• Nancy Ming Zhang, Gillian Vesty, and Zhen Zheng.
• School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Australia. Electronic address: Nancy.Zhang@acu.edu.au.
• Pain Manag Nurs. 2021 Dec 1; 22 (6): 684-693.

BackgroundAcupuncture is practiced in many Western countries with increasing evidence supporting its use across the healthcare system. However, this nonpharmacological intervention is yet to be widely integrated into hospitals. Fundamental to the integration of any innovation into healthcare systems is the attitudes of healthcare professionals.AimsTo explore healthcare professionals' attitudes towards acupuncture and identify the enablers and barriers to integration in the hospital setting.DesignThis review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines; we conducted a mixed-method systematic review following Joanna Briggs Institute Reviewer's Manual 2017.Data SourcesPubMed, CINAHL, AMED, EMBASE, Cochrane Library, and SCOPUS were searched from their inception to December 2019 using different combination of keywords.MethodsAttitude and perception data were extracted from the articles and constructs were categorized as barriers and enablers. A convergent integrated approach was adopted whereby qualitative data themes were integrated with quantitative data constructs to generate descriptive codes around enablers and barriers at intrapersonal, interpersonal, and environmental levels according to the framework proposed by Manias et al. (2014).ResultsTwenty-six studies comprising 19 survey and seven interview studies were identified, with 24 articles (92%) reporting positive attitudes, supporting the integration of acupuncture into Western medicine. Enablers identified were prior positive experience, belief in the treatment's efficacy, and patient demand. Barriers were lack of evidentiary knowledge or experience; lack of resources such as time, providers, and funding; and paradigm differences. Twenty studies (77%) focused on medical doctors or medical student perceptions. A conceptual framework for implementing and integrating acupuncture into Western medicine is proposed.ConclusionHealthcare professionals' attitudes to acupuncture are positive. Barriers to integrating acupuncture into the hospital system exist at intrapersonal, interpersonal, and external levels, with lack of resources being the key barrier. Nurses' role in facilitating integration into Western medical pain management practice provides an avenue for future research. The proposed conceptual framework provides guidance for nursing researchers interested in the role of acupuncture and integrated medicine in patient-centric, value-based healthcare.Copyright © 2021 Elsevier Ltd. All rights reserved.

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