Attitudes and Knowledge of Community Pharmacists Toward Complementary and Alternative Medicine: A Narrative Review.

Context: The use of complementary and alternative medicine (CAM) in Australia is widespread, and self-treatment with CAM often occurs. Community pharmacies are a major supplier of CAM in Australia; consequently pharmacists may be approached by consumers in relation to self-treatment. Objectives: The study intended to appraise peer-reviewed literature regarding the supply of CAM in retail pharmacies and pharmacists' knowledge and attitudes in relation to it. Design: The research team performed a narrative review of peer-reviewed studies published between January 1997 and December 2017. Four electronic databases-Web of Science, ScienceDirect, CINAHL, and PubMed-were systematically searched using keywords. A search strategy was devised using 4 keywords: knowledge and attitude, complementary and alternative medicine, stress, and pharmacist. English-language, full-text studies were sought, and the team considered only the results of studies conducted in Australia or in countries with similar healthcare systems. Setting: The study is a literature study. Results: Performance rankings were considered, with 10 studies being identified. Pharmacists were generally positive about CAM; however, they displayed a degree of uncertainty, particularly about efficacy and safety, that pointed toward a lack of confidence and a desire for better education. Knowledge, both self-rated and assessed, was lacking. Few studies explored the use of CAMs for specific physical-health conditions and fewer still addressed mental health. Conclusions: Pharmacists are ideally placed to interact with consumers and are often the first point of contact for those people wanting to self-treat. Pharmacists may lack the necessary practice knowledge and skills to appropriately advise consumers about CAM or about those conditions where self-treatment products fall predominantly into the CAM category, such as for stress.

Community pharmacists' recommendations for natural products for stress in Melbourne, Australia: a simulated patient study.

BACKGROUND: Community pharmacists are often the first health professional approached to provide treatment for health issues, including the important mental health challenge, stress. Over-the-counter products for stress almost always are complementary and alternative medicines (CAM) and in Australia no protocol exists for their recommendation and sale in community pharmacies. OBJECTIVE: To assess the quality and relevance of community pharmacists' information gathering (questioning), counselling and product selection when interacting with customers requesting a CAM product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for 'pharmacy only' (S2) and 'pharmacist only' (S3) medicines. METHODS: A covert simulated patient was used to investigate the response of pharmacists to a request for a natural product for stress. The SPs documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then re-entered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature. RESULTS: Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively). The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flower essence product (19 pharmacists). A two-step cluster analysis revealed two sub-groups of pharmacists: one cluster (74 pharmacists) with a high Total CARE score provided an appropriate product. The other cluster (20 pharmacists) had a low total CARE score and provided an inappropriate product. CONCLUSIONS: The pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation. There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending complementary and alternative medicine.

Community pharmacists' recommendations for natural products for stress in Melbourne, Australia: a simulated patient study

BACKGROUND: Community pharmacists are often the first health professional approached to provide treatment for health issues, including the important mental health challenge, stress. Over-the-counter products for stress almost always are complementary and alternative medicines (CAM) and in Australia no protocol exists for their recommendation and sale in community pharmacies. OBJECTIVE: To assess the quality and relevance of community pharmacists' information gathering (questioning), counselling and product selection when interacting with customers requesting a CAM product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for 'pharmacy only' (S2) and 'pharmacist only' (S3) medicines. METHODS: A covert simulated patient was used to investigate the response of pharmacists to a request for a natural product for stress. The SPs documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then re-entered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature. RESULTS: Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively). The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flower essence product (19 pharmacists). A two-step cluster analysis revealed two sub-groups of pharmacists: one cluster (74 pharmacists) with a high Total CARE score provided an appropriate product. The other cluster (20 pharmacists) had a low total CARE score and provided an inappropriate product. CONCLUSIONS: The pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation. There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending complementary and alternative medicine

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Exploring the information and communication technology competence and confidence of nursing students and their perception of its relevance to clinical practice.

AIM: This paper profiles a study that explored nursing students' information and communication technology competence and confidence. It presents selected findings that focus on students' attitudes towards information and communication technology as an educational methodology and their perceptions of its relevance to clinical practice. BACKGROUND: Information and communication technology is integral to contemporary nursing practice. Development of these skills is important to ensure that graduates are 'work ready' and adequately prepared to practice in increasingly technological healthcare environments. METHODS: This was a mixed methods study. Students (n=971) from three Australian universities were surveyed using an instrument designed specifically for the study, and 24 students participated in focus groups. FINDINGS: The focus group data revealed that a number of students were resistant to the use of information and communication technology as an educational methodology and lacked the requisite skills and confidence to engage successfully with this educational approach. Survey results indicated that 26 per cent of students were unsure about the relevance of information and communication technology to clinical practice and only 50 per cent felt 'very confident' using a computer. CONCLUSION: While the importance of information and communication technology to student's learning and to their preparedness for practice has been established, it is evident that students' motivation is influenced by their level of confidence and competence, and their understanding of the relevance of information and communication technology to their future careers.

Intercultural communication in child and family health: insights from postcolonial feminist scholarship and three-body analysis.

Concerns about intercultural communication practices in child and family health were raised during a South Australian ethnographic study. The family partnership model was observed as a universal pedagogic tool introduced into the host organisation in 2003. It has a role in shaping and reshaping cultural production within child health practice. In this study, we draw on insights from postcolonial feminist scholarship together with three-body analysis to critique the theoretical canons of care that inform intercultural communication in the child and family health setting. We contend that although the family partnership model may be very useful, its intended universal application is problematic in the context of multiculture. Issues of race, gender and class were seemingly unattended when using a communication approach based in historical scientific rationalism. Liberal interpretations of discourses of equity and empathy arising out of contemporary models of communication were often adopted by child and family health nurses and protected them from seeing the inherent binaries that constrain practice. Insights from postcolonial feminist thinking enabled us to recognise the problems of applying theory to practice in a linear fashion. We demonstrate the use of three-body analysis as a deconstruction strategy to refigure how theory might be understood and worked with in the multiculture that is Australia.

Yaitya tirka madlanna warratinna: exploring what sexual health nurses need to know and do in order to meet the sexual health needs of young Aboriginal women in Adelaide.

Young Aboriginal women are consistently identified as having poorer health outcomes and access to sexual health services than non-Indigenous Australians. Yet the literature is particularly silent on what sexual health nurses need to know and do in order to work well with young urban Aboriginal women. This paper reports on a qualitative pilot study undertaken by a non-Indigenous nurse in Adelaide. The participatory action research methods used in this study were sensitive to the history of problems associated with research in Aboriginal communities. A reference group of Elder Aboriginal women and Aboriginal health workers guided all aspects of the study. A partnership approach between the researcher and the Reference Group ensured that the methods, analysis, and final report were culturally safe. Three groups participated in this study: Elders and Aboriginal health workers; young Aboriginal women, and sexual health nurses. All participants acknowledged the importance of nurses being clinically competent. However, the overarching finding was a lack of a clear model of cultural care to guide health service delivery. Three interrelated themes emerged from the data to support this contention. These were: the structural and personal importance of establishing and maintaining trustworthy relationships between nurses, Aboriginal health workers and Elders; the recognition that Aboriginal culture does exist, and is important in urban areas; and the importance of gender considerations to understanding urban women's health business. A partnership approach was recommended as a way to use these findings to develop a transparent cultural model of care. Further research is currently being undertaken to progress this agenda.

Establishing an Australian nurse practitioner-led colorectal cancer screening clinic.

In Australia, colorectal cancer is the most commonly occurring internal cancer affecting both men and women, and the second most common cause of cancer-related death. Flexible sigmoidoscopy has not been commonly used as a screening tool in Australia due primarily to lack of resources. Until now, people at average risk of developing bowel cancer frequently undergo colonoscopy after referral to a specialist. To fill an identified need, a nurse practitioner-led colorectal screening service providing fecal occult blood testing and flexible sigmoidoscopy, health education and promotion, patient counseling, information and a referral point for general practitioners, and a referral service for above average-risk patients was established in a South Australian metropolitan teaching hospital. Establishment of this clinic required advanced and extended theoretical and clinical preparation for the nurse practitioner, as well as development of interdisciplinary relationships, referral processes, clinical infrastructure, and a marketing strategy. An audit of the first 100 flexible sigmoidoscopy patients revealed service and procedural outcomes that compared favorably with other colorectal screening services as well as a high level of patient satisfaction.

Culture, communication and child health.

Cultural beliefs and values implicitly and explicitly shape every aspect of the way we parent our children and how we communicate about parenting. To appropriately support parents in this new and challenging role, child health services for parents in Australia need to do more than acknowledge a diverse range of cultural practices. While many health professionals believe they act in culturally sensitive ways, we need to closely examine this belief, question the cultural assumptions implicit in the information we give, and assess the extent to which our interactions are culturally appropriate. In this paper, we present a critical review of the literature on health care provision for migrant women and families. We then suggest a need to re-examine the values, beliefs and attitudes within cultural frameworks that inform how child health professionals communicate. Specifically, communication between child health professionals and migrant parents requires further analysis. We suggest that professionals need to reflect on the cultural self rather than solely on the culture of others.