Doctors’ and Nurses’ Attitudes of Acupuncture and Acupressure use in Perioperative Care: An Australian National Survey

Published:September 21, 2022DOI:


      • Positive attitudes among Australian nurses and doctors towards AA use in perioperative care.
      • Perioperative nurses are willing to embrace AA despite a low level of knowledge and personal exposure.
      • Majority of perioperative nurses want AA education.



      Acupuncture and acupressure are not being systematically used in the management of postoperative nausea and vomiting and pain, despite being included in the guidelines.


      To examine the beliefs, attitudes, and knowledge of Australian nurses/midwives and doctors toward the perioperative use of AA for the management of postoperative nausea and vomiting and pain; to explore the barriers and enablers influencing acupuncture and acupressure integration into hospital setting.


      A mixed-mode approach was undertaken for data collection. An online approach was used to recruit respondents from Australian College of Perioperative Nurses. Three hospitals from three different Australian states were selected via convenience sampling.


      A total of 421 usable surveys were included in data analysis. The respondents comprised 14.3% doctors and 72.9% nurses/midwives. Overall, 69.4% were female, 85% were trained in Australia with 35% and 51.4% having knowledge or personal exposure to AA in general respectively. Over 60% of the respondents agreed AA should be routinely integrated into perioperative care, and over 80% would recommend AA to their patients if it was provided at their hospital, and, 75% would be willing to receive further education. The three main reported barriers included: perceived lack of scientific evidence (80.9%), unavailability of credentialed provider (77.2%) and lack of reimbursement (60.4%).


      Positive attitudes are reported by Australian doctors and nurses toward AA. This is despite of low levels of knowledge or personal exposure to AA. Further studies are required to explore the implementation of barriers and address respondent calls for further education.
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      1. Australian Institute of Health and Welfare (AIWH). (2014-2015). Employed specialist, main speciality of practice, selected characteristics [Table 7].

      2. Australian Institute of Health and Welfare (AIHW). (2018). Australia's health 2018: 2.3 Who is in the health workforce? Retrieved Febuary 21, 2022, from

      3. Australian Government Department of Health. (2017). Retrieved May 04, 2021, from factsheet-mdcl-anaesthesia-2016.pdf (

        • Birch S.
        • Lee M.S.
        • Alraek T.
        • Kim T.H.
        Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: A bibliometric analysis.
        Journal of Alternative and Complementary Medicine. 2018; 24: 752-769
        • Campbell G.
        • Lintzeris N.
        • Gisev N.
        • Larance B.
        • Pearson S.
        • Degenhardt L.
        Regulatory and other responses to the pharmaceutical opioid problem.
        Medical Journal of Australia. 2018; 210 (e1): 6-8
        • Cochran W.G.
        Sampling techniques.
        3rd ed. John Wiley & Sons, Hoboken, NJ1977
        • Cohen M.M
        • Peenman S.
        • Pirotta M.
        • Da Costa C.
        The integration of complementary therapies in Australian general practice: Results of a national survey.
        Journal of Alternative and Complementary Medicine. 2005; 11: 995-1004
      4. Department of Health. (2016). Australia's future health workforce-Anaesthesia. Department of Health.

        • Donald G.K.
        • Mackereth P.
        • Tobin I.
        Medical students and acupuncture: A short sharp placement experience!.
        Acupuncture in Medicine. 2010; 28: 12-15
        • Easthope G.
        • Tranter B.
        • Gill G.
        Normal medical practice of referring patients for complementary therapies among Australian general practitioners.
        Complementary Therapies in Medicine. 2000; 8: 226-233
        • Faircloth A.
        Perceptions of Acupuncture and Acupressure by Anaesthesia Providers Ph.D. dissertation.
        Virginia Commonweath University, Richmond, VA2014
        • Faircloth A.
        • Dubovoy A.
        • Biddle C.
        • Dodd-McCue D.
        • Butterworth J.
        Perceptions of acupuncture and acupressure by anesthesia providers: A quantitative descriptive survey.
        Medical Acupuncture. 2016; 28: 79-86
        • Fan Y.A.
        • Miller D.W.
        • Bolash B.
        • Bauer M.
        • McDonald J.
        • Faggert S.
        • He H.
        • Li Y.M.
        • Matecki A.
        • Camardella L.
        • Koppelman M.H.
        • Stone J.A.M.
        • Meade L.
        • Pang J.
        Acupuncture's role in solving the opioid epidemic: evidence, cost-effectiveness, and care availability for acupuncture as a primary, non-pharmacologic method for pain relief and management–White paper 2017.
        Journal of Integrative Medicine. 2017; 15: 411-425
      5. Flanigan, T. S., McFarlane, E., & Cook, S. (2008). Conducting survey research among physicians and other medical professionals – A review of current literature. Retrieved October 18, 2020, from

        • Fincham J.E.
        Response rates and responsiveness for surveys, standards, and the journal.
        American Journal of Pharmaceutical Education. 2008; 72: 43
        • Gan T.J.
        • Belani K.G.
        • Bergese S.D.
        • Chung F.
        • Diemunsch P.
        • Habib A.S.
        • Jin Z.
        • Kovac A.
        • Meyer T.A.
        • Urman R.D.
        • Apfel C.C.
        • Ayad S.
        • beagley L.
        • Candiotti K.
        • Englesakis M.
        • Hedrick T.L.
        • Kranke P.
        • Lee S.
        • Lipman D.
        • Minkowitz H.S.
        • Morton J.
        • Philip B.K.
        Fourth consensus guidelines for the management of postoperative nausea and vomiting.
        Anesthesia & Analgesia. 2020; 131: 411-448
        • Gelman D.
        • Gelmanas A.
        • Urbanaitė D.
        • Tamošiūnas R.
        • Sadauskas S.
        • Bilskienė D.
        • Naudžiūnas A.
        • Širvinskas E.
        • Benetis R.
        • Macas A.
        Role of multimodal analgesia in the evolving enhanced recovery after surgery pathways.
        Medicina (Kaunas, Lithuania). 2018; 54: 20
        • Hah J.M
        • Bateman B.T
        • Ratliff J.
        • Curtin C.
        • Sun E.
        Chronic opioid use after surgery: Implications for perioperative management in the face of the opioid epidemic.
        Anesthesia & Analgesia. 2017; 125: 1733-1740
        • Institute of Medicine (IOM)
        Relieving pain in America: A blueprint for transforming prevention, care, education, and research.
        National Academies Press, Washington, DC2011
        • Jarzyna D.
        • Jungquist C.R.
        • Pasero C.
        • Willens J.S.
        • Nisbet A.
        • Oakes L.
        • Dempsey S.J.
        • Santangelo D.
        • Polomano R.C.
        American Soceity for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression.
        Pain Managment Nursing. 2011; 12 (e10): 118-145
        • Kemppainen V.
        • Tossavainen K.
        • Turunen H.
        Nurses' roles in health prmotion practice: an integrative review.
        Health Promotion International. 2013; 28: 490-501
        • Kidanemariam B.Y.
        • Elsholz T.
        • Simel L.L.
        • Tesfamariam E.H.
        • Andemeskel Y.M.
        Utilization of non-pharmacological methos and the perceived barriers for adult postoperative pain management by the nurses at selected National Hospitals in Asmara, Eritrea.
        BMC Nursing. 2020; 19: 100
        • Kielczynska B.B.
        • Kligler B.
        • Specchio E.
        Integrating acupuncture in an inpatient setting.
        Qualitative Health Research. 2014; 24: 1242-1252
        • Klabunde C.
        • Willis G.
        • McLeod C.
        • Dillman D.
        • Johnson T.
        • Greene S.
        • Brown M.
        Improving the quality of surveys of physicians and medical groups: a research agenda.
        Evaluation & the Health Professions. 2012; 35: 477-506
        • Kreitzer M.J.
        • Mitten D.
        • Harris I.
        • Shandeling J.
        Attitudes toward CAM among medical, nursing, and pharmacy faculty and students: A comparative analysis.
        Alternative Therapies in Health and Medicine. 2002; 8 (50-53): 44-47
        • Langevin H.M.
        • Wayne P.M.
        What is the point? The problem with Acupuncture research that no one wants to talk about.
        Journal of Alternative and Complementary Medicine. 2018; 24: 200-207
        • Lee A.
        • Chan S.K.C.
        • Fan L.T.Y.
        Stimulation of the wrist acupuncture point StePC6 for preventing postoperative nausea and vomiting.
        Cochrane Database of Systematic Reviews. 2015; 11CD003281
        • Manias E.
        • Rixon S.
        • Williams A.
        • Liew D.
        • Braaf S.
        Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings.
        Health Expectations. 2014; 18: 2787-2798
        • Milton C.L.
        Will nursig continue as the most trusted proession? An ethical overview.
        Nursing Science Quarterly. 2018; 31: 15-16
        • Norheim A.
        • Fønnebo V.
        Doctors' attitudes to acupuncture–A Norwegian study.
        Social Science and Medicine. 1998; 47: 519-523
        • Platt M.S
        • Coventry T.
        • Monterosso L
        Perioperative nurses' perceptions of cross-trainingL a qualitative descriptive study.
        Journal of Perioperative Nursing. 2019; 32: 19-25
        • Quinlan J.
        • Rann S.
        • Bastable R.
        • Levy N.
        Perioperative opioid use and misuse.
        Clinical Medicine. 2019; 19: 441-445
        • Richebe P.
        • Capdevila X.
        • Rivat C.
        Persistent postsurgical pain: Pathophysiology and preventive pharmacologic considerations.
        Anesthesiology. 2018; 129: 590-607
        • Rogers E.M.
        Diffusion of innovation.
        5th ed. Free Press, Glencoe, IL2003
      6. Schug, S. A., Palmer, G. M., Scott, D. A., Mark, A., Halliwell, R., & Mott, J. F. (Eds.). (2020). Acute Pain Management: Scientific Evidence (5th ed.). Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine.

        • Sewitch M.J
        • Cepoiu M.
        • Rigillo N.
        • Sproule D
        A literature review of health care professional attitudes toward complementary and alternative medicine.
        Complementary Health Practice Review. 2008; 13: 139-154
        • Shani-Gershoni Z.
        • Freud T.
        • Press Y.
        • Peleg R.
        Knowledge and attitudes of internists compared to medical students regarding acupuncture.
        Isreal Medical Association Journal. 2008; 10: 219-223
        • Shao J.Y.J.
        • Borthwick A.M.
        • Lewith G.T.
        • Hopwood V.
        Attitudes towards traditional acupuncture in the UK.
        Evidence-Based Integrative Medicine. 2005; 2: 37-45
        • Shorofi A.A.
        • Arbon P.
        Nurses' knowledge, attitudes, and professional use of complementary and alternative medicine (CAM): A survey at five metropolitan hospitals in Adelaide.
        Complementary Therapies in Clinical Practice. 2010; 16: 229-234
        • Shorofi S.A.
        Complementary and alternative medicine (CAM) among hospitalised patients: Reported use of CAM and reasons for use, CAM preferred during hospitalisation, and the socio-demographic determinants of CAM users.
        Complementary Therapies in Clinical Practice. 2011; 17: 199-205
        • Simons J.
        • Roberson L.F.
        Parent involvement in children's pain care: views of parents and nurses.
        Journal of Advanced Nursing. 2001; 36: 591-599
        • Stark N.
        • Kerr S.
        • Stevens J.
        Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study.
        Anaesthesia and Intensive Care. 2017; 45: 700-706
        • Steel A.
        • McIntyre E.
        • Harnett J.
        • Foley H.
        • Adams J.
        • Sibbritt D.
        • Wardle J.
        • Frawley J.
        Complementary medicine use in the Australian population: Results of a nationally-respresentative cross-sectional survey.
        Scientific Reports. 2018; 8: 17325
        • Tang X.
        • Shi X.
        • Zhao H.
        • Lu L.
        • Chen Z.
        • Feng Y.
        • Liu L.
        • Duan R.
        • Zhang P.
        • Xu Y.
        • Cui S.
        • Gong F.
        • Fei J.
        • Xu N.-G.
        • Jing X.
        • Guyatt G.
        • Zhang Y.Q.
        Characteristics and quality of clinical practice guidelines addressing acupuncture interventions: A systematic survey of 133 guidelines and 433 acupuncture recommendations.
        BMJ Open. 2022; 12e058834
        • Templemen K.
        • Robinson A.
        • McKenna L.
        Complementary medicine teaching in Australian medical curricula: The student perspective.
        Australian Journal of Nursing Practice, Scholarship and Research. 2018; 25: 421-427
        • Tiralongo E.
        • Wallis M.
        Attitudes and perceptions of Australian pharmacy students towards Complementary and Alternative Medicine - A pilot study.
        Complementary and Alternative Medicine. 2008; 8
        • Vadivelu N.
        • Kai A.M.
        • Kodumudi V.
        • Sramcik J.
        • Kaye A.D.
        The opioid crisis: A comprehensive overview.
        Current Pain and Headache Reports. 2018; 22: 16
        • von Conrady D.M.
        • Bonney A.
        Patterns of complementary and alternative medicine use and health literacy in general practice patients in urban and regional Australia.
        Australian Family Physician. 2017; 46: 316-320
        • Wade D.T.
        • Halligan P.W.
        Do biomedical models of illness make for good healthcare system?.
        BMJ. 2004; 329: 1398-1401
        • Wardle J.L.
        • Sibbritt D.
        • Adams J.
        Acupuncture referrals in rural primary healthcare: a survey of general practitioners in rural and regional New South Wales, Australia.
        Acupuncture in Medicine. 2013; 31: 375-382
        • Waterfield J.
        • Bartlam B.
        • Bishop A.
        • Holden M.A.
        • Barlas P.
        • Foster N.E.
        Physical therapists’ views and experiences of pregnancy-related low back pain and the role of acupuncture: Qualitative exploration.
        Physical Therapy. 2015; 95: 1234-1243
        • Weeks E.M.
        • Trinca J.
        • Zheng Z.
        Knowledge of and willingness to try acupuncture for postoperative nausea and vomiting: An Australian survey of surgical patients.
        Acupuncture in Medicine. 2017; 35: 345-351
        • Yildirim Y.
        • Parlar S.
        • Eyigor S.
        • Sertoz O.O
        • Eyigor X.
        • Fadiloglu C.
        • Uyar M
        An analysis of nursing and medical students' attitudes towards and knowledge of complementary and alternative medicine (CAM).
        Journal of Clinical Nursing. 2010; 19: 1157-1166
        • Zhang N.M.
        • Vesty G.
        • Zheng Z.
        Healthcare professionals' attitudes to integration of acupuncture in Western Medicine: a mixed-method systematic review.
        Pain Management Nursing. 2021; 22: 684-693
        • Zheng Z.
        Acupuncture in Australia: Regulation, education, practice, and research.
        Integrative Medicine Research. 2014; 3: 103-110
        • Zheng Z.
        • Stelmach W.
        • Ma J.
        • Briedis J.
        • Hau R.
        • Tacey M.
        • Atme J.
        • Bourne D.
        • Crabbe J.
        • Fletcher C.
        • Howat P.
        • Layton J.
        • Xue C.C.
        Health professionals’ attitudes towards acupuncture/acupressure for post-operative nausea and vomiting: A survey and implications for implementation.
        Acupuncture in Medicine. 2022;
        • Zhu J.
        • Xu Q.
        • Zou R.
        • Wu W.
        • Wang X.
        • Wang Y.
        • Fangbing J.
        • Zheng Z.
        • Zheng M.
        Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: A systematic review and implications for clinical practice.
        Complementary and Alternative Medicine. 2019; 19: 192