Complementary and alternative medicine (CAM) is distinct from orthodox western medicine. In the modern time¡Adue to chronic disease increase year by year and the consumer¡¦s concept of health is not merely without disease. These had changed the people¡¦s seeking medical help behavior. Western medicine in controlling and treating of acute disease had achieved remarkable results, but of chronic disease is disappointed due to chemical drugs long tern side effects. Complementary and alternative medicine relative to western medicine is more nature and modest without severe side effect. In many studies , people utilization of CAM as medical treatment increase year by year. In this study , I will explore the using conditions and degrees of CAM of patients in chronic psychiatric ward. We purposely select the patients and under the informed consensus of patient we apply questionnaires to them. After collecting the questionnaires, we perform statistic analysis. According to statistic results, we discuss the clinical meaning and hope to offer some valuable informations to mental heath providers.

Complementary and alternative medicine (CAM) is increasingly in demand and utilized by the public, specifically by families and their children who are being cared for by current mainstream in-hospital services. Integrative medicine (IM) is a strategy by which conventional health care is attempting to address the use of CAM and explore considerations to implement a pediatric integrative medical (PIM) service. This study will add the otherwise unexplored perspectives of CAM practitioners and hospital administrators to current literature. Semi-structured interviews with 10 CAM practitioners and 4 administrators were conducted. A qualitative comparative content analysis explored considerations for CAM integration in a pediatric hospital, including varied attitudes; levels of understanding and experiences with CAM; communication between professionals; expectations; skepticism and resistance to change; gaining knowledge about CAM; opposing health care ideologies; adapting to different health care environments; funding; safety; redistribution of care; therapeutic milieu; and patient centered care. There is a reservation toward IM in pediatric hospitals, despite generally positive personal and professional experiences and attitudes towards CAM. The realities and challenges of IM are identified. Implications for inclusion of key stakeholder perspectives are discussed in the context of IM for pediatric patients. / Graduate

BACKGROUND:Researchers are finding limitations of currently available disease-focused questionnaire tools for outcome studies in complementary and alternative medicine/integrative medicine (CAM/IM).METHODS:Three substudies investigated the new one-item visual analogue Arizona Integrative Outcomes Scale (AIOS), which assesses self-rated global sense of spiritual, social, mental, emotional, and physical well-being over the past 24 hours and the past month. The first study tested the scale's ability to discriminate unhealthy individuals (n = 50) from healthy individuals (n = 50) in a rehabilitation outpatient clinic sample. The second study examined the concurrent validity of the AIOS by comparing ratings of global well-being to degree of psychological distress as measured by the Brief Symptom Inventory (BSI) in undergraduate college students (N = 458). The third study evaluated the relationships between the AIOS and positively- and negatively-valenced tools (Positive and Negative Affect Scale and the Positive States of Mind Scale) in a different sample of undergraduate students (N = 62).RESULTS:Substudy (i) Rehabilitation patients scored significantly lower than the healthy controls on both forms of the AIOS and a current global health rating. The AIOS 24-hours correlated moderately and significantly with global health (patients r = 0.50 / controls r = 0.45). AIOS 1-month correlations with global health were stronger within the controls (patients r = 0.36 / controls r = 0.50). Controls (r = 0.64) had a higher correlation between the AIOS 24-hour and 1-month forms than did the patients (r = 0.33), which is consistent with the presumptive improvement in the patients' condition over the previous 30 days in rehabilitation. Substudy (ii) In undergraduate students, AIOS scores were inversely related to distress ratings, as measured by the global severity index on the BSI (rAIOS24h = -0.42, rAIOS1month = -0.40). Substudy (iii) AIOS scores were significantly correlated with positive affect (rAIOS24h = 0.56, rAIOS1month = 0.57) and positive states of mind (rAIOS24h = 0.42, rAIOS1month = 0.45), and inversely correlated with negative affect (rAIOS24h = -0.41, rAIOS1month = -0.59).CONCLUSIONS:The AIOS is able to distinguish relatively sicker from relatively healthier individuals / and correlates in expected directions with a measure of distress and indicators of positive and negative affect and positive states of mind. The AIOS offers a tool for CAM/IM research that extends beyond a disease emphasis.

Inom dagens hälso- och sjukvård finns det metoder som kompletterar den västerländska skolmedicinen. Metoder som kan komma att användas när skolmedicinen inte räcker till. Genomgående för vården med Komplementär och alternativ medicin, KAM metoder är en prägling av helhetstänkande ibland även kallat holistiskt synsätt.Syftet med denna uppsats är att beskriva den befintliga forskningslitteraturen med avseende på sjuksköterskans och övriga vårdpersonalens uppfattningar om KAM samt hur KAM används inom vården.Åtta studier sammanställdes och analyserades i en litteraturöversikt för att få en överblick över kunskapsläget. Resultatet presenteras med två huvudkategorier. Kategorierna är Uppfattning om KAM och Hur KAM används i vården. Uppfattning om KAM påverkas av önskan om mer kunskap om KAM, oklar definition av KAM, varierande personligt förhållningssätt till KAM och bristande evidens hos KAM. Hur KAM används i vården påverkas av hur sjuksköterskorna och övrig vårdpersonal uppfattar det att tala med patienter om KAM samt att makt- och organisationsstrukturer är ett hinder på arbetsplatsen. I diskussionen behandlas underkategorierna att tala med patient om KAM, där det diskuteras om hur sjuksköterskorna och övrig vårdpersonal talade om KAM med patienter trots att de kände sig obekväma, sjuksköterskor och övriga vårdpersonals önskan om ökad kunskap samt makt- och organisationsstrukturer som hinder för KAM inom hälso- och sjukvården. / Program: Sjuksköterskeutbildning

Doctor of Philosophy / ABSTRACT Integrative medicine (IM) is a dynamic and increasingly prevalent model of primary health care that combines complementary and alternative medicine with mainstream medicine. This research is about the practice of IM and its value to primary health care in Australia. It locates IM within Australian health care by revealing its processes and outcomes in terms of: practice styles, interactions between practitioners and clients and among practitioners, range of diagnostic and treatment options, and health benefits. In this research I examine the nature of integrative medicine (IM) in co-located primary health care practices and consider the influence that integrating mainstream medicine and CAM can have on the perceived quality of primary health care in Australia. My goal was to contribute the knowledge of the phenomenon of IM through a deeper understanding and interpretation of IM gained by investigating the perceptions of core stakeholders, in this case clients and practitioners of IM. This research was situated in the interpretive paradigm and used two research methodologies: hermeneutics (to interpret the value of IM as reported in the literature) and hermeneutic phenomenology (to understand meanings and significance that clients and practitioners attach to their experiences of IM). Data collection involved the collation of existing literature texts and by cumulative case studies (using semi-structured interviews and observation), focus groups, and key informant interviews. Using a blend of methodologies provided a rich and powerful means of understanding the processes and outcomes of IM through the interpretations of its core stakeholders’ lived experiences. In particular I sought perceptions of clients and practitioners of IM about their health and health care including assessment and treatment options, health outcomes, congruence with beliefs and values, collaborative practices and power sharing. Data analysis was conducted concurrently with and subsequent to data collection so that questioning, observation and textual interpretation were progressively guided by the data. A set of meta-themes emerged from the fusion of findings from all phases of the research. These meta-themes represented answers to key research questions. They are: • Power/authority • Mutual respect • Professionalism • Ontological perspectives • Duty of care. This thesis identifies IM practice styles according to different levels of client agency and degrees of power sharing that exist among CAM and mainstream medical practitioners. A theorised model based on the research findings which depicts quality of health care as a variable consequence of diverse practice styles of IM is produced in two parts: Part 1 acknowledges that IM is a variable phenomenon in practice with different levels of collaboration, power-sharing and quality of health care; Part 2 presents an optimum mode of IM practice. Authentically client-centred health care is at the core of all of these practice styles. This thesis has significant implications for the way IM is practised and for primary health care delivery more broadly. IM that is mutually respectful and genuinely collaborative is flexible, inclusive, and socially relevant and has a substantial and far-reaching contribution to make to the quality of primary health care.

Purpose & Objectives: To foster improved client care and the continued professionalization of Massage Therapy (MT), it is important that MT practitioners research utilization is more clearly understood. The purpose of the study was to explore Massage Therapists (MTs) perceptions of research and their self-reported research utilization. Specifically, to 1) describe MTs perceptions of research and their appraised self-efficacy in research literacy and capacity; 2) better understand the nature of MTs research utilization; 3) identify what practitioner characteristics are associated with research utilization.<p> Methods: Using a sequential explanatory mixed methods design, the study was conducted in two phases. In the first phase, all (815) registered members of the Massage Therapist Association of Saskatchewan (MTAS) were invited to participate in a mail-out survey. In the second phase, semi-structured qualitative interviews using a critical incident framework explored the nature of practitioners use of research. Univariate and logistic regression analysis were conducted using SPSS.<p> Results: In total, 333 questionnaires were returned for a 41% response rate. MTAS members reported overall positive perceptions of research as indicated by high endorsement of its value in adding credibility to MT and by majority agreement that MT practice should be based on research. Reported self-efficacy in various research literacy and capacity skills revealed low levels of knowledge and experience. Reported reference to online research databases, reference to peer-reviewed journals, the belief that MT practice should be based on research, and working more than 20 hours per week were all predictive of research utilization. Case study participants described specific events regarding challenges and successes in utilizing research in their practices and key factors underpinning research utilization were issues of access, issues related to the practitioner, issues of the research itself, and issues of impact on care.<p> Conclusion & Implications: While members of the MTAS perceive research positively, a gap exists between research and practice. Challenges to the diffusion of research appear to be occurring at the stages of research awareness and understanding. Curriculum in MT schools should include more critical appraisal training and more research-based resources. Provincial regulatory status may be the first step to quality training and service delivery.

Purpose & Objectives: To foster improved client care and the continued professionalization of Massage Therapy (MT), it is important that MT practitioners research utilization is more clearly understood. The purpose of the study was to explore Massage Therapists (MTs) perceptions of research and their self-reported research utilization. Specifically, to 1) describe MTs perceptions of research and their appraised self-efficacy in research literacy and capacity; 2) better understand the nature of MTs research utilization; 3) identify what practitioner characteristics are associated with research utilization.<p> Methods: Using a sequential explanatory mixed methods design, the study was conducted in two phases. In the first phase, all (815) registered members of the Massage Therapist Association of Saskatchewan (MTAS) were invited to participate in a mail-out survey. In the second phase, semi-structured qualitative interviews using a critical incident framework explored the nature of practitioners use of research. Univariate and logistic regression analysis were conducted using SPSS.<p> Results: In total, 333 questionnaires were returned for a 41% response rate. MTAS members reported overall positive perceptions of research as indicated by high endorsement of its value in adding credibility to MT and by majority agreement that MT practice should be based on research. Reported self-efficacy in various research literacy and capacity skills revealed low levels of knowledge and experience. Reported reference to online research databases, reference to peer-reviewed journals, the belief that MT practice should be based on research, and working more than 20 hours per week were all predictive of research utilization. Case study participants described specific events regarding challenges and successes in utilizing research in their practices and key factors underpinning research utilization were issues of access, issues related to the practitioner, issues of the research itself, and issues of impact on care.<p> Conclusion & Implications: While members of the MTAS perceive research positively, a gap exists between research and practice. Challenges to the diffusion of research appear to be occurring at the stages of research awareness and understanding. Curriculum in MT schools should include more critical appraisal training and more research-based resources. Provincial regulatory status may be the first step to quality training and service delivery.

Constipation is the most common gastrointestinal complaint in the United States, resulting in about 2 million annual visits to the doctor. The purposes of this dissertation were to: 1) describe four theories of traditional Korean medicine; 2) review mechanisms of acupuncture and moxibustion and develop a conceptual model; 3) review findings from randomized controlled trials that tested the effects of acupressure used for the management of symptoms such nausea, pain, and dyspnea; 4) examine the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) in heart failure patients with constipation compared to those with gastrointestinal disease; 5) describe how Korean women experienced constipation and how constipation affected the quality of life and the experience of using complementary and alternative medicine for constipation; 6) test the effect of acupressure on constipation and to examine the quality of life and depressive symptoms in cancer patients with constipation. Meridian theory explains that acupressure stimulates meridians, a network of energy pathways in the body to increase the flow of bio-energy. Authors of 48 studies supported that acupressure reduced nausea and vomiting during pregnancy, pain, fatigue, and dyspnea. The Patient Health Questionnaire-9 (PHQ-9) was used to examine the depressive symptoms in cancer patients with constipation, but has not been tested in patients with constipation. Therefore, in this study, the psychometric properties of PHQ-9 were tested in patients with constipation. Cronbach’s alphas for the Patient Health Questionnaire were .89 and the correlation between the PHQ-9 and the BDI-II (Beck Depression Inventory) was .81 (p<.01) in 382 heart failure patients with constipation. Ten Korean women reported that living with constipation is a stressful and uncomfortable experience which impacts daily activity, lifestyle, social relationships, and diet. In this pilot study, three out of five patients in the acupressure group reported that acupressure was effective in improving constipation. Cancer patients with less than a four-month history of constipation had less depressive symptoms and higher quality of life compared to patient with more than a four-month history of constipation. In conclusion, acupressure can be a safe and cost effective alternative medicine for constipation.

Research Doctorate - Doctor of Philosophy (PhD) / In recent decades, complementary and alternative medicine (CAM) has gradually assumed a growing popularity and economic importance in the health care systems of Western nations including Australia. Personal expenditure on CAM now represents a significant investment by the Australian general population. During this period, various CAM professions have steadily emerged as popular, if unofficial, healthcare providers. Despite the growing popularity of CAM, little is known outside of special interest groups about most CAM practices or about the professionals who provide them. In Australia one of the most well known and popular forms of CAM is herbal medicine. The focus of this thesis is on the professional practice of herbal medicine in Australia, specifically Western Herbal Medicine (WHM). It is estimated that practitioners of WHM conduct almost two million consultations a year representing an investment of $AUS 85 million (excluding the cost of medicines)in the Australian health economy. Typically described as a complete system of medicine, WHM boasts a comprehensive philosophy and claims to offer a unique approach to treatment, diagnosis and prescription. WHM practitioners reputedly operate within a broad range of autonomy, including some acting as primary health care professionals. Nevertheless, little is known about the Australian WHM profession: their approach to clinical practice; their use of herbal medicines; the patients and problems seen in WHM practice; or the nature of the WHM profession’s relationship with the mainstream healthcare sector. This thesis presents a pragmatic health services inquiry that aims to provide empirical data for the purpose of stimulating reflective practice within the WHM profession and seeks to inform discussion about the role of WHM in the Australian healthcare system. The analysis employs the concept of 'mainstreaming' (the increasing popularity, acceptance and legitimacy of CAM within the dominant healthcare structures) to explore the response of WHM to the changing role of CAM within mainstream healthcare. Mainstreaming is interpreted as an active social process in which the boundaries between CAM and mainstream healthcare are shifting, and is a concept that implies the dominance of the mainstream medical paradigm. The investigation triangulates quantitative and qualitative methods to provide an in-depth account of WHM practice from the perspective of the WHM practitioner. The study population is the membership of the National Herbalists’ Association of Australia (NHAA), and the unit of analysis is the individual WHM practitioner. The research describes the clinical practice of WHM and explores the WHM profession’s developing relationship with the mainstream – including the Australian public and the mainstream healthcare professions, particularly medical practice. A social theoretical framework is employed to examine WHM practice within its social context. The conceptual framework directs the examination of the evolving relationship between WHM and mainstreaming towards three core areas of intersection: (1) the inter-professional; (2) the intra-professional; and (3) the professional/non-professional. The inquiry consists of a mixed methods design in which an initial survey study is followed by a qualitative in-depth interview study. The rationale of adopting a mixed methods approach was threefold: firstly, to increase the scope of inquiry by selecting methods most appropriate for each inquiry component; secondly, to better understand the research problem by converging both types of data; and finally, to increase the validity of constructs and inquiry results by triangulation of data sources. The survey study consisted of a postal questionnaire that was distributed to the membership of the NHAA. The survey was specifically designed for this study in consultation with the NHAA. A preliminary pilot study of the draft questionnaire was conducted consisting of both a formal and informal stage of testing. The questionnaire was distributed with the association’s quarterly professional journal (The Australian Journal of Medical Herbalism) in December 2003 and again in March 2004. Achieving a response rate of 58% (n=378), the survey data described key aspects of the WHM profession; its approach to clinical practice, herbal prescribing and aspects of its professional relationships. The survey results demonstrated an increased influence of medical science on WHM principles and practices including the incorporation of medical concepts,clinical procedures, technologies and language into clinical practice. Although the survey provided strong evidence of a trend towards the rationalisation of WHM clinical practice, the results showed how the prescription of herbal medicines remains a predominantly traditional practice. In terms of the WHM profession, the survey results indicate that WHM practitioners are not assuming a primary healthcare role in Australia but are predominantly providing treatments for chronic conditions. The data indicated high levels of concurrent patient care, including concurrent use of pharmaceutical and herbal medicines;thus, suggesting that WHM clientele consider WHM a complementary rather than an alternative form of medicine. The survey also showed that WHM practitioners would welcome improved inter-professional and intra-professional relationships. The second phase of the mixed methods study consisted of a series of qualitative in-depth interviews with a sub-sample of survey respondents (n=18)resident in NSW, Australia. The objectives of the in-depth interview study were twofold: firstly, to add depth and meaning to survey data; and secondly, to understand the practice of WHM from the perspective of the WHM practitioner.To ensure flexibility and to uncover novel data from the participants the in-depth interviews were carried out on a semi-structured basis. Building upon the survey findings, the qualitative study explored the WHM practitioners���� conceptualisations, explanations and rationalisations of their approach to WHM practice. The interview participants represented a broad range of WHM practitioners who commonly shared a holistic worldview, but who also offered a range of interpretations of the philosophical and theoretical basis of WHM. The investigation described how mainstream conceptualisations of healthcare have impacted upon the traditional model of WHM practice. The analysis identifies a number of competing sub-groups within WHM who each advocate particular approaches to WHM practice. In particular, the analysis highlights a significant degree of internal tension operating within WHM about the salience of medical science within WHM. The analysis also revealed how the perceived subordination to, and thus distinction from, mainstream medicine is a dominant issue within the WHM practitioner’s discourse. The explanation for this emerged from the perception amongst the in-depth interview participants of the widespread appropriation of herbal medicine by the mainstream, as well as systematic discrimination towards the WHM profession. Furthermore, there was evidence of not only poor intra-professional cohesion but significant intra-professional differences regarding the apposite location of WHM in relation to mainstream healthcare. This research provides new understandings about the clinical practice of WHM practice, but also about the role of the WHM practitioner in Australian healthcare. The thesis reveals a story of irony. Despite the increasing popularity of herbal medicines and significant concessions within WHM to the medicalparadigm, the WHM profession is struggling to achieve legitimate participation within the mainstream and continues to operate on the fringe of Australian healthcare. The thesis concludes that the process of mainstreaming is challenging the authenticity of WHM herbal tradition and challenging the future viability of the WHM profession, the implications of which suggest that the WHM practitioner will continue to experience financial insecurity unless the WHM profession can collectively move to demarcate its scope of practice and legitimate its professional role.

Doctor of Philosophy / ABSTRACT Integrative medicine (IM) is a dynamic and increasingly prevalent model of primary health care that combines complementary and alternative medicine with mainstream medicine. This research is about the practice of IM and its value to primary health care in Australia. It locates IM within Australian health care by revealing its processes and outcomes in terms of: practice styles, interactions between practitioners and clients and among practitioners, range of diagnostic and treatment options, and health benefits. In this research I examine the nature of integrative medicine (IM) in co-located primary health care practices and consider the influence that integrating mainstream medicine and CAM can have on the perceived quality of primary health care in Australia. My goal was to contribute the knowledge of the phenomenon of IM through a deeper understanding and interpretation of IM gained by investigating the perceptions of core stakeholders, in this case clients and practitioners of IM. This research was situated in the interpretive paradigm and used two research methodologies: hermeneutics (to interpret the value of IM as reported in the literature) and hermeneutic phenomenology (to understand meanings and significance that clients and practitioners attach to their experiences of IM). Data collection involved the collation of existing literature texts and by cumulative case studies (using semi-structured interviews and observation), focus groups, and key informant interviews. Using a blend of methodologies provided a rich and powerful means of understanding the processes and outcomes of IM through the interpretations of its core stakeholders’ lived experiences. In particular I sought perceptions of clients and practitioners of IM about their health and health care including assessment and treatment options, health outcomes, congruence with beliefs and values, collaborative practices and power sharing. Data analysis was conducted concurrently with and subsequent to data collection so that questioning, observation and textual interpretation were progressively guided by the data. A set of meta-themes emerged from the fusion of findings from all phases of the research. These meta-themes represented answers to key research questions. They are: • Power/authority • Mutual respect • Professionalism • Ontological perspectives • Duty of care. This thesis identifies IM practice styles according to different levels of client agency and degrees of power sharing that exist among CAM and mainstream medical practitioners. A theorised model based on the research findings which depicts quality of health care as a variable consequence of diverse practice styles of IM is produced in two parts: Part 1 acknowledges that IM is a variable phenomenon in practice with different levels of collaboration, power-sharing and quality of health care; Part 2 presents an optimum mode of IM practice. Authentically client-centred health care is at the core of all of these practice styles. This thesis has significant implications for the way IM is practised and for primary health care delivery more broadly. IM that is mutually respectful and genuinely collaborative is flexible, inclusive, and socially relevant and has a substantial and far-reaching contribution to make to the quality of primary health care.