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Touch Therapies Andrea Hammond, Sharon Hendon, Stacey Klein, Angel Schneider

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Purpose To explore alternative, nonpharmacological methods that could provide better management of pain, fatigue, and anxiety in our patients.

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Research Question Is there a sufficient amount of valid research on touch therapies (Therapeutic Touch, Healing Touch, and Reiki) to consider utilization as an EBNP?

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What are Touch Therapies? Touch therapy is based on the assumption that all human beings are surrounded by a universal energy field. When there is an imbalance in energy, illness can result. This imbalance can be treated by trained practitioners. Therapeutic Touch (TT) has been used since 1973 to reduce anxiety, accelerate time of wound healing, decrease pain and anxiety, and accelerate relaxation in those who are ill. As of 2000, 90 countries practice TT throughout the world (Coppa, p. 17).

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Theorist The nursing theory by Martha Rogers supports this view. Rogers postulates that the human and environmental fields are identified by wave patterns, and that change is propagated by waves. Nursing interventions such as TT are directed towards promoting the rhythmic flow of energy waves that order and re-order the human field (Aghabati, p. 376).

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Touch Therapy-The Beginning Reiki was conceived by Buddhist monk Mikao Usui in 1914. Therapeutic Touch was co-founded by Dora Kunz and Dolores Krieger in 1973. Healing touch was founded by Janet Mentgen in the 1980s.

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Primary Research Articles The Effect of Therapeutic Touch on Pain and Fatigue of Cancer Patients Undergoing Chemotherapy (Aghabati, Mohammadi, & Esmaiel, 2008) The researchers studied 90 cancer patients undergoing chemotherapy in an experimental study. The patients were split into 3 groups of 30 each. A control no treatment group, a placebo group, and a therapeutic touch group. The results found that the patients who received TT experienced less pain and fatigue than the other 2 groups of patients. The Internal Process of Therapeutic Touch (Coppa, 2008) The researchers used a descriptive qualitative design to study TT between the nurse and the client. Each nurse had one adult and one infant client that they treated. The researchers stood back and only observed the treatments, there was no interaction between the researcher and the clients. Detailed notes were taken during this observation.

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Primary Research Articles The Effect of Therapeutic Touch on Postoperative Patients (Coakley & Duffy, 2010) The researchers studied 21 vascular surgery postoperative patients from post-op days 1-7 to determine if TT is effective in reducing post-op pain and stress after surgery. This study measured the level of pain and blood levels of cortisol and natural killer cells (NKC) before and after each TT treatment. This study found that the patients receiving TT reported a lower level of pain and blood levels of cortisol and NKC were also decreased. Effects of Healing Touch on Stress Perception and Biological Correlates (Maville, Bowen, & Benham, 2008) The researchers used a quantitative, quasi-experimental design to study the effect of healing touch on anxiety and physiological measures of blood pressure, heart rate, muscle tension and skin temperature in health adults. After the data was collected and reviewed, the researchers concluded that healing touch promotes relaxation and stress reduction. The results showed a decrease in the physiological parameters during and after treatments.

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How the Evidence is Effected by Your Experience Point of View The evidence in any literature review is affected by the nurses personal experience, patient preferences, and nursing values. Some of our group members have positive personal experience with touch therapies, while others remain skeptical. Patient preferences need to be taken into consideration. Some patients enjoy a relaxing back rub, while others do not. Our nursing values provide a framework for each of us to work in while caring for patients. We need to use the policies and procedures put in place by our institutions, as well as the scope of nursing as described by the American Nurses Association.

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Assumptions Our point of view is shaped by the assumptions we have. Whether we have personal experience with a given modality or not, we are still shaped by what we assume to be true regarding its use in our practice. Two opposing assumptions are present in our group. One member assumes that western medicine fails to help all patients and there is definitely a place for eastern medicine along with current practice to treat the whole patient. Another member assumes that touch therapy would not be effective based on her skepticism of eastern medicine.

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Implications and Consequences There are significant implications to allowing our point of view and assumptions to direct our review of literature. If we are to move ahead with best practice nursing we must set aside our biases and review the literature objectively. The modality of TT is an intervention, not a cure. TT is very low tech, low cost, and within the scope of nursing practice (Coakley, p. 3).

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Recommendations The four primary research articles that we critiqued, recorded positive results for a wide variety of patients when TT was used. The use of touch therapy as a nonpharmacological method to reduce pain and anxiety is starting to receive its deserved notice in the medical community. Research continues to verify the findings that touch therapy is effective in reducing pain, anxiety, and fatigue. Touch therapy is a low cost option that should be considered for pain control. Research needs to continue to collect additional support for the use of touch therapy as a nonpharmacological method for reducing pain, anxiety, and fatigue.

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Conclusion As nurses, we are often frustrated by the failure of traditional medicine to help patients with their pain, stress, and fatigue. Each of the articles reviewed presented clinical support of touch therapy as an effective alternative treatment for pain, anxiety, and fatigue. Alternative medicine is open to a lot of skepticism in our modern medical world. Within our group this bias was evident. Our findings were inconclusive to recommend touch therapies as an EBNP, but there is sufficient evidence to suggest touch therapies be considered in holistic nursing practice.

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References Aghabati, N., Mohammadi, E., & Esmaiel, Z. P. (2010). The Effect of Therapeutic Touch on Pain and Fatigue of Cancer Patients Undergoing Chemotherapy. Evidence-Based Complementary and Alternative Medicine, 7(3), 375-381. doi:10.1093/ecam/nen006 Coakley, A., & Duffy, M. (2010). The effect of Therapeutic Touch on Post Operative Patient [Electronic version]. Journal of Holistic Nursing, x(xx), 1-8. doi:10.1177/0898010110368861 Coppa, D. (2008). Internal Process of Therapeutic Touch. Journal of Holistic Nursing, 26(17). doi:10.1177/0898010107306691 Fazzino, D., Griffin, M., Mc Nulty, R., & Fitzpatrick, J. (2010). Energy Healing and Pain. Holistic Nursing Practice, 24(2), 79-88. Retrieved June 20, 2010, from CINAHL. Maville, J., Bowen, J., & Benham, G. (2008). Effects of Healing Touch on Stress Perception and Biological Correlates. Holistic Nursing Practice, 22(2), 103-110. Retrieved June 20, 2010, from CINAHL. Monroe, C. (2009). Effects of Therapeutic Touch on Pain. Journal of Holistic Nursing, 27(2). doi:10.1177/08980101083227213 Peck, S. (2007). Aftermath of the Unexpected Unexplained and Abrupt Termination of Healing Touch and Extrapolation of Related Cost. Complementary Health Practice Review, 12(2), 144-160. doi:10.1177/1533210107302934 Pierce, B. (2009). A Nonpharmalogical Adjunct for Pain Management. The Nurse Practitioner, 34(2), 10-13. doi:10.1097/01.NPR.0000345262.116335e So, P., Jiang, Y., & Quon, Y. (2008). Thereaputic Touch for Pain Relief in Adults (Review). The Cochrane Library, 4, 1-10. Retrieved June 20, 2010, from CINAHL. Tan, G., Craine, M., Bair, M., Garcia, M., Gordiano, J., Jensen, M.,... Tsao, J. (2007). Efficacy of Selected Complementary and Alternative Medicine Interventions for Chronic Pain. Journal of Rehabilitation Research Development, 44(2), 195-222. Retrieved June 20, 2010, from CINHAL