ReviewNurses’ attitudes towards complementary therapies: A systematic review and meta-synthesis☆
Introduction
Complementary therapies are a diverse range of health-related practices and products that have a history of use outside of conventional biomedical use (NCCIH, 2016). Complementary therapies usually fall under one of two major categories: natural products (such as herbal medicine or dietary supplements), and mind and body practices (such as acupuncture, chiropractic, massage, meditation or yoga). Despite the availability and benefits of modern biomedicine, complementary therapies are growing in popularity. A review of international research found 9.8–76% of the general population utilised complementary therapies in the previous 12 months, and 1.8–48.7% had visited a practitioner (Harris et al., 2012).
Given the popularity of complementary therapies amongst the general population, most health professionals are likely to be exposed to patients that use them. However, many people self-prescribe with little or no input from qualified health providers and furthermore, often they do not disclose their use (Thomson et al., 2012). Patients may not reveal their use of complementary therapies due to a concern that they will encounter a negative attitude, a belief that the practitioner does not need to know or simply that they were not specifically asked (Jou and Johnson, 2016, Robinson and McGrail, 2004). Non-disclosure results in the health provider lacking the necessary information to assist the patient to formulate an appropriate, well-informed clinical decision. Despite a widely held assumption that complementary therapies are ‘natural’ and therefore safe, there are a number of associated risks (Hall et al., 2010). In particular, there is concern that some oral supplements may interact with pharmaceuticals (Alsanad et al., 2014). Alternatively, complementary therapies may also offer benefits to some patients. For example mindfulness training has been found to be a helpful intervention for some people suffering with anxiety and depression (Khoury et al., 2013).
Nurses represent the largest health workforce, and play a pivotal role in patient care, education, advocacy and decision making. As such, they are well-positioned to communicate with patients about their use of complementary therapies. Further, nurses may be more approachable and able to engage in more meaningful conversations with patients due to their general acceptability of these therapies. Indeed, a recent scoping review of quantitative studies revealed that most (66.4%) nurses demonstrate a positive attitude towards complementary therapies and more than half (53.7%) integrate them into their professional practice, despite a lack of formal training (Chang and Chang, 2015).
Understanding nurses’ attitude towards complementary therapies is important because it is likely to influence patients’ decision regarding these therapies. While the definition for attitude varies, it is generally understood as a multifaceted concept which refers to an individual’s perceptions and may have a significant impact on their behaviour (Kaus, 1995). A synthesis of the current qualitative research evidence exploring this phenomenon will help in developing a new, more substantial interpretation of this issue.
Section snippets
Methods
The aim of this meta-synthesis is to review, critically appraise and synthesize the research to develop a new, more substantial interpretation of nurses’ attitudes regarding complementary therapies. Although there are a variety of approaches, the fundamental purpose of meta-synthesis is to generate new interpretations from combining qualitative research studies, while still preserving the integrity of the primary data (Downe, 2008).
This review is reported according to the Enhancing Transparency
Results
A total of 739 papers were identified by the preliminary search strategy. Of these 628 were excluded on title or abstract review, as they did not fit the inclusion criteria. The remaining 44 papers were assessed for edibility as full-text articles. Fifteen studies that met the inclusion criteria were then methodologically reviewed and ultimately all of these were incorporated in the final synthesis (Fig. 1). The findings of this review are based on five papers from the USA, three papers from
Findings
Five analytical themes relating to nurses’ attitudes towards complementary therapies emerged from the data: the strengths and weaknesses of conventional medicine; complementary therapies as a way to enhance nursing practice; patient empowerment and patient-centeredness; cultural barriers and enablers to integration; and structural barriers and enablers to integration.
Discussion
The purpose of this meta-synthesis is to provide an interpretation of the qualitative research literature exploring nurses’ attitudes towards patient’s use of complementary therapies. Previous work has identified that many nurses have positive attitudes (Chang and Chang, 2015, Sewitch et al., 2008), however by synthesising the results of multiple studies conducted in different settings, our findings provide a richer understanding of their perceptions and the challenges they face, when
Limitations
This meta-synthesis yields valuable insights into nurses’ attitudes and behavior towards complementary therapies. Yet, despite the study being conducted in accordance with ENTREQ guidelines, there are several limitations. First, the review was restricted to articles published in English. Given the popularity of complementary therapies in many non-English speaking countries, for example China, it is likely that there are relevant studies published in other languages that may have influenced the
Conclusion
The increasing use of complementary therapies amongst the general population has made these therapies an important consideration for all health care professionals. Nurses’ attitudes towards complementary therapies are influenced by their professional ideology, their knowledge and the context in which they work. For some nurses, complementary therapies provides an opportunity to reclaim holistic person centred care and broaden the meaning of contemporary nursing practice. Yet despite their
Conflict of interest
None.
Funding
This research project is part of a larger research piece for which the authors received funding from Endeavour College of Natural Health.
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Sources of support that require acknowledgment: Endeavour College of Natural Health.