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

2. What Is “Energy Medicine” “Biofield Medicine” ?

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 & Mission 2010

8. Arrive in PACU after T&A Surgery Complete Healing Touch Done Improved Ease of Wake Up Less Emergence Delirium & Agitation Less Anxiety Earlier Discharge to Home Parents More Satisfied

9. Review of Literature Weight 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Meta-analysis or SR 3 RCTs 3 descriptive studies 1 Qualitative 3 CCHMC PACU staff surveys 1 CCHMC Retrospective Study (Unpublished) 2 NACHRI Responses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

15. Barnes PM, Powell-Griner E, McFann K, Nahin Rl. Complementary and alternative medicine use among adults: United States, 2002. Adv Data. 2004; 343:1-19. Jain, S & Mills, P (2010) Biofield Therapies: Helpful or Full of Hype? A best evidence Synthesis. Int. J. Behav. Med. 17:1-16 So, PS, Jiang Y, Qin Y. Touch therapies for pain relief in adults. Cochrane Database of Systematic Reviews 2008. Issue 4. Art. No.: CD006535. DOI: 10.1002//14651858. CD006535. pub2. Lee, MS, Pittler, MH, Ernst, E. (2008) Effects of Reike in clinical practice: a systematic review of randomized clinical trials. International Journal of Clinical Practice Volume 62, Issue 6, pages 947-954 MacIntyre, B, Hamilton, J, Fricke, T, Ma, W Mehle, S Michel, M (2008). The efficacy of Healing Touch in coronary artery bypass surgery recovery: A randomized clinical trial. Alternative Therapies Jul/Aug 2008. Vol 14. No 4 Maville, J, Bowen, J, Benham, G. (2008) Holistic Nursing Practice, March/April:103-110. Whitley, J, Rich, B. (2008) A double-blind randomized controlled pilot trial examining the safety and efficacy of Therapeutic Touch in premature infants. Advances in Neonatal Care, Vol.8, No.6: 315-33 Im, H, Eunjung, K Effect of Yakson and Gentle Human Touch versus usual care on urine stress hormones and behaviors in preterm infants: A quasi –experimental study. International Journal of Nursing Studies 46 (2009) 450-458. Kemper K, Flecher, N, Hamilton, C, McLean, T. (2009) The Impact of Healing Touch on Pediatric Oncology Outpatients: Pilot Study. Journal of Society for Integrative Oncology, Vol 7, No 1 (Winter),:12-18 Hanley, M (2008) Therapeutic touch with preterm infants: composing a treatment. Explore. July/August Vol. 4, No. 4 249-258. Kramer, N (1990) Comparison of Therapeutic Touch and casual touch in stress reduction of hospitalized children. Pediatric Nursing. September-October Vol.16/no.5.483-485. Bibliography