Therapeutic Touch Essay, Research Paper

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

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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

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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

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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

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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.

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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

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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

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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

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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

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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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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). Psychoimmunologic effects of therapeutic touch on practitioners and

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