SDS Pain Management-Complementary therapies offer pain control options
Therapeutic touch, healing touch, and Reiki enhance patient care
Pain management is increasingly recognized as a significant part of the postoperative recovery as evidenced by the recent inclusion of pain management standards for accreditation by the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL. (See pain management standards, p. 4.)
Although the majority of pain management is handled with traditional medical methods such as medication, some same-day surgery programs are exploring the use of complementary therapies to help patients manage the anxiety preceding surgery and the pain following surgery.
Often the referrals are from nurses, physicians, or the patients themselves, who describe the pain they are experiencing.
"Same-day surgery patients are ideal candidates for complementary therapies because they are healthy people who want to maintain control over their treatment and generally don't like to take drugs," says Carolyn Bartlett, RN, MS, staff nurse on the same-day surgical unit at Massachusetts General Hospital in Boston.
At Massachusetts General, nurses who are trained in Reiki, therapeutic touch, or positive imagery work with same-day surgery patients at the time they come in for preadmission and pre-op teaching or on the day of surgery, says Bartlett. (See definitions of therapies, p. 2.) Pre-op nurses have handouts that explain different therapies, and they can discuss complementary therapies with patients, she says.
Several same-day surgery nurses have been trained for therapeutic touch, and each day one nurse serves as the "on-call" therapeutic touch provider, says Bartlett. On the day of surgery, nurses give treatments before or after surgery, to help the patient relax and reduce pain.
The program has evolved from the bottom up with nurses providing the therapy on an informal basis and receiving positive reinforcement from patients, says Bartlett. "Because we have had good feedback from patients, we are now starting to formalize the program and introduce protocols," she says. Some physicians refer patients to Bartlett, but most of the referrals come from nurses, she adds.
The program at DeKalb Medical Center in Decatur, GA, is more formalized, says Kas Sheehan, RN, CHTP, healing touch practitioner. Same-day surgery patients benefit from healing touch and similar therapies most when the treatments can be applied in small doses before and after surgery, she says. "The wonderful thing about healing touch is that family members can easily be taught some techniques that will relax the patient before surgery and reduce pain after surgery," she explains.
While the complementary therapy program at Massachusetts General is based within the same-day surgery program, DeKalb's healing touch and other complementary therapies are offered as part of an overall complementary medicine program at the facility. The therapy is scheduled through and performed within the medical center's Wellness Center, says Sheehan.
"It is ideal to be within the Wellness Center because patients don't have to have a nurse or physician referral to access our services," she explains. Patients learn of the therapies from nurses and some physicians and through literature offered during pre-op teaching. While patients often will ask for a particular modality, the practitioner will suggest other treatments if the patient does not respond to the treatment they requested, she says.
Because third-party payers generally don't reimburse for complementary therapies, Sheehan's patients pay for the therapy themselves. Sheehan's charge for healing touch is $60 per hour. At Massa-chusetts General, staff nurses provide the therapy as part of their care of the patient and don't bill separately for the service.
"We see this as a value-added service for our patients that can set us apart from other same-day surgery programs, and patients experience less pain postoperatively," says Bartlett. (For information on complementary therapies and postoperative pain, see recommended reading list, p. 2.)
Research supports the use of complementary therapies, says Sheehan. Patients who receive training in positive imagery, meditation, or energy techniques such as healing touch before surgery experience a boost to their immune system and are more relaxed, she says. Therapy following surgery results in less wound pain and a faster recovery, she adds.1
If you want to evaluate adding a complementary therapy pain management program to your same-day surgery program, Bartlett and Sheehan offer these suggestions:
• Evaluate financial impact. Take a look at your payers' policies, because you might have a payer that will reimburse for complementary therapies in some instances, says Bartlett. Even if no one reimburses for the therapy now, see if the addition of the service will make your program more appealing than a competitor's program that doesn't offer complementary therapies, she says.
• Obtain physician support with scientific data. Use the research that exists in medical and professional publications to present your case to physicians, says Bartlett. Anecdotal information and patient feedback alone won't convince most physicians that there is scientific support for the therapy, she adds.
• Develop protocols. Not only should your protocols include credentialing requirements for nurses or other practitioners, but you also should be specific about charting requirements to document therapy provided, says Sheehan. "Organizations such as Healing Touch International and Nurse Healers-Professional Associates International can be valuable resources for models and examples," she adds. (See resource box, at left, for contact information.)
• Offer a variety of therapies. Different therapies work for different people, says Bartlett. For this reason, offer a variety of complementary therapies so patients can choose a therapy with which they feel most comfortable, she suggests.
Reference
• P. Huddleston. Prepare for Surgery, Heal Faster: A Guide to Mind-Body Techniques. Cambridge, MA: Angel River Press; 1996.
• The Agency for Health Care Policy and Research. Acute pain management can be improved. JAMA 1992; 267:2,580.
• Good M. Effects of relaxation and music on postoperative pain: A review. J Adv Nurs 1996: 24:905-914.
1. Wirth D. The effects of on-contact therapeutic touch on the healing rate of full thickness dermal wounds. Subtle Energy 1990; 1:1-20.
For more information about complementary therapy pain management programs, contact:
• Carolyn Bartlett, RN, MS, Staff Nurse, Same-Day Surgical Unit, Massachusetts General Hospital, P.O. Box 199, Rowley, MA 01969. E-mail: [email protected].
• Kas Sheehan, RN, CHTP, Healing Touch Practitioner, Complementary Medicine Program, DeKalb Medical Center Wellness Center, 2701 N. Decatur Road, Decatur, GA 30033. Telephone: (404) 501-2222. E-mail: [email protected].
For information and resources about therapeutic touch and healing touch, contact:
• Healing Touch International, 12477 W. Cedar Drive, Suite 202, Lakewood, CO 80228. Telephone: (303) 989-7982. Fax: (303) 980-8683. E-mail: [email protected]. Web site: www.healingtouch.net.
• Nurse Healers-Professional Associates International, 11250-B Roger Bacon Drive, Suite 8, Reston, VA 20190. Telephone: (703) 234-4149. Fax: (703) 435-4390. E-mail: nh-pai@ drohanmgmt.com. Web site: www.therapeutic-touch.org.
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