Anesthesia Alert: Easing Anxious Patients

Pre-op anxiety in patients is a common medical concern that is often ignored. Reducing preoperative anxiety is a key indicator of postoperative outcomes. When a patient feels anxious, their hormone levels become elevated, and they can wake up from surgery feeling increased levels of pain. If it is addressed and taken seriously, an anesthesia provider will typically employ pharmacological interventions such as midazolam, diazepam, ketamine or fentanyl prior to wheeling a patient back to the operating room. Therapeutic touch offers a natural alternative to help patients relax as they’re waiting for surgery.

Therapeutic touch is a contemporary interpretation of several ancient laying-on-of-hands healing practices that was developed by Delores Krieger, PhD, RN, professor emeritus of nursing at New York University, and Dora Kunz, an energy healer, in the 1970s. It is a holistic, evidence-based therapy that incorporates the intentional and compassionate use of universal energy to promote balance and well-being and represents a consciously directed process of energy exchange during which the practitioner uses the hands as a focus to facilitate the process. This method works by altering the body’s energy, nervous system and associated physiological processes to reduce feelings and symptoms of anxiety. Therapeutic touch does involve gentle touching. In a preoperative context, it can be integrated as part of the preoperative assessment and evaluation, as a component of preoperative education and preparation and as needed or requested by a patient.

Here’s the framework for the healing process:

• Preparation. The practitioner moves into therapeutic presence by centering, grounding, attuning and setting intention.
• Assessment. The practitioner collects subjective, objective and subtle energetic data by talking to the patient, observes physical presentation, patterns and energy fields, and centers using hands, a pendulum or higher- sense perception.  
• Problem identification. The practitioner draws a conclusion, based on the assessment, regarding the patient’s response to actual or potential health conditions or needs.
• Mutual goals. In collaboration with the patient, the practitioner addresses and prioritizes each problem identified by setting measurable and achievable goals.
• Planning. For each goal identified, the practitioner selects a technique or set of techniques that provides a rational basis for implementation in the present circumstance.
• Intervention. The practitioner implements the techniques identified to meet the mutual goals, documenting the techniques used and the subtle energetic shifts noted during the intervention. At the conclusion of the intervention, the practitioner grounds the patient and consciously releases the field.
• Evaluation. The practitioner uses data collected through the session to determine the achievement of the mutual goal outcomes.

Therapeutic touch interests me because it can be nurse-driven if they receive the proper training. I attended a weekend therapeutic touch training session at a local hospital that was taught by a nurse who works in an infusion clinic and who uses the technique to calm patients receiving chemotherapy. By the end of the weekend, I became certified in level one therapeutic touch, which teaches you how to identify different stressors or stress points and how to feel for different tensions in the human body.

There are a total of four levels, and with each graduating level you receive more time to practice and more education to the point where you can also become an instructor. Keep in mind that accessibility and availability of practitioners trained in therapeutic touch may be limited. Do your research to find a certified and reputable instructor. Also, not all patients will be open to alternative interventions. Educate them on the possible benefits and be sure they understand all the steps that are involved.

Therapeutic touch interests me because it can be nurse-driven if they receive the proper training.

Nurses in the preoperative setting are often not trained to assess patients for preoperative anxiety. And while alternative therapies such as aromatherapy, guided imagery and mindfulness are more commonplace, they are still not the norm. Having non-pharmacological options is especially important in treating patients from diverse backgrounds. For example, veterans are often dealing with post-traumatic stress disorder, and making them feel safe is key to making sure they do not opt out of care that they desperately need. Therapeutic touch can also help manage post-op pain, wound care and integrative health care in chronic illness.

My goal is to work with patients to implement therapeutic touch in the days leading up to surgery, rather than on the day of surgery. The scene when a patient is admitted for surgery is often busy and hectic, and rushing through a therapeutic touch session would not be beneficial. However, studies have shown that a patient can achieve some benefits from therapeutic touch in as little as 10 minutes.

Don’t be quick to reject alternative therapies because, believe it or not, patients prefer to hear about treatment options and are typically open to trying new approaches. You might be surprised at how accepting patients are to therapeutic touch therapy because a gentle touch can be just what they need to calm their nerves. Surgery is a significant experience in someone’s life, and making a patient feel safe is just as important as keeping a patient safe through their continuum of care. OSM