Despite the widespread use of CAM therapies by the public, HCPs rarely recommend CAM therapies to their patients.2,3 This has been attributed to a lack of scientific evidence, a lack of knowledge or comfort, and a lack of an available CAM provider.3 The basic philosophy of self-motivated stress and pain management, which is fundamental to most CAM therapies, is learned and embraced by most HCPs, but the implementation is not often seen in the real world of busy clinical practice. With its numerous benefits, CAM has the potential to significantly improve the health and QOL. Therefore, innovative programs that help HCPs become knowledgeable and competent in incorporating CAM into current systems of care are needed.
In 2010, the Cleveland VAMC was funded through the Innovations in Patient-Centered Care grant to design and implement a complementary therapy resource center. This project was the CARES program and was organized through the Cleveland Geriatric Research Education and Clinical Center (GRECC). The project team included researchers and clinicians within the GRECC as well as other clinical departments. A CAM coordinator was hired to organize lectures, order supplies, and network with various departments within the Cleveland VAMC. Additionally, a major focus of the CARES program was to encourage the involvement of family and friends in the care of the veteran. An integral goal of this project was to bring CAM resources to the bedside of veterans in acute and long-term care on a 24/7 basis.
The rationale for the implementation of a complementary therapy resource center was based on the Planetree model of patient-centered care, which encourages healing in all dimensions and the integration of complementary therapies with conventional medical practices.17 Offering such therapies in an established medical center with knowledgeable HCPs may increase the safety of such use.1 Providing workshops and lectures for HCPs about various complementary therapies would help educate them and provide them with a knowledge base to feel comfortable in recommending therapies to their patients. By opening workshops and lectures about CAM to the public, veterans would be given the opportunity to learn about the therapies available and their efficacy.
Advancing Patient QOL
The Cleveland VAMC has a history of research and policies to advance a culture of patient-centered care with an emphasis on QOL, customer service, and the use of CAM.In 2001, Anthony D’Eramo, a member of the Cleveland VAMC GRECC, developed a program to educate nursing assistants at the Cleveland and Chillicothe VAMCs on complementary therapies, including meditation, spirituality, therapeutic touch, and yoga. The overall response to the program was positive.18 The focus of the training was on the QOL of nursing assistants; most found participation in the training to be a valuable and worthwhile experience. They indicated their intent to use the techniques they learned for themselves, their families, and their patients.18
Also in 2001, researchers at the Cleveland and Pittsburgh VAMCs identified that older veterans with osteoarthritis perceived the use of prayer and meditation as more useful than medications or surgery for the treatment of pain associated with osteoarthritis.19 Since that time, the Cleveland VAMC has worked with the Pittsburgh VAMC to study the use of motivational interviewing—a communication technique that focuses on patient engagement to achieve changes in behavior—for patients with knee osteoarthritis to consider total knee replacement surgery.
In 2004, Antall and Kresevic implemented a program of guided imagery for patients undergoing joint replacement surgery.20 Although the sample size was small, results indicated positive trends for pain relief, decreased anxiety, and decreased length of stay following surgery. Due to the small sample size, statistical comparisons were not performed; however, the mean pain medication use in the 4 days following surgery was morphine 84.76 mg in the control group vs 36.7 mg in the guided imagery group.20 The overall response to the guided imagery tapes was positive, with 75% of the subjects indicating that use of the tapes made them feel more relaxed and decreased their pain.
More recently, the clinical nurse specialist group at the Cleveland VAMC began a study using music and education to decrease pain. In 2009, a Patient-Centered Care Council was established for the medical center to advance a culture of patient-centered care by analyzing the results of performance measures and satisfaction reports. Additionally, the nursing staff at the Cleveland VAMC Community Living Center (CLC) expressed an interest in expanding the use of CAM by creating a wellness center with exercise equipment and aromatherapy. This center was well-received but had only limited access to patients in acute and long-term care and was unable to be sustained due to insufficient staffing.