CCNS, lead author of this journal club article, provided additional information about the study. Tracy explained that the study team chose to conduct the survey based on the increasing popularity of CAT: "We’d seen more and more patients and healthcare providers talking about CAT in the critical care units, so it seemed like a ripe topic to explore."

Tracy and the research team had conducted 2 previous studies on the topic of CAT. Tracy explained, "The first was using the survey to obtain information from critical care units at 2 local tertiary hospitals: a university hospital and another large tertiary hospital in Minneapolis. That led to slight revision of the survey tool and then this research of a national sample of critical care nurses."

Tracy explained that there were several interesting findings of the current study, including the openness of using CAT in critical care. She added, "I think the fact that there were no geographical differences in usage was an interesting finding. Additionally, the respondents to this survey were very interested in learning more about all of the CAT we listed in our tool, even if they stated they already knew a lot about a particular one or not."

Implications for Practice: According to the study results, critical care nurses are open to the use of CAT in clinical practice. Additionally, they indicate an interest in obtaining more information on the use of CAT. This finding has implications for education as well as research on the use of CAT in critical care. Tracy highlighted that the study has several major implications for critical care nursing: "I think for critical care nurses it is important to recognize that many patients and nurses are aware of these therapies and may be using them personally and/or with patients. This has implications for the care of patients who present to our intensive care units. Even if nurses may not personally believe in any or all of these therapies, it is in our best interest to become aware, learn about them, and be open to bringing up the topic with our patients, since many are using these therapies. Some therapies used by patients may impact the care we are trying to provide for them. We need to take that into consideration."

Journal Club feature commentary is provided by Ruth Kleinpell.

This article has been cited by other articles:

				K. G. Mellott, P. B. Sharp, and L. M. Anderson Biobehavioral Measures in a Critical-Care Healing Environment J Holist Nurs, June 1, 2008; 26(2): 128 - 135. [Abstract] [PDF]

This Article Abstract Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Take the CE Test Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tracy, M. F. Articles by Berman, B. Search for Related Content PubMed PubMed Citation Articles by Tracy, M. F. Articles by Berman, B.