patients turn to complementary and alternative medicine (CAM) in pursuit of healing as a last resort following unsuccessful application of traditional or Western medicine. A National Health Interview Survey (NHIS) which also included an aspect of alternative medicine revealed that approximately 38% of adults use alternative medicine (Centers for Disease Control and Prevention, 2012). Some of the drugs attempted to improve human condition include herbal or botanical substances. There have been numerous botanical products inventoried for their medicinal effects. Nurses working in the hospice care lack the basic knowledge in administering alternative medicine on patients. Thus, to ensure efficient administration of treatment using alternative or complimentary therapy, it is necessary to education nurses on practical methods. The nurses as practitioners need to be educated on Bell’s three stages for proper administration of alternative procedures.

Contribution to the Future of Healthcare

The model herein described is deduced from theoretical and related research literature as well as from theory of change. This change of design model provides practitioners with a guide in the implementing a combination of alternative and traditional therapy in hospice care practice. The process commences with evaluation of the need for change and ends with integration of the design an evidence-based protocol in the care of patients with end of life expectancy. This model is also useful in primary care setting as well as in acute inpatient units.

Change Model Overview

The Rosswurm and Larrabbee Model here is a guide through a systematic process for the change to evidence-based practice. There is availability of clinical research with significant findings that lay the foundation for change from traditional and intuition-driven practice to evidence-based practice. Medical practitioners require necessary skills as well as resources to help them appraise, synthesize, and diffuse the best evidence into practice. Furthermore, patient results or outcomes need to be consistent with discipline-specific and interdisciplinary accountabilities.

The Applying the Rosswurm and Larrabbee Model

The partnership between researchers and medical practitioners is helpful in facilitating diffusion of evidence-based practice innovations. Therefore, in this proposal, Rosswurm and Larrabbee Model is the chosen option for change.

Step 1: Assess the Need for Change in Practice

To increase hospice care nurses’ knowledge in the administration and procedures of alternative medicine the first step involves the introduction of the therapy including Yoga therapy with in-bed postures, Reiki, Aromatherapy, Nutrition, Education in death and dying awareness (Forester, 2012). There is need for hospice nurses to acquire clinical experience and proper over-sight in alternative therapy. This type of therapy is a departure from the typical traditional protocol available to nurses. This is an opportunity for hospice nurses to embrace values of wellness and alternative medicine into the care of patients (Bardia, Barton, Prokop, & Bauer, 2006). It is an opportunity for the nurses to grow career wise and spiritually. This way they can give comfort and care to patients when they most need it, at the transition from this life (Forester, 2012). The PICOT question presented in Milestone 1 is:

Patients admitted to hospice care

I -Combining traditional/Western medicine with alternative/complimentary therapy

C- Patients who are not receiving alternative therapy, such as Reiki therapy, mass- age therapy, aromatherapy therapy but who are only receiving traditional, conventional therapy.

O-Increase in patient symptom control, increase in patient comfort by combining conventional and alternative medicine and therapy.

T-One to six months

Step 2: Link the Problem, Interventions, and Outcomes

The nurses identify and select possible interventions and patient outcomes based on their clinical judgment, system priorities as well as available resources. The care provided in a hospice care is not curative, but helpful toward managing symptoms and pain (Mayoclinic.com, 2011). Medical practitioners need to embrace alternative therapy that has been found to be beneficial in controlling conditions related to this care. Results of studies in this field indicate that certain measures such as gentle touch, stroking, and massage have positive impact on patients in regard to the heart rate, blood pressure, respiration, and even hormone levels (Kow02).

Step 3: Synthesize the Best Evidence

In this stage, medical practitioners as well as researchers undertake a comprehensive literature review on combining traditional/Western medicine with alternative/complimentary therapy. The information is appraised and synthesizing thereafter their evidence compared with clinical judgments as well as related data. Subsequently, they choose to begin a preliminary trial that the nurses can implement and which is highly beneficial in reducing pain and if possible casualty among patients (Rosswurm & Larrabee, 1999).

The three databases best addressing their research question are PubMed, CINAHAL, and the nursing reference center. The subject headings used to modify the search included alternative/complimentary therapy. In synthesizing evidence peer-reviewed journals and publications are used to ensure that these articles are relevant to the specific topic.

Literature Review

Kohara, et.al, (2004) in combined modality treatment of aromatherapy, footsoak, and reflexology relieves fatigue in patients with cancer talks about the effectiveness of aromatherapy, foot soak, massage and reflexology against fatigue in cancer patients and hospice patients. They describe quantitative research performed to test the effectiveness of the treatments. The study involved 20 terminally ill patients as participants rating their CFS, (cancer fatigue scale) before, 1 hour after and 4 hours after treatment. It showed that their CFS scores improved significantly. In the same line, Kowalski (2002) examines the use of aromatherapy in hospice patients to decrease pain, anxiety, and other symptoms they experience with an end of life expectancy. Kowalski points at the importance of creating a sense of well-being with the use of alternative medicine combined with Western medicine. The article is a quantitative analysis of the effects of using lavender oil aromatherapy. It identifies positive results in decreasing pain, decreasing blood pressure and creating a better sense of well-being. Furthermore, Heath, et, al.(2012), discusses the use of complementary and alternative medicines during the end of life period. This qualitative study analyses interviews with parents of children with end of life expectancy. The conclusion of the study found CAM beneficial when administered to patients with end of life expectancy.

A body of research point at the importance of comfort and pain elevation in hospice care. Cummings (2011) talks about the importance of comfort and support provided to the patients admitted to palliative and/or hospice care and helpful therapies available. Cummings in this article makes a quantitative analysis of a study of more than 300 hospice patients. She adds that the National Center for Complementary and Alternative Medicine, massage therapy, reflexology, healing touch Reiki and music therapy provided pain relief, alleviated nausea and fatigue as well as decreased anxiety and depression. The study recommendations can be used as a guide for future therapy and research. Bardia, et, al.(2006), furthers this issue by providing a quantitative analysis of RCTs using CAM interventions for pain control. These were abstracted using Medline, Embase, Cinahl, Amed and Cochrane databases. This study covers the lack of evidence based about their efficacy. In this article, eighteen trials were identified with a total of 1499 patients. It is therefore evident that there is a growing use of complementary and alternative medicine use among the general population: a systematic review of the literature. According to Rees (2004), describes quantitative analysis by which a protocol which was developed to conduct a systemic review of published research. Twelve studies were reviewed from research. This article reviewed twelve studies and included six countries. The most aggressive studies were conducted in Australia and the U.S., showing a high proportion of the population using CAM. This study was large and global enough to be able to use as a guide for use in future studies and use.

Step 4: Design Practice Change

In the effort to combining traditional or western medicine with alternative or complimentary therapy, the team will incorporate nursing activities for patients who are not receiving alternative therapy, such as Reiki therapy, mass- age therapy, aromatherapy therapy but who are only receiving traditional, conventional therapy. This will be an in-service training and hands-on experience done between one and six months.

Step 5: Implement and Evaluate the Change in Practice

In implementing the combination of traditional or western medicine with alternative or complimentary therapy, hospice nurses will be divided into two groups; and three nurses from each group will serve as coordinators during the implementation period. These will be registered Hospice nurses certified as hospice workers by the department of health. This program will be an in service program incorporating those RNs with Bachelors of Science nursing degree (BSN). In addition to the 6 trainees, there will also be 2 trainers on the implementation of alternative therapy. The trainers will conduct two 40 minute alternating classes every week for the two groups; these will be formal classes that will include teaching theory and analyzing recent studies on alternative therapy. There will also be two 30 min practical sessions that are intended to introduce practical best practices on using alternative treatment on patients. These sessions will include practices such as massage, acupressure, acupuncture, aromatherapy, ayurvedic medicine among other. Alongside the trainers, there will also be 2 coordinators who will monitor the six-month implementation process and obtain the nurses’ feedback. In line with this, they will analyze and document progress data of fellow nurses. During the implementation, the coordinator of the study will need to keenly monitor the process and be readily accessible to staff on the study units to give the needed direction. It is essential that follow-up as a reinforcement of the practice change be properly coordinated

Step 6: Integrate and Maintain the Change in Practice

In integrating combining traditional or western medicine with alternative or complimentary therapy, the research team will seek other nurses’ feedback about feasibility and benefits related to the interventions highlighted above. In addition, in-service sessions concerning the new protocol will be presented to nurses caring for patients within the hospice centers. Moreover, periodic monitoring of the changes will be conducted to evaluate their effectiveness and improve upon them. It is important for practitioners to be sensitive to the cultural climate of the hospice center as an attempt to integrate these new innovations. This is because people affected by the change usually view it as disruptive.

Summary

According this PICOT worksheet, hospice nurses should have necessary skills and resources to appraise, synthesize, and diffuse a combination of traditional or western medicine with alternative or complimentary therapy in practice. In addition, patient outcomes should match discipline-specific and interdisciplinary accountabilities of hospice nurses. It is important for the intervention to increase patient symptom control, increase in patient comfort by combining conventional and alternative medicine and therapy. This program is a pilot that will follow the best practice guidelines in order to introduce and implement alternative therapy in hospice care. This program is well-structured following a simple framework for six months. There is need for ongoing and effective partnerships between researchers and hospice nursing in order to enhance the diffusion of evidence-based practice innovations.

References

Bardia, A., Barton, D., Prokop, L., & Bauer, B. (2006). Efficacy of complementary and alternative medicine therapies in relieving cancer pain: A systematic review. American Society of Clinical Oncoloty, 5457-5464.

Centers for Disease Control and Prevention. (2012, November 16). National Health Interview Survey. Retrieved November 24, 2012, from www.cdc.gov.

Cummings, K. (2011). End of life and hospice care . Minneapolis: University of Minnesota.

Forester, H. (2012). Alternative Medicine and Hospice Care for LPN/RNs. Retrieved November 24, 2012, from http://nursinglink.monster.com/education/articles/8397-alternative-medicine-and-hospice-care-for-lpnrns

Heath, J., Oh, L., Clarke, N., & Wolfe, J. (2012). Complementary and alternative medicine use in children with cancer at the end of life. Journal of Palliative Medicine, 1218-1221.

Kohara, M., Miyauchi, T., Suehiro, Y., Ueoka, H., Takeyama, H., & Morita, T. (2004). Combined modality treatment of aromatherapy, footsoak, and reflexology relieves fatigue in patients with cancer. Journal of Palliative Medicine, 791-797.

Kowalski, L. (2002). Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being. American Journal of Hospice and Palliative Care, 381-386.

Mayoclinic.com. (2011). Meditation: A simple, fast way to reduce stress. Retrieved November 25, 2012, from http://mayoclinic.com/health/meditation/HQ01070

Rosswurm, M.A., & Larrabee, J.H. (1999). A Model for Change to Evidence-Based Practice. Image, the Journal of Nursing Scholarship, Vol. 31 Issue 4, 317-322.