1. Nurse Led Guided Imagery: An Education Initiative Katrina James, SN Abstract The purpose of this project was to implement an education program concerning the use of nurse led guided imagery on hospitalized adult clients. The target group consisted of the night shift nurses of 4 Main at Wellspan York Hospital. The efficacy of the education was measured using a pre and post-test survey. An informational handout was given in addition to a verbal teaching session on the benefits, ease of implementation, and overall knowledge concerning the intervention. A literature review of 13 studies was done to provide current data on the subject. The review focused on the use of guided imagery as a cost effective intervention for anxiety, stress, and pain perception in the adult client with various disease processes. There is currently a lack of scientific evidence to completely prove or disprove the efficacy of guided imagery. There is however, significant statistical data to support that it is effective in reducing anxiety, stress, and pain in adult clients. Further systematic research to include a larger study population is needed to persuade more to adopt guided imagery into practice. Background Nursing as a whole is both part art and part science in nature. In order to provide the best quality of holistic care, the nurse must address both physical and psychological needs of the client (Selimen & Andsoy, 2011). Guided imagery is a technique that can link the psychological mind to the physical body and alter its response to stressors when performed correctly. Guided imagery is defined as a form of deliberate, directed daydreaming, usually consisting of words and phrases which invoke a detailed depiction of peaceful or serene scenery, a place of fond memories, or a fantasy location. When effective these images can have several sensory qualities such as visual, auditory, olfactory, and tactile (Bonadies, 2009). The purpose of imagery is to elicit a relaxed state and allow for an increased sense of control over the stressing symptoms the client may be experiencing (Geidt, 2015). Purpose The use of guided imagery and distraction techniques can decrease anxiety, pain perception, and stress in the adult client. This therapeutic mind-body technique can also improve overall feelings of well-being before, during, and/or after invasive or stress inducing procedures such as wound care, cancer treatment, venipuncture, surgery, and dressing changes. There is evidence to support that it can also have an effect on those dealing with chronic conditions to include fibromyalgia, osteoarthritis, asthma, and musculoskeletal pain. The purpose of this project was to implement an education program concerning the use of nurse led guided imagery on hospitalized adult clients. Methodology A total of ten night shift nurses participated in the project. A pre-test survey was given out to obtain an unbiased knowledge on the subject. All participating nurses were then provided a verbal education session to include a summary handout. After the teaching, a post-test survey was given to the nurses to complete. The final post-test survey was given to assess the efficacy of the teaching and to gauge the acceptance and confidence level of the nurses on guided imagery as a nursing intervention. All surveys collected were anonymous. See below for an image of the handout provided. Discussion The educational material that was presented did improve post-test survey scores while also showing an increase in the confidence levels of nurses in the efficacy of guided imagery as an intervention for anxiety, pain, and stress. This is hopeful and sheds light on the possibility of a future protocol and wide based acceptance of this simple technique to improve the inpatient experience. Overall, the project was a success. Results The pre-test survey results showed significant variation. Guided imagery was only defined correctly by 3 out of 10 of the survey participants, leaving the other 4 to provide only a partially correct answer and 3 to either state knowledge deficit or an unrelated topic. Answers on implementation in the pre-test survey were also rather dispersed. Only 3 participants were able to correctly identify how a nurse might implement the intervention whereas 4 had a partially correct response, leaving the remaining 3 to have no knowledge on the subject. The majority of nurses responded to confidence in using guided imagery as a therapeutic intervention with a “not at all confident” or “slightly confident” during the pre-test. All of this data supports the need for education on guided imagery as a simple intervention technique, that when practiced can help clients with a plethora of symptomology to better their own experience. The post-test survey results differed greatly from the pre-test. The occurrence of incorrect answers to knowledge based questions was less than 20 percent. Results continued: The confidence level in applying the intervention also increased from “not at all”, or “slightly” to the majority either “moderately” or “very” confident. This finding indicates that the education was able to provide simple examples that nurses felt they could implement without issue. Overall efficacy scores improved as well with an average of 4 out of 5 score. The increased scores could indicate that there was enough supporting evidence in the research that was presented, to show more benefit than risk to clients. See below for visual graph of score changes pre and post-test. PICO For nurses caring for both acute and chronic Medical-Surgical adult clients in the hospital setting, will an education program targeting nurse led guided imagery result in an improved understanding and potential implementation in practice?