- Email: [email protected]
Attitudes and Perceptions Regarding Complementary Therapy Interventions for Radiology
Attitudes and Perceptions Regarding Complementary Therapy Interventions for Radiology j Sandra E. Bates, RN; Eugene A. Meyer, PsyD; Mary Jane Ott, MN, MA, APRN, BC; Wendy L. Wornham, MD; and Elizabeth Dean-Clower, MD, MPH, Boston, MA ABSTRACT: Mind-body interventions can help facilitate pediatric procedures. This study evaluated the perceptions and attitudes of 49 staff members regarding the use of mind-body interventions to facilitate magnetic resonance imaging procedures for children. Reported obstacles to the use of such interventions included identification of children in need of intervention, identification of qualified personnel in the department to provide intervention, and limited time to provide intervention. Such obstacles, once noted, can be addressed to improve opportunities for use of interventions. (J Radiol Nurs 2005;24:2-5.)
R
elaxation, imagery, and hypnosis are some complementary therapies or behavioral techniques that can be extremely helpful for addressing behavioral distress and anxiety experienced by children related to medical procedures (Jay & Elliott, 1990; Powers, 1999). Parents can also benefit from such interventions because they not only learn new skills to facilitate their own coping but also
Sandra E. Bates is from the Department of Radiology, Children’s Hospital Boston. Eugene A. Meyer is from the Pediatric Oncology Department, DanaFarber Cancer Institute and Children’s Hospital Boston, and the Department of Psychiatry, Harvard Medical School. Wendy L. Wornham is from the Pediatric Oncology Department, Dana-Farber Cancer Institute and Children’s Hospital Boston, and the Department of Pediatrics, Harvard Medical School. Mary Jane Ott and Elizabeth Dean-Clower are from the Pediatric Oncology Department, Dana-Farber Cancer Institute and Children’s Hospital Boston. Address reprint requests to Sandra E. Bates, RN, Children’s Hospital, Radiology Department, 300 Longwood Ave, Boston, MA 02115. E-mail: [email protected] 1546-0843/$30.00 Copyright Ó 2005 by the American Radiological Nurses Association. doi: 10.1016/j.jradnu.2005.01.001
2
experience less distress as their child’s ability to cope with medical procedures improves. It has been suggested that patients with severe chronic health issues may be more likely to use complementary and alternative medicine (CAM) therapies (Cassileth & Chapman, 1996; Ernst & Cassileth, 1998; Ernst, Willoughby, & Weihmayr, 1995). Pediatric oncology studies that have examined mind-body interventions such as relaxation, guided imagery, and hypnosis have reported ameliorating effects in perceptions of pain, anxiety, and behavioral distress during invasive medical procedures (Ellis & Spanos, 1994; Genuis, 1995; Smith, Barabasz, & Barabasz, 1996; Steggles, DamorePetingola, Maxwell, & Lightfoot, 1997). Despite such findings, there have been few studies examining the role of mind-body interventions in radiological procedures (Tyc, Fairclough, Fletcher, Leigh, & Mulhern, 1995; Tyc, Leigh, Mulhern, Srivastaba, & Bruce, 1997). Children and adolescents with brain tumors require serial diagnostic procedures during the course of their medical treatment and as part of their follow-up care. Magnetic resonance imaging (MRI) is the most frequently used diagnostic and follow-up surveillance procedure for this population. MRIs require extended periods of motion control for successful completion
www.radiologynursing.org
MARCH 2005
Complementary Therapy Interventions
of the scan. Children may be required to remain absolutely motionless for 45 to 90 minutes with only brief, intermittent rest periods. Given the confines of the MRI machine, many children experience anxiety or behavioral distress in anticipation of or during the MRI scan. Parents may also experience a significant level of anxiety, in anticipation of a negative behavioral response by their child, the actual scan procedure, or the implications of the diagnostic results. For anxious and agitated children or very young children who cannot remain motionless during the MRI scan, intravenous (IV) medication is required for sedation. In addition, certain types of MRI scans require the injection of IV contrast materials to enhance the accuracy of monitoring tumor growth and metastases. While sedation assists the child in remaining still and calm during the procedure and contrast is sometimes a necessary aspect of the scanning procedure, the associated invasive medical procedures (i.e., butterfly needle insertion or IV placement for sedation or contrast) can be as distressing as the MRI scan itself (Tyc, et al., 1995). Interventions targeting the child’s (and potentially the parent’s) behavioral and emotional reaction associated with MRI procedures are likely to improve the quality of the patient’s repeated experience in radiology as well as ensuring the quality of the scan. The authors hypothesize that one reason for limited research in this area is limited interest or understanding regarding the use of such interventions in radiology. The aims of this study were to evaluate attitudes and practices regarding mind-body interventions in a pediatric radiology setting and to identify potential obstacles to the use of such interventions for pediatric neuro-oncology patients. METHODOLOGY Subjects The sample for this study consisted of 49 professional staff members out of 85 eligible radiology staff members in a large pediatric academic teaching hospital (58% participation rate). Table 1 presents a breakdown of participants by discipline, demonstrating that the sample approximates the discipline representation in the eligible population. Study Design This was first a descriptive study using surveys for data collection to capture information on staff members’ attitudes and perceptions regarding CAM interventions in the radiology setting. Second, the authors were interested in evaluating an educational presentation as a means of informing staff about the potential uses of CAM interventions in a radiology VOLUME 24 ISSUE 1
Bates et al
JOURNAL OF RADIOLOGY NURSING
Table 1. Proportion of eligible staff and study participants by discipline
Discipline Nursing Physician Radiology technologist Child life specialist
% of eligible staff (n = 85) 38% 39% 21% 2%
(32) (33) (18) (2)
% of study participants (n = 49) 57% 31% 8% 4%
(28) (15) (4) (2)
setting. A multidisciplinary project team was assembled for this study, including a clinical psychologist, a pediatrician/CAM physician, a research fellow, a nurse practitioner with experience in CAM, and the oncology liaison nurse (RN) from the department of radiology. This project received full approval from the hospital internal review board. The project team designed the surveys used for this study and provided the educational presentation to staff in the radiology department. This 30-minute presentation was developed to provide (a) a brief overview of CAM mind-body interventions appropriate for use with pediatric neuro-oncology patients undergoing serial MRIs, (b) a review of research supporting or demonstrating the usefulness of such interventions, and (c) a review of existing CAM resources and services available to staff in the department of radiology to facilitate MRIs for pediatric neuro-oncology patients. A prepresentation survey was administered, followed immediately by the educational presentation on CAM interventions, and a brief postpresentation survey was administered upon conclusion of the presentation. The presentation was offered to radiology staff on three different dates at different times on each date to maximize recruitment. General information regarding the presentation as well as the date and time for each scheduled presentation were provided to staff. After the presentation was offered the third time, a review of participants indicated that 35 staff members had attended, with the majority representing the disciplines of nursing or allied health sciences and with no representation from physicians. Three additional dates and times for the presentation were selected and offered to radiology staff in an extended effort to obtain physician participation. The three additional presentations resulted in 14 physicians participating in the study. Results Results were not reviewed until all presentations had been completed. Forty-nine participants completed the prepresentation survey and forty-seven completed the postpresentation survey. All except 2 of the participants who attended the presentation completed greater
www.radiologynursing.org
3
Bates et al
JOURNAL OF RADIOLOGY NURSING
Complementary Therapy Interventions
Table 2. Sample familiarity with core mind-body interventions
Table 3. Ranking of obstacles to using complementary/ alternative mind-body interventions
Intervention
% of sample (n = 49)
Distraction Relaxation techniques Guided imagery Meditation Hypnosis
% familiar with (n = 49) 90% 86% 61% 43% 39%
59%
57%
than 75% of the forced-choice questions across both surveys. Data from the prepresentation survey (n = 49) indicated that a substantial number of the participants were already familiar with some of the core mind-body interventions appropriate for use during medical procedures (Table 2). As a group, nursing staff members were more familiar with such interventions than physicians. When asked if they had ever heard of such interventions being used for procedures associated with MRI scans (e.g., butterfly contrast, IV insertion), 78% of participants (n = 38) responded affirmatively while 22% (n = 11) responded negatively. Nine of the eleven participants who responded negatively were physicians (residents and fellows). When the participants were asked if they had ever heard of such interventions being used to facilitate the actual MRI scan (e.g., to address anxiety, facilitate motion control), 63% (n = 30) responded affirmatively and 37% (n = 18) responded negatively. Eleven of the eighteen participants who responded negatively were physicians. When asked to identify the obstacles to the use of CAM interventions, the participants identified three primary obstacles. Table 3 presents the three most identified obstacles to the use of CAM interventions in the department. The postpresentation survey (n = 47) focused on obtaining feedback regarding the content of the educational presentation and this modality as a means for educating staff regarding CAM. Results showed that 98% of the study participants indicated that the modality used for this study was effective for communicating with and educating staff regarding CAM, 93% of the participants indicated that the format of the presentation was ‘‘just right,’’ and 91% perceived the content of the presentation to be ‘‘somewhat to very informative.’’ In addition, 88% of the participants indicated that they believed this educational presentation would have some impact on their clinical work. Specifically, these participants indicated that (a) they would be ‘‘more open’’ to learning about or trying CAM interventions in the future, (b) they would like to be more involved or receive specific training in CAM interventions for use with the pediatric neuro-oncology population, and (c) the presentation increased their 4
35%
Reported obstacle Reported that not having some forewarning about which children will need mind-body interventions was a primary obstacle to their use of mind-body interventions Reported that not having an identified person within the department to provide the mind-body interventions was a primary obstacle to their use of mind-body interventions Reported time constraints (too busy, complementary/alternative interventions too time-consuming, scanner too busy) as a primary obstacle to their use of mind-body interventions
awareness regarding CAM mind-body resources available to the department of radiology. DISCUSSION The current study provides examples of the system and unique department culture issues that may be encountered when attempting to increase the use of CAM interventions in a radiology setting for pediatric neurooncology patients. Overall, there was a positive perception of mind-body interventions within the group of participants in this study as well as clear indication that staff perceive pediatric patients as having some level of behavioral or regulatory difficulty with both the medical procedures associated with the scan and the scan itself. There may be less awareness regarding the usefulness of CAM interventions for facilitating actual MRI scans. Responses also indicate, however, that there is need for clarification and education regarding specifics about these interventions. Specifics such as the length of time needed to implement such interventions, their usefulness for skill acquisition rather than as emergent interventions, and clarification regarding existing departmental CAM resources would further enhance staff knowledge and, subsequently, appropriate use of such interventions within this setting. As might be expected, the nursing staff members in this sample were very familiar with CAM interventions, more so than the other participating disciplines. The project team hypothesizes that these results are related to discipline roles (e.g., who provides such interventions). Still, the question is raised regarding the degree to which nonnursing staff should be educated about such interventions to address potential system barriers. Although most participants were familiar with CAM interventions in general, the brief educational presentation increased awareness of the usefulness of such interventions for patients receiving serial MRI scans,
www.radiologynursing.org
MARCH 2005
Complementary Therapy Interventions
and it increased interest in learning more about CAM interventions. Educational programs for acquiring CAM intervention skills were recommended to the department of radiology to encourage staff’s developing interest in this area. There are several limitations to be noted regarding the current study. This study design tested only one modality for educating staff about the potential uses of CAM interventions. Higher participation rates for this study would have ensured that the results were not biased in favor of CAM interventions (providing a smaller percentage of attendees who already had an interest in or support for CAM interventions) as well as ensuring that the true obstacles to use of such interventions were identified. Despite endorsements by the participants that they perceived this educational format to be the most desirable and best suited for their needs, the difficulty in securing representation by attending physicians poses questions that must be answered for any such intervention to be effective; one is whether the modality used in this study (educational/ informational presentation) is most appropriate for physicians. Although the majority of participants (predominantly nursing and allied health professionals) indicated that the modality met their needs for education and information sharing, it is unknown if this is true for physicians and whether a different modality would have resulted in better rates of physician participation. UPDATE Resulting from this brief study, the radiology department has tried to address the obstacles to using CAM interventions to facilitate MRI scans. First, the nursing department has offered 4 hours of CAM training with contact hours for staff. Training was offered in (a) breathing and centered techniques, (b) distraction: storytelling and guided imagery, (c) focusing: progressive relaxation and affirmations, (d) touch: comfort and balance. The training sessions were scheduled to fit the varied working schedules of the nursing staff. These training sessions were designed to provide nursing staff with minimum skills in each area of CAM intervention for use in MRI scans. Second, a brief screening questionnaire was pilottested in an effort to proactively identify patients who would benefit from receiving CAM interventions during MRI procedures. Ten parent and nurse pairs completed the screening questionnaire rating the child’s comfort level during the prescan procedures and during scans. A review of the 10 pairs revealed that nurses and parents had good agreement regarding their perception of the
VOLUME 24 ISSUE 1
Bates et al
JOURNAL OF RADIOLOGY NURSING
child’s comfort level. Although further evaluation will be necessary to determine the true clinical and practical usefulness of such a screening tool, this tool has already been instrumental in helping staff awareness of general screening questions to ask families during their admission assessment. Given the preliminary training in CAM interventions provided, a system has been devised in which nursing staff members will provide basic interventions to facilitate procedures and scans and will receive additional support as needed on a case-by-case basis from the hospital psychology staff and CAM consultation service. Acknowledgment This project was funded in part by a grant from the National Brain Tumor Foundation.
References Cassileth, B.R., & Chapman, C.C. (1996). Alternative and complementary cancer therapies. Cancer, 77, 1026-1034. Ellis, J.A., & Spanos, N.P. (1994). Cognitive-behavioral interventions for children’s distress during bone marrow aspirations and lumbar punctures: A critical review. Journal of Pain and Symptom Management, 9(2), 96-108. Ernst, E., & Cassileth, B.R. (1998). The prevalence of complementary/alternative medicine in cancer: A systematic review. Cancer, 83(4), 777-782. Ernst, E., Willoughby, M., & Weihmayr, T.H. (1995). Nine possible reasons for choosing complementary medicine. Perfusion, 11, 356-358. Genuis, M.L. (1995). The use of hypnosis in helping cancer patients control anxiety, pain, and emesis: A review of recent empirical studies. American Journal of Clinical Hypnosis, 37(4), 316-325. Jay, S.M., & Elliot, C.H. (1990). A stress inoculation program for parents whose children are undergoing painful medication procedures. Journal of Consulting and Clinical Psychology, 58(6), 799-804. Powers, S.W. (1999). Empirically supported treatments in pediatric psychology: Procedure-related pain. Journal of Pediatric Psychology, 24(2), 131-145. Smith, J.T., Barabasz, A., & Barabasz, M. (1996). Comparison of hypnosis and distraction in severely ill children undergoing painful medical procedures. Journal of Counseling Psychology, 43(2), 187-195. Steggles, S., Damore-Petingola, S., Maxwell, J., & Lightfoot, N. (1997). Hypnosis for children and adolescents with cancer: An annotated bibliography, 1985-1995. Journal of Pediatric Oncology Nursing, 14(1), 27-32. Tyc, V.L., Fairclough, D., Fletcher, B., Leigh, L., & Mulhern, R.K. (1995). Children’s distress during magnetic resonance imaging procedures. Children’s Health Care, 24(1), 5-19. Tyc, V.L., Leigh, L., Mulhern, R.K., Srivastava, D.K., & Bruce, D. (1997). Evaluation of a cognitive-behavioral intervention for reducing distress in pediatric cancer patients undergoing magnetic resonance imaging procedures. International Journal of Rehabilitation and Health, 3(4), 267-279.
www.radiologynursing.org
5
R
elaxation, imagery, and hypnosis are some complementary therapies or behavioral techniques that can be extremely helpful for addressing behavioral distress and anxiety experienced by children related to medical procedures (Jay & Elliott, 1990; Powers, 1999). Parents can also benefit from such interventions because they not only learn new skills to facilitate their own coping but also
Sandra E. Bates is from the Department of Radiology, Children’s Hospital Boston. Eugene A. Meyer is from the Pediatric Oncology Department, DanaFarber Cancer Institute and Children’s Hospital Boston, and the Department of Psychiatry, Harvard Medical School. Wendy L. Wornham is from the Pediatric Oncology Department, Dana-Farber Cancer Institute and Children’s Hospital Boston, and the Department of Pediatrics, Harvard Medical School. Mary Jane Ott and Elizabeth Dean-Clower are from the Pediatric Oncology Department, Dana-Farber Cancer Institute and Children’s Hospital Boston. Address reprint requests to Sandra E. Bates, RN, Children’s Hospital, Radiology Department, 300 Longwood Ave, Boston, MA 02115. E-mail: [email protected] 1546-0843/$30.00 Copyright Ó 2005 by the American Radiological Nurses Association. doi: 10.1016/j.jradnu.2005.01.001
2
experience less distress as their child’s ability to cope with medical procedures improves. It has been suggested that patients with severe chronic health issues may be more likely to use complementary and alternative medicine (CAM) therapies (Cassileth & Chapman, 1996; Ernst & Cassileth, 1998; Ernst, Willoughby, & Weihmayr, 1995). Pediatric oncology studies that have examined mind-body interventions such as relaxation, guided imagery, and hypnosis have reported ameliorating effects in perceptions of pain, anxiety, and behavioral distress during invasive medical procedures (Ellis & Spanos, 1994; Genuis, 1995; Smith, Barabasz, & Barabasz, 1996; Steggles, DamorePetingola, Maxwell, & Lightfoot, 1997). Despite such findings, there have been few studies examining the role of mind-body interventions in radiological procedures (Tyc, Fairclough, Fletcher, Leigh, & Mulhern, 1995; Tyc, Leigh, Mulhern, Srivastaba, & Bruce, 1997). Children and adolescents with brain tumors require serial diagnostic procedures during the course of their medical treatment and as part of their follow-up care. Magnetic resonance imaging (MRI) is the most frequently used diagnostic and follow-up surveillance procedure for this population. MRIs require extended periods of motion control for successful completion
www.radiologynursing.org
MARCH 2005
Complementary Therapy Interventions
of the scan. Children may be required to remain absolutely motionless for 45 to 90 minutes with only brief, intermittent rest periods. Given the confines of the MRI machine, many children experience anxiety or behavioral distress in anticipation of or during the MRI scan. Parents may also experience a significant level of anxiety, in anticipation of a negative behavioral response by their child, the actual scan procedure, or the implications of the diagnostic results. For anxious and agitated children or very young children who cannot remain motionless during the MRI scan, intravenous (IV) medication is required for sedation. In addition, certain types of MRI scans require the injection of IV contrast materials to enhance the accuracy of monitoring tumor growth and metastases. While sedation assists the child in remaining still and calm during the procedure and contrast is sometimes a necessary aspect of the scanning procedure, the associated invasive medical procedures (i.e., butterfly needle insertion or IV placement for sedation or contrast) can be as distressing as the MRI scan itself (Tyc, et al., 1995). Interventions targeting the child’s (and potentially the parent’s) behavioral and emotional reaction associated with MRI procedures are likely to improve the quality of the patient’s repeated experience in radiology as well as ensuring the quality of the scan. The authors hypothesize that one reason for limited research in this area is limited interest or understanding regarding the use of such interventions in radiology. The aims of this study were to evaluate attitudes and practices regarding mind-body interventions in a pediatric radiology setting and to identify potential obstacles to the use of such interventions for pediatric neuro-oncology patients. METHODOLOGY Subjects The sample for this study consisted of 49 professional staff members out of 85 eligible radiology staff members in a large pediatric academic teaching hospital (58% participation rate). Table 1 presents a breakdown of participants by discipline, demonstrating that the sample approximates the discipline representation in the eligible population. Study Design This was first a descriptive study using surveys for data collection to capture information on staff members’ attitudes and perceptions regarding CAM interventions in the radiology setting. Second, the authors were interested in evaluating an educational presentation as a means of informing staff about the potential uses of CAM interventions in a radiology VOLUME 24 ISSUE 1
Bates et al
JOURNAL OF RADIOLOGY NURSING
Table 1. Proportion of eligible staff and study participants by discipline
Discipline Nursing Physician Radiology technologist Child life specialist
% of eligible staff (n = 85) 38% 39% 21% 2%
(32) (33) (18) (2)
% of study participants (n = 49) 57% 31% 8% 4%
(28) (15) (4) (2)
setting. A multidisciplinary project team was assembled for this study, including a clinical psychologist, a pediatrician/CAM physician, a research fellow, a nurse practitioner with experience in CAM, and the oncology liaison nurse (RN) from the department of radiology. This project received full approval from the hospital internal review board. The project team designed the surveys used for this study and provided the educational presentation to staff in the radiology department. This 30-minute presentation was developed to provide (a) a brief overview of CAM mind-body interventions appropriate for use with pediatric neuro-oncology patients undergoing serial MRIs, (b) a review of research supporting or demonstrating the usefulness of such interventions, and (c) a review of existing CAM resources and services available to staff in the department of radiology to facilitate MRIs for pediatric neuro-oncology patients. A prepresentation survey was administered, followed immediately by the educational presentation on CAM interventions, and a brief postpresentation survey was administered upon conclusion of the presentation. The presentation was offered to radiology staff on three different dates at different times on each date to maximize recruitment. General information regarding the presentation as well as the date and time for each scheduled presentation were provided to staff. After the presentation was offered the third time, a review of participants indicated that 35 staff members had attended, with the majority representing the disciplines of nursing or allied health sciences and with no representation from physicians. Three additional dates and times for the presentation were selected and offered to radiology staff in an extended effort to obtain physician participation. The three additional presentations resulted in 14 physicians participating in the study. Results Results were not reviewed until all presentations had been completed. Forty-nine participants completed the prepresentation survey and forty-seven completed the postpresentation survey. All except 2 of the participants who attended the presentation completed greater
www.radiologynursing.org
3
Bates et al
JOURNAL OF RADIOLOGY NURSING
Complementary Therapy Interventions
Table 2. Sample familiarity with core mind-body interventions
Table 3. Ranking of obstacles to using complementary/ alternative mind-body interventions
Intervention
% of sample (n = 49)
Distraction Relaxation techniques Guided imagery Meditation Hypnosis
% familiar with (n = 49) 90% 86% 61% 43% 39%
59%
57%
than 75% of the forced-choice questions across both surveys. Data from the prepresentation survey (n = 49) indicated that a substantial number of the participants were already familiar with some of the core mind-body interventions appropriate for use during medical procedures (Table 2). As a group, nursing staff members were more familiar with such interventions than physicians. When asked if they had ever heard of such interventions being used for procedures associated with MRI scans (e.g., butterfly contrast, IV insertion), 78% of participants (n = 38) responded affirmatively while 22% (n = 11) responded negatively. Nine of the eleven participants who responded negatively were physicians (residents and fellows). When the participants were asked if they had ever heard of such interventions being used to facilitate the actual MRI scan (e.g., to address anxiety, facilitate motion control), 63% (n = 30) responded affirmatively and 37% (n = 18) responded negatively. Eleven of the eighteen participants who responded negatively were physicians. When asked to identify the obstacles to the use of CAM interventions, the participants identified three primary obstacles. Table 3 presents the three most identified obstacles to the use of CAM interventions in the department. The postpresentation survey (n = 47) focused on obtaining feedback regarding the content of the educational presentation and this modality as a means for educating staff regarding CAM. Results showed that 98% of the study participants indicated that the modality used for this study was effective for communicating with and educating staff regarding CAM, 93% of the participants indicated that the format of the presentation was ‘‘just right,’’ and 91% perceived the content of the presentation to be ‘‘somewhat to very informative.’’ In addition, 88% of the participants indicated that they believed this educational presentation would have some impact on their clinical work. Specifically, these participants indicated that (a) they would be ‘‘more open’’ to learning about or trying CAM interventions in the future, (b) they would like to be more involved or receive specific training in CAM interventions for use with the pediatric neuro-oncology population, and (c) the presentation increased their 4
35%
Reported obstacle Reported that not having some forewarning about which children will need mind-body interventions was a primary obstacle to their use of mind-body interventions Reported that not having an identified person within the department to provide the mind-body interventions was a primary obstacle to their use of mind-body interventions Reported time constraints (too busy, complementary/alternative interventions too time-consuming, scanner too busy) as a primary obstacle to their use of mind-body interventions
awareness regarding CAM mind-body resources available to the department of radiology. DISCUSSION The current study provides examples of the system and unique department culture issues that may be encountered when attempting to increase the use of CAM interventions in a radiology setting for pediatric neurooncology patients. Overall, there was a positive perception of mind-body interventions within the group of participants in this study as well as clear indication that staff perceive pediatric patients as having some level of behavioral or regulatory difficulty with both the medical procedures associated with the scan and the scan itself. There may be less awareness regarding the usefulness of CAM interventions for facilitating actual MRI scans. Responses also indicate, however, that there is need for clarification and education regarding specifics about these interventions. Specifics such as the length of time needed to implement such interventions, their usefulness for skill acquisition rather than as emergent interventions, and clarification regarding existing departmental CAM resources would further enhance staff knowledge and, subsequently, appropriate use of such interventions within this setting. As might be expected, the nursing staff members in this sample were very familiar with CAM interventions, more so than the other participating disciplines. The project team hypothesizes that these results are related to discipline roles (e.g., who provides such interventions). Still, the question is raised regarding the degree to which nonnursing staff should be educated about such interventions to address potential system barriers. Although most participants were familiar with CAM interventions in general, the brief educational presentation increased awareness of the usefulness of such interventions for patients receiving serial MRI scans,
www.radiologynursing.org
MARCH 2005
Complementary Therapy Interventions
and it increased interest in learning more about CAM interventions. Educational programs for acquiring CAM intervention skills were recommended to the department of radiology to encourage staff’s developing interest in this area. There are several limitations to be noted regarding the current study. This study design tested only one modality for educating staff about the potential uses of CAM interventions. Higher participation rates for this study would have ensured that the results were not biased in favor of CAM interventions (providing a smaller percentage of attendees who already had an interest in or support for CAM interventions) as well as ensuring that the true obstacles to use of such interventions were identified. Despite endorsements by the participants that they perceived this educational format to be the most desirable and best suited for their needs, the difficulty in securing representation by attending physicians poses questions that must be answered for any such intervention to be effective; one is whether the modality used in this study (educational/ informational presentation) is most appropriate for physicians. Although the majority of participants (predominantly nursing and allied health professionals) indicated that the modality met their needs for education and information sharing, it is unknown if this is true for physicians and whether a different modality would have resulted in better rates of physician participation. UPDATE Resulting from this brief study, the radiology department has tried to address the obstacles to using CAM interventions to facilitate MRI scans. First, the nursing department has offered 4 hours of CAM training with contact hours for staff. Training was offered in (a) breathing and centered techniques, (b) distraction: storytelling and guided imagery, (c) focusing: progressive relaxation and affirmations, (d) touch: comfort and balance. The training sessions were scheduled to fit the varied working schedules of the nursing staff. These training sessions were designed to provide nursing staff with minimum skills in each area of CAM intervention for use in MRI scans. Second, a brief screening questionnaire was pilottested in an effort to proactively identify patients who would benefit from receiving CAM interventions during MRI procedures. Ten parent and nurse pairs completed the screening questionnaire rating the child’s comfort level during the prescan procedures and during scans. A review of the 10 pairs revealed that nurses and parents had good agreement regarding their perception of the
VOLUME 24 ISSUE 1
Bates et al
JOURNAL OF RADIOLOGY NURSING
child’s comfort level. Although further evaluation will be necessary to determine the true clinical and practical usefulness of such a screening tool, this tool has already been instrumental in helping staff awareness of general screening questions to ask families during their admission assessment. Given the preliminary training in CAM interventions provided, a system has been devised in which nursing staff members will provide basic interventions to facilitate procedures and scans and will receive additional support as needed on a case-by-case basis from the hospital psychology staff and CAM consultation service. Acknowledgment This project was funded in part by a grant from the National Brain Tumor Foundation.
References Cassileth, B.R., & Chapman, C.C. (1996). Alternative and complementary cancer therapies. Cancer, 77, 1026-1034. Ellis, J.A., & Spanos, N.P. (1994). Cognitive-behavioral interventions for children’s distress during bone marrow aspirations and lumbar punctures: A critical review. Journal of Pain and Symptom Management, 9(2), 96-108. Ernst, E., & Cassileth, B.R. (1998). The prevalence of complementary/alternative medicine in cancer: A systematic review. Cancer, 83(4), 777-782. Ernst, E., Willoughby, M., & Weihmayr, T.H. (1995). Nine possible reasons for choosing complementary medicine. Perfusion, 11, 356-358. Genuis, M.L. (1995). The use of hypnosis in helping cancer patients control anxiety, pain, and emesis: A review of recent empirical studies. American Journal of Clinical Hypnosis, 37(4), 316-325. Jay, S.M., & Elliot, C.H. (1990). A stress inoculation program for parents whose children are undergoing painful medication procedures. Journal of Consulting and Clinical Psychology, 58(6), 799-804. Powers, S.W. (1999). Empirically supported treatments in pediatric psychology: Procedure-related pain. Journal of Pediatric Psychology, 24(2), 131-145. Smith, J.T., Barabasz, A., & Barabasz, M. (1996). Comparison of hypnosis and distraction in severely ill children undergoing painful medical procedures. Journal of Counseling Psychology, 43(2), 187-195. Steggles, S., Damore-Petingola, S., Maxwell, J., & Lightfoot, N. (1997). Hypnosis for children and adolescents with cancer: An annotated bibliography, 1985-1995. Journal of Pediatric Oncology Nursing, 14(1), 27-32. Tyc, V.L., Fairclough, D., Fletcher, B., Leigh, L., & Mulhern, R.K. (1995). Children’s distress during magnetic resonance imaging procedures. Children’s Health Care, 24(1), 5-19. Tyc, V.L., Leigh, L., Mulhern, R.K., Srivastava, D.K., & Bruce, D. (1997). Evaluation of a cognitive-behavioral intervention for reducing distress in pediatric cancer patients undergoing magnetic resonance imaging procedures. International Journal of Rehabilitation and Health, 3(4), 267-279.
www.radiologynursing.org
5