Reiki and guided imagery classes for increasing relaxation and comfort are still offered to veterans. An attendee of the initial level 1 training offered from the first grant progressed in certifications and received Master status. This Master has trained 60% of the nurses in her unit in level 1 Reiki. Weekly sessions are being implemented for veterans. Guided imagery training provided by the initial CARES grant project is sustained via weekly groups. Reports of an increased sense of well-being and relaxation as well as relief from chronic pain have been reported.
Although evaluations were created for the comfort carts, they were not regularly completed by patients. However, direct subjective feedback from nursing staff who spoke to organizers of the project about both the beds and the carts was very positive. Additionally, members of the project were able to talk to some veterans and family members who agreed to discuss their use of these items. They expressed appreciation for the snacks, which helped “tide them over,” and the beds, which allowed them to stay and comfortably visit their sick loved ones. Utilization of the CARES comfort carts and mobile sleepers on the inpatient units continued after completion of this study. The GRECC has continued to function as a resource center by distributing educational materials, restocking the comfort carts, and providing educational programs on CAM.
Objectively measuring satisfaction related to the implementation of the program proved challenging. At program commencement, plans involved an evaluation of the CARES program using overall hospital satisfaction measures. However, different components of the program took effect at different times, and not all components affected all parts of the hospital. Satisfaction measures, such as the National Veteran’s Survey of Healthcare Experiences of Patients (SHEP) and the local Quick-Kards, which report aggregate scores for patient satisfaction, were analyzed prior, during, and after program implementation but could not be clearly correlated to program impact on patient and family satisfaction with health care. Additionally, the categories addressed in the surveys were very broad while the CARES program addressed only some aspects of hospital care. Despite the weak correlation, SHEP results of inpatient services were analyzed and evaluations did increase in the categories of inpatient overall quality and shared decision making from prior-to-program implementation to postprogram implementation. Quick-Kard results remained essentially the same related to patient-provider communication pre- and postprogram implementation. Additional quantitative and qualitative measures of satisfaction linked specifically to program components need to be created or further explored.
Limitations
This project was not able to address all aspects of the wide range of topics under the general term CAM. In a short time, many individuals taught courses in their areas of expertise. However, many areas, such as acupuncture, chiropractic manipulation, and massage therapy, were not included. Additionally, although herbal therapies are likely the most used CAM method, they also present many challenges when combined with medications and other common therapies among veteran patients.11 The study was not intended to provide any general information endorsing the safety of these herbal therapies when combined with medications, so this topic was avoided altogether. However, this is a topic that needs further exploration and medical involvement, as these therapies can have medical consequences despite their casual use and availability.
Conclusions
The most important lesson learned through this program was that CAM is a very “hot topic” at the Cleveland VAMC and many staff members are enthusiastic and open to integrating it into their practice. This was important throughout program implementation as staff buy-in is integral to a successful medical center initiative. Veterans and family members were receptive to learning about CAM and participating in programs. An abundance of local experts outside of the facility were also willing to share their knowledge about their particular therapy.
Securing continuing education (CE) credit hours was challenging, requiring applications and close work with presenters. However, the added benefit of CE credits helped to garner an audience. Marketing the programs in a time sensitive nature to allow staff or family members to arrange schedules was critical.
Multiple opportunities, including initiatives for patient-centered care, CLCs, and management of veterans with pain and delirium can be helpful for maintaining and expanding the CARES program. Most important, it was learned that a small group of clinicians who can think outside the box can make a big difference for veterans. Implementing a holistic and patient-centered program of CAM that brings resources to veterans 24/7 is both feasible and fun.
Future Directions
Plans for future educational programs on CAM will include the use of interactive audio/video technology to expand outreach, yet still allow the active participation of HCPs and possibly veterans. Cleveland VAMC GRECC staff members continue to work on various aspects of the CARES program, such as the use of audio tapes for relaxation and augmentation of pain treatment and to support the Wellness Center. The carts and mobile sleepers are still heavily used to support the “Care Partners” program at the Cleveland VAMC, and they continue to be stocked with items. These items helped meet the project’s goal of providing resources to be available 24/7.