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Therapeutic Touch, Quiet Time, and Dialogue: Perceptions of Women With Breast Cancer
Abstract
To compare the perceptions of women with breast cancer to an experimental therapeutic touch (TT) plus dialogue nursing intervention with perceptions of a control quiet time plus dialogue nursing intervention.
Qualitative study based on the Science of Unitary Human Beings. Setting: Data collected as part of a larger experimental study of the effects of TT on pre- and postoperative anxiety and mood and postoperative pain in women with breast cancer.
18 women with early-stage breast cancer.
Telephone interviews at the completion of an experimental or control nursing intervention administered in the women's homes before and after breast cancer surgery.
Women's perceptions of participation in a study of the effects of dialogue and TT or quiet time.
Content analysis of transcribed telephone interviews revealed few differences in participants' perceptions of experimental and control interventions. Only participants who received the experimental intervention reported body sensations, and only participants in the control group inquired about the study and its purpose. Regardless of experimental or control intervention participation, women expressed feelings of calmness, relaxation, security, and comfort and a sense of awareness. The few women who commented about the nurse who administered the experimental or control intervention indicated that the nurse was empathetic, concerned, supportive, or helpful.
The women regarded either nursing intervention as a positive experience. Some also expressed positive regard for the research nurse.
Nurses who are not trained in the administration of TT may use quiet time and dialogue to enhance feelings of calmness and relaxation in patients with breast cancer.
... Concerning cancer related symptoms, the included studies focused primarily on energy healing as a way of diminishing pain, fatigue, depression, anxiety and nausea. Indication of effectiveness concerning the ease of pain was found in 6 studies [9][10][11][14][15][16]. Olson et al. [15] reported a significant drop in pain in the treatment group on day 4 (from 3.9 to 2.4 on the visual analogue scale (VAS)) immediately after treatment (p = 0.002). ...
... Two studies concluded that there was no significant change in pain perception [9,14]. Kelly et al. [16] reported that patients subjectively experience and report a decrease in pain. A significant reduction in fatigue was reported in one trial [11] and a non-significant reduction in another [14]. ...
... The trials included in this review indicate that there might be positive effects of energy healing on pain, fatigue, well-being and quality of life, while there were only mixed or no results concerning anxiety, physical indicators and medication. Five quantitative studies [9-11, 14, 15] and one qualitative study [16] reported on effectiveness and efficacy concerning pain; of these 3 studies noted a significant pain reduction [10,11,15]. However, the changes are moderate or marginal, and no change in pain medication could be demonstrated. ...
This article explores the evidence base of efficacy and effectiveness of 'energy healing' for cancer patients. The term 'energy healing' refers to a wide variety of therapies which are based on the premise that the healer transfers energy to the patient. Among the most researched forms of energy healing are reiki, therapeutic touch and healing touch.
PubMed, AMED, JStor, Social Science Citation Index and PsycInfo databases were searched, and articles were rated according to the SIGN (Scottish Intercollegiate Guidelines Network) quality scale. Six quantitative and two qualitative studies on the efficacy and effectiveness of energy healing for cancer patients met the inclusion criteria.
None of the studies are of a size or quality that allows to draw reliable conclusions. The results of the studies are, however, interesting and should be considered when developing new studies and hypotheses on working mechanisms.
The existing research does not allow conclusions regarding the efficacy or effectiveness of energy healing. Future studies should adhere to existing standards of research on the efficacy and effectiveness of a treatment, and given the complex character of potential outcomes, cross-disciplinary methodologies may be relevant. To extend the scope of clinical trials, psychosocial processes should be taken into account and explored, rather than dismissed as placebo.
... Figure 3 provides a summary of nine qualitative studies. Designs and methods used include case study (Cowling, 2004), descriptive (Kelly, Sullivan, Fawcett, & Samarel, 2004;Kim, 2004;MacNeil, 2006;Walling, 2006), grounded theory (Zahourek, 2005), phenomenology (Davis, 2006;France, Fields, & Garth, 2004), and rational hermeneutic interpretive (Alligood & Fawcett, 2004). Research methods derived from the science of unitary human beings were used in two studies. ...
... and between power and diversity (r = .57). (Cowling, 2004;Davis, 2006;Kelly et al., 2004;MacNeil, 2006), nurse healers (Zahourek, 2005), and nursing students (France et al., 2004). Literature was used in three studies (Alligood & Fawcett, 2004;Kim, 2004;Walling, 2006). ...
... Instead of using terms such as "the effect of," "the impact of," "the consequence of," or "as a result of" which imply causal relationship, terms such as "was related to" or "could be Pre-treatment phase themes: discomfort, optimism, relief for both groups; Post-treatment phase themes: ATT = general well-being and relaxation; STT = acceptance and optimism. Kelly et al. 2004 Descriptive Women with mastectomy Age 55 (mode) n = 18 ( N = 31) ...
The purpose of this column is to review the published studies conducted within Rogers' science of unitary human beings from 2004 to 2007. The findings from a critical review of 24 research studies (15 quantitative and 9 qualitative) are presented.
... 16 Qualitative studies have unanimously reported that patients have positive experiences with energy healing. [17][18][19][20][21][22] A mixed-methods study found an apparent discrepancy between negative results based on quantitative data (quality of life with sub-scales) and positive changes reported in qualitative interviews (p. 154). ...
... While previous qualitative studies refer to patients' positive experiences, [17][18][19][20][21][22] this study found additional changes for the intervention groups. The findings of this study do not contradict the results of the trial wherein the patients were recruited 26 but add insights to the role of mediators and the complexity of healing processes. ...
The use of complementary and alternative medicine has increased, most markedly among cancer patients. Previous research on energy healing is inconclusive, but qualitative studies have mainly reported positive healing experiences, whereas positive results from trials are scarce. Considering the apparent discrepancy between qualitative and quantitative studies, we aimed to describe the interpretation processes of the patients receiving energy healing. We followed the interpretation processes of a subsection of cancer patients who participated in a pragmatic trial on energy healing, including patients in the control groups. No significant differences between the groups were found in the quantitative part of the trial, but the majority of patients in both the intervention and control groups reported subjective improvements. A subset of 32 patients from the trial was selected for this qualitative sub-study to gain insight into their interpretation processes. These 32 patients recruited from the trial were followed with qualitative interviews before, during, and after the treatment period, using a cultural-phenomenological approach. Most patients who received energy healing changed their perception of bodily experiences, and they perceived a wider variety of signs as indicative of healing than the patients in the control groups. After receiving energy healing, the patients also perceived signs that from a medical perspective are regarded as symptoms, as signs of healing. The changes in perception of illness and healing affected decision-making dynamics and should be considered when producing information and communication strategies for health promotion.
... Qualitative studies of Reiki and Therapeutic Touch in other disease areas have highlighted concepts such as sense of awareness, feeling cared for, security, feelings of comfort, and feeling connected to self and universal energy (Roberts et al., 2005;Hayes & Cox, 1999;Kiernan, 2002;Kelly et al., 2004) , concepts that have not generally been measured in the Reiki studies carried out to date in cancer. ...
... Our findings correlate with other studies and systematic reviews that demonstrated benefits of Reiki including increased well-being (Catlin & Taylor-Ford, 2011), reduced fatigue and mood disturbance (Post-White et al., 2003) and lowered pain and anxiety (Thrane & Cohen, 2014). Other studies have shown that people having Reiki partly do so to take control and to promote self-management and self-healing (Kelly et al., 2004). Self-healing was not an issue that arose in our research. ...
Aims:
To explore the perceptions and experiences of reiki for women who have cancer and identify outcome measures for an intervention study.
Methods:
A cross-sectional qualitative study of 10 women who had received reiki after cancer treatment was conducted. Interviews were audiotaped, transcribed and coded using framework analysis.
Results:
Key themes identified were: limited understanding of reiki prior to receiving any reiki; release of emotional strain during reiki-feelings of a release of energy, a clearing of the mind from cancer, inner peace/relaxation, hope, a sense of being cared for; experience of physical sensations during reiki, such as pain relief and tingling; physical, emotional and cognitive improvements after reiki, such as improved sleep, a sense of calm and peace, reduced depression and improved self-confidence.
Conclusion:
Findings suggest that reiki could be a beneficial tool in the self-management of quality of life issues for women who have cancer.
... Therapeutic touch is similar to reiki, with the key differences being the philosophic basis of the therapies and the training procedures (Potter, 2003). Qualitative studies of reiki and therapeutic touch in other disease areas have highlighted concepts such as sense of awareness, feeling cared for, security, feelings of comfort, and feeling connected to self and universal energy (Hayes and Cox, 1999; Kiernan, 2002; Kelly et al, 2004; Roberts et al, 2005). These concepts have not generally been measured in the reiki studies carried out to date in cancer. ...
... The findings correlate with other studies and systematic reviews that demonstrated benefits of reiki, including increased wellbeing (Catlin and Taylor-Ford, 2011), reduced fatigue and mood disturbance (Post-White et al, 2003) and lowered pain and anxiety (Thrane and Cohen, 2014). Other studies have shown that people having reiki partly do so to take control and to promote self-management and self-healing (Kelly et al, 2004). Self-healing was not an issue that arose in the authors' research. ...
... 16 Qualitative studies have unanimously reported that patients have positive experiences with energy healing. [17][18][19][20][21][22] A mixed-methods study found an apparent discrepancy between negative results based on quantitative data (quality of life with sub-scales) and positive changes reported in qualitative interviews (p. 154). ...
... While previous qualitative studies refer to patients' positive experiences, [17][18][19][20][21][22] this study found additional changes for the intervention groups. The findings of this study do not contradict the results of the trial wherein the patients were recruited 26 but add insights to the role of mediators and the complexity of healing processes. ...
... Therapeutic touch is a therapy in which the hands are used to facilitate the healing process ( Lafreniere et al., 1999). The therapy was introduced in the early 1970s by Delores Krieger and Dora Kuntz as a noninvasive nursing intervention derived from ancient Eastern forms of healing (Kelly, Sullivan, Fawcett, & Samarel, 2004). ...
... Studies assigned to level VI have "evidence from a single descriptive or qualitative study as one of its weakest traits, or evidence levels [implying] that conclusions for practice are not as significant" but still valuable (Melnyk & FineoutOverholt, 2005, p. 10). Kelly et al. (2004) conducted phone interviews with women with early-stage breast cancer following therapeutic touch treatment and dialogue or the control method of quiet rest. The women reported positive feelings of calmness, relaxation, comfort, and security, regardless of the intervention. ...
With more than 10 million patients with cancer in the United States, pain and symptom management is an important topic for oncology nurses. Complementary therapies, such as therapeutic touch, may offer nurses a nonpharmacologic method to ease patients' pain. Using 12 research studies, the authors examined the evidence concerning the effectiveness of this type of treatment in reducing pain and anxiety.
... Binns-Turner, Wilson, Pryor, Boyd, and Prickett [18] found that women diagnosed with breast cancer face the stressors and anxiety about future prognosis, mortality, treatment options, and changes in their body image. [21], music therapy [22], therapeutic touch [23], muscle relaxation [24], mindfulness-based stress reduction [25], guided imagery [26], and other forms of complementary alternative treatments have been evaluated in these patient populations. Many of these investigators found a significant decrease in anxiety when these treatments were used. ...
... Coakley (2001) found that both providers and recipients of TT described feeling more relaxed, more focused and calmer following TT treatments. Denison (2004) found that TT decreased the intensity of pain in the patients with fibromyalgia syndrome during the six sessions of TT. Kelly et al. (2004) evaluated the effect of TT and nurse dialogue on cancer patients' mood, anxiety and postoperative pain. They failed to find any significant effects of TT on anxiety. ...
This study was carried out to investigate the effect of therapeutic touch on sleep quality in the elderly people living in the nursing homes. The study is a randomized controlled experimental study (pretest–posttest control group). The sample of the research consisted of 25 elderly people. As a result of the study, although there was a significant increase (p < 0.05) in the sleep quality of each group, no significant difference was found between the groups (p > 0.05). Therapeutic touch is an effective method of improving the sleep quality of the elders living at a nursing home.
... From the Rogers' perspective, TT is an example of how professionals work to strengthen the integrity and perfection of humans and their environmental fields so that patients can reach an optimal health status (16). TT is a non-invasive nursing intervention which takes place by the hands and in the form of energy transfer (17). Jack-son et al. by investigating twelve studies found that TT can be an acceptable method for reducing physical and psychological symptoms of patients with cancer (18). ...
Background:
The use of complementary and alternative medicine (CAM) techniques has been growing. The National Center for Complementary and Alternative Medicine places therapeutic touch (TT) into the category of bio field energy. This literature review is aimed at critically evaluating the data from clinical trials examining the clinical efficacy of therapeutic touch as a supportive care modality in adult patients with cancer.
Methods:
Electronic databases (PubMed, Scopus, Scholar Google, and Science Direct) were searched from the year 1990 to 2015 to locate potentially relevant peer-reviewed articles using the key words therapeutic touch, touch therapy, neoplasm, cancer, and CAM. Additionally, relevant journals and references of all the located articles were manually searched for other potentially relevant studies.
Results:
The number of 334 articles was found on the basis of the key words, of which 17 articles related to the clinical trial were examined in accordance with the objectives of the study. A total of 6 articles were in the final dataset in which several examples of the positive effects of healing touch on pain, nausea, anxiety and fatigue, and life quality and also on biochemical parameters were observed.
Conclusion:
Based on the results of this study, an affirmation can be made regarding the use of TT, as a non-invasive intervention for improving the health status in patients with cancer. Moreover, therapeutic touch was proved to be a useful strategy for adult patients with cancer.
... 7 huvudteman beskrev patienternas upplevelser av sjuksköterskor med expertiskunskaper om cancer: någon att dela upplevelsen av cancer med, avlastning, tid att tillmötesgå patientens behov, hjälp till förståelse av sjukdomen, länk till information och andra resurser, stabilitet och bidragande till en styrka att överleva. Kelly, A.E., Sullivan, P., Fawcett, J. & Samarel, N. (2004). ...
... Kvalitativ innehållsanalys med manifest ansats enligt Graneheim och Lundman (2004) har använts för att analysera artiklarna, en metod som lämpar sig väl i syfte att lyfta fram människors upplevelser ur ett inifrånperspektiv. Kvalitativ innehållsanalys innebär att särskilda textenheter som svarar mot ett uppställt syfte markeras och tas ut (Graneheim & Lundman, 2004 (Barron et al., 2008;Kelly, Sullivan, Fawcett & Samarel, 2004). Dessa känslor gav sammantaget en upplevelse av lindrat obehag och oro. ...
... These therapies are used for many purposes and tend to increase relaxation and improve stress management. In one study of pre-and postoperative BC patients, women who received therapeutic touch expressed calm and relaxed feelings and a sense of comfort and awareness (Kelly, Sullivan, Fawcett, & Samarel, 2004). ...
Advancements in breast cancer treatment continue to improve the likelihood of survival. The increase in survival has come at a cost, however; the late effects of breast cancer treatment have remained a constant reminder to women of what they have endured and require holistic nursing's attention. One area of nursing practice that might improve the condition of breast cancer survivors once their treatment has ended is complementary and alternative medicine (CAM) therapies. To provide guidance to nurses working with breast cancer survivors, a focused review of the literature exploring the symptomatology and prevalence of breast cancer's late effects as well as the use of CAM therapies to improve those effects is presented. Evidence suggests that CAM therapies have sometimes been incorporated into symptom management strategies currently employed; however, the evidential claims as a whole have been generally inconclusive, especially for complete resolution of the late effects. Regardless, a number of studies demonstrate a reduction of negative symptoms experienced with few to no side effects of CAM therapies.
... They resulted that nursing intervention including therapeutic touch may use to enhance feelings of calmness and relaxation in patients with breast cancer and reduce their anxiety. 19 In addition, a study by McEillgott et al showed a significant difference between the nurses' anxiety before and after intervention. 20 Ireland et al in 1998 studied the anxiety of HIV-Infected children before and right after the intervention witch the results showed that the mean of anxiety in therapeutic touch group reduced while it did not change in the placebo group. ...
Background: Coronary artery bypass graft (CABG) surgery is very traumatic and makes patients very nervous. Since it is a main task of nurses to improve patients' comfort and safety, this study investigated the effect of therapeutic touch in cardi-ovascular patients' anxiety before CABG surgery.
... Spending more time with residents is vital, plays a therapeutic role in a holistic approach to clients (Peplau, 1952), results in improvements in the relationships between caregivers and residents, and builds trust and feelings of understanding and empathy (McGilton and Boscart, 2007;McGilton et al., 2008). Quiet time and dialog shared with care providers develop feelings of calmness and relaxation in women with breast cancer (Kelly et al., 2004). We suggest that sharing time (quiet or in dialog) with older adults may lead to similar positive feelings. ...
Organizational resources such as caregiver time use with older adults in residential long-term care facilities (nursing homes) have not been extensively studied, while levels of nurse staffing and staffing-mix are the focus of many publications on all types of healthcare organizations. Evidence shows that front-line caregivers’ sufficient working time with residents is associated with performance, excellence, comprehensive care, quality of outcomes (e.g., reductions in pressure ulcers, urinary tract infections, and falls), quality of life, cost savings, and may be affiliated with transformation of organizational culture.
... In a small study using mixed methods, no significant difference was observed in anxiety levels before and after therapeutic touch between the intervention and the control group. Both groups expressed feelings of calmness, relaxation, security, and control (Kelly, Sullivan, Fawcett, & Samarel, 2004). Because of the small sample size (N = 18) and no significant difference between the intervention and control groups, the effectiveness of this therapy is not established. ...
Anxiety is a common form of distress that oncology nurses often observe in their patients. The incidence of anxiety may be as high as 50% in recently diagnosed patients and may persist into survivorship. How nurses respond to patients experiencing distress and anxiety influences further assessment of the patient's concerns, identification of anxiety, and the initiation of appropriate interventions. Evidence-based interventions are essential to improving outcomes for patients experiencing anxiety and directing future research. The authors of this article reviewed the evidence of effectiveness for different interventions to reduce anxiety in patients with cancer.
Background: Pain is a global public health problem affecting the lives of large numbers of patients and their families. Touch therapies (Healing Touch (HT), Therapeutic Touch (TT) and Reiki) have been found to relieve pain, but some reviews have suggested there is insufficient evidence to support their use. Objectives: To evaluate the effectiveness of touch therapies (including HT, TT, and Reiki) on relieving both acute and chronic pain; to determine any adverse effect of touch therapies. Search methods: Various electronic databases, including The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and others from their inception to June 2008 were searched. Reference lists and bibliographies of relevant articles and organizations were checked. Experts in touch therapies were contacted. Selection criteria: Randomized Controlled Trials (RCTs) or Controlled Clinical Trials (CCTs) evaluating the effect of touch on any type of pain were included. Similarly, only studies using a sham placebo or a 'no treatment' control was included. Data collection and analysis: Data was extracted and quality assessment was conducted by two independent review authors. The mean pain intensity for completing all treatment sessions was extracted. Pain intensity from different pain measurement scales were standardized into a single scale. Comparisons between the effects of treatment groups and that of control groups were made. Main results: Twenty four studies involving 1153 participants met the inclusion criteria. There were five, sixteen and three studies on HT, TT and Reiki respectively. Participants exposed to touch had on average of 0.83 units (on a 0 to ten scale) lower pain intensity than unexposed participants (95% Confidence Interval: -1.16 to -0.50). Results of trials conducted by more experienced practitioners appeared to yield greater effects in pain reduction. It is also apparent that these trials yielding greater effects were from the Reiki studies. Whether more experienced practitioners or certain types of touch therapy brought better pain reduction should be further investigated. Two of the five studies evaluating analgesic usage supported the claim that touch therapies minimized analgesic usage. The placebo effect was also explored. No statistically significant (P = 0.29) placebo effect was identified. Authors' conclusions: Touch therapies may have a modest effect in pain relief. More studies on HT and Reiki in relieving pain are needed. More studies including children are also required to evaluate the effect of touch on children.
After the diagnosis of cancer in a child is made, many families complement conventional medical care with lifestyle changes including diet, exercise, environment, and mind-body therapies. Biomechanical, bioenergetic, and other therapies are also sometimes sought. These include massage, chiropractic, acupuncture/acupressure, therapeutic touch, Reiki, homeopathy, and prayer. Some of these complementary therapies have well-established roles in cancer therapy for children, whereas others are controversial and require more research.
Purpose of the study:
To investigate the effects of Therapeutic Touch (TT) on anxiety, vital signs, and cardiac dysrhythmia in women undergoing cardiac catheterization.
Design:
It was a quasi-experimental study. The participants had no history of hallucination, anxiety, or other psychological problems. Participants had to be conscious and have attained at least sixth-grade literacy level. Participants were randomly assigned into an intervention group (n = 23; received 10-15 minutes TT), a placebo group (n = 23; received 10-15 minutes simulated touch), and a control group (n = 23; did not receive any therapy). Data were collected using Spielberger's anxiety test, cardiac dysrhythmia checklist, and vital signs recording sheet. Statistical analyses were considered to be significant at α = .05 levels.
Findings:
Sixty-nine women ranging in age from 35 to 65 years participated. TT significantly decreased state anxiety p < 0.0001 but not trait anxiety (p = .88), decreased the incidence of all cardiac dysrhythmias p < 0.0001 except premature ventricular contraction (p = .01), and regulated vital signs p < 0.0001 in the intervention group versus placebo and control group.
Conclusions:
TT is an effective approach for managing state anxiety, regulating vital signs, and decreasing the incidence of cardiac dysrhythmia during stressful situations, such as cardiac catheterization, in Iranian cardiac patients.
To review the published research related to the interventions of Reiki, Therapeutic Touch, and Healing Touch representing energy therapies in relation to oncology nursing.
Peer-reviewed literature.
There is growing evidence that energy therapies have a positive effect on symptoms associated with cancer. While there is need for further research, it is clear that an appreciation for the value of research methods beyond the randomized control trial is important.
Energy therapies offer additional strategies for oncology nurses providing integrated nursing care to alleviate suffering and symptom distress of patients with cancer.
This study examined the feasibility of brief instruction in massage and touch therapy for caregivers ("partners") to provide comfort to cancer patients. Fifty partners and 49 patients participated. A longitudinal, within-subjects, repeated measures, control and intervention phases design used self-report instruments to assess feasibility via change in frequency, duration, partner-perceived self-efficacy, and patient-perceived helpfulness over a 90-day follow-up. Exploratory data were collected on psychosocial and quality of life variables. Focus groups provided qualitative data. A structured 6-hour workshop taught basic manual techniques for comfort and relaxation, followed by home practice. Significant increases in frequency (1.2 vs 2.7 times per week) and duration (4.7 vs 12.2 minutes) of massage, both p < .001, were sustained through the 3-month follow-up. Partners' perceived self-efficacy in massage and patients' ratings of its helpfulness more than doubled. Classification tree analysis found caregiver burden, relationship quality, and frequency and duration of practice to predict individual responses. Inhibitions about touch in cancer caregiving may lead to unnecessary physical and emotional distancing at a time when patients need touch the most. Brief instruction may be a feasible intervention to increase caregiver efficacy, patient satisfaction, quality of life, and quality of the relationship.
Pain is a global public health problem affecting the lives of large numbers of patients and their families. Touch therapies (Healing Touch (HT), Therapeutic Touch (TT) and Reiki) have been found to relieve pain, but some reviews have suggested there is insufficient evidence to support their use.
To evaluate the effectiveness of touch therapies (including HT, TT, and Reiki) on relieving both acute and chronic pain; to determine any adverse effect of touch therapies.
Various electronic databases, including The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and others from their inception to June 2008 were searched. Reference lists and bibliographies of relevant articles and organizations were checked. Experts in touch therapies were contacted.
Randomized Controlled Trials (RCTs) or Controlled Clinical Trials (CCTs) evaluating the effect of touch on any type of pain were included. Similarly, only studies using a sham placebo or a 'no treatment' control was included.
Data was extracted and quality assessment was conducted by two independent review authors. The mean pain intensity for completing all treatment sessions was extracted. Pain intensity from different pain measurement scales were standardized into a single scale. Comparisons between the effects of treatment groups and that of control groups were made.
Twenty four studies involving 1153 participants met the inclusion criteria. There were five, sixteen and three studies on HT, TT and Reiki respectively. Participants exposed to touch had on average of 0.83 units (on a 0 to ten scale) lower pain intensity than unexposed participants (95% Confidence Interval: -1.16 to -0.50). Results of trials conducted by more experienced practitioners appeared to yield greater effects in pain reduction. It is also apparent that these trials yielding greater effects were from the Reiki studies. Whether more experienced practitioners or certain types of touch therapy brought better pain reduction should be further investigated. Two of the five studies evaluating analgesic usage supported the claim that touch therapies minimized analgesic usage. The placebo effect was also explored. No statistically significant (P = 0.29) placebo effect was identified.
Touch therapies may have a modest effect in pain relief. More studies on HT and Reiki in relieving pain are needed. More studies including children are also required to evaluate the effect of touch on children.
Improvisation has long been considered a function of music, dance, and the theatre arts. An exploration of the definitions and characteristics of this concept in relation to the art and practice of nursing provide an opportunity to illuminate related qualities within the field of nursing. Nursing has always demonstrated improvisation because it is often required to meet the needs of patients in a rapidly changing environment. However, little has been done to identify improvisation in the practice of nursing or to teach improvisation as a nursing knowledge-based skill. This article strives to explore the concept of improvisation in nursing, to describe the characteristics of improvisation as applied to nursing, and to utilize case studies to illustrate various manifestations of improvisation in nursing practice.
Comfort is a term that has a significant historical and contemporary association with nursing. Since the time of Nightingale, it is cited as designating a desirable outcome of nursing care. Comfort is found in nursing science, for example in diagnostic taxonomies, and in references to the art of nursing, as when practice is described. Roy, Orlando, Watson, Paterson and others use comfort in major nursing theories. The term can signify both physical and mental phenomena and it can be used as a verb and a noun. However, because comfort has many different meanings, the reader has had the burden of deciding if the term is meant in one of its ordinary language senses or if its context reveals some special nursing sense. The purpose of this paper is to analyse the semantics and extension of the term 'comfort' in order to clarify its use in nursing practice, theory and research. The semantic analysis begins with ordinary language because the common meanings of the term are the primary ones used in nursing practice and are the origin of technical nursing usages. Comfort is discussed as the term is found in nursing, including texts, standards of care, diagnoses and theory. An account of patient needs assessment is used to cull three technical senses of the term from its ordinary language meanings. After contrasting these senses in order to justify their separateness, they are shown to reflect differing aspects of therapeutic contexts. Defining attributes of the three senses are then explicated and presented in table format. The last section of the paper addresses some of the ways that the extensions of the senses can be measured.
Ethics committees typically apply the common principles of autonomy, nonmaleficence, beneficence and justice to research proposals but with variable weighting and interpretation. This paper reports a comparison of ethical requirements in an international cross-cultural study and discusses their implications.
The study was run concurrently in New Zealand, UK, Israel, Canada and USA and involved testing hypotheses about believability of testimonies regarding alleged child sexual abuse. Ethics committee requirements to conduct this study ranged from nil in Israel to considerable amendments designed to minimise participant harm in New Zealand. Assessment of minimal risk is a complex and unreliable estimation further compounded by insufficient information on probabilities of particular individuals suffering harm. Estimating potential benefits/ risks ratio and protecting participants' autonomy similarly are not straightforward exercises.
Safeguarding moral/humane principles should be balanced with promotion of ethical research which does not impede research posing minimal risk to participants. In ensuring that ethical standards are met and research has scientific merit, ethics committees have obligations to participants (to meet their rights and protect them from harm); to society (to ensure good quality research is conducted); and to researchers (to treat their proposals with just consideration and respect). To facilitate meeting all these obligations, the preferable focus should be promotion of ethical research, rather than the prevention of unethical research, which inevitably results in the impediment of researchers from doing their work. How the ethical principles should be applied and balanced requires further consideration.
To describe what women diagnosed with primary gynecologic cancer reported to be important during their interaction with the healthcare system.
Qualitative.
A specialized gynecologic cancer care unit in central Sweden.
14 women diagnosed with primary gynecologic cancer were recruited. The women had been referred to the specialized care unit for radiation or cytostatic therapy.
Tape-recorded interviews were transcribed, coded, categorized, and analyzed.
Primary diagnosed women with cancer and their experience with quality of care during diagnosis and treatment.
Three partly overlapping categories (i.e., optimal care, good communication, and self-image and sexuality) were found to be of central importance in quality of health care. Participants stated that health care should be based on their own perceptions of the need for information and dialogue and how the disease and treatment would affect their health, self-image, and sexuality. Everyday conversations also were very important.
Central importance in health care for the women included both rational and human aspects. The primary need of participants was to achieve a rapid cure, which necessitated health care that was available, competent, and coordinated.
Women with gynecologic cancer should be given individualized information and care to satisfy their individual needs and reinforce their self-image. Nurses have an important role in strengthening women's feelings of hope and supporting them in maintaining as positive a self-image as possible. Information and everyday conversation are of great significance. Sexuality should be an integral part of holistic care; to this end, inclusion of each woman's sexual partner may be helpful when discussions concerning sexuality occur.
This article builds on one published in the Journal of Holistic Nursing (1988) which reviewed all research on Therapeutic Touch completed to that time. The author, considering research completed since then, identifies, discusses and prioritizes three related directions for future Therapeutic Touch research : outcome studies, theory development studies and replications studies. The article then looks at methodological issues which should be considered by anyone planning Therapeutic Touch studies: treatment personnel, length of treatment and research design.
The purpose of this article is to provide readers with a comprehensive review of Therapeutic Touch research. Specifically, the article reviews and describes doctoral and/or published research which is directed at testing either outcomes of Therapeutic Touch or theories underlying the process. Critique of selected studies is offered where it seems appropriate and critical to interpretation of the results. This review provides the foundation for discussion, in a later article, related to future directions for research in this evolving, holistic nursing intervention.
The purpose of this qualitative study was to describe the patient's experience of receiving therapeutic touch (TT) treatments The design was informed by phenomenology in the sense that it was searching for a definition of the lived experience of the phenomenon of TT Data were obtained through one open-ended interview and a second clarifying interview of each subject All data were subjected to content analysis For participants, the lived experience of TT was described as a linear process that began with the perceived need for and decision to seek treatment It progressed through one or more treatments and continued to have an impact upon the participants’ lives These findings were examined within the context of Martha Rogers’ conceptual system This study has shown that, for 20 participants receiving treatment, TT was a fulfilling multidimensional experience that facilitated personal growth Such an experience can only enrich the lives of those who receive treatment Certainly, a nursing intervention that can achieve such a positive influence has potential for use in all areas of nursing care and needs to be explored further
Communication in nursing care is an important topic assessing the specific needs of elderly patients and providing nursing care that is tailored to the individual patient's needs. In this review of the literature, we describe the role attributed to communication in theoretical nursing models and we report how research in communication in nursing elderly patients has taken place over the last ten years. It appears that since the eighties there has been an increase in observation studies into nurse-patient communication. There still is, however, a lack of observation instruments to do justice to the interactive nature of nurse-patient communication. Special attention should be paid to reliability and validity.
Relaxation and music to reduce postsurgical pain
Aims: We investigated the effects of relaxation, music, and the combination of relaxation and music on postoperative pain, across and between two days and two activities (ambulation and rest) and across ambulation each day. This secondary analysis of a randomized controlled trial was conducted from 1995 to 1997.
Background: After surgery, patients do not always receive sufficient relief from opioids and may have undesired side-effects. More complete relief (10–30%) was found recently with adjuvant interventions of relaxation, music, and their combination. Comparison of effects between days and treatments have not been examined longitudinally.
Methods: With a repeated measures design, abdominal surgery patients (n = 468) in five US hospitals were assigned randomly to one of four groups; relaxation, music, their combination, and control. With institutional approval and written informed consent, subjects were interviewed and taught interventions preoperatively. Postoperative testing was at ambulation and rest on days 1 and 2 using visual analogue (VAS) sensation and distress of pain scales.
Results: Multivariate analysis indicated that although pain decreased by day 2, interventions were not different between days and activities. They were effective for pain across ambulation on each day, across ambulation and across rest over both days (all P < 0·001), and had similar effects by day and by activity.
Conclusions: Nurses can safely recommend any of these interventions for pain on both postoperative days and at both ambulation and rest.
This article presents the basic elements of Rogers' science of unitary human beings. It defines science, explicates nursing as a science and an art, addresses the meaning of the principles of hemodynamics, and discusses the building blocks of these principles. Several theories arising from the science of unitary human beings are elaborated, and noninvasive therapeutic modalities are discussed as part of nursing practice.
The constant comparative method was used to generate a grounded theory explaining the process of therapeutic touch for seven nurses and seven patients. Interviews and observations of one treatment session each indicate that the primary experience of therapeutic touch is opening to the flow of the universal life energy. This includes three major categories of experience: (a) opening intent--allowing oneself to focus on getting the universal life energy moving again; (b) opening sensitivity--assessing the quality of its flow; and (c) opening communication--participating in a healing relationship that unblocks, engages and enlivens its movement. Further research on therapeutic touch using qualitative methodology may deepen our understanding of the inner experiences of both patients and nurses to experiences that facilitate the healing process.
Therapeutic touch (TT) is a modern derivative of the laying on of hands that involves touching with the intent to help or heal. This study investigated the effects of TT on tension headache pain in comparison with a placebo simulation of TT. Sixty volunteer subjects with tension headaches were randomly divided into treatment and placebo groups. The McGill-Melzack Pain Questionnaire was used to measure headache pain levels before each intervention, immediately afterward, and 4 hours later. A Wilcoxon signed rank test for differences indicated that 90% of the subjects exposed to TT experienced a sustained reduction in headache pain, p less than .0001. An average 70% pain reduction was sustained over the 4 hours following TT, which was twice the average pain reduction following the placebo touch. Using a Wilcoxon rank sum test, this was statistically significant, p less than .01. Study results indicated that TT may have potential beyond a placebo effect in the treatment of tension headache pain.
Effect of therapeutic touch on the anxiety of 90 volunteer male and female subjects between the ages of 21 and 65, hospitalized in a cardiovascular unit of a large medical center in New York City, was examined. The dependent variable, state anxiety, was defined as a transitory emotional state of the individual at a particular point and was measured by the Self-Evaluation Questionnaire x-1, developed by Spielberger, Gorsuch, and Lushene. Subjects were administered this tool pre- and postintervention. Three matched intervention groups were formed; each subject received an individual five-minute period of intervention by therapeutic touch, casual touch, or no touch. Subjects who received intervention by therapeutic touch experienced a highly significant (p < .001) reduction in state anxiety, according to a comparison of preposttest means on A-state anxiety using a correlated t ratio. Subjects who received intervention by therapeutic touch had a significantly (p < .01) greater reduction in posttest anxiety scores than subjects who received intervention by causal touch or no touch.
Family nursing assessment has traditionally followed an illness-care model. This paper proposes a re-evaluation of traditional family assessment and suggests an approach which is fundamentally based in health promotion. The paper includes a discussion of varying perspectives of health and health care, the health promotion perspective adopted by the World Health Organization, and the relevance of these perspectives for family nursing practice. Central elements of health promotion are outlined and serve as the guiding principles for family nursing assessment. Two inherent aspects of health-promoting family nursing practice are proposed and described. These include an emphasis on a human caring nursing ontology, and a framework for guiding family nursing assessment. This health-promoting assessment framework contains four essential components: (a) listening to the family; (b) participatory dialogue; (c) recognizing patterns; and (d) envisaging action and positive change. These components are described, together with the strategic elements inherent in each. Based on this health-promoting family nursing assessment, implications for nursing practice are discussed, and recommendations are made for research into this assessment framework.
This is a descriptive, exploratory, phenomenological study on children's lived experiences of perceiving the human energy field using Therapeutic Touch (TT). Eleven children, 3 to 9 years of age, willingly participated in the study. The study's findings suggest that children can feel the human energy field with purpose or intent to help, thus supporting TT as an innate potential.
This article details Meehan's research study concerning the conceptualization of therapeutic touch within Rogers' science of unitary human beings and an investigation of the effects of therapeutic touch on pain experience in postoperative patients. Using a single trial, single-blind, three-group design, 108 postoperative patients were randomly assigned to receive one of the following: therapeutic touch, a placebo control intervention which mimicked therapeutic touch, or the standard intervention of a narcotic analgesic. Using a visual analogue scale, pain was measured before and one hour following intervention. The hypothesis, that therapeutic touch would significantly decrease postoperative pain compared to the placebo control intervention, was not supported. Secondary analyses suggest that therapeutic touch may decrease patients' need for analgesic medication. Implications for further research and practice are suggested.
Seven hospitalized, adolescent psychiatric patients who received a total of 31 Therapeutic Touch treatments over two 2-week periods were interviewed about their experience. Findings from the interviews were categorized within 2 overarching themes-the therapeutic relationship and the body/mind connection. The study participants enjoyed the Therapeutic Touch, and in fact, they wanted more of it. This research shows the possibility of Therapeutic Touch as a nursing intervention with adolescent psychiatric patients if all care is taken to obtain their consent and to provide them with a safe environment for touch therapy.
Communication in nursing care is an important topic assessing the specific needs of elderly patients and providing nursing care that is tailored to the individual patient's needs. In this review of the literature, we describe the role attributed to communication in theoretical nursing models and we report how research in communication in nursing elderly patients has taken place over the last ten years. It appears that since the eighties there has been an increase in observation studies into nurse-patient communication. There still is, however, a lack of observation instruments to do justice to the interactive nature of nurse-patient communication. Special attention should be paid to reliability and validity.
Therapeutic Touch is investigated using an integrative review of the literature. Using Ganong's (1987) methodology, the article explores the research question, What is the state of development of research regarding Therapeutic Touch? by analyzing primary research reports from 23 articles in 14 referred journals. The findings of the review indicate positive regard for the use of Therapeutic Touch. All research points to the need for further study in this area. Research methods used are satisfactory, but more rigorous methodologies would promote a more scientific contribution to the body of literature on Therapeutic Touch.
The purpose of this case study was to explore the experiences of giving and receiving Therapeutic Touch. Attempts were made to capture the subjective qualities of the experience by providing a description of the Therapeutic Touch interaction that took place. The central theme of this study is the process of reflection-in-action. This process is shown to facilitate learning; it is an effective vehicle for expanding and developing the knowledge and skills of Therapeutic Touch. This case study provides valuable qualitative information on a Therapeutic Touch experience. It has been possible to analyse this information in a more critical way through reflective thinking.
The purpose of this case study was to explore the experience of both giving and receiving Therapeutic Touch. A subjective account of the Therapeutic Touch experience is given in an attempt to throw light on its unique creative and therapeutic qualities. In most instances it was shown that the experience of both giving and receiving Therapeutic Touch was a parallel experience. This case study explores the effects of Therapeutic Touch on a client experiencing pain and associated anxiety. Whilst a response to treatment was observed, the need for further case studies and research studies in this area was identified.
To obtain preliminary data and determine the feasibility of a large-scale experimental study to test the efficacy of the Rogerian Science of Unitary Human Beings-based intervention of dialogue and therapeutic touch (TT) on pre- and postoperative anxiety and mood and postoperative pain from breast cancer surgery.
Experimental.
Mid-Atlantic region; ambulatory.
29 Caucasian and 2 African American English-speaking women with positive breast cancer biopsy (experimental, n = 14; control, n = 17), ranging in age from 31-84 years old (F = 55.6).
Treatments administered in subjects' homes within seven days prior to surgery and 24 hours after hospital discharge. Experimental treatment consisted of 10 minutes of TT and 20 minutes of dialogue. Control treatment consisted of 10 minutes of quiet time and 20 minutes of dialogue. Data (Spielberger State-Trait Anxiety Inventory. Affects Balance Scale, and Visual Analog Scale-Pain) were collected at the conclusion of each home visit.
Anxiety, mood, and pain.
The experimental group had lower preoperative state anxiety than the control groups (p = 0.008). No difference was found for preoperative mood. No differences were found for any postoperative measure.
A large-scale study of dialogue and TT would require changes in design and recruitment strategies.
Nurses may provide more comprehensive care by incorporating dialogue and TT or quiet time into their pre- and postoperative care. Additional research, however, is recommended to determine the differential effects of dialogue, TT, and quiet time on women's experiences with breast cancer prior to incorporating these noninvasive modalities into clinical practice.
The purpose of this study was to examine the effect of three Therapeutic Touch treatments on the well-being of 20 persons with terminal cancer in palliative care. Participants in the experimental group (n = 10) received three noncontact Therapeutic Touch treatments, the duration of which varied between 15 to 20 minutes. Participants in the control group (n = 10) participated in three rest periods. Well-being was measured at preintervention time and immediately postintervention time using the Well-Being Scale, a visual analogue scale measuring pain, nausea, depression, anxiety, shortness of breath, activity, appetite, relaxation, and inner peace. The results of the study support the hypothesis that three noncontact Therapeutic Touch treatments increase sensation of well-being in persons with terminal cancer.
The purpose of this study was to assess the effectiveness of music therapy in decreasing anxiety in ventilator-dependent patients.
A crossover repeated measures design with random assignment was used.
The intensive care unit of a university hospital in Hong Kong was used as the setting for this study.
Twenty patients who were ventilator-dependent were recruited for the study. They were all Chinese with a mean age of 58.25 years (range, 19-84 y). Most (75%) were men. Outcome Measures: Physiologic measures of anxiety assessed in this study were mean blood pressure and respiratory rate. An additional measure was the Chinese version of the Spielberger State-Trait Anxiety Inventory.
Patients were randomized to receive either 30 minutes of uninterrupted rest and then 30 minutes of music therapy or the music therapy first and then the uninterrupted rest period. Patients listened to relaxing music by using audiocassette players and headphones. Subjects selected the music of their choice from a selection including both Chinese and Western music. Subjects had physiologic measures taken immediately before the intervention (or rest period) and at 5-minute intervals throughout the intervention. The Chinese version of Spielberger's State-Trait Anxiety Inventory was completed before the intervention and immediately after the intervention.
Findings indicated that music therapy was more effective in decreasing state anxiety than was an uninterrupted rest period (P <.01). As measured by analysis of variance with repeated measures, blood pressure and respiratory rate showed no significant differences in the 2 conditions over time. However, significant differences were observed at the end of the intervention (after 30 minutes) between the 2 conditions, with music therapy being superior to the rest period.
Music therapy is an effective nursing intervention in decreasing anxiety in ventilator-dependent patients and its use should be incorporated into the care of mechanically ventilated patients. For the Chinese patients, culture and language were the predominant factors in their choice of music.
The purpose of this article is to explore the adequacy of published scientific evidence supporting therapeutic touch as a nursing intervention. Meta-analytic techniques were used to integrate the research-based literature published in the past decade. The results seem to indicate that therapeutic touch has a positive, medium effect on physiological and psychological variables. It is impossible to make any substantive claims at this time because there is limited published research and because many of the studies had significant methodological issues that could seriously bias the reported results. Resolving these methodological issues is imperative for therapeutic touch research to move forward.
The purpose of this randomized controlled trial was to investigate the effect of three nonpharmacologic nursing interventions: relaxation, music, and the combination of relaxation and music on pain following gynecologic (GYN) surgery. A total of 311 patients, ages 18 to 70, from five Midwestern hospitals, were randomly assigned using minimization to either three intervention groups or a control group and were tested during ambulation and rest on postoperative days 1 and 2. Pain sensation and distress were measured using visual analogue scales. Multivariate analysis of covariance of posttest sensation and distress was used with pretest control and a priori contrasts. The intervention groups had significantly less posttest pain than the control group (p =.022-.001) on both days. The three interventions were similar in their effect on pain. Patients who received the interventions plus patient-controlled analgesia (PCA) had 9% to 29% less pain than controls who used PCA alone. Reduced pain was related to amount of activity (ambulation or rest), mastery of the use of the intervention, and decreased pulse and respiration. Those who slept well had less pain the following day. Nurses who care for GYN surgical patients can provide soft music and relaxation tapes and instruct patients to use them during postoperative ambulation and also at rest on days 1 and 2.
To provide this second 10-year review of nursing research on blood pressure (BP) and to focus attention on incorporating biopsychosocial factors affecting BP in nursing research.
Blood pressure is a dynamic, multidimensional, cardiovascular indicator of a person's state rather than a one-dimensional static measurement.
This 10-year literature review 1990-1999 included 54 nursing research articles with BP as an outcome measure. Four nursing research journals were reviewed to identify all nurse-authored articles investigating BP as an outcome variable in adult populations. Inclusion of individual characteristics, environmental factors, dynamic nature of blood pressure, and interpersonal aspects of blood pressure were assessed for each article.
Age, gender, and health status were mentioned consistently in both decades. Reporting of socioeconomic, occupational, educational, activity, and martial status remained low. Descriptions of environments increased, and automated devices were the most common method for BP assessment. Less than half of the articles included a description of the person measuring the BP. Measurements of BP under multiple conditions increased, but measurement within conditions did not.
Advances in technology and data analysis have increased knowledge of the dynamic nature of BP, but recognition of the complex nature of BP has not progressed rapidly over the last 2 decades.
Healing through nursing: The lived experience of thera-peutic touch, Part 2
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