الفهرس 
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Abstract
Summary
Complementary and alternative medicine is often taught of as medicine that is not based on the principles of mainstream a western medicine. The nurses are in a key position to help integrate use of complementary and alternative medicines into practice. Because they are available “24/ h,” they can play a unique role in guiding the growth and use of CAM in hospitals. Nurses have the philosophical background and educational preparation that focuses on holistic care. The nursing profession has long been a strong advocate of integrated care.
Aim of the study
This study aimed to assess knowledge and perception of nursing students towards complementary and alternative medicine through the following:
• Assess nursing students` level of knowledge towards complementary and alternative medicine.
• Assess nursing students` perception towards complementary and alternative medicine.
• Assess correlation between nursing students` level of knowledge and perception towards complementary and alternative medicine.
Research questions of the current study was:
• What’re the nursing students’ knowledge levels towards complementary and alternative medicine?
• What’s the nursing students’ perception towards complementary and alternative medicine?
• Is there correlation between knowledge level and perception of nursing students towards complementary and alternative medicine?
Subjects and methods
The study design: A descriptive exploratory research design was used to achieve the aim of this study.
Study Setting: This study was conducted in the faculty of nursing, at Al-Azhar University, Cairo, Egypt.
Sampling type and size: Stratified random sample of (226) nursing students participated in this study.
Sample criteria:
Exclusion criteria:
Students who were not present in the class during the period of data collection.
4) Tools of data collection:
Tool (I): Structured interview questionnaire (appendix I) was developed by the researcher used to collect data based on previous literatures Jafari et al., (2021), Khan et al., (2021), Berretta et al., (2020), Ahmad et al., (2019) written in a simple Arabic language It was contained on 82 points and classified into three parts:
Part 1: Sociodemographic data of nursing students
It included 8 items: (age, marital status, year of study, residence, income, ventilation, number of rooms/house, number of family).
Part 2: The use of CAM
It included 5 questions: (previously use of CAM, type of CAM, feeling better after using CAM, complication of CAM, and family history about use of CAM).
Part 3: The nursing students’ knowledge about CAM.
Structured interview questionnaire for students’ nurses to assess level of knowledge. it was consisted of sections
• Section 1: Assessment of the basic knowledge about CAM: it consisted of 12 MCQ questions as (definition of CAM, difference between complementary and alternative medicine, history of CAM, causes of using CAM, example of CAM methods, the aim of using CAM in patient with cancer, a patient using CAM therapy, main aspects considered in patient’s care, the common believes in patient recovery, the CAM`s practitioners, precautions of CAM during pregnancy, barriers of CAM using).
• Section 2: Assessment the knowledge about CAM methods: it consisted of 60 MCQ questions classified as:
A- Whole medical system: it consisted of 13 MCQ questions as: (definition of whole medical system, definition, origin, concept, and contraindication of acupuncture, cupping therapy`s definition, benefits, uses, contraindication, and side effect, and origin, definition and uses of Ayurveda).
B- Mind-body therapy: it consisted of 16 MCQ questions as: (types and aim of mind-body therapy, definition and side effect of meditation, definition and side effect of yoga, definition, benefits and side effect of hypnosis, guided imagery depends on and which affect successful imagery session, definition of spirituality, definition of prayer, example of believe that is unique to folk medicine, uses of prayer, and type of CAM effective on different body parts pain).
C- Manipulative-based practice: it consisted of 9 MCQ questions as: (definition, side effect and contraindication of massage, definition, uses and contraindication of Tai Chi, and definition, uses and complication of chiropractic).
D- Biological-based practice: it consisted of 14 MCQ questions as: (Biological-based practice definition, aromatherapy`s definition, safety guideline and complication, definition of herbal therapy, uses of curcumin, herbs used to decrease weight, contraindication of herbal therapy, condition response well to herbal therapy, side effect of diet therapy, precaution of diet therapy for diabetic patient, effect of supplement on cardiac patient, uses of honey, and diet therapy for patient with constipation).
E- Energy medicine: it consisted of 8 MCQ questions as (definition and benefits of energy medicine, definition, uses and side effect of reflexology and origin, uses and side effect of Reiki).
• Section 3: Assessment the knowledge about nursing role toward CAM: it consisted of 10 MCQ questions as:
• “Who`s responsible for answering the basic question about CAM.
• The main nursing role toward CAM.
• Basic elements for nursing to implement CAM.
• Role of nurse during patient care using CAM.
• Effect of knowledge and application of CAM on nurse.
• The integral part of nursing-patient relationship. Nursing practice for CAM.
• What nurses need to discuss with a patient regarding CAM.
• The nurse needs of knowledge about CAM.”
Scoring system:
The questionnaire was a multiple-choice question and the scores were distributed as following: One for each correct answer and zero for incorrect answer and these scores were converted into precent score. (60% and above (graded ≥49) considered satisfactory while below 60% (graded <49) considered unsatisfactory where the total grade 82).
Tool (II): self-administered perception scale towards CAM (appendix II):
It was developed by researcher based on related literature Jafari et al., (2021), Khan et al., (2021), Berretta et al., (2020), Ahmad et al., (2019) to assess nursing students` perception regarding CAM. It consisted of 40 statements such as (the use of CAM is beneficial for health, use of CAM together with conventional medicine, CAM therapies can stimulate the body’s natural therapeutic powers, the nurse has impact role to advice or encourage the patient to use CAM, CAM therapies are not a threat to public health).
Scoring system:
The perception scale ranged from agree to disagree, each statement was scored as following: “three” if the response was ”agree”, “two” if it was ”neutral” and “One” if it was ”disagree”. The total score was expressed as a percentage and classified into:
- Positive perception: ≥60% (≥72). -Negative perception: < 60% (<72). where the total grade is 120.
Operational design:
The operational design includes elaboration of the phases of the study, namely preparatory phase, ethical considerations, pilot study, and fieldwork.
Preparatory phase
It included reviewing of related literatures, and theoretical knowledge of various aspects of the study using books, articles, internet periodicals and magazines to develop tools for data collection.
Validity: refers to how well the results among the study participants represent true findings among similar individuals outside the study (Rose & Johnson, 2020).
Tools of data collection was reviewed by a panel of five experts(two of them are professor and two of them is assistant professor of medical surgical nursing, faculty of nursing, Ain Shams University and one of them is professor of psychiatric medicine, Faculty of Medicine for girl, Al-Azhar University) to test validity, clarity, relevance and applicability and little changes in sentence writing were required to give most appropriate meaning and the questionnaire was modified according to their valuable comments.
Reliability phase:
The reliability of the tools refers to how consistently a method measures something (Middelton, 2019) and was done to check its internal consistency through using The Cronbach’s alpha test. The internal consistency of knowledge assessment tool was 0.907 and internal consistency of perception scale was 0.926.
Pilot Study
A pilot study was carried out on 10% of total sample (23 students) to test the clarity and applicability of the study tools. It was done to estimate the period required to fill in the questionnaire, evaluate applicability and clarity of tools and assess feasibility of field work. Questionnaire were not required modifications, so nursing students in the pilot study were included in the total sample of the study.
Field work
An approval was taken from faculty of nursing affiliated to Al-Azhar University and nursing students involved in the study.
Data collection of this study was carried out at the beginning of the first semester in the academic year 2022 -2023 in the period from October 2022 and to end of April 2023.
The researcher obtained the academic schedules and lectures time of every academic year (from first to fourth years) from the study conduct department of nursing faculty.
The researcher meets 226 students who agreed to be involved in the study sample. The researcher introduced herself to all undergraduate nursing students, the purpose of the study and how to fill-in the questionnaire was explained to the students prior to any data collection in order to gain their trust, co-operation and confidence.
Approval was obtained verbally before taking socio-demographic data and explaining misunderstanding questions. The researcher attended in 2 days a week (Sunday and Monday).
The students were assured that information collected would be treated confidentially, and it would be used only for the purpose of the research not for evaluation of curriculum or grade.
The tools of data collection were filled in and completed by the researcher. The study tools filled in and completed by the nursing students.
The students of first academic year were divided into two groups; every group consisted of 22 students, the students of second academic year were divided into 3 groups; every group consisted of 20 students except one consisted of 17 students, the students of the third academic year were divided into 3 groups; every group consisted of 20 students except one consisted of 21 students and students of fourth academic year were divided into 3groups; every group consisted 21students except one consisted of 22 students.
The researcher visited the selected setting two times per week on Sunday and Monday from 10:00 am to 12:00 pm and the researcher collecting the data from each group in an organized time and date.
The researcher was presented to assure that all questions were completed. Filling the tools lasts from 20-30 minutes for each subject included in the study sample.
Collecting data was done in teaching class in the first floor. The academic class was not crowded with students, well ventilated, having all teaching facilities also faculty members were co-operative with the researcher.
Administrative design:
An official approval with written letter clarifying, the purpose and setting of the study was obtained from the dean of faculty of nursing at Ain Shams University and the dean of faculty of nursing at Al-Azhar university in which the study was conducted to obtain permission for data collection during their academic year 2022- 2023. Verbal consent was obtained from each participant in the study and co-operation.
Ethical considerations
• Approval to conduct the study was obtained from the Scientific Research Ethical Committee at Faculty of Nursing, Al-Azhar University.
• The aim of the study was explained to each student before applying the tools to gain their confidence and trust.
• The researcher took written consent from nursing students to participate in the study.
• The study had no physical, social or psychological risks.
• Each student was informed about time throughout the study.
• Maintain confidentially, self-esteem and dignity of nurses.
• Nursing students have Freedom to withdraw from participation in the study at any time.
• All students were assured that this questionnaire has no effect on their academic degree and it will not be added to any of their activities.
Statistical design
The statistical analysis of data was done by using computer Software for excel program 2019 and the statistical package for Social Science (SPSS) Program, version 20 First part of data, were descriptive data, which were revised, coded, tabulated and statistically analyzed using the proportion and percentage, the arithmetic mean, and stander deviation. Second part of statistical analysis was presented as numbers and percentages
- P-value< 0.05 not significance (NS)
- P-value>0.05 significance(S)
- P-value> 0.001 highly significance (HS)
r- test was used to test the association between variables by using the Pearson r- test. Degrees of significance of results were: r-test > zero (1) positive significance.
r- test < zero (-1) negative significance.
Results of the study:
• Regarding sociodemographic characteristics of the studied students 94.3% aged between 18-21 years with Mean± SD 19.23 ± 0.93. As regard to marital status 97.3% of them were single. Also, 89.8% of them were from rural residence.
• Regarding CAM using 78.3% of nursing students used CAM before and 76.0% of them use herbal therapy. Also, 95.5% feel better after using CAM and 97.7% didn’t suffer from any complication after CAM using. In addition, 71.7% of them had family history of CAM using.
• Regarding total Knowledge 28.8% of studied nursing students had satisfactory knowledge about CAM whenever, 71.2% of them had unsatisfactory knowledge.
• Regarding total perception 73.5% of studied nursing students had positive perception towards CAM whenever, 26.5% of them had negative perception.
• Regarding relation between demographic characteristics and total knowledge level among studied nursing students there was no statistically significant difference between total students’ knowledge and their sociodemographic characteristics except for age and educational grade there were highly statistically significant relation (p<0.001**) and for their income, there was statistically significant relation (p<0.05*).
• Regarding relation between demographic characteristics and total perception there was no statistically significant difference between total students’ perception and their sociodemographic characteristics except for age there were statistically significant relation (p<0.05**) and for their educational grade there were highly statistically significant relation (p<0.001**).
• Regarding correlation between total nursing students’ knowledge and their total perception towards CAM there was highly statistically significant positive correlation between total nurses’ knowledge and their total perception regarding CAM (p<0.001**).
Conclusion
Based on the results of the present study, it could be concluded that: less than three quarters of nursing students had unsatisfactory knowledge and had positive perception towards CAM. There was a highly statistically significant positive correlation between total nurses’ knowledge level and their total perception regarding CAM.
Recommendation
In the light of the present study findings the following recommendations are suggested:
• Organize workshops and seminars annually to strengthen nursing students’ knowledge regarding CAM methods in nursing role.
• Raise awareness of health care professionals regarding safety issues and regulation of CAM to get prepared with appropriate knowledge through collaboration and teaching hospitals.
• For nurses to respond to the challenges that the simultaneous use of CAM and conventional medicine cause, curriculum of the future medical personnel could include studies regarding CAM.
Further studies:
• Relation between common believes and behavior of CAM users.
• Uses and effect of cupping therapy on some health conditions.
• Factors affecting application of CAM in health care facilities among patients with chronic diseases.
• Replication of the current study on a larger probability sample is recommended to achieve generalization of the results and wider utilization of the designed instructions.
• More research is required to provide evidence-based practices regarding CAM uses and benefits.