ONS: Holistic Nursing Interventions Reduced Patient Anxiety, Nausea, and Pain During Hospitalization or RT Treatments

A pilot study of several holistic nursing interventions, presented as a poster (113142) at the 38th Annual Oncology Nursing Society Congress, highlights the benefit of specific holistic interventions in supportive care, specifically in the reduction of anxiety, nausea, and pain, and improvement in select vital signs. The study, which included more than 400 patients, was conducted by Marilyn Haas, PhD, RN, CNS, ANP-BC, from Mission Hospital, Cleveland, with Sheri Denslow, PhD, MPH, and Lourdes Lorenz, RN, MSN-IH, NEA-BC, AHN-BC, from Mission Hospital in Baltimore.

Dr. Haas and her coinvestigators explained that nurses are ideally positioned to provide holistic nursing, which is defined by the American Association of Holistic Nurses as “all nursing practice that has healing the whole person as its goal.” Noting that “there is a growing body of evidence supporting integrative nursing modalities in oncology,” they said that holistic nursing and a variety of integrative therapies “fall within the domain of nursing, thus providing opportunities for nurses to engage [and] support patients at a higher level of care.”

The investigators assessed the parasympathetic effects of four different holistic nursing modalities, offered by physicians and nurses to oncology patients being treated on an oncology inpatient floor and  radiation oncology outpatient department, and provided by certified holistic nurses (registered nurses who have achieved credentialing from the American Holistic Nursing Credentialing Corporation). They measured changes from baseline of physiological vital signs including blood pressure, pulse, and respiratory rate, and patients self-reported their levels of anxiety, nausea, and pain before and after the nursing intervention.

The holistic nursing modalities offered to a convenience sample of 442 participating patients (who were mostly female [68%] and white [85%], about half with private insurance, and who provided verbal consent to the intervention) were healing touch, guided imagery, aroma therapy, and massage, and patients could choose which therapy/therapies they preferred. Most (66%) chose healing touch, followed by guided imagery (23%) and hand/foot massage (21%). Only 8% chose aroma therapy.

For the aroma therapy intervention, an aromatic oil (lavender, lemon, or peppermint) in a carrier oil (jojoba) or cotton balls with oil were applied to the skin or inhaled. For the healing touch intervention, the principle is applied energy (in a hands-on or hands-off mode) creates a biomagnetic field that can affect a biochemical and immune-system response within the body. Guided imagery, or visualization, Dr. Haas and coauthors wrote, is a “lighter form of hypnosis…that directs imagination and attention in ways that produce symptom relief” and which “reduces pain, anxiety, and nausea in oncology patients.” The massage intervention involved the hands or feet, “[using] various manipulative techniques that touch the skin in comforting ways and move muscles and soft tissue, reduce tension [and/or] pain, improve circulation, and encourage relaxation in oncology patients.”

Dr. Haas and her coauthors reported that healing touch, guided imagery, and massage (but not aroma therapy) were associated with both “statistically significant drops in vital sign measurements (P < .01) and statistically significant changes in self-reported improvement of anxiety, nausea, and pain (P < .01). They concluded that nurses can offer these three modalities to patients “with confidence, to improve patient care,” and recommended that they be added “to [the] nursing intervention toolbox” by teaching nurses how to perform them and incorporating them into patient care. In terms of future research in this area, they said that [I]nvestigation is needed beyond the parasympathetic nervous system, with quality-of-life studies, to assess how these modalities affect other mind-body connections.”