Does the Use of Healing Touch Decrease Anxiety, Decrease Emergence Delirium

1. Does the Use of Healing Touch Decrease Anxiety, Decrease Emergence Delirium/Emergence Agitation and Decrease Length of Stay in Preschool Tonsillectomy & Adenoidectomy (T&A) Patients in the Post Operative Anesthesia Care Unit? (PACU)Wendy Grace Rolf RN, MSN, CHTP, AHN-BC Clinical Issue: Surgery is often traumatic for children and for their families 40-65% of all children develop significant stress prior to surgery (Kain, 2004) . Increases in anxiety has been related to increases in ED/EA.. Ease of WAKE UP. We have been doing HT at CCHMC since 1998. In the PACU we noticed that children who had HT seemed to wake up easier, they were calmer, seemed to need less pain medication and they were able to be discharged earlier. Clinical Issue: Surgery is often traumatic for children and for their families 40-65% of all children develop significant stress prior to surgery (Kain, 2004) . Increases in anxiety has been related to increases in ED/EA.. Ease of WAKE UP. We have been doing HT at CCHMC since 1998. In the PACU we noticed that children who had HT seemed to wake up easier, they were calmer, seemed to need less pain medication and they were able to be discharged earlier.

2. What Is �Energy Medicine��Biofield Medicine� ? Energy healing has been used for thousands of years by numerous cultures. Indian �prana�, Chinese �chi� Japanese �qi�. Religious traditions �Laying on of hands�. Nurses & health care providers Therapeutic Touch (TT), Reiki Healing Touch (HT), 100,000 This was a program created by a nurse. It is a multi level class, reading, experimental work and mentoring that leads to a certification. Energy healing has been used for thousands of years by numerous cultures. Indian �prana�, Chinese �chi� Japanese �qi�. Religious traditions �Laying on of hands�. Nurses & health care providers Therapeutic Touch (TT), Reiki Healing Touch (HT), 100,000 This was a program created by a nurse. It is a multi level class, reading, experimental work and mentoring that leads to a certification.

3. Healing Touch Healing Touch is a biofield therapy that is an energy-based approach to health and healing. It uses touch to influence the human energy system. The energy system energy centers, the fields that surround the body, the meridians.

4. Goal of Healing Touch Goal restore harmony and balance Healing Touch complements conventional health care

5. PICO Question: P (population) Pediatric Post Operative T&A Patients ages 3 - 6 I (intervention) Healing Touch C (comparison) No Healing Touch O (outcome) Decrease post op anxiety Decrease emergence delirium/emergence agitation Decrease time to meet PACU discharge criteria

6. Outcomes Anxiety- Patient�s & Family�s Ease of Wake Up--Emergence Delirium/Emergence Agitation Patient Flow- Earlier Discharge to home Increase Patient And Family Satisfaction

7. Cincinnati Children�s Hospital Medical Center is committed to improving children�s health and CCHMC values the patient�s and family�s positive experience and quality of life. CCHMC Vision & Mission2010

8. Arrive in PACU after T&A Surgery Complete

9. Review of LiteratureWeight of the Evidence CINAHL, MEDLINE, Cochrane, EBSCO, PUBMED, OVID, Centre for Reviews & Dissemination, Healing Touch International, Healing Touch Program, Dissertations, & NACHRI 1960-PRESENT TERMS: Healing touch Reiki Bioenergy Energy medicine Energy therapies Energy healing Children Anxiety Anxiety in hospitalized children Relaxation Pain Surgery Emergence delirium Length of stay

10. Findings: 62 articles reviewed 10 most recent & highest level that addressed PICO question 3 Meta-analysis or SR 3 RCTs 3 descriptive studies 1 Qualitative 3 CCHMC PACU staff surveys 1 CCHMC Retrospective Study (Unpublished) 2 NACHRI Responses

11. Synthesis of Evidence High grade of evidence to support the safety of Healing Touch with adults and children (Jain,2010 [1a]; Lee, (2008) [1a]; So, 2008 [1a]; Whitley, 2008 [1a]). High grade of evidence to support Healing Touch for pain and anxiety with adults (Jain,2010 [1a]; Lee, 2008 [1a]; So, 2008 [1a]). High grade of evidence to support the use of HT to decrease stress with premature infants (Hanley, 2008 [2a]; Im, 2009[2b]; Whitley, 2008 [2a]). Moderate evidence that Healing Touch may decrease the length of stay (MacIntyre, 2008 [2a]). Moderate evidence to support the use of Healing Touch with children�s stress & anxiety (Kramer, 1990 [4b]; Kemper, 2009 [4a]; Zimmer, 2008 [Unpublished]).

12. Evidence Summary Healing Touch may decrease the child�s anxiety and support the ease of wake up from anesthesia which may lead to earlier discharge to home. There is evidence that supports the use of Healing Touch and other biofield therapies with adults but little research has been done with children. To date, there has been no published research with HT and post operative pediatric patients (Healing Touch International Research Survey 2010).

13. Recommendations Research is needed to answer clinical question Submit research proposal to IRB for a a prospective, repeated measures randomly controlled trial to compare two groups of pediatric T&A patients. One group will receive Healing Touch post operative, while the control group will receive the usual standard of care. Research Questions 1. Does Healing Touch decrease stress in post operative pediatric patients ages 3-6? 2. Does Healing Touch decrease emergence delirium/ emergence agitation? 3. Does Healing Touch decrease the time it takes to meet discharge criteria?

14. Next Steps Research & evaluate outcomes Share outcomes Posters & podium presentations Manuscripts Teach nurses Healing Touch to support their patients. Guide staff in Evidence-Based Practice initiatives at the unit level