Integrating CAM Into Nursing Research Proposal
It is difficult to argue that complementary and alternative medicine (CAM) is gaining its popularity among average patients. This trend caused a need for a respective nursery response. However, CAM modalities are usually not included in mainstream scope of nursery practice. Hence, a need for studying CAM integration into traditional nursing practice is apparent. The following paper proposes a research on the given subject and outlines the purpose for identification of the effectiveness of CAM integration into traditional nursing practice. The research proposal also outlines specific aims of the study: safety considerations, effectiveness, measurements, and extents of CAM integration. The proposal also conducts a literature review on the subject of CAM integration into nursing and describes methodology for the future research.
Integrating CAM into Nursing Research Proposal
A growing popularity of complementary and alternative medicine (CAM) among patinets has become difficult to ignore. A great number of people prefer undergoing various modalities of CAM treatment as the primary, as well as supplementary course of care. Without doubt, appliance of CAM to a traditional nursery setting is insufficiently studied and practiced, especially in Western nursery practice (NIH, 2016). As a result, safety concerns still emerge in regards to integration of CAM into nursery mainstream practice. However, some CAM modalities are successfully deployed to mainstream nursery environment owing to their effectiveness and general absence of harms. Such forms of CAM can be potentially implemented in regular scope of nursery practice, but multiple obstacles are present. Such hardships with integration are justified by a lack of scientific nursery knowledge of CAM (NIH, 2016). Practitioners, as well as theoretitians, do not deny CAM’s potential, but numerous factors prevent CAM from integrating into nursing.
In such way, a proposed research will pay attention to measurement of CAM safety in mainstream nursery environment. As it has been already mentioned, many CAM modalities are effective and safe, meanwhile approximately the same number of practices imply a dangerous threat to health of patients (NIH, 2016). One more argument in this regard is that some CAM modalities can be safe under specific circumsatnces. Consequently, the suggested research will give an account of differentiation safe CAM practices from potentially or partially dangerous. Nevertheless, the research will particularly focus on a development of frameworks for differentiation, once a current state of knowledge does not provide a comprehensive methodology for safety consideration of CAM appliance. It is the primary aim of the future study, as long as safety is a minimal requirement to CAM integration into mainstream nursery practice. Implementation of potentially dangerous CAM modalities is beyond ethical terms of nursery practice traditional scope, so that this aspect should be primarily addressed.
Subsequently, identification of CAM effectiveness in inetgartion with standard nursery practices will be the second specific aim of the study. Regarding various media speculations in favor of CAM, efficiency of its modalities remains scientifically unverified. Thus, a framework for measuring effectiveness of CAM modalities should be respectively designed. The same CAM modality can be effective for a specific population, gender, age, or patients with peculiar health characteristics (NIH, 2016). Hence, the study will give an account of key determinants and circumstances of CAM effectiveness in complex with traditional nursery practices. Such consideration is essential, since combination of traditional and alternative means of treatment may result is severely adverse effects (Mayo Clinic Staff, 2016). It is becoming increasingly apparent that frameworks for effectiveness and its conditions will be mainly determined with the best practice retrieved from previous studies. This source is fairly insufficient for provision the study with supplementary knowledge, but a present state of knowledge still can drastically improve.
Eventually, there is a need for distinguishing extents of CAM integration into nursing practice. First of all, a general potential to inetgarte with mainstream nursing will be revealed. Provided that this finding is positive, the future study will describe how CAM modalities can be integrated into nursing practice and to what distinct extent. Nobody would argue with the fact that CAM modalities are still less widespread than traditional means of care (Mayo Clinic Staff, 2016). Therfore, the future research will identify main obstacles, as well as positive conditions for an effective integration of CAM into nursing. In general, such specific aims comprise the primary orientation of the future study, so that the research problem can be formuled. As a result, the purpose of the study is to distinguish whether CAM integration into nursing practice is effective.
1. What CAM practices are safe and under what circumstances? The research question is largely determined by spreading concerns regarding safety of CAM. Such modalities are believed to be insufficiently studied and not used by a mainstream nursing practice. In addition, cases of adverse effects after appliance of CAM are also a typical concern in that regard.
2. Is CAM effective, and how its effectiveness can be measured? It is becoming increasingly apparent that little infomration is known about a general effectiveness of CAM, as long as various modalities of CAM produce different effects depending heavily upon gender, age, and demographic background of a patient.
3. What are the extents of CAM integration? Provided that the main research problem is a possibility of CAM integration in nursing scope of practice, it is reasonable to determine borders and frameworks for its effective and safe integration.
It is obvious that use of CAM is closely attached to cultural background of patients and nurses. Consequently, appliance of cultural perspective is a compulsory element of the proposed research. Leninger’s theory of culture care should be deployed to the study as one of main constraints of theoretical framework. The theory provides numerous terms that determine cultural compliance of nursing practice (Nursing Theories, 2011). At the same time, this framework should be applied to the study of CAM integration in nursing scope of practice. It is informative to note that Leninger’s theory also touches upon cultural perspective on its generic level, so that a focus on naturalistic and professional levels of the research problem is extremely important for the study’s outcomes (Leddy, 2006). As a result, the theory is important to the proposed study.
Research of CAM in Nursing
Among the current volume of literature published on a subject of CAM studies, a general tendency suggests that CAM is insufficiently studied. The article by Buchan et al. (2012) reveals that the majority of practicing and currently educating nurses are generally uninformed about CAM modalities and their integrity with traditional scope of nursery practice. Buchan et al. (2012) explain this evidence by the fact that CAM practices are not integrated into a contemporary curriculum for nursing students, so that already graduated nurses possess a general knowledge regarding CAM, as well as any average patient. Buchan et al. (2012) place a specific emphasis on this tendency, since almost 80% of patients admitted to use CAM in the past and 41% is using CAM as the current course of treatment (Buchan et al., 2012). As a result, nurses are unable to assist patients in that regard owing to lack of knowledge. Hence, research of CAM in nursing practice is insufficient, meanwhile a need for a profound study is increasingly apparent.
A large presence of patients, who utilize CAM for personal treatment, still includes a surprising fact that many patients tend to avoid telling nurses about past or current admission to CAM practices. Without doubt, CAM is unstudied and unintegrated treatment, which is why probability of adverse effects is always present. Therefore, Netherwood and Derham (2014) argue that confirmation of such evidence should be included in a standard nursery admission form, so that nurses will be able to take specific preventive measures for avoidance of adverse effects. Thus, Netherwood and Derham (2014) state that inter professional education in relation to CAM modalities is especially important for nurses nowadays. It is certainly true, as long as Netherwood and Derham (2014) also provide data, which prove general increase in knowledge among nurses, who participated in courses of IPE. In such way, it is evident that CAM modalities are not well-studied but can contribute much to the holistic nursery practices and elimination of prejudices.
Current State of Knowledge
In order to speak about current state of nursery knowledge in regards to CAM, a general lack of information and empirical knowledge should be indicated. At the same time, Somani et al. (2014) suggest that nurses and students are willing to gain such knowledge, especially under circumstances of a strong trend on CAM among patients. Somani et al. (2014) also admit that nurses feel positive to gain CAM knowledge because they consider these practices to be generally effective and useful for regular scope of nursing practice. Somani et at. (2014) explain that considering the fact that CAM modalities are not involved in traditional nursing curriculum, many nurses would like to reveal practices that were unavailable for them in nursery institutions. The article considers such factors as a distinct evidence of a strong need for integrating CAM into mainstream nursery practice, since nurses are mainly convinced to gain distinct effectiveness from CAM modalities (table below). However, many sources of knowledge are often not reliable or present a little value for practicing nurse, so that nurses express a general desire to adopt CAM modalities in their scope of practice instead of attempting to learn related practices independently. Still, their appliance will be not approved with standards of nursery practice within almost any healthcare organization.
Besides that, Somani et al. (2014) argue that nurses believe in a considerable increase in quality and variety of treatments offered to patients. Similarly, the article admits that increase in CAM knowledge among mainstream nurses will positively reflect their general professional skills. The scheme below demonstrates a model of transaction, which is proved to deliver the best quality of care and enhance basic nursery skills. Nevertheless, these advantages are hypothetical only, once a current state of CAM knowledge requires improvements owing to multiple reasons.
On the contrary, Yildirim et al. (2010) confirm that any CAM modality is scientifically grounded. The article conducts a research regarding beliefs, experiences, and attitudes of nursing students towards CAM practices, so that Yildirim et al. (2010) have managed to observe a wide range of CAM modalities. The majority of them had certain scientific underpinning to various extents. As a result, the current state of knowledge is actually limited to implications that are generally unknown to mainstream practitioners, as well as for those individuals, who deploy CAM as the primary care. Moreover, a current state of CAM knowledge is also limited by external obstacles. Yildirim et al. (2010) note that a lack of time and absence of credible sources are the main external factors that thwart nursing students from obtaining CAM knowledge. A factor of time origins from absence of CAM disciplines in students’ curriculum, so that they have to study CAM on their own. As a consequence, lack of credible sources makes CAM disciplines extremely redundant in terms of nursery education. Therefore, nursing students generally prefer to avoid obtaining unverified CAM knowledge even for improvement of their general knowledge base. Nevertheless, a lack of knowledge causes a general willingness of students to study CAM modalities.
Hence, Yildirim et al. (2010) conclude that nursing students would study and adopt CAM practices provided that they have credible sources and well-organized course within their regular curriculum. Additionally, it is necessary to pay attention to the fact that sources of knowledge are multiple, but their credibility is unverified. The table below presents types of sources and frequency of their use by nursing and medical students. On a large scale, a current state of CAM knowledge is obviously poor, but practitioners express a strong desire to gain the related knowledge at all professional levels.
Experiences and Attitudes towards CAM
With regard to experiences and attitudes towards CAM modalities, Smith and Wu (2012) argue that they traced a possibility to immerse CAM modalities in regular scope of nursing practice. Practices, which are scientifically proved, demonstrate the same effectiveness as mainstream methods of treatment. However, it is informative to make a remark that the research took place in Taiwan where adoption of folk medicine is much more active than in Western standard-driven scope of nursery practice. Thus, lack of experience in CAM practice can be justified with a respective absence of policy-making enabling practitioners to access these experiences.
In addition, Smith and Wu (2012) admit that CAM experiences produce a positive impact on nurses and students. Their study has witnessed a strong appreciation of CAM modalities by mainstream nurses. Smith and Wu (2012) claim that integration of CAM into standard nursing practice is possible throughout numerous minor changes, once CAM is still scientifically-based dimension of care. It results in the fact that nurses, who had a chance to gain some CAM experience, admit that they would like to proceed on adoption of CAM modalities and their integration into mainstream nursing. In addition, Smith and Wu (2012) explain the drastic professional impacts produced on nurses. Hence, a possibility to implement CAM experience into nursing practice is absolutely real. Nurses with even little CAM experience confirm an overall efficiency of practiced modalities owing to such factors as simplicity, natural basis, addressing spiritual and psychological perspectives, and easy combinability with traditional means of nursery care. It is important to note that possibility to combine with mainstream practices is possible in case a CAM modality is scientifically grounded. At any rate, launching of CAM modalities in nursing practice on a large scale is not limited to lack of experience, as long as practitioners express a strongly positive attitude.
Smith and Wu (2012) also noticed a tendency that nurses are much more willing to adopt CAM practices than doctors. This evidence is explainable, as long as nurses work with factual procedures of treatment on a regular basis, meanwhile doctors usually guide the course of treatment. To the greatest extent, nurses are more exposed to evidence-based practice, so that comprehension of CAM principles is more possible with this group of practitioners. In addition, a positive attitude of nurses can also be underpinned with a deeper understanding of cultural, holistic, and even spiritual perspectives of care. Such aspects are closely related to CAM’s constraints, which makes a distinct similarity observable. In contrast, Booth-Laforce et al. (2010) suggest that nursery CAM practice is still risky without active participation of doctors. The article reveals that doctors are better aware of combinability between CAM modalities and mainstream treatment methods. In such way, absence of experience is actually a considerable obstacle for integration CAM into nursing. Besides that, CAM also requires doctoral top-down guidance, since admission to CAM has the same limitation as standard methods of treatment (Booth-Laforce et al. 2010). Therefore, a lack of experience in CAM prevents mainstream medicine from adopting CAM modalities.
Overall, Booth-Laforce et al. (2010) also confirm a great lack of experience in CAM owing to multiple reasons. At the same time, the article promotes a view that nurses feel positive concerning implantation of CAM modalities into a standard scope of nursery practice. Booth-Laforce et al. (2010) respectively describe benefits that can be gained from the integration of CAM into nursing. A growth of general nursery skill, a response and satisfaction of patients, and addressing the scope of care on a large scale with consideration of cultural perspective are recognized by the scholars as the main advantages of the suggested integration. Therefore, nurses’ positive attitude towards CAM experience is apparent.
The future research will be based on systematic review of the related literature published on a subject of integration CAM into nursing. The study will evaluate each piece of literature, especially according to developed questionnaire, so that the research will have stricitly theoretical value to the filed of integrative nursing. The design presupposes sampling, data collection, analysis, and its further interpretation with related discussion of outcomes.
The future research will use the convenience sampling. The sample will include 118 articles from PubMed and other credible sources, as long as this number has been determined with consideration of t-test, which has a significance (alpha) criterion equal to 0. 05, a power (1-beta) equal to 0. 8, and effect size (ES) equal to 0. 5. As a result, this method will dramatically reduce chances of false positives (type I error), as well as fales negatives (type II error). The inclusion criteria for the sampling is articles published within 50 past years (2009 – 2016). The excluision criteria is articles published earlier than 2009.
The research will deploy questionnaire, which will evaluate evidence provided with the reviewed literature. The questionnaire will use the following data that will be collected and gathered in the questionnaire: article title, journal, publication year, purpose of the studies, results. A score from 0-3 will be attributed to each articles based on the following results (strength of evidence): Was CAM, as cited in the article, really served as a proven therapeutic or palliative modality? The definition of score is the following:
· 0: not proven;
· 1: somehow proven;
· 2: effectively proven, but not currently or commonly integrated into nursing practice due to insufficient nurses knowledge and experience of working with the alternative modality;
· 3: effectively proven and integrated into current nursing practice (nurses have good knowledge, experience of working, and attitudes toward the modality).
Data Collection Procedure and Analysis
The data will be collected on the basis of the questionnaire’s results. In consequence, the collected data will be tested and processed throughout Chi square (X2). This test is used to test hypothesis and assess the difference between proportion of articles in favor or against integration of CAM into nursing. The sensitivity analysis will also be quite useful to evaluate consistency of the findings with regards to the hypothesis.
· Hypothesis of the Research Question # 1
Contemporary research of CAM in nursing practice is insufficient to determine safety of CAM modalities. This evidence is apparent within literature review and general background of the study.
· Hypothesis of the Research Question # 2
Effectiveness of CAM practices can be measured, as long as the majority of CAM modalities is scientifically proved.
· Hypothesis of the Research Question # 3
CAM modalities are integartable with mainstream nursing practices, since certain minor success is explicit in that regard.
In the end, it is appropriate to make a general comment on the fact that the study is limited in regards to empirical evidence of the research problem. However, such fact is acceptable due to the fact that accessing CAM empricially credible knowledge is difficult for this study. Furthermore, the selected volume of literature is proved to have a sufficient reliability and value for the future study.
Booth-Laforce, C., Scott, C .S., Heitkemper, M. H., Cornman, B. J., Lan, M. C., Bond, E. F., & Swanson, K. M. (2010). Complementary and alternative medicine (CAM) attitudes and competencies of nursing students and faculty: Results of integrating CAM into the nursing curriculum. Journal of Professional Nursing, 26(5), 293 – 300.
Buchan, S., Shakeel, M., Trinidade, A., Buchan, D., & Ah-See, K. (2012). The use of complementary and alternative medicine by nurses. British Journal of Nursing, 21(11), 672 – 675.
Leddy, S. (2006). Integrative health promotion: Conceptual bases for nursing practice. Sudbury, MA: Jones & Barteletts Publishers.
Mayo Clinic Staff (2016). Complementary and alternative medicine. Consumer health. Retrieved from http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/alternative-medicine/art-20045267?reDate=13042016
Netherwood, M., & Durham, R. (2014). Interpfrofessional education: Merging nursing, midwifery, and CAM. British Journal of Nursing, 23(13), 740 – 743.
NIH (2016). Are you considering a complementary health approach? Retreived from https://www.nccih.nih.gov/health/are-you-considering-a-complementary-health-approach
Nursing Theories (2011). Leninger’s theory of culture care. Retrieved from http://nursingtheories.blogspot.com/2011/07/leiningers-theory-of-culture-care.html
Smith, G. D., & Wu, S. C. (2012). Nurses’ beliefs, experiences and practice regarding complementary and alternative medicine in Taiwan. Journal of Clinical Nursing, 21, 2659 – 2667.
Somani, S., Ali, F., Ali, T.S., & Lalani, N.S. (2014). Complementary and alternative medicine in oncology nursing. British Journal of Nursing, 23(1), 40 – 46.
Yildirim, Y., Parlar, S., Eyigor, S., Sertoz, O. O., Eyigor, C., Fabiloglu, C., & Uyar, M. (2010). An analysis of nursing and medical student’s attitudes towards and knowledge of complementary and alternative medicine. Journal of Clinical Nursing, no. 19, 1157 – 1166.