In recent decades, complementary, alternative, and traditional therapies have become increasingly popular both overseas and in Hong Kong. As nursing involves providing holistic and client-centred care to meet the changing health needs of society, the Nursing Council of Hong Kong stipulates that the training of general registered nurses include a minimum of 40 hours of theoretical input on Chinese medicine as a requirement for registration. The objective of the curriculum is to give nursing students some knowledge of the basic theories of Chinese medicine, including the scope and principles of Chinese Medicinal Nursing and an appreciation of its use in modern society.
Methods
A quasi-experimental design. The study adopts the nonequivalent pretest-posttest control group design. The research design is similar to the usual pretest-posttest experimental design, except that participants are not randomly assigned to groups. The study will be conducted in two phases: in the first phase the control group of students will be recruited and will undergo an existing education intervention. In the second phase, students will receive the enhanced education intervention on integrative nursing. Two different cohorts of students will be recruited for different phases of the study.
Study setting
The study setting is the Integrative Health Centre of Tung Wah College.
Intervention
The students will be required to utilize integrative therapy incorporating nurse case management to provide patients with individualized care in the IHC. The existing education intervention will be used for the control group. The students will provide an assessment of the vital signs of the patients, including their blood pressure, pulse and respiratory rate, and oxygen saturation (if needed).In order to successfully implement the interventions, the learning protocol and guideline on integrated care will be developed. The new learning protocol integrating Chinese medicine, case management, and therapeutic communication. For the study group, students will be the case manager for patients in the IHC. Students will assess the vital signs of all patients. The Lawton Instrumental Activities of Daily Living (IADL) Scale will be used to assess the independent living skills of patients over the age of 65. The students will submit the patient’s IADL score to the Chinese Medicine practitioner and stay with the patient during the medical consultation. The health education provided before discharge will include information about the effects and possible side effects of the prescribed Chinese medicine, plus information on how to attend to the specific disease, followed by the dispensing of medications. It is essential for students to understand herbal therapies because prescribed regimens could have interactions that the patients do not recognize. Based on the IADL scores, the students will give the patients reminders about adhering to their medications, their daily nutritional needs, and follow-up appointments, if any. The rationale behind the interventions is to enhance the students’ abilities in the areas of individualized culturally competent health promotions and patient-centred therapeutic communication. To reinforce the students’ learning, teachers will conduct a case seminar using an integrative care approach. The students will be required to work in pairs to select a client case to present during the course of their placement. They will be required to collect a patient’s clinical data and draw up healthcare advice, integrating Chinese medicine and incorporating Western nursing interventions for optimal patient care. The formulated care plan will be guided by a model of nursing care that is based on 12- activities of living (12 ALs) and concept mapping that will facilitate reflections on the delivery of integrated care.
Because of the wide diversity of patients who attend the IHC, for the benefit of the students’ learning and practice, patients with chronic pain, influenza, sleep disturbances, and skin problems will be recruited to take part in this study.
Outcomes
A self-reported questionnaire will be used for outcome measures. The Nursing Students Competence Instrument (NSCI) will be used to measure the difference in nursing competence among the two groups before and after the intervention. For measuring therapeutic communication skills, the scale developed by Rosenberg will be used for both the self-assessment and the teacher’s assessment. For students’ perceptions of integrative care in the PHC placement, the reflective journals will be analysed and used as evidence of the students’ learning experiences.
Data analysis
A statistical analysis will be performed using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp, Armonk, NY). The data on demographics, clinical competence, and therapeutic communication will be put through a descriptive analysis. A parametric test, General Linear Model (GLM) with repeated measures, will be employed to determine between-group (study vs control), within-group (time) and interaction (group x time) effects. P<0.05 is considered statistically significant.
For the qualitative analysis of the students’ reflective journals, the data will be analysed and coded into themes and then categorized to form conclusions.
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