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Running Head: GUIDED IMAGERY: IMPROVING CLIENT CARE IN ADULTS 1

Nurse Led Guided Imagery Education and Improving the Adult Client Experience:

A Pre and Post Test Study

Katrina James

Pennsylvania State University

GUIDED IMAGERY: IMPROVING CLIENT CARE IN ADULTS 2

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 was 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. Several databases were searched to

include ProQuest Nursing and Allied Health Journals, PubMed (Medline), and CINAHL

(Cumulative Index for Nursing and Allied Health). 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.

Keywords: guided imagery, distraction, anxiety, pain, non-pharmacological, stress, adult


Introduction

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).

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. Guided imagery is a cost

effective, non-pharmacological intervention that can be utilized by nurses in and out of the

hospital setting. This project discusses the following question; 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?


Background

Anxiety and stress are two commonalities that present when an individual is ill or

experiencing pain. This especially holds true for those individuals who are experiencing an acute

illness or health related event such as being scheduled for an unexpected surgery or losing a limb

in an accident. Also affected, are those being treated for chronic illnesses such as receiving

chemotherapy treatment for cancer, or being hospitalized for an asthma exacerbation or

worsening of fibromyalgia or osteoarthritis symptoms. In addition to the stress related to the

disease process itself, the client is usually in an unfamiliar setting and is experiencing feelings of

hopelessness, worry, powerlessness, and role conflict (Lewandowski & Jacobson, 2013). It is

the body’s natural response to such stressors to activate the sympathetic nervous system via the

release of adrenal-medullary hormones such as adrenaline and noradrenaline, which can in turn

cause vasoconstriction increasing the respiratory rate, heart rate, blood pressure and body

temperature (Lin, Hsieh, Hsu, Fetzer, & Hsu, 2011). The anxiety response can decrease

immunity and delay wound healing and can alter the client’s thoughts and behaviors (Selimen &

Andsoy, 2011).

Guided imagery as a complementary and alternative medicine (CAM) therapy can

improve the patient’s emotional state and in turn lessen the effects of the stress response when

used consistently. Due to the benefits that have been associated with guided imagery, a review of

literature will be completed to answer the following question; can nurse led guided imagery and

distraction techniques during invasive procedures lessen the perception of pain, anxiety, and

discomfort of the adult patient?

Review of Literature


Method

The following databases were accessed through the Penn State Library Nursing Research

Center; PubMed (Medline), CINAHL (Cumulative Index for Nursing and Allied Health), the

Cochrane Library, and ProQuest Nursing and Allied Health Journals. The publication dates of

these studies ranged from the years 1997 to 2015. The article published in 1997 was chosen to

be included in this study due to its relevance and background information on the topic. The other

12 articles were published within the past 10 years. All articles were available in English but

some studies were performed outside of the United States to include Turkey, Greece, Spain,

United Kingdom, and China. Articles chosen for this review were found using various

combinations of the following search terms; guided imagery, distraction, adults, nursing, non-

pharmacological, CAM therapies, pain, anxiety, depression, stress, and intervention. A total of

25 studies was originally found and then narrowed down to 13 using specific inclusion and

exclusion criteria.

Inclusion Criteria

The inclusion criteria consisted of adults, both male and female aged 18 and older. To be

included in the review the study participants had to have been experiencing anxiety, stress, or

pain (both chronic and acute) in relation to either a disease process such as cancer, osteoarthritis,

fibromyalgia, or asthma. Burn patients, cardiac surgery patients, and arthroplasty patients were

also included in the collection of research. Combination of guided imagery and other CAM

therapies were included due to the close relationship of the type of intervention.

Exclusion Criteria

All studies that included children or infants were excluded. Also, outpatient or strictly

home based interventions without close monitoring were excluded from this pool of data.


Studies not provided in an English translation were also excluded.

Guided Imagery Methodology and Holistic Care of Clients

Guided imagery as a nursing intervention uses the principle of psychoneuroimmunology

(PNI) in order to relieve the client of the stressing symptoms they are experiencing (Giedt,

1997). The theory behind this technique is based upon the connection between mind and body

and how a person’s perceptions influence their interactions between both the external and

internal environments. As stated by Bonadies (2009), care planning and practice by both the

nurse and client are integral in the efficacy of the guided imagery intervention. Guided imagery

involves more than just the visual sense and nearly anyone can use it as an intervention as

adjunct to various types of pain and anxiety responses. The psychological changes that one

experiences in the stress response such as fear of an upcoming procedure need to be treated

according to that client’s specific personality, which encompasses the need for holistic care

(Selimen & Andsoy, 2011). In the peri-operative setting, nurses are entrusted with creating a

therapeutically calm environment in order to assist in decreasing the client’s fear, tension, and

overall stressors. Studies have shown that by providing an additional intervention as simple as

recalling a happy event from the past can assist in decreasing the stress response and physical

symptoms that come along with it (Selimen & Andsoy, 2009).

Guided Imagery and Acute Illness or Stressors

In the systematic review done by Posadzki and Ernst (2011), clinical trials were reviewed

involving both musculoskeletal pain and guided imagery intervention. They included a total of 9

studies involving 201 patients from various countries. The population ranged in the middle age

category and included fibromyalgia syndrome (FMS), elderly osteoarthritis (OA), postoperative

patients, and those suffering from chronic pain. The control groups received standard care, sham


guided imagery, placebo and standard care, or no intervention. The total number of patients that

benefitted from the guided imagery technique was 115 (Posadzki & Ernst, 2011).

In the instance of burn clients, the stress response can be detrimental in that it places

them in a hypermetabolic response state, further increasing their need for nutritional support.

Enteral or parenteral feedings are usually required due to the difficulty most post burn clients

have consuming the needed 20-100% increase in caloric consumption (Hoffman & Klein, 2010).

In order to see what the effect guided imagery would have on the hypermetabolic state of these

clients a pilot study was performed to include 10 subjects. Six subjects were in the control group

and received usual care and 4 subjects were in the treatment group and to receive the guided

imagery intervention. To gather the baseline data the subjects were monitored using a

computerized system which measured heart rate, blood pressure, and respirations. The resting

energy expenditure was also measured as a method to record the caloric expenditure. Patients in

the intervention group received intervention daily and were asked to imagine a place where they

felt safe and comfortable (Hoffman & Klein, 2010). Subjects were encouraged to use the

intervention throughout the day, especially during times of dressing changes and any type of

active therapy sessions.

In the study done by Thomas and Sethares (2010), they included 121 patients scheduled

for elective total joint arthroplasty. A 2-group quasi-experimental design was used. The

interventional group of 69 clients listened to a guided imagery CD that promoted harmony and

peacefulness, while the control group of 52 clients received usual care. The theoretical

framework used in this study was the gate control theory developed by Melzack and Wall in

1965. The focused concentration related to the use of guided imagery may possibly interrupt the


negative sensory stimulus, causing the perception of pain and therefor help to alleviate the

client’s symptoms and provide relief.

In regards to the efficacy of guided imagery on clients undergoing cardiac surgery, a

study was done by Casida and Lemanski (2010), which analyzed how pre and post-operative

pain could be reduced by using this as an intervention. There was a total of 7 articles included in

their study and both the control groups received usual care and the intervention group received

guided imagery. The topics of interest were length of stay, anxiety/tension, and pain reduction.

Numeric, open-ended, and visual scales were used to measure anxiety and pain while length of

stay was gathered from hospital data.

Guided Imagery and Chronic Conditions

Fibromyalgia pain is a chronic condition that can in turn affect the quality of life of those

suffering from it. A study was done to evaluate the effects that guided imagery can have on pain

perception of clients diagnosed with the condition. The use of Marth Rogers’ science of unitary

beings was used in this study in order to correlate the holism involved in the health dynamic

connecting both mind and body (Onieva-Zafra, Garcia, & del Valle, 2015). One of the many

benefits of guided imagery is that it is a self-management technique and once taught the client

can continue to utilize it to improve their symptoms. This study consisted of 55 participants

aged 18-70 years old. A 2 group experimental design was used. There were 28 clients in the

intervention group who listened to 15-minutes of a relaxation CD daily and the remaining 27

received usual care as the control group. There were significant changes in the depression ratings

reported by participating subjects indicating that the guided imagery was effective.

A study done by Lahmann et. al (2009) indicated that a strong relationship existed

between the use of functional relaxation and guided imagery and a reduction of seriousness of


asthma related illness. In this study a total of 64 participants, 16 of which received functional

relaxation as an intervention, 14 who received solely guided imagery, 15 who received both

interventions, and a control group who received a placebo relaxation technique. The findings

from this study indicated that the process of functional relaxation was more effective than the

guided imagery intervention in having a positive effect on respiratory parameters. Another study

by Charalambous, Giannakopoulou, Bozas, and Paikousis (2015), studied the effects of

progressive muscle relaxation and guided imagery have on cancer patients suffering from

prostate or breast cancers. There was a primary emphasis on the anxiety and depression suffered

by those who are receiving treatment for these disease processes. The study itself was well done

in that it was randomized, the accessors were blinded, and a scientific methodology was

followed. The Zung Self rating anxiety (SAS) was used to measure anxiety while the Beck

depression interview (BDI) was used to measure depression. Measurements were acquired both

at baseline and throughout the length of the study. The results of this study provided strong

evidence of the correlation between the decreased anxiety and depression in the intervention

group. This is yet another positive outcome of the use of guided imagery as an effective

intervention.

In a systematic review in relation to orthopedic pain and the use of non-pharmacological

interventions, Büyükyýlmaz (2015) found that there was a decrease in perception of pain while

using a combination of both pharmacological pain medicines and CAM therapies. It was agreed

there was no reason to not implement the intervention in more settings to help reduce the need

for increased analgesics and to improve the clients’ quality of life.

Discussion


The findings from the Casida and Lemanski (2010) study were significant in that not only

did 3 of the studies show a decreased length of stay, but fatigue was reduced, sleep was

improved, pain required less analgesic, and anxiety was reduced. One of the many benefits of

guided imagery is that it is a self-management technique and once taught the client can continue

to utilize it to improve their symptoms. Each person is unique in that the imagery modality may

work for a 39 year old woman with cancer related pain but not for another with the same age and

disease process. We must keep this in mind in that the study of CAM therapies such as guided

imagery will never be a clear cut study. Statistical analysis of variability can decrease this level

of human error. Overall, the practice of nurse guided imagery has a hopeful future in the care

facilities of tomorrow.

Implications for Practice

Although there is not a significantly large group of data that has been collected to

strongly support the claims that guided imagery is in fact effective, in decreasing clients’

perceptions of pain, anxiety, and stress the research is promising that there will soon be an

implementation of this intervention in the near future. With no evidence of client harm the

research will continue. As the trends continue in that clients are more interested in holistic and

non-pharmacological interventions I see a push for the implementation of guided imagery

protocols in the research led institutions within the next decade.

In order to better the practice of today, simple implementation should be applied in the

inpatient setting with all mentally capable patients. The first step in this implementation is to

create a basic script that contained several different approaches. An educational meeting would

be scheduled where all staff go over basics and practice the script with one another. After the

rehearsal and education process, the nurse would choose the script containing the topic that best


fits the patient. The next step would be to lead the patient in creating the mental image or topic

of their choosing. If the evidence based practice committee would want to do a pilot study to

measure effectiveness and acceptance by both patients and staff, a study would be planned and

implemented. If the pilot study were a success then a protocol would be suggested and created.

Limitations

There was a lack of large group randomized controlled trial studies that specifically look

at guided imagery and distraction techniques for adult clients in both acute and chronic health

situations. A majority of the adult focused research on the topic is now outdated and needs to be

recreated using more reliable scientific methods. There is a significant amount of research on

distraction and guided imagery focusing on children, but there is a research gap when applying it

to an adult population. Also there are few concrete studies done on the implementation of

nursing based interventions in these settings using a blinded and randomized methodology.

There is much to be done to further support the use of guided imagery into evidence based

practice.

Conclusion

The use of guided imagery and distraction techniques in both the acute and chronic

treatment of stress, anxiety, and pain is a cost effective adjunctive therapy with promising

results. Although there is a need for further research most studies have found statistically

significant differences in the intervention versus control groups in that there was a decrease in

one of the aforementioned symptoms. With the support that there is no negative impact to

implementing distraction techniques or guided imagery interventions with clients of any of the

mentioned conditions, there is no harm in completing more studies to better support this

alternative therapy.


Project Plan: Part 1

The guided imagery educational project plan was completed and was initiated from

October 2015 to November 2015. The focus of this project was to educate nurses on the basics

of guided imagery, with a focus on patient benefits, and ease of implementation. The unit

involved was the 4 Main medical-surgical telemetry unit at Wellspan York Hospital. Deneen

Harbold, RN was the project coordinator. Sheila Perry, RN also assisted in the educational

process of this project. Current research from well-known databases such as PubMed, and

ProQuest Nursing and Allied Health Journals, present guided imagery as an effective non-

pharmacological intervention to decrease anxiety, stress, and patient pain perception. Due to its

ease of nurse led implementation as well as it being cost effective, there was an opportunity to

test the current staff’s knowledge on the topic, acceptance of the intervention, and confidence

level of implementation.

Purpose of Project

There is substantial evidence describing the use of guided imagery to improve patients’

overall hospital experience, to include prolonged health benefits through use of this learned

technique in the outpatient setting. From the aforementioned research and areas of interest, the

following PICO question was formed to guide this project; 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? The purpose of this initiative was to provide an overview of guided imagery to the

nursing staff on 4 Main to increase awareness of the technique and to encourage use and possible

implementation of a guided imagery protocol. The scope of this initiative is vast in that it could

transfer to a variety of hospital and outpatient settings to include numerous acute or chronic


conditions. Any area of practice in which there are clients who are able to comprehend verbal

direction, execute simple commands, and are in a sound state of mind.

Logistics and Methodology

The key leader of the project, Katrina James, SN was assisted by both Deneen Harbold,

RN and Sheila Perry, RN two night shift nurses on 4 Main, Wellspan York Hospital. The

research, educational material, and pre and post-test surveys was completed by Katrina James,

SN. All surveys collected were anonymous. Ten night shift nurses were given a pre-test survey

to assess their baseline knowledge on the topic of guided imagery. The staff was then given

verbal instruction about the use and research regarding the topic as well as given an informative

handout. 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.

The survey and handout material was dispersed by all three team members while the teaching

was completed by Katrina James, SN only.

Results

The pre and post-test surveys can be found in Appendix A and B. The informational

handout can be located in Appendix C. 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. 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.

Project Plan: Part 2

The changes that took place as a result of the education initiative, were in the minds of

and attitudes of the nursing staff. Their overall knowledge on the topic increased and they were

also more encouraged to try guided imagery as a nursing intervention. The process measure

were pre and post-test surveys which were comprised of multiple choice, open ended, and Likert

Scale questions. The frequency of measures were weekly. The data collection process lasted

three weeks after October 30 and was ongoing. The overall outcome measures were centered on

staff surveys. The pilot area barriers included staff non-compliance, feelings of increased

workload and inability to find time for survey, and lack of interest. The facilitators included

Deneen Harbold, RN (preceptor), Sheila Perry, RN (staff nurse) and Katrina James, SN (project

leader).

Implementation


The communication for this project consisted of peer coach meetings. The education was

targeted for the 4 Main night shift nurses at Wellspan York Hospital from October 2015-

November 2015. Teaching was reinforced through peer coaching and handouts. Peer feedback

was collected and overall acceptance levels were high.

Modifications/ Limitations

In order to provide more sound results a larger sample would have been preferred. Also,

if this project were to not have any limitations, it would have been preferred that it was done on a

variety of different floors with various client bases. A larger poster board that could have been

hung in several nursing lounges would have provided more education than a simple handout

alone. If management or educational committees were to get involved and express interest then a

possible pilot study to include an actual implementation of guided imagery on the floor plus an

added client survey on their perception of the intervention would have provided excellent data.

Overall for a starter project the results were few but gave a good insight into the knowledge and

acceptance of nurses at this health care facility.

Discussion

The PICO question, “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?” was answered to

a degree. 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.


References

Bonadies, V. (2009). Guided imagery as a therapeutic recreation modality to reduce pain and

anxiety. Therapeutic Recreation Journal, 43(2), 43-55.


Büyükyýlmaz, F. (2014). Non- pharmacological intervention in orthopedic pain: A systematic

review. International Journal of Caring Sciences, 7(3), 718-726.

Casida, J., & Lemanski, S. A. (2010). An evidence-based review on guided imagery utilization

in adult cardiac surgery. Clinical Scholars Review, 3(1), 22-30. doi:10.1891/1939-

2095.3.1.22

Charalambous, A., Giannakopoulou, M., Bozas, E., & Paikousis, L. (2015). A randomized

controlled trial for the effectiveness of progressive muscle relaxation and guided imagery

as anxiety reducing interventions in breast and prostate cancer clients undergoing

chemotherapy. Evidence-Based Complementary and Alternative Medicine, 1-10.

http://doi.org/10.1155/2015/270876

Giedt, J. F. (1997). Guided imagery: A psychoneuroimmunological intervention in holistic

nursing practice. Journal of Holistic Nursing, 15(2), 112-127.

doi:10.1177/089801019701500204

Hoffman, C. A., & Klein, J. M. A. (2010). Relaxation and visual imagery techniques: Do they

work? Can they really help burn clients? MedSurg Nursing, 19(3), 169-174.

Lahmann, C., Nickel, M., Schuster, T., Sauer, N., Ronel, J., Noll-Hussong, M., Loew, T. (2009).

Functional relaxation and guided imagery as complementary therapy in asthma: A

randomized controlled clinical trial. Psychotherapy and Psychosomatics, 78(4), 233.

doi:10.1159/000214445

Lewandowski, W., & Jacobson, A. (2013). Bridging the gap between mind and body: A

biobehavioral model of the effects of guided imagery on pain, pain disability, and

depression. Pain Management Nursing: Official Journal of the American Society of

Pain Management Nurses, 14(4), 368. doi:10.1016/j.pmn.2011.08.001


Lin, M., Hsieh, Y., Hsu, Y., Fetzer, S., & Hsu, M. (2011). A randomised controlled trial of the

effect of music therapy and verbal relaxation on chemotherapy‐induced anxiety. Journal

of Clinical Nursing, 20(7‐8), 988-999. doi:10.1111/j.1365-2702.2010.03525.x

Onieva-Zafra, M. D., García, L. H., & del Valle, M. G. (2015). Effectiveness of guided imagery

relaxation on levels of pain and depression in clients diagnosed with fibromyalgia.

Holistic Nursing Practice, 29(1), 13-21. doi:10.1097/HNP.0000000000000062

Posadzki, P., & Ernst, E. (2011). Guided imagery for musculoskeletal pain: A systematic

review. The Clinical Journal of Pain, 27(7), 648-653.

doi:10.1097/AJP.0b013e31821124a5

Selimen, D., & Andsoy, I. I. (2011). The importance of a holistic approach during the

perioperative period. AORN Journal, 93(4), 482-490. doi:10.1016/j.aorn.2010.09.029.

Thomas, K. M., & Sethares, K. A. (2010). Is guided imagery effective in reducing pain and

anxiety in the postoperative total joint arthroplasty client? Orthopaedic Nursing, 29(6),

393-399.


Appendix A: Capstone Pre-test Survey

Clinical Capstone Project: Pre-test SurveyKatrina James, SN

The Pennsylvania State UniversityFall 2015

1. What is guided imagery?

2. Guided imagery is a type of ____ (circle one)A. ExaminationB. Deep sleep C. MeditationD. Yoga

3. What are some patient benefits of nurse led guided imagery?

4. How might a nurse implement the use of guided imagery?

5. As a nurse, how confident do you feel using guided imagery to decrease anxiety and discomfort in your patients during invasive procedures or stress inducing care tasks? Using a scale of 0= Not at all confident to 5= Very effective, please circle your answer

A. Not at all confident (0)B. Mildly confident (1)C. Moderately confident (2)D. Very confident (3)

6. How well do you think that guided imagery as a nursing intervention would be as an effective means of decreasing overall patient anxiety, pain, and/or stress? *Using a scale of 0=Not at all effective to 5=Extremely effective, please circle your answer.

0 1 2 3 4 5


Appendix B: Capstone Post-test Survey

Clinical Capstone Project: Post-test SurveyKatrina James, SN

The Pennsylvania State UniversityFall 2015

1. What is guided imagery? (circle one)E. An ultrasound or visually-assisted/guided procedureF. Helping a recently blind individual to imagine or visualize imagesG. A relaxation technique using words to evoke positive mental images, feelings, and

thoughts with the purpose of reducing stress, anxiety, and pain perceptionH. Using a magnifying device to examine a patient

2. Guided imagery is a type of ____ (circle one)A. Examination techniqueB. DreamingC. Guided relaxationD. Yoga

3. An example of using guided imagery would be____? (circle one or more)A. Talking with a patient to describe a setting in which the patient feels is relaxingB. Telling a client to think of their favorite food while NPOC. Having a client describe a favorite vacation spot while performing wound careD. Discussing with the patient whether to keep the TV on during assessment

4. As a nurse, how confident do you feel using guided imagery to decrease anxiety and discomfort in your patients during invasive procedures or stress inducing care tasks? Using a scale of 0= Not at all confident to 5= Very effective, please circle your answer

A. Not at all confident (0)B. Mildly confident (1)C. Moderately confident (2)D. Very confident (3)

5. Which of the following are benefits of using guided imagery? (circle one or more)A. Decreased stress for the patientB. Improved patient experienceC. Decreased use of analgesicsD. Reduced self-rated anxietyE. Decreased length of stay in the hospital

6. How well do you think that guided imagery as a nursing intervention would be as an effective means of decreasing overall patient anxiety, pain, and/or stress? *Using a scale of 0= Not at all effective to 5= Extremely effective, please circle your answer.

0 1 2 3 4 5


Appendix C: Education Summary Handout

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