The CARES Program
The objectives of the CARES program were to (1) change the culture of the medical center to a more holistic approach, encouraging family and patient participation in care and emphasizing comfort and satisfaction; (2) increase knowledge of complementary therapies for relaxation; (3) improve patient and family satisfaction with nursing and medical care; and (4) build on preexisting medical center initiatives for patient-centered care.
The CARES program presented lectures and training workshops on various CAM therapies for all HCPs in order to provide useful information that may not otherwise have been available. Evidence has shown that those who receive training for complementary therapies respond positively and view the experience as valuable.18 It was hoped that these training sessions would empower nurses and other health care staff to provide care while recognizing the importance of treating the entire person. Programs were planned for various times of the day and evening in various patient care locations. (Aims and initiatives of the CARES program are further expanded in the Figure.)
Prior to any educational sessions, a survey was distributed to HCPs about their knowledge and experience with CAM. Though responses to the survey were limited, the results indicate interest in learning more about CAM therapies (Table 1).
Over the course of the yearlong grant, a total of 19 workshops were scheduled and held for HCPs and veterans for a total of 346 participants. This included 3 intensive training sessions for staff, 1 on Reiki and 2 on Healing Touch. All programs, including the intensive training sessions, were available free to participants. Some of the sessions were videotaped and archived for later viewing. (See Table 2 for a list of all training sessions provided by the CARES program.) The project was limited in both time and funds, so only a limited number of topics were able to be covered, and the topics were based mostly on the availability of experts in each field.
Resources
In addition to lectures, organizers of the CARES program purchased 20 comfort carts for inpatient units at the Cleveland VAMC. These were small rolling lockable wooden carts approved by Interior Design, who evaluated and designed previous work spaces at the Cleveland VAMC to make them functional, appealing, and well-suited for the veterans. The carts were stocked with various resources that focused on comfort and entertainment. Specifically related to CAM, these carts contained guided imagery CDs and Playaways. (Playaways are small audio players with included earbud headphones meant for individual use, which are preloaded with a specific guided imagery session.) Additionally, the comfort carts contained books, books on tape, magazines, portable CD players, music CDs, games, exercise bands, healthy snacks, DVDs, and a portable DVD player. Other items purchased to be distributed to various inpatient and outpatient units included Nintendo Wii game consoles and small televisions. Mobile sleepers were purchased for inpatient units to encourage extended-family visitation. These sleepers have been widely adopted throughout the medical center.
Additional resources purchased by the CARES program included educational pamphlets on various health issues affecting veterans, such as the management of stress. In an effort to increase patient education about complementary therapies, the CARES program provided funding for 2 dedicated channels on the patient television system, broadcasting 24-hour, evidence-based relaxation and guided imagery programming. Finally, the CARES program enhanced the Wellness Center begun by the nurses in the CLC. This included the purchase of exercise equipment, computers, aromatherapy, massage tables, and massage cushions. The exercise equipment, including a recumbent stepper, recumbent bike, and treadmill, was provided by funds from the CARES project. The equipment was available 24/7 to veterans and could be accessed once the veteran was cleared by his primary care and admitting physician. Competencies were developed and completed by the staff. The competencies included orienting the patient on use of the equipment, observation and documentation of equipment used, and response. Veterans who had established home exercise routines were able to continue their programs while hospitalized in the CLC. This helped maintain and regain leisure activity and promoted wellness.
Program Outcomes
Evaluations of the training sessions were overwhelmingly positive (Table 3), and many individuals requested further education and training. A total of 204 participants (59%) completed posttraining evaluations. Some common themes identified through comments on program evaluations included requests for training in the evenings and on weekends. Of the 329 HCPs who participated, 36.5% were nurses or nurse practitioners, 13.7% were ancillary staff (eg, nursing assistants), 9.7% were social workers, 8.5% were students, 5.8% were physicians or physician assistants, 5.2% were psychiatry staff members, 4.9% were occupational/physical/recreational therapy staff members, and 15.7% were other/unknown. The remaining 17 individuals who participated were veterans and their family members.
