Essay/Term paper: Therapeutic touch : its effectiveness on surgical incision site pain

Essay, term paper, research paper:  Medicine

Therapeutic Touch : Its Effectiveness On Surgical Incision Site Pain


INTRODUCTION

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 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 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 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.

CONCEPTUAL FRAMEWORK

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 Hungler, 1993).

RESEARCH HYPOTHESIS

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.

METHOD

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. 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.

DEFINITIONS

"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

RESEARCH DESIGN


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 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 scientific study
*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)

SUMMARY

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 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.

REFERENCES

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).
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bereaved recipients: A pilot study. Advances in Nursing Science, 15, (4), 13-26.