Therapeutic Touch 1
Therapeutic touch has been shown to decrease patients anxiety levels and increase their pain tolerance levels when other more mainstream therapies have not been completely effective. "Therapeutic touch is a process by which energy is transmitted from one person to another for the purpose of potentiating the healing process of one who is ill or injured." (Heidt, 1981; Krieger, 1979; Lionberger, 1985; Randolph, 1984; Kramer, 1990). In my capacity as a nursing student on a medical- surgical unit, I have noticed an increase in pain medication requests among patients with incision site pain and a minimal use of alternative therapies for this pain management. With the use of therapeutic touch nurses can regain a closeness with patients and also have a direct effect on their pain level. Therefore the purpose of this study will be to determine if therapeutic touch is an effective intervention for patients experiencing surgical incision site pain within the first forty-eight hours after surgery.
PROBLEM STATEMENT The question posed for study is: "Is therapeutic touch an effective intervention for decreasing a patients surgical site pain within the first forty-eight hours after surgery?". The independent variable is therapeutic touch. The dependant variable is decreasing surgical site pain. The population to be studied will be patients on a thirty bed medical-surgical floor of a Lake Charles hospital. Fifty surgical patients will be studied over a four week period. The patients will be randomly selected to avoid any bias by the researcher.
SIGNIFICANCE OF THE PROBLEM "... therapeutic touch is a nursing intervention that has the potential for eliciting a state of physiological relaxation in patients and for decreasing patients anxiety" (Heidt, 1991). The use
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of therapeutic touch is very important to the nursing community. The need for immediate intervention in acute or chronic pain could be handled at the bedside with no need to await a doctor's order for pharmacological intervention. Anxiety could be lessened to let patients rest more comfortably in the stressful hospital environment. Also teaching could be enhanced in the less anxious and more pain free client. A client that is admitted to the hospital for surgery may not get all the rest needed for proper recovery and healing due to inadequate pain relief from pharmacologic interventions. The need for more in depth research and application in the field of therapeutic touch as a nursing intervention is essential.
REVIEW OF LITERATURE In preparing to undertake this research, various forms of literature must be examined. In a study done by Nancy Ann Kramer, MSN, RN on therapeutic touch and casual touch stress reduction of hospitalized children (1990), her study supported the use of therapeutic touch. She states "... the intervention of therapeutic touch will more quickly reduce the child's stress and provide comfort for a longer time, which eventually may decrease the hospital stay and decrease nursing work.". The author states that more research may need to be done with a larger sample and a wider range of patient stressors to further support the use of therapeutic touch in a clinical setting. She used a sample of thirty children ages two weeks to two years old.
In the next study, done by Patricia R. Heidt, RN, PhD, "Helping patients to rest: Clinical studies in therapeutic touch"(1991), she studied patients who wanted help with pain relief. Her main reason for this was to increase the "descriptive data on patient care" so further research could be done and therapeutic touch could be applied in nursing interventions. The strength of this study came from its in depth look at two case studies and how the therapeutic touch was
Therapeutic Touch 3
used on two specific patients. The case studies gave an in depth look at the patients history and treatment and out comes after therapeutic touch was used. It also explained the settings and exactly what was done step-by-step through the therapeutic touch treatment by Heidt herself. The weakness of this study was also its strength. It had a very narrow focus and was not applied to a large group.
In a study, done by Janet F. Quinn, RN, PhD, FAAN and Anthony J. Strelkauskas, PhD, named "Psychoimmunologic effects of therapeutic touch on practitioners and recently bereaved recipients: A pilot study"(1993), they wanted to identify the variations and "address conceptual inconsistencies...in previous Therapeutic Touch research...". The study was done with two therapeutic touch practitioners and four recently bereaved patients. They wanted to determine if there was a correlation between who received the therapeutic touch and who applied the therapeutic touch. Their study supported the use of therapeutic touch on practitioners and others who are bereaved and how therapeutic touch can increase white blood cell response. The weaknesses of this study were: that a short time frame was used (two weeks) and a small sample of practitioners and recipients was used. The strength of this study flowed from its use of
descriptive language and its ease of obtaining bereaved subjects for use in the study.
In the following study, " Effects of Therapeutic Touch on Tension Headache Pain" (1986), done by Elizabeth Keller and Virginia M. Bzdek they reviewed a sample of sixty volunteers from ages eighteen to fifty-nine that experience tension headaches. Their study supported the use of therapeutic touch in tension headache pain. They used a large sample population and various testing components for grading pain and relief of pain. I find this to be the strength of this study. A weakness of this study was its non-use of any pharmacological
Therapeutic Touch 4
intervention and also the total subjectiveness of a person's pain rating. It also did not rule out whether any of the subjects had ever previously tried alternative therapies for their headache pain.
In summary, the results of the literature seem to support that therapeutic touch is an effective intervention, whether for pain, stress, or anxiety. The literature also suggests that use of therapeutic touch can aid in recovery of a patient's physiological and psychological homeostasis. The literature reviewed has set the base for the proposed study: To determine if therapeutic touch is an effective nursing intervention for surgical site pain in the hospitalized patient.
Rogers' model of the unitary person provided the theoretical framework for this study. "Rogers' model (1986) focuses on the individual as a unified whole in constant interaction with the environment. The unitary person is viewed as an energy field that is more than, as well as
different from, the sum of the biologic, physical, social, and psychological parts." (Polit and Hungler , 1993).
Therapeutic touch allows the patient to be seen as "more than a sum of the parts". The
use of therapeutic touch gives the patient an alternate course of treatment when others have failed or are ill suited for other interventions such as intramuscular narcotics due to allergies or increased risk of infection. Therapeutic touch is said to work with the interaction between energy fields of the healer and patient. When an incision is made into a person's body, it disrupts this energy field. A nurse with experience in therapeutic touch could help rectify this disruption and "...help people achieve maximum well-being within their potential." (Polit and
Therapeutic Touch 5
1. There is a relationship between the use of therapeutic touch on a patient with incisional site pain and decrease in the use of narcotic analgesia.
The sample will be taken from a thirty bed medical-surgical floor of a Lake Charles, Louisiana hospital. Fifty surgical patients will be studied over a four week period. Inclusion criteria: all the subjects must have an incisional site and be on some prescribed narcotic
analgesia for pain relief. They must be able to rate their incisional pain verbally on a scale of one to ten with ten being the most excruciating pain they ever felt in their life and zero being no pain at all.
Twenty-five patients will be given a placebo therapeutic touch treatment within five minutes of their request for pain medication. The treatment will last for five minutes then the patient will be asked to rate their pain level again. Next, the prescribed analgesia will be given and the patient's pain level will be assessed again in thirty minutes.
Twenty-five patients will receive the actual therapeutic touch treatment within five minutes of their request for pain medication. The treatment will last for five minutes and then the patients will be asked to rate their pain level again. The prescribed analgesia will then be administered, and the patient's pain level again will be assessed in thirty minutes.
In both groups no actual physical contact will be made. Deep breathing and a quiet atmosphere will be required with both groups. Neither group will know whether they are the placebo or actual therapeutic group. They will be assigned by using a random selection table.
Therapeutic Touch 6
All participants will be required to sign a written informed consent form. This will include the stipulation that if at any time they do not want to participate in this study, then they may remove themselves from it.
"Therapeutic touch is an intervention that is a derivative of laying-on of hands, during
which it is assumed that the practitioner knowingly participates in the repatterning of the recipient's energy field for the purpose of helping or healing the person. In treating a person with therapeutic touch, the practitioner: makes the intention mentally to therapeutically assist the subject; moves the hands over the body of the subject from head to feet, attuning to the condition of the subject by becoming aware of changes in sensory cues in the hands; redirects areas of accumulated tension in the subject's energy field by movement of the hands; and focuses attention on the specific direction of energies to the subject using the hands as focal points. " (Quinn and Strelkauskas, 1993).
The pain rating scale to be used will consist of numbers zero to ten with ten being the most excruciating pain ever felt by the subject and zero being no pain at all. Since pain and this scale are both subjective in nature, their validity and reliability are compromised.
The pain rating scale is defined as the following:
*0-2 No therapeutic intervention needed relate to a mild headache
*2-5 Mild analgesia needed for pain relief equivilent to two Tylenol for pain relief
*5-7 Medical intervention required for adequate pain relief, oral narcotics
*7-10 Strong narcotic analgesic needed for pain relief, intraveneous or intramuscular administration
Therapeutic Touch 7
The design used for this study will be a before- after design. It will study the subjects' level of pain before the use of therapeutic touch, after therapeutic touch treatment, and also after
the use of a narcotic analgesia. The reason for selecting this design is its simplicity. Half of the fifty patients will be randomly chosen as a control group. Observation of the dependant variable will be taken at those points in time as listed above. It will allow us to examine the changes of the patients response before and after the therapeutic touch treatment. SAMPLE The study subjects will be fifty surgical patients from a thirty bed medical-surgical floor at a Lake Charles hospital over a four week period. Each patient will have to meet the following criteria for the study:
1. The patient must have experienced an uncomplicated surgery.
2. The patient must have a surgical incision of at least two inches in length.
3. The patient must have some narcotic analgesia ordered for post-operative pain control.
4. The patient must be admitted into the hospital for a stay of greater than forty-eight hours after surgery.
5. The patient must sign a consent form to participate in the study.
6. The patient must be between the age of eighteen and thirty years old.
The sample will include both male and female subjects. The nursing staff will identify candidates for this study when admitted to the post-operative surgery floor from the post- anesthesia care unit. If the patient cannot read the staff can read the consent to the patient. After
Therapeutic Touch 8
verbalizing understanding of the consent, the staff member and one witness can sign the consent form for the patient. If the patient meets this criteria noted above they will be asked to sign a consent to participate in the study.
HUMAN RIGHTS PROTECTION
Freedom from harm will be assured by the giving of pain medication promptly after the therapeutic touch treatment. The nurse will respond within five minutes with the therapeutic
touch treatment that will last five minutes. If the patient still requests pain medication after the therapeutic touch treatment, it will be administered. If at any time the patient cannot wait for the narcotic analgesic until after the therapeutic touch treatment, it shall be administered. This will effectively remove the subject from this study.
The subjects will have the benefits of this study explained to them before participating in it. The risks are minimal as all that will be introduced is the therapeutic touch treatment. The use of narcotic analgesia will still be an option for the patient and will not be withheld if asked for before the therapeutic touch treatment is over. The benefit of this study will be enhanced knowledge for the use of pain management without or in conjunction with pharmacological measures in the post-operative period.
The subjects will have the right to decide to join the study voluntarily. There will be no penalties or prejudicial treatment for not joining the study or for leaving the study at any time before it is over.
The subjects will have full knowledge of the study to be performed and will have to sign a consent from which will include the following:
"*The fact that the data provided by or obtained from the subjects will be used in a Therapeutic Touch 9
*The purpose of the study
*The type of data to be collected
*The nature and extent of the subjects' time commitment
*The procedures to be followed in collecting the research data
*How subjects came to be selected
*Potential physical or emotional discomforts or side effects
*If injury is possible, an explanation of any medical treatments that might be available
*Potential benefits to subjects (including whether or not a stipend is being offered) and potential benefits to others
*A description of the voluntary nature of participation and the right to withdraw at any time without penalty
*A pledge that the subjects' privacy will at all times be protected
*The names of people to contact for information or complaints about the study". (Polit and Hungler 1993)
The use of therapeutic touch treatment in a clinical setting is a growing trend all over the world today. Therapeutic touch was derived from many ancient healing arts. In its contemporary form, therapeutic touch was developed by Dolores Krieger, Ph.D., RN., and her mentor, Dora Kinz, in the early 1970s.
Research has shown that therapeutic touch is effective in promoting relaxation and reducing anxiety; changing the patients perception of pain; and in restoring the body's natural
Therapeutic Touch 10
processes. The importance of therapeutic touch to nursing is tremendous. Nurses must use a holistic approach to healing. The only way to succeed with this is by using all the tools that can
be used. Therapeutic touch is being supported and taught in many nursing schools in Canada. It is put into practice in a wide range of settings from nursing homes to stress reduction of the
nursing staff themselves to reduce "burnout".
Research indicates that therapeutic touch does produce significant levels of effective healing. The continued research in therapeutic touch and its use is essential.
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Heidt, P.R. RN,PhD, (1980). Effect of therapeutic touch on anxiety level of hospitalized patients. Nursing Research, 30, (1), 32-37.
Heidt, P.R. RN,PhD, (1991). Helping patients to rest: Clinical studies in therapeutic touch. Holistic Nursing Practice, 5, (4), 57-66.
Hill, L. PhD, RN, Oliver, N., PhD, RN., (1993). Therapeutic touch and theory-based mental health nursing. Journal of Psychosocial Nursing, 31, (2), 19-22.
Keller, E., MSN,RN-C, Bzdek, V.M., PhD, RN, (1986). Effects of therapeutic touch on tension headache pain. Nursing Research, 35, (2), 101-106.
Kramer, N.A., MSN, RN, (1990). Comparison of therapeutic touch and casual touch in stress reduction of hospitalized children. Pediatric Nursing, 16, (5), 483-485.
Mathews, K.M., RN, MN, SCM, (1991). Mothers' satisfaction with their neonates' breast feeding behaviors. Journal of Gynecological and Neonatal Nursing, 20, (1), 48-55.
Polit, D.F., PhD, Hungler, B.P., RN,PhD, (1993). Essentials of nursing research methods,
appraisal, and utilization (3rd ed.). Philadelphia: J.B. Lippincott company.
Publication manual of the american psychological association (6th ed.). (1995).
Washington D.C.: American Psychological Association.
Quinn, J.F., RN, PhD, FAAN, Strelkauskas, A.J., PhD, (1993). Psychoimmunologic effects of therapeutic touch on practitioners and recently bereaved recipients: A pilot study. Advances in Nursing Science, 15, (4), 13-26.
Therapeutic touch : its effectiveness on surgical incision site pain
December 2, 1996
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