. . . to a study investigating the midwifery use of complementary therapy in the care of women. If you have actively practiced midwifery within the last 12 months--you are invited to participate in . . .

Complementary therapy (CT) can be defined as non-orthodox treatments whose therapeutic explanations usually lie outside the traditional Western biomedical model. The National Center for Complementary and Alternative Medicine (NCCAM) categorizes many common health practices as forms of CT. Included in the NCCAM taxonomy are chiropractic manipulation, massage, herbs and nutritional supplements.
This study examines the inclusion of complementary therapy in the practice of certified nurse midwives and certified midwives. If you would like to participate, please complete the survey that follows and then click "Submit" at the bottom of the webpage.

To help you decide if you would like to participate in this study, we would like you to know:

• Your participation in this study is strictly voluntary. If you decide to take part, you may anonymously withdraw at anytime by either selecting the "Reset" button at the bottom of the survey or by just leaving the webpage;
• Any information that you give will be essentially anonymous. The only identifying data we receive about participants is an "IP Address" (e.g., 129.11.29.40). This is usually assigned randomly by your Internet Service Provider to identify which of the its computers is transmitting your responses;
• The information submitted by this website in un-encrypted. There is a slight risk of lack of confidentiality when conveying un-encrypted responses over the Internet. For instance, hackers might be able to access the information being transmitted over unsecured telephone lines. Also, the IP address which is automatically transmitted to the investigators may be identifiable;
• There are no tangible benefits from participating in this study; and
• Your consent is indicated by the transmission of your responses to the survey.
• Please submit only one response (:->).

1. From the box below please select the state, province or other location where you are licensed to practice midwifery :
   Alaska Alabama Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Maryland Maine Manitoba Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick Newfoundland New Hampshire New Jersey New Mexico New York Nova Scotia North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other ( in box below, please type where ) (Note: this study is focused on the US and Canada. However, if you are practicing outside of either nation, please select "Other" and then, in the box below, type the country where your are licensed to practice)
   Other:
   

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2. Please select your ETHNICITY (If it is not listed, please type your response in the box after "Other"):
   Select one . . . Asian Black Hispanic Native American White (not Hispanic) Other
   Other:
   

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3. What is your AGE?
   

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4. What is your HIGHEST EDUCATIONAL PREPARATION? (Please check all that apply)
   RN, Associate Degree in Nursing
   RN, Diploma
   RN, Bachelor of Science in Nursing
   Master of Science in Nursing
   Certified Midwife (without any nursing education)
   Doctorate in Nursing (PhD, DNSc, DN)
   Other:(please type your response)
   

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5. How many YEARS have you PRACTICED MIDWIFERY since being certified?
   years (please round-off your response to the closest year--e.g., 1, 2, etc.)

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6. Do you PERSONALLY USE any form of complementary therapy for wellness-related benefits?

   NO (if no, are you interested about complementary therapies for your practice? YES NO)
   YES (if yes, what form(s)? )

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7. Please select one of the following:
   Within the past 12 months, I HAVE NOT PRACTICED OR ADVISED my clients to use one or more forms of COMPLEMENTARY THERAPY.
   (If you selected this response, please go to the bottom of the survey now and select"SUBMIT")
   Within the past 12 months, I HAVE PRACTICED OR ADVISED my clients to use one or more forms of COMPLEMENTARY THERAPY.
   (Please continue with survey)

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8. Do you DOCUMENT the administration or suggestion of COMPLEMENTARY THERAPIES to a client IN THE MEDICAL RECORD?
   NO
   YES
   

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9. Does your facility HAVE PROTOCOLS OR CLINICAL GUIDELINES that address COMPLEMENTARY THERAPY?
   NO
   YES
   

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10. Do you have FORMAL TRAINING OR CERTIFICATION to practice a form of complementary therapy?
    NO
    If YES, select all that apply:

    Formal Training in:
    Certification in:
    

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11. If you responded that you "have" practiced or advised your clients to use one or more forms of complementary therapy within the past 12 months, please complete the cooresponding number of sections (A-E) below (using the following instructions):

• "Practiced/Advised ComplementaryTherapy . . .":
  From the "pull-down" menu, select a complementary therapy which you have administered or advised to a client in the past 12 months. If the therapy is not listed, type its name in the "Other" text box.
• "Indications":
  Describe the clinical signs/symptoms for which you have performed or suggested the CT selected.
• "Expected Outcome":
  Describe the results you anticipated from administering/suggesting the CT.
• "Actual Outcome":
  Describe the manifestations you have actually observed resulting from the administered/suggested CT.

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  1. Practiced/Advised Complementary Therapy (CT) "A"

     Select one . . . Acupressure Acupuncture Aroma Chiropractic Herbal Homeopathy Hypnosis Imagery Magnetic Massage Therapeutic Touch Other
     Other CT:
     
     Indications:
     
     Expected Outcome:
     
     Actual Outcome:
     

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  2. Practiced/Advised Complementary Therapy (CT) "B"

     Select one . . . Acupressure Acupuncture Aroma Chiropractic Herbal Homeopathy Hypnosis Imagery Magnetic Massage Therapeutic Touch Other
     Other CT:
     
     Indications:
     
     Expected Outcome:
     
     Actual Outcome:
     

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  3. Practiced/Advised Complementary Therapy (CT) "C"

     Select one . . . Acupressure Acupuncture Aroma Chiropractic Herbal Homeopathy Hypnosis Imagery Magnetic Massage Therapeutic Touch Other
     Other CT:
     
     Indications:
     
     Expected Outcome:
     
     Actual Outcome:
     

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  4. Practiced/Advised Complementary Therapy (CT) "D"

     Select one . . . Acupressure Acupuncture Aroma Chiropractic Herbal Homeopathy Hypnosis Imagery Magnetic Massage Therapeutic Touch Other
     Other CT:
     
     Indications:
     
     Expected Outcome:
     
     Actual Outcome:
     

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  5. Practiced/Advised Complementary Therapy (CT) "E"

     Select one . . . Acupressure Acupuncture Aroma Chiropractic Herbal Homeopathy Hypnosis Imagery Magnetic Massage Therapeutic Touch Other
     Other CT:
     
     Indications:
     
     Expected Outcome:
     
     Actual Outcome:
     

Finally, if you have any comments or questions that you would like included with your responses, fill free to type them in the following text field:

When you have completed the survey, please select "SUBMIT" below. Once your responses have been received, a computer-generated screen "Thank You" will appear.

The results of this study should begin to be posted on this page by late November, 1999, so bookmark it now for a speedy return, and once again--Thank you!!

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