Nevada RNformation - September 2021

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Page 6 • Nevada RNformation September, October, November 2021 Using Holistic Modalities in the Hospital? You Bet! by Deborah McKinney and Michelle McGrorey In 2010, the use of holistic modalities in healthcare elicited nothing but eye-rolling, smirks, condescension, and the question, "What the heck is that?" How can the use of "energy," nice fragrances, or breathing help people feel better? Frankly, holistic modalities were thought of as hokey, woo-woo, or coming from some religious practice. They all seemed silly and were without credible, rigorous research. Fast forward to present day, 2021: Research on holistic modalities has increased exponentially over the last 10 years. Why? Because it was becoming apparent that many of the modalities had proven to be clinically effective — and not as a placebo. People and patients who regularly used holistic modalities were showing faster healing times, shorter hospital lengths of stay, an increase in wellbeing, reduction in depression, pain, anxiety, stress, tension, nausea, and vomiting, lower blood pressure, preservation of cardiac function, changes in blood chemistry results, and better overall health. (The list could go on!) The demonstration of the effectiveness of these modalities, along with trying to understand why they work, has been at the forefront of ongoing research. Because of the work that we were doing with our oncology patients at University Medical Center of Southern Nevada, our Chief Nursing Officer (with knowledge of Healing Touch herself) asked us to start a hospital-wide integrative therapies program that included both patients and staff. As a result, we were both given full-time positions as integrative therapy nurses, and our “Tranquility at UMC" program was born. In building this new program, we were given two stipulations. First, each modality we incorporated into our program had to have clinical research demonstrating its effectiveness. Second, the modality had to be evidence-based; it had to show effectiveness for the population on whom it was used. We began by going to every single unit in our hospital and completing Healing Touch on patients with every diagnosis and condition common to the hospital setting. From our NICU babies to our pediatric patients, to cardiology, med-surg, oncology, trauma, burn, ICU, and labor and delivery patients — everyone benefited from Healing Touch. The effects that it had on them were really quite amazing! In order to determine if what we were doing had any merit at all, we kept data on the effects that Healing Touch had on patients’ pain, anxiety, nausea, tension, and stress. Using a simple 0 – 10 Likert scale, patients rated the severity of each symptom before versus after each Healing Touch session. What we found was surprising. Data collected from 157 patients demonstrated, on average, a 60% reduction in pain, an 83% reduction in stress and tension, an 80% reduction in anxiety, and a 90% reduction in nausea. These reductions are clearly outside the realm of the placebo effect. Arguably, this is a low level of research; it does suggest the need for more study. However, it was clear that patients felt a significant reduction in their experience of adverse symptoms, and this reduction came about through the use of a holistic modality. Needless to say, we felt that we had justified the use of Healing Touch, and, as time went on, that justification would be borne out more and more. After exhaustive research on the use of essential oils, aromatherapy was the next modality added to our program. Before going any further, it must be clearly stated from the outset that aromatherapy must be used carefully and safely! Too many people use, distribute, sell, and advocate the use of essential oils without regard to their potential risks and dangers. All too often, it is thought that because essential oils are natural, they are safe. Nothing could be further from the truth. Essential oils are biologically active; they are not inert, and they can cause serious injuries. Therefore, take the time to learn the safety profiles for the essential oils you use or promote. Having said that, it is precisely because of the safe and proper use of each oil’s biologically active constituents that desired effects can be elicited in our bodies. Our most popular essential oil for our patients is lavender; its effects are well known. We use lavender in aroma sticks as well as lotion. Its two main constituents, linalool and linalyl acetate, produce feelings of calm and relaxation, often making it possible for patients to get some much-needed rest and sleep. Research studies have demonstrated that lavender has significant anxiolytic and sleep–improving properties which are not associated with sedation. This means that, while lavender is very useful in mitigating anxiety and promoting sleep, it does not produce the residual drowsiness and, subsequently, the fall risks associated with the use of commonly prescribed sleep medications. Did you know that lavender also helps mitigate pain? Who knew?! Research has shown that lavender is an effective analgesic and anti-inflammatory. As such, those who suffer with pain are able to enjoy the benefits of lavender's pain-relieving properties and with little to no adverse side–effects. Because lavender helps to promote sleep, calm and relax the body, and mitigate pain and inflammation, it's no wonder that it is the most requested essential oil in our hospital! While it would take books to cover all the essential oils and everything they have to offer, suffice it to say that the use of aromatherapy in our hospital has been nothing short of revolutionary. We have literally gone through gallons of essential oils with incredible results that we never thought possible! Many of our physicians are so impressed with what essential oils can do that not only are they consulting us to see their patients, they are now using the oils themselves. One of the best investments our hospital has made was in purchasing the Continuous Ambient Relaxation Environment (C.A.R.E.) Channel. The creators of this channel have made it their mission to provide exceptionally beautiful natural scenery, along with soft, ethereal, relaxing music, specifically for the benefit of patients. Their whole purpose is to help [hospitalized] patients feel better by creating a healing environment through the use of music and imagery. It’s truly amazing how effective this simple modality is with reducing stress, tension, and even pain by providing a wonderful and calming distraction. After looking at the research, we spearheaded the purchase of this channel. Interestingly, we each had the opportunity to test it out for ourselves. At different times, we were both hospitalized. We took full advantage of the C.A.R.E. Channel to see if it really helped us feel better during our hospital stays. We were truly amazed at how well it worked! This channel is available on every patient's television. As we go throughout the hospital, it can be seen and heard playing in many patients' rooms. Our ICU units have the C.A.R.E. Channel on extensively for their patients who are intubated, sedated, or agitated. The nurses find that patients respond positively to the music and imagery. They have even told us that it has been effective in helping patients wean off their ventilators. Additionally, there have been numerous times when less sedation was required because of the calming effects of the channel. Nurses in our Trauma ICU have reported similar experiences with their patients as well. The positive feedback we have received has been overwhelming. The healing power of music with imagery must not be underestimated. It most definitely makes a difference! The next modality we introduced was breath work, breathing, but with a purpose. If you thought you knew how to breathe, you were [likely] wrong. To make my point, think of the last time you were stressed... (Which was what, about 15 minutes ago?) Remember how you felt? Your breathing became shallower and more rapid; your neck and shoulder muscles tightened; your thinking started to cloud; maybe your mind was racing. You got impatient, irritable. You might have noticed you were getting a headache or felt your heart pounding. Perhaps you wished you had a nitroglycerine tablet to take care of that chest tightness you felt. Whatever the case, your pattern of breathing only lent to the stress you felt instead of relieving it. With simple breath work techniques, you can significantly calm your stress response (sympathetic nervous system) and more fully engage your relaxation response (parasympathetic nervous system). Here’s how it works: By taking slow, deep breaths, you contract your diaphragm more profoundly than with normal or stressful breathing. This deep breathing activates specific neurons that detect blood pressure. These neurons then send signals to the vagus nerve that blood pressure is becoming too high. The vagus nerve, in turn, responds by lowering your heart rate. Additionally, by stimulating the vagus nerve, your body's relaxation response is triggered, and the stress response is quieted. The result: you feel calmer, you can think more clearly, your reasoning improves, you work more efficiently, and your problem-solving abilities increase. Plus, you decrease your blood pressure, cortisol levels, heart rate, adrenaline output, and inflammation response. Remember, chronic stress leads to chronic inflammation, and chronic inflammation leads to chronic illness. Deep breathing helps put the brakes on your body’s stress response. We primarily use two breathing exercises. The first was developed by the HeartMath Institute as a way to improve cardiac coherence (the heart-brain connection), called the "Heart–Focused Breathing (HFB) Technique.” You focus your attention in the area of your heart. Imagine your breath is flowing in and out of your heart or chest area, breathing a little slower and deeper than usual. Inhale for five seconds, and exhale for five seconds (or whatever rhythm is comfortable). By taking a few minutes to do HFB, you create significantly more coherence between your heart and your brain, enabling you to function better and improve your health. The second technique we use is called, “4–7–8 breathing.” Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise. You will be exhaling through your mouth around your tongue; try pursing your lips slightly if this seems awkward. Exhale completely through your mouth, making a whoosh sound. Close your mouth and inhale quietly through your nose to a mental count of 4. Hold your breath for a count of 7. Exhale completely through your mouth, making a whoosh sound to a count of 8. This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths. Note that you always inhale quietly through your nose and exhale audibly through your mouth. The tip of your tongue stays in position the whole time. Exhalation takes twice as long as inhalation. The absolute time you spend on each phase is not important; the ratio of 4:7:8 is important. If you have trouble holding your breath, speed up the exercise but keep to the ratio of 4:7:8 for the three phases. With practice, you can slow it all down and get used to inhaling and exhaling more and more deeply. Believe it or not, these simple breathing techniques help immensely with anxiety, pain, stress, and tension — and with practice and continued use, they will help with overall health and wellness. Lastly, we have “Tranquility Rooms,” for our staff. These are quiet, reflective rooms to retreat to during the workday for staff members to reconnect with Self, to be still, close their eyes, and refresh and re-energize. Each Tranquility Room is decorated as a home-like room, offering the C.A.R.E. Channel, an essential oil diffuser, ambient lighting, a comfortable recliner, and several modalities known for their calming effects. When able to take a few minutes after a particularly stressful time or incident, staff are given the ability to regain enough resilience to effectively finish their shifts. To see just how effective these rooms are, staff was asked to rate their stress on a 0–10 Likert scale, going into the room versus after using the room. The results were impressive. 132 staff had an average stress level of 6.83 going into the rooms and an average stress level of 2.43 on leaving the rooms. By using the rooms as a brief respite from the stresses of their jobs, staff was able to bring down their stress level by 4.4 points and continue working effectively for the rest of the day! In a large academic medical center where staff has to continuously work at a high level, that's no small thing! The feedback from staff has been incredibly positive, so much so that our administration is looking to create more rooms for more staff members to have the opportunity to take advantage of their benefits. Holistic modalities are not new; they’re just not mainstream. In a culture where western medicine and western medicine practices prevail, holistic modalities are not especially popular or used as they should be. However, things are changing. Skeptics are being faced with continuously mounting research and outcomes that are compelling, even irrefutable, to say the least. It's now clear that many of these modalities have health-promoting and illness prevention advantages, even though western medicine typically does not mark them significantly beneficial for our health and well– being. More and more physicians are realizing their benefits; they are not only offering these alternative options to their patients but also using them for their
September, October, November 2021 Nevada RNformation • Page 7 own sake! In fact, functional medicine is a developing specialty across the country as physicians incorporate natural and holistic practices into patient care. Hospitals would do well to incorporate integrative therapies as active treatment interventions into their patients' documented plans of care, as the evidence of their effectiveness is clearly undeniable. We have found that our patient satisfaction scores have definitely increased! Integrative therapies provide a distinct patientcentered aspect to their care, the opportunity for more rest and relaxation, and give patients more control over their environment. We've seen instances of cost reductions, less medications used, decreased lengths of stay, and faster healing. Nurses are given additional "tools" to use in providing care, giving them an added level of effectiveness and compassion to their practice. Patients feel like they matter and not merely the recipients of medical attention. That means everything…and on every level! To date, the University Medical Center of Southern Nevada remains the first and only hospital in the state of Nevada to have a full–time integrative therapies program. Frankly, what started out as something of an experiment by our CNO has exploded into a program that has touched every unit and every department in our hospital and remains available to our patients, families, staff, and physicians. The benefits that holistic modalities have given are immeasurable. Because of the tremendous vision of our nursing leadership and our commitment to caring for all our customers, holistic modalities are a regular part of our care and our culture. They are here to stay! References 1. Allred KD, Byers JF, Sole ML. The effect of music on postoperative pain and anxiety. Pain Management Nursing. 2010 Mar: 11(1):15-25. 2. Buckle, J. (2003). Clinical aromatherapy; essential oils in practice (2nd Ed.). NY: Churchill Livingstone. Page 30. 3. Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease, JAMA: Journal of the American Medical Association, 298(14),1685-1687.doi:10.1001/ jama.298.14.1685. 4. Good M, Albert JM, Anderson GC, Wotman S, Cong X, Lane D, Ahn S. Supplementing relaxation and music for pain 5. after surgery. Nursing Resources. 2010 Jul-Aug: 59(4):259-69. 6. HeartMath. Retrieved from https://www.heartmath.org/ May 2020. 7. Johnson JR, Rivard RL, et al. The effectiveness of nurse-delivered aromatherapy in an acute care setting. Complement Ther in Med 25(2016) 164-169. 8. Kasper S, Gastpar M, Muller WE, Volz HP, Moller HJ, Dienel A, Schlafke S. Silexan, an orally administered Lavandula oil preparation, is effective in the treatment of `subsyndromal` anxiety disorder: a randomized, double-blind, placebo controlled trial. Int Clin Psychopharmacol. 2010;25(5):277- 287. 9. Lee, K.S., Jeong, H.C., Yim, J.E., & Jeon, M.Y. (2016). “Effects of Music Therapy on the Cardiovascular and Autonomic Nervous System in Stress-Induced University Students: A Randomized Controlled Trial.” The Journal of Alternative and Complementary Medicine, 22(1), 59–65. doi: 10.1089/ acm.2015.0079. 10. Lehrer P. M., Gevirtz R. (2014). Heart rate variability biofeedback: how and why does it work? Front. Psychol. 5:756 10.3389/fpsyg.2014.00756 11. Mofredj A, Alaya S, Tassaioust K, Bahloul H, Mrabet A. J Crit. Care. Music therapy, a review of the potential benefits for the critically ill. 2016 May 28;35:195-199. 12. Relaxation Techniques. https://nccih.nih.gov/health/relaxation-techniques-for-health. 13. Sayorwan, W.,Siripornpanich, T.,Hongratanaworakit, T., Kotchabhakdi, N.,and Ruangrungsi,. N. (2012). The effects of lavender oil inhalation on emotional states, autonomic nervous system, and brain electrical activity. The Journal of the Medical Association of Thailand,95 (4), 598-606. 14. Wang S.-Z., Li S., Xu X.-Y., Lin G.-P., Shao L., Zhao Y., et al. (2010). Effect of slow abdominal breathing combined with biofeedback on blood pressure and heart rate variability in prehypertension. J. Altern. Complement. Med. 16 1039–1045. 10.1089/ acm.2009.0577 15. Whitaker, MH. Sounds soothing: music therapy for postoperative pain. Nursing. 2010 Dec: Volume 40 - Issue 12 - p53–54. 16. Woelk H, Schlafke S. A multi-center, double-blind, randomized study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010;17(2):94-99. 17. Xiao Ma, Zi-Qi Yue, Zhu-Qing Gong, Hong Zhang, Nai-Yue Duan, Yu-Tong Shi, Gao- Xia Wei, and You-Fa Li. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology. 2017; 8: 874. West Hills Hospital located in Reno, NV, a leader in the treatment of behavioral, mental health care and substance abuse treatment is seeking FT/PT/PRN Registered Nurses to implement the nursing process as it relates to our programs. We are currently offering sign-on bonuses up to $10,000. Visit www.westhillshospital.net and click on CAREERS to apply. Truckee Meadows Community College is a comprehensive educational institution located in Reno, Nevada and is part of the Nevada System of Higher Education. TMCC’s five instructional sites and numerous community locations serves an increasingly diverse population of more than 11,000 students each semester. TMCC, an HSI (Hispanic Serving Institution), is a progressive institution that celebrates inclusion and diversity while supporting core themes of academic excellence, student success, and access to lifelong learning. Nursing Instructor, Tenure Track (Multiple Openings) Truckee Meadows Community College (TMCC), located in Reno, Nevada is seeking applicants for multiple full-time, tenure track, Nursing Instructors. The primary responsibility of Nursing Instructors is to facilitate student learning in the classroom and clinical settings. Teaching and workload assignments are scheduled throughout the calendar year, including summer. May require evening and weekend obligations at the Redfield campus and at off-campus clinical settings. Minimum Qualifications 1. Bachelor’s degree or higher in Nursing from a regionally accredited institution. 2. Master’s degree in a related field from a regionally accredited institution. 3. Current unencumbered Nursing License in Nevada or other state and the ability to obtain a Nevada License upon hire. Preferred Qualifications 1. Master’s degree in Nursing from a regionally accredited institution 2. Terminal nursing degree from a regionally accredited institution 3. Certification in a specialty area of nursing. 4. Experience in higher education including teaching, simulation instruction, accreditation, program review or assessment. Responsibilities Candidates must exhibit an appreciation of, a sensitivity to, and respect for a diverse academic environment, inclusive of students, faculty, and staff of varying social, economic, cultural, ideological and ethnic backgrounds. Visit tmcc.edu for more information and to apply. If you need assistance or have questions regarding the application process, please contact Human Resources at (775) 673-7168 or humanresources@tmcc.edu.
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Nevada RNformation - September 2021

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