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Enfermería: Cuidados Humanizados

versión impresa ISSN 1688-8375versión On-line ISSN 2393-6606

Enfermería (Montevideo) vol.9 no.2 Montevideo dic. 2020  Epub 01-Dic-2020

https://doi.org/10.22235/ech.v9i2.2316 

Original articles

Analysis into the experience of health professionals at incorporating complementary therapies in their clinical practice

1 Escuela de Enfermería, Pontificia Universidad Católica de Chile

2 Escuela de Enfermería, Universidad Finis Terrae- Chile


Abstract:

Introduction: Complementary therapies have been increasingly incorporated into health care, especially in areas such as oncology, palliative care, rehabilitation and obstetrics. In several countries, it´s the health professionals themselves who have incorporated them into their clinical practice in an integrated way, leading them to change the paradigm of the current biomedical system, allowing them to provide a more comprehensive and autonomous care. Objective: To comprehend the experience of health professionals in Chile when incorporating complementary therapies in their clinical practice. Method: Qualitative phenomenological study. Health professionals certified in unconventional therapy were invited to participate, which they integrate into their clinical practice. After signing the consent, in-depth interviews were carried out until the data was saturated. The research process was carried out following the 10 steps of Streubert. Results: 11 health professionals participated, who develop therapies such as reiki, flower therapy and acupuncture integrated into their clinical practice. It was revealed that the incorporation of Complementary Therapies gave greater meaning to the work itself as a health professional, however, there were facilitators and obstacles to the process, which generated new challenges for integration with allopathic medicine. Conclusion: The integration of Complementary Therapies expanded the therapeutic tools, which generated in them greater professional satisfaction by providing a more human and person-centered care, recognizing the need to incorporate this knowledge into the curricula of health careers.

Keywords: Complementary Therapies; Health professionals; Clinical practice

Resumen:

Introducción: Las terapias complementarias se han ido incorporando cada vez más en la atención de salud, especialmente en áreas como la oncología, cuidados paliativos, rehabilitación y obstetricia. En varios países, son los propios profesionales de la salud los que las han incorporado en forma integrada a su práctica clínica, llevándolos a cambiar el paradigma del sistema biomédico actual, permitiendo brindar un cuidado más integral y autónomo. Objetivo: Comprender la experiencia de los profesionales de salud de Chile al incorporar las terapias complementarias en su práctica clínica. Método: Estudio cualitativo fenomenológico. Se invitó a participar a profesionales de la salud, con certificación en una terapia no convencional, la cual integran a su práctica clínica. Tras la firma del consentimiento, se realizaron las entrevistas en profundidad hasta lograr la saturación de los datos. El proceso de investigación se realizó siguiendo las 10 etapas de Streubert. Resultados: Participaron 11 profesionales de salud, quienes desarrollan terapias como el reiki, terapia floral y acupuntura integrada a su práctica clínica. Se develó que la incorporación de Terapias Complementarias le dio mayor sentido a la propia labor como profesional de la salud, sin embargo, hubo facilitadores y obstaculizadores del proceso, lo cual les generó nuevos desafíos para la integración con la medicina alópata. Conclusión: La integración de las Terapias Complementarias ampliaron las herramientas terapéuticas, lo que generó en ellos mayor satisfacción profesional al brindar una atención más humana y centrada en la persona, reconociendo la necesidad de incorporar estos saberes en los currículos de las carreras de la salud.

Palabras clave: Terapias Complementarias; Profesionales de la salud; práctica clínica

Resumo:

Introdução: As terapias complementares têm sido cada vez mais incorporadas à assistência à saúde, principalmente em áreas como oncologia, cuidados paliativos, reabilitação e obstetrícia. Em vários países, os próprios profissionais de saúde os incorporaram à prática clínica de forma integrada, levando-os a mudar o paradigma do sistema biomédico vigente, permitindo-lhes uma atenção mais integral e autônoma. Objetivo: compreender a experiência dos profissionais de saúde no Chile ao incorporar as terapias complementares em sua prática clínica. Método: estudo fenomenológico qualitativo. Foram convidados a participar profissionais de saúde com certificação em terapia não convencional, que integram à sua prática clínica. Após a assinatura do Termo de Consentimento Livre e Esclarecido, foram realizadas entrevistas em profundidade até a saturação dos dados. O processo de pesquisa foi realizado seguindo as 10 etapas de Streubert. Resultados: participaram 11 profissionais de saúde, que desenvolvem terapias como reiki, floroterapia e acupuntura integradas à sua prática clínica. Revelou-se que a incorporação das Terapias Complementares deu maior sentido ao próprio trabalho como profissional de saúde, porém, surgiram facilitadores e obstáculos ao processo, o que gerou novos desafios para a integração com a medicina alopática. Conclusão: A integração das Terapias Complementares ampliou os instrumentos terapêuticos, o que gerou nelas maior satisfação profissional por proporcionar um cuidado mais humano e centrado na pessoa, reconhecendo a necessidade de incorporação desse conhecimento nos currículos das carreiras em saúde.

Palavras-chave: Terapias complementares; Profissionais de saúde; prática clínica

Introduction

Several studies have made evident the increase in the use of Complementary Therapies (CT) by users 1,2, and their incorporation in health care in a complementary manner, especially in areas such as oncology, palliative care, rehabilitation and obstetrics 3-7.

In the last two decades, many healthcare professionals agree that these therapies can be used complementary to the practices of scientific or allopathic medicine, observing that people improve their health, have fewer side effects of pharmacological treatment and improve their quality of life (8.9). Furthermore, some studies have shown that healthcare professionals are also users of these therapies, especially nurses, who report that they have benefited physically, emotionally and spiritually, which have generated important changes in their lifestyle 10-12.

Despite the increased acceptance of CT by healthcare professionals, some consider that there is a lack of information on the different types of practices and sufficient scientific evidence to support its effectiveness 13,14, generating among them the need to receive greater instruction on these types of therapies, in order to be able to recommend them to their patients with certainty 11,14. For this reason, they suggest that there should be more training centers that allow professionals to be accredited by health authorities 15,16.

In Chile, accreditation is carried out by the Ministry of Health (MINSAL), which defines the hours of training and the quality of the academic formation of the students. To date, the Ministry only certifies the practice of Homeopathy, Naturopathy and Acupuncture, other therapies are in the process of being accredited, therefore, the therapists are only certified by the training centers 17. A study carried out on therapists certified by the Ministry of Health in Chile, found that only 43% corresponded to professionals of the healthcare area 18.

Several studies in developed countries show that health professionals who have incorporated these types of therapies as an addition to their professional practice, consider that it has motivated them to change their paradigm of the biomedical system 19,20. In turn, they point out that it has allowed them to provide more comprehensive care and acquire greater autonomy in their clinical practice 16. Added to this is the perception of an increase in the well-being of treated patients 21,22.

In this context, it is necessary to go probe deeper into the experience of healthcare professionals in Chile who have experienced this phenomenon. Therefore, the objective of this study was to reveal the experience of healthcare professionals who have incorporated complementary therapies in their professional care and attention. It is expected this will provide knowledge that supports the need to include these practices in the training of health professionals, to deliver comprehensive care and contribute to people's quality of life.

Method

Qualitative study with phenomenological design, which is based on the philosophy of Husserl and Heidegger, which allows "to place in the light something that can become visible in itself" 23. For Farber, this method has a reflective and subjective character, which is developed through a rigorous, critical and systematic methodology when approaching a phenomenon 24.

The sample was for convenience via the snowball method; therefore, healthcare professionals (nurses, doctors, midwives, kinesiologists, nutritionists, occupational therapists and psychologists), who practiced their profession in public and private healthcare centers in Chile and had the experience of incorporating complementary therapies into their professional practice, were invited to participate. The inclusion criteria were: healthcare worker with more than one year of professional practice, who had obtained certification for formal training in the complementary therapy they performed and who had permanently incorporated it into their practice. The number of participants was determined by applying the classic criterion of saturation of meanings, which was reached with 11 interviews.

The data generation and analysis technique were performed according to the ten stages described by Streubert 25, beginning with the braketing of each of the project researchers. After an invitation by email, the professional who agreed to participate was contacted by one of the interviewers, who confirmed the voluntary nature of the process, and then arranged the date, time and place of the interview. Each interview was conducted by a researcher who had no connection with the participant. The interviews were conducted between September 2017 and May 2018, after signing an informed consent, in a private office of the participant's choosing. Each interview was audio recorded and started with the guiding question: What has been your experience in incorporating a complementary therapy into your clinical practice? During the interview other questions were asked that would allow us to probe deeper into dialogue. The narratives, once literally transcribed, were subjected separately to a thematic analysis by the researchers, who later triangulated their findings, reaching a consensus on the units of meaning, and thus structuring the essence of the phenomenon once the data was saturated. To confirm the findings, a member check was performed on 3 of the participants, who expressed feeling represented. During the process, compliance with the methodological rigor proposed by Guba & Lincoln 25 was ensured.

This study was approved by the Scientific Ethics Committee of the Faculty of Medicine of the Pontificia Universidad Católica de Chile (N ° 16-1222005) and with funding from the Research and Doctorate Directorate of the School of Nursing of the Pontificia Universidad Católica of Chile.

Results

11 healthcare professionals took part in the present study, who through their narrative shared their experiences. The sociodemographic characteristics of the participants are shown in Table 1.

Table 1: Sociodemographic Characteristics of the Participants 

Source: own development

The average age of the 11 participants was 45 years old, with eight women and four men having an average of 19 years professional practice. Six of them were certified in more than two complementary therapies. Furthermore, all have used some complementary therapy for their own health needs.

Findings. From the accounts, three fundamentals were identified: Give greater meaning to the work of a healthcare professional; Challenges to generate greater integration with allopathic medicine; Facilitators and obstacles of the process. In this article, the first two fundamentals will be described.

Give greater meaning to the work of a health professional

For professionals, training and practicing complementary therapies has allowed them to become aware of the existence of a new health paradigm, which has led them to experience personal and professional changes. In the first, by experiencing in themselves the benefits of CT and helping themselves in the process of being a therapist, and professionally, by expanding the therapeutic tools and generating greater professional satisfaction.

“… I would say that more than the therapies, it is the paradigmatic vision behind these disciplines. The philosophy behind oriental medicine is very profound and its meaning plays an intrinsic part of the therapies themselves. There is something very deep-seated behind all this, where I believe our Western medicine has forgotten its origins and it has been reduced, modernized, concretized, materialized and, therefore, we practice it without the deep meaning it originally had.” Nurse 1, Chinese Medicine Therapist

Personal changes: Experiencing the benefits of CT for themselves

Therapists report that among the motives they had to start CT, they highlight having personally experienced healing as users, either prior to their training or during. What led them not only to become familiar with them, but to train and apply them.

"First is to seek healing yourself, we become aware by healing ourselves and then of course, you do the studies and then you go out as if to heal others ... the one who needs to heal is you." Nurse 2, Reiki Therapist

“I was looking for a more humanistic, more comprehensive, broader way of understanding mankind… Therefore, what this path has given me for years, is that distinct understanding of what reality is, and therefore, I manage my own life in a different way ... " Doctor, Traditional Chinese Medicine

"I think that it also makes one a better person and more grateful, at least that's my vision". Nurse 2, Traditional Chinese Medicine

“This about Bach Flowers and meditation… focusing on having contact with your inner self and accepting yourself, accepting yourself as you are… So, personally, it has helped me to accept myself as I am, to be more relaxed, more tolerant and that of course influences those who are with me…” Nurse 3, Reiki therapist

Personal changes: Helping oneself in the process of being a therapist

One of the benefits mostly referred to by professional therapists is the personal growth achieved thanks to the paradigm on which complementary therapies are based. They, based on this experience, feel that they are more humane and thus closer to others, being better people and professionals.

In addition, they recognize that this type of training allows them self-knowledge, which over time is their strength to continue working.

“… It has meant for me a growth in the workplace, professionally; a growth also in the personal because I, nowadays, regardless of everything, when I am meeting with patients, I realize that they are my own issues. So, I have managed to continually develop it, it is like my own psychotherapy with all the patients - they are an entire world too. And indeed, it is a wonderful growth. " Psychologist, Acupuncture

“So, the fact of applying the therapies in the hospital has been a super important achievement for me and also, I feel that it has changed my perception of life in many things. It has even helped me, as I work in oncology, on the issue of grief… it is still super important. So, it has helped me a lot to solve many things regarding death, many things that deep down I think have helped me to emerge as a person, like how to understand the actions of other people ... I feel that I am much more empathic with people now. " Nurse, Reflexology

"Additionally, that's the other thing, one works for people, but one does not stop having their share of therapy, there is always a therapy with flowers, with reiki, with all the complementary therapies. You are always helping yourself too, apart from the fact that when you like what you do you are happy, so your heart is even happier. "Nurse 1, Reiki Therapist

Professional changes: Broaden therapeutic tools

Professional therapists report that the use of CT in their professional practice allows them to have greater skills in evaluation and therapeutic intervention, complementing their disciplinary knowledge and becoming a very valuable therapeutic tool.

“When you give floral therapy to children who have abdominal pain, we would perform echograms on them and everything, and there would be nothing. So, I started giving them Bach Flower remedies because there was fear… fear of dying. Once we began working with the flowers, they would still pass away, but (their) death was different."Medical, Bach Flowers

“In rural areas, I applied it to terminally ill patients. I would give Reiki treatments to patients in pain. And in the CESFAM (Family Health Center) where I work, we apply all the therapies according to protocol. So, we have a protocol that we are to manage all difficult-to-manage patients with therapies… Well, people say that the pain goes away… Then they started to send us fibromyalgia cases… We have some assessment tools and with her (the therapist) we see if they need Reiki or flowers…” Nurse 2, Reiki Therapist

Professional changes: Greater professional satisfaction

Professionals perceive that the use of CT generates satisfaction in their professional work, as they expand their personal skills, managing to embrace the person (patient) as a holistic being.

“So, well, you look to help them (the patients) with homeopathic medicines and you can see the results in them. They later come back to ask and even thank you! (laughs). Something just happens… tremendous personal and professional satisfaction, I find." Pharmacist, Homeopathy

“I love it, love my job! … It fills me. I leave full of happiness; I leave full of love and that's the best. Hopefully many more colleagues experience it and realize how rewarding it is… My patients are extremely well, super grateful!! Nurse, Reiki Therapist

“… For these children, the fact that they have deep hope, that other types of therapies can help them, it helps a lot, a lot, a lot! Above all, the therapy that I practice, i.e. reflexology, which is like foot massages. The affection that one gives patients when you touch them or feeling that you are close to the other, has also been super gratifying for me and for them. " Nurse, reflexology

"It has really been a personal satisfaction, because I am getting old, I have just turned 63 and I studied this a few years ago, because I am projecting myself for what is to come." Nurse 1. Traditional Chinese Medicine

Challenges to generate greater integration with allopathic medicine

Professionals see integrating these therapies with allopathic medicine, as a single holistic health practice, as a challenge. Also, they consider it necessary to incorporate it into the curricula of the health professions to give them a more humane sense.

Integration of these therapies with allopathic medicine to achieve holistic health

Professionals consider that complementary therapies are being accepted and considered by allopathic medicine given their effectiveness in the integral health of individuals, so their challenge is to promote this integration from their reality, in favor of the integral health of human beings and in turn give meaning to their own lives.

"... now there are a large number of pharmacist colleagues, doctors ... who have sought a path through complementary medicine, they are training and there are official training facilities and I find that to be good." Pharmacist, Homeopathy

“Also, to be able to change this very scientific outlook to this practise that can be included. I am not saying that it only be this, but that it can be made compatible without any problem." Nurse 2. Traditional Chinese Medicine

"So, our challenge is an all-inclusive health care Model; to delve into it, to breakdown it down, an internalization of occupational health and also with the focus on complementary therapies." Nurse 4. Reiki Therapist

Incorporate it into the curricula of the health professions to humanize them

The participants consider that one of the challenges is to begin incorporating them into undergraduate teaching, in order to favor the integration of both medicines. This incorporation would go beyond just the technique, it would include the meaning and philosophical basis of complementary therapies. Therefore, the challenge is to nurture the curricula with a more humanized approach, centered on the person.

"But I think so, if that were included, for example, in the curricular networks we would have much more humane professionals, which today I feel are being lost more and more." Nurse 1. Reiki therapist

"... at least to have a superficial knowledge regarding these therapies in undergraduate training ..." Nurse, Reflexology

Discussion

Following the increased need for more humanized healthcare and with greater emphasis on prevention and promotion, in recent decades there has been a growing number of patients and users seeking to be cared for under the CT approach. This has generated the need for health professionals to become more informed, seeking scientific evidence on its effectiveness and uses, in order to advise their patients with greater assuredness 26-28). However, some of them have not only been informed, but have also trained in these therapies and incorporated them into their professional practice 29,30).

After the findings of the present investigation, it has been revealed that, for the participants, the integration of CT in their clinical practice has led them to give greater meaning to their own work as a health professional.

Several of the professionals interviewed stated that their approach to CT began by first being users of this type of therapies, which allowed them to experience personal changes that led them not only to trust in their effectiveness but also to train in them. In this sense, in the research conducted by Shorofi et als. 31 in South Australia, 95.7% of nurses used CT for their own well-being, and 49.7% applied it in the care of their patients, who agreed that this allowed them to practice with a more holistic approach, in accordance with what was stated by German doctors in a research published in 2020 20. In relation to this, in several investigations a positive association has been observed between the knowledge of CT and the attitude towards their use. 32,33. Thus, in some studies, it was shown that this knowledge determines that there is a greater possibility of recommending them to users and even incorporating them into their clinical practice 27,34,35.

Other studies have indicated that health professionals maintain that applying this type of therapy in their work had meant a profound transformation in themselves and in their outlook on life, especially in the spiritual realm 36.

Moreover, in a study carried out in the United States on nursing students, 70% were "very open" or "open" towards the use or recommendation of CT; who also considered that these "holistic" therapies had a positive impact on personal health. Additionally, the students who were users reported feeling more harmonized in body, mind and soul, which allowed them greater empowerment regarding their own health 37.

Regarding the implications of the use in their clinical practice, one of the findings of this study was that the participants perceived that they helped themselves within the therapeutic process, generating a relationship of mutual help between patient and professional. When reviewing the literature, no studies were found that made reference to this link in relation to the use of CT. However, the statements made by Jean Watson 38 indicate that the nurse-patient relationship within transpersonal care achieves this type of mutual help, by favoring sensitivity towards oneself and towards others, generating an authentic therapeutic relationship and nurturing for both people.

Regarding the changes in their clinical practice, the study participants indicated that the implementation of CT allowed them to expand the therapeutic tools and thus generate greater professional satisfaction. This phenomenon is observed in several studies, in which midwives, nurses and doctors stated that, by incorporating these therapies into their professional lives, they had rediscovered the essence of holistic care and acquired a new vision of the profession, generating greater satisfaction in their clinical practice 29,33,39. In turn, in the meta-synthesis carried out by Hall et al., several studies on nursing professionals reveal that CT align and strengthen the values ​​of these professionals, providing greater job satisfaction. In this sense, the nurses argued that CT allowed to compensate for some limitations of conventional medicine, such as chronic health problems and pain control 40. However, in this same study, nurses argued that the implementation of CT depends on the context of the clinical practice.

Given the above, studies have indicated that the meaning given by health professionals to the use of CT has allowed them to maintain the motivation to continue incorporating them into their clinical practice and, in turn, motivate other professionals in this type of practice 41-43.

In relation to the above, the participants of this study stated that there is currently the challenge of generating a greater integration of CT with scientific or allopathic medicine, based on their own implementation experiences, and thus integrate them as a single view of holistic health. Thus, in several studies, professionals emphasize that it is necessary to know these therapies, starting with their personal use, which would lead to having a positive attitude and being motivated for their (CT) integration into the clinic, by creating the opportunity to personalize the treatment and practice a humanistic form of care 26,31,40. In this same sense, in a study carried out in Indonesia, nurses did not recommend CT to users, due to the scarce information they had on these therapies, which is why they themselves expressed the need to acquire this knowledge 32.

This need to receive training is also raised by the participants of the present study, arguing that it is necessary to incorporate the knowledge of CT in the undergraduate training programs of the health professions, which would allow to give a more humane meaning to the practice. Furthermore, several healthcare papers have pointed out the importance of integrating knowledge about CT in the curricula, thus improving their disposition towards this type of therapy and favoring the development of the practice based on the existing evidence in this regard 37,44.45).

Conclusion

The present study sought to reveal the experience of health professionals who have incorporated complementary therapies into their treatments and professional care. In this regard, the professionals reported that their approach to CT arose mainly from being users of these treatments, allowing them to experience the favorable changes that led them to trust their effectiveness and motivate them to further training in the area.

One of the main contributions of this research was to reveal that professionals consider that the use of CT integrated into their clinical practice generates a therapeutic process constituted by a relationship, in which the patient and the professional benefit. In turn, for the participants, the CT expanded their therapeutic tools, which generates greater professional and personal satisfaction.

Therefore, the challenge for future generations is to achieve a greater integration of CT with allopathic or scientific medicine, as well as the need to incorporate the knowledge of CT in the curricula of health professions, which would allow a more humane and holistic meaning to be given to the practice of each of the disciplines.

Acknowledgements

We thank all the participants of this study, who generously collaborated in this research as well as Dr. Dayann Martínez Santana who collaborated with the translation of the abstract into Portuguese

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Funding: Financial support was provided by Research and Doctorate Directorate of the School of Nursing of the Pontificia Universidad Católica de Chile

How to cite: Vega Vega P, Urrutia Egaña M, Aliaga Barros V, Campos Romero S. Analysis into the experience of health professionals at incorporating complementary therapies in their clinical practice. Enfermería: Cuidados Humanizados. 2020;(9): 191-204. Doi: https://doi.org/10.22235/ech.v9i2.2316

Authors' participation: a) Conception and design of the work; b) Data acquisition; c) Analysis and interpretation of data; d) Writing of the manuscript; e) Critical review of the manuscript. P.V.V. has contributed in a,b,c,d,e; M.U.E. in a,b,c,d,e; V.A.B. in a,b,c,d,e; S.C.R. in a,b,c,d,e.

Correspondence: Solange Campos; e-mail: scamposr@uc.cl

Scientific editor in charge: Dra. Natalie Figueredo

Received: May 14, 2020; Accepted: October 07, 2020

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