The purposed purpose of this study is to explore nursing students perception on the use of non-pharmacological treatment for pain in the hospital setting. The study will also explore the types of complementary therapies used to alleviate pain at the main local government run, general hospital, assessing nursing students’ knowledge and perception on complementary and their use and to identify possible benefits and contraindications in the use of complementary therapies.
The proposed quantitative research will be used as data collection through a self administered questionnaire.
Table of Contents
Page
Title Page i
Abstract 2
Table of Contents 3
List of tables 5
1. Introduction 6
2. Background to the study
2. 1 Definition of Complementary and Alternative therapies 7
2. 2 Defining Acupuncture 9
2. 3 Types of Acupuncture Techniques 9
2. 4 Mechanisms of Action of Acupuncture 10
2. 5 Clinical Applications and Efficacy 10
2. 5 Research Issues 12
3. The Research Method
3. 1 Aim and Objectives 13
3. 2 The Research Design 13
3. 3 The Population 13
3. 4 Sampling Technique 14
3. 5 Method of Data Collection 15
3. 6 Research Tool 15
3. 7 Data Analysis 15
4. Ethical Consideration 16
Reference List 17
Time Scale and Budget 18
List of tables Page
Table 1: List of Complementary Therapies 8
Table 2: Contraindications to the use of acupuncture 11
Table 3: Adverse effects of acupuncture 12
Introduction
Complementary Therapies have established a place in health care and have developed rapidly over the past ten years in terms of recognition, acceptance and use (Peters et al, 2002). Integrating complementary therapies with conventional medicine presents a challenge to all sectors of health care, but specifically to nurses who are at the forefront of providing patient care, health education and information (Chu and Wallis, 2007). The review of the proposed study identifies a number of these therapies but it explores only one in particular; analyzing its prevalence and use, and exploring its perceived efficacy and safety and nursing students’ attitudes towards it.
Pertinent research and reviewing of articles for this review were sought from within the Faculty of Health Sciences and Medical School Library, using Cumulative Index of nursing and Allied Health Literature (CINAHL), EBSCO host and Medline and the University of Dublin website. Dissertation abstracts, and books that were relevant to the subject were also examined. Keywords utilized for searches included “ complementary”, “ therapies”, “ alternative”, “ attitudes”, “ nursing students”, “ acupuncture”, “ pain management”.
Due to the increase in demand of complementary therapies, numerous articles have been written on the subject throughout the years, especially in the last decade. The amount of research available varies depending on the therapy in question. Very few local studies were encountered regarding complementary therapies, as a matter of fact, at the main local government run, general hospital, only one type of complementary therapy is acknowledged.
Background to the study
2. 1 Definition of Complementary and Alternative therapies
Complementary and alternative medicine (CAM) encompasses a wide range of therapeutic procedures and philosophies that are not traditionally viewed to be part of conventional medicine (Smith, G. D, 2009)
The Cochrane Complementary Medicine Field within the Cochrane Library defines complementary therapies as a broad domain of healing resources that comprises all the healthcare systems and practices – their accompanying theories and beliefs.
The World Health Organization defined Complementary Alternative Modalities (CAM) as ‘ a comprehensive term used to refer to both traditional medical systems such as Traditional Chinese Medicine, Indian ayurveda and Arabic unami medicine and to various forms of native medicine’ (WHO, 2004)
Thus, the words complementary and alternative can, and often do, refer to the same therapy, product, or practitioner. It is the context of use that changes an alternative therapy into a complementary one. The term describes health care practices such as those shown in Table 1.
Table 1: List of Complementary Therapies (Alphabetical order)
Acupressure (Shiatsu)
Colonic hydrotherapy
Iridology
PIP Scans
Acupuncture
Colour therapy
Juice Therapy
Raw Vegetable Juice Therapy
Alexander technique
Counselling
Kinesiology
Reflexology
Allergy testing
Craniosacral Therapy
Light therapy
Reiki
Aromatherapy
Dream Therapy
Light Touch therapy
Rolfing
Art therapy
Eye Movement Desensitization & ReprocessingEMDR
Magnotherapy
Shiatsu (Acupressure)
Auricular Acupuncture
Exercise
Marma therapy
Spiritual counselling
Australian Flower Essences therapy
Guided Imagery
Massage therapy
Stress management
Autogenics
Healing
Medical Herbalism
Swimming therapy
Ayurvedic medicine
Health Clubs
Meta-Aromatherapy
Tai Chi
Bach Flower remedies
Health Screening
Microwave Resonance therapy
TENS therapy
Bee Venom therapy
Herbal medicine
Music therapy
T. C. M. – Traditional Chinese Medicine
Bowen Technique
Homoeopathy
Naturopathy
Transcendental Meditation
Biofeedback
Humour
Nutritional therapy
Tragerwork
Chelation Therapy
Hydrotherapy
Osteopathy
Vegetable Juice Therapy
Chiropractic
Hypnotherapy
Oxygen therapy
Yoga
Chinese Herbal Medicine (T. C. M.)
Indian Head Massage
Panchakarma therapy
2. 2 Defining Acupuncture
Acupuncture is a complementary therapy that is being increasingly used in the day-to-day management of pain. It originated in China, over 3000 years ago and is practiced worldwide (Wilkinson, J. & Faleiro, R., 2007).
Locally, in the main local government run, general hospital, Acupuncture is the only complementary therapy to be officially used in alleviating physical pain. Other therapies such as Exercise, Counseling, Music Therapy and others are used for various other reasons in combination with conventional medicine.
Acupuncture involves the insertion of fine sterilized needles through the skin at specific point (called acupoints) and is one of the key components in traditional Chinese medicine (Chen, L., 2005). A major assumption is Traditional Chinese Medicine is that health is achieved by maintaining the body in a ‘ balanced state’ and that disease is as a result of an internal imbalance of yin and yang (Wilkinson, J. & Faleiro, R., 2007).
There are five main techniques practiced. Dry needling is probably the most common but electro acupuncture (EA) possesses the most promising research endorsement.
2. 3 Types of Acupuncture Techniques
Moxibustion
Moxibustion involves the burning of mugwort, a small, spongy herb, to facilitate healing. It is applied onto the needle over the acupoints.
Laser acupuncture
A fine low-energy laser beam is directed onto the acupoint.
Acupressure
In Acupressure, pressure is used to stimulate the acupoints. This can be in the form of a bracelet or strap. Such method is commonly used to alleviate motion sickness.
2. 4 Mechanisms of Action of Acupuncture
Alan K. Halperin, M. D in his article Acupuncture in Pain Management writes that according to Chinese acupuncture theory, there are over 300 acupunture points on the body that connect to 12 principal and 8 secondary pathways called meridians. These pathways conduct energy force, Qi throughout the entire body. Health is maintained by the unobstructed flow of Qi that regulates the physical, mental and spiritual balance. In addition, the opposing forces of yin and yang regulate all organs. When the entire system is in balance, optimal health occurs. Disease occurs when there are obstructions to the flow of Qi, deficient or axcessive Qi, or when there is an imbalance of yin and yang.
2. 5 Clinical Applications and Efficacy
Research shows that Acupuncture can be used in virtually any medical condition, but most Americans use it for pain control (Halperin, 2005). Such pain controls are for osteoarthritis, headache, chronic neck and lower back pain. Studies conducted on the subject also revealed that the mentioned complementary therapy is often seen as a last resort for pain relief. This creates adverse selection bias, leaving acupuncture as an option only for those patients who fail to respond to all other methods and can create unrealistic expectations from patients (Wilkinson, J. & Faleiro, R., 2007).
There are also many pain conditions which have demonstrated improvement with acupuncture. These include: lateral epicondylitis, peripheral neuropathy, temporomandibular disorders, phantom limb pain, chronic pelvic pain, irritable bowel syndrome and Crohn’s Disease.
Literature shows that although acupuncture has gained much professional recognition, its applications and over all efficacies remains a subject of debate (Chen, 2005). Even so, the risk of serious events associated with acupuncture treatments is quite low (Halperin, 2005).
The National Institute of Health (NIH) consensus panel on acupuncture in the United States states that the documented occurrence of adverse events in the practice of acupuncture is extremely low. Nevertheless, Acupuncture is technically an invasive procedure with the most common reported complication being bruising or bleeding at the needle insertion site, followed by the transient vasovagal response. Other complications might include; infection, dermatitis, and broken needle fragments. In some cases contraindications and adverse effects listed in Table 2 and Table 3 might occur:
Table 2: Contraindications to the use of acupuncture
Absolute Contraindications
Relative Contraindications
Needle Phobia
Pregnancy – avoid any points known to stimulate uterine contractility
Severe bleeding diathesis
Points over nipples, umbilicus, and major vessels are forbidden by conventional texts
Inability to remain still for treatment
Point over infant fontanel
Systemic Sepsis
Application during menses (less effective)
Unco-operative – hallucinating, delusions, etc.
If patient is on corticosteroids, benzodiazepines, or narcosis (less effective)
Cellulitis
Anticoagulant drugs
Burns
Ulceration
EA – do not apply over heart or brain. Do not apply in region of pacemaker or implanted medical pump.
Table 3: Adverse effects of acupuncture
Pneumothorax
Local pain
Cardiac tamponade
Bruising
Neurovascular damage
Bleeding
Infection
Hematoma formation
Metal allergy
2. 6 Research Issues
Little research was found with regards to nursing students’ perception on Complementary Therapies. Moreover on Acupuncture and it’s use in pain management. It is proposed that the this aspect should be explored more in detail by conducting a small-scale research study on the subject.
Two separate studies were conducted addressing nursing students’ knowledge and attitudes on Complementary Therapies. One of which was a quantitative study conducted in Britain and it investigated the use of CAM in cancer and palliative care and another study was conducted in southern Taiwan exploring student nurses’ knowledge, attitude and behavior toward Chinese Medicine.
More medical research than nursing research exists in complementary therapies, mainly in randomized-controlled trials. However, this field is still poorly researched compares with conventional medicine (Nahin & Straus, 2001).
The Research Method
3. 1 Aim of the study
The proposed aim of this study is to explore nursing students’ perception on the use of non-pharmacological treatment for pain in the hospital setting.
3. 2 The Objectives of the study
The proposed objectives of this study are to:
Identify the types of complementary and alternative therapies used to alleviate pain at the local government run, general hospital (Mater Dei Hospital).
Identify nursing students’ knowledge and perception on complementary and
alternative therapies and their use.
Identify possible benefits and contraindications in the use of complementary
therapies.
3. 3 The Research Design
It is proposed that a quantitative research approach is used for the purpose of this study. This means in quantitative research your aim is to determine the relationship between one thing (an independent variable) and another (a dependent or outcome variable) in a population. Quantitative research designs are either descriptive (subjects usually measured once) or experimental (subjects measured before and after a treatment). A descriptive study establishes only associations between variables (Hopkins, 2000). It is also proposed to use a descriptive approach; Descriptive research design is a scientific method which involves observing and describing the behavior of a subject without influencing it in any way. This is so as to explore nursing students’ own perceptions, views and knowledge on the subject.
The research setting is the physical location and conditions in which data collection takes place in a study (Polit and Beck, 2006). It is proposed that for the purpose of this study, the leading government run hospital in Malta which hosts the Faculty of Health Sciences lecture rooms will be chosen as the research location for the completion of this study.
3. 4 The Population and Sampling Technique
According to Cormack (2000), Target Population refers to all of the people that the researcher wishes to include in his / her study. The proposed population of this study will be student nurses following an undergraduate course in Nursing Studies. The target population will be second year Diploma and Degree in Nursing Studies students within the Faculty of Health Sciences.
Sampling is the portion of the defined population who are selected by the researcher to participate in the study in order to collect data. The researcher strives to get data from the sample which will reflect all the characteristics of that population (Cormack, 2000).
The participants have to fulfill all of the inclusion criteria, where candidates are proposed to be:
Full time student nurses following an undergraduate course at the Faculty of Health Sciences
20 years of age and older
Second year student
Be willing to participate in the study
The exclusion criteria will be candidates who:
Students who refuse to participate in the study
Younger than 20 years of age
3. 5 Method of Data Collection
Data collection in quantitative studies may be achieved by various methods such as questionnaires, interviews and observations (Polit and Beck, 2006). A questionnaire may be considered as the most appropriate tool for data collection, since it offers the possibility of complete anonymity. A questionnaire helps to avoid bias which can happen in the presence of the interviewer, by reflecting the participants’ reaction to the interviewer (Polit and Beck, 2006).
As the method of choice for data collection is not yet ready, it is proposed that a self-administered with close and open ended questions questionnaire be utilized; requiring a yes or no answer or completion of a question.
3. 6 Research Tool
The research tool for this study is yet to be provided. It will be developed by the novice researcher and based on the aim and objectives of the study.
3. 7 Data Analysis
Results of the findings will be presented either in the form of graphs or pie charts.
Ethical Considerations
Consent to carry out the research will be sought and obtained from the University of Malta Research Ethics Committee and the Faculty of Health Sciences Dissertation Panel. In order to ensure that participants of the study would not be subject to any harm, anonymity will be held throughout the study. In order to maintain privacy, for those participant who don’t wish to complete the questionnaire in the presence of piers; a self addressed enveloped will be give incurring any expenses from the participant. Participants may also abstain from taking part in the study. A participation letter will be handed, explaining the nature of the study to the participants. Since the researcher might know any participant, a blank envelope will be handed.
