Date of Award

2020

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chair

Dr. Mary Coucoules

Faculty Reader

Dr. Julie Pusztai

Executive Summary

Introduction: Integrative medicine (IM) is a holistic philosophy to providing patient-centered care which prioritizes patient preferences in compiling a plan that may include conventional or unconventional treatments. Healthcare personnel willing to engage in IM have the potential to improve care quality, while not doing so may result in suboptimal patient satisfaction, patient distrust, and care inequities (Roter et al., 2016; Singer & Adams, 2014). The need for IM within oncology is growing quickly (Horneber et al., 2012) due to the current difficult treatments with coexisting side effects. Despite elevated interest, only a small number of clinic visits have any mention of complementary and alternative medicine (CAM), and discussions are often patient-initiated and brief (Roter et al., 2016). There are vast opportunities for programs aimed at furthering an IM program within the oncology setting.

Background: Multiple IM program evaluations exist that offer insight to the barriers to implementation and potential interventions. Intervention commonalities across programs include continued staff education, practitioner networking, institutional protocols, funding acquisition, and personnel allotment (Vohra, Feldman, Johnston, Waters, & Boon, 2005). Many limitations occur within the literature that reduces intervention transferability including cross-country adaptation, low evaluation rigor, and vague methodology description. An organization assessment offers more practical insight than the literature for what may be feasible when considering a small unique department with minimal funding allotment.

Problem and Project Purpose: The highest quality care cannot be provided without utilization of an IM philosophy. The need for IM is magnified in diverse populations and within the oncology setting. Barriers to IM are discussed in the literature, but are organization-specific and have transference limitations. The purpose of this project was to identify the unique IM barriers within a singular oncology department through interviewing and surveying of clinical staff. This information was used to develop customized interventions aimed at increasing the department’s ability to implement an IM philosophy. The ability to implement an IM philosophy was measured through self-report staff surveying after intervention completion.

Methods: Data collection in the form of interviewing and surveying occurred during project planning. The qualitative/quantitative dataset was simplified into two departmental strengths (willingness to engage in continued education, advocating for patient’s rights) and two departmental areas for growth (locating CAM resources, discussing multiple CAM therapies). The project partnered with a co-existing patient education initiative to provide symbiotic change benefits. Final project interventions included the creation of integrative patient education materials, furthering the nurse’s role in patient education, and updating the departmental website. The integrative materials reviewed nonpharmacologic, pharmacologic, and CAM therapies for mild, moderate, and severe symptom management. The new materials, as well as workflow adjustments and education in-services, allowed for nurses to take a larger role in patient education. The new materials prompted the revisiting of the department’s website as a patient education tool, requiring alteration of organization and content. Website alterations are unfinalized and remain under interdepartmental negotiation.

Results/Outcomes: The results from follow-up surveying (see Table 2) indicate that staff perceive each of the three interventions as moderately to majorly impactful on the department’s ability to implement an IM philosophy. The differences in discipline-specific averages when compared to department averages allowed for speculation of specific interventions impacts on various disciplines. The perception of nurse-led education was particularly high within oncology nurses, which suggests an affinity to the new and increased responsibility. The perception of integrative education materials was particularly low within oncologists, which may reflect a semblance of displeasure in content or organization. Despite website alterations being incomplete during surveying, all disciplines see this as an area of major potential.

Sustainability: The sustainment plan included the addition of responsibilities to an existing full-time staff member. Responsibilities included maintaining integrative patient education (materials and workflow) and the training of new staff with the provided curriculum. Accountability was maintained through a quarterly checklist, which also prompted management to consider alternative ways to promote growth.

Implications: While the interventions within this project were perceived as moderately to majorly impactful on the department’s ability to implement an IM philosophy, the transferability of interventions within this project remains unknown. Organizations are recommended to conduct detailed needs assessments that facilitate staff input prior to attempting to transfer interventions from this project. Continued measurement and analysis of intervention effectiveness may further support program spread. Organizations are recommended to budget resources, time, and personnel to developing IM programs due to the potentially positive impacts these programs could have on patient-centered care.

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