Spa hospitalRAYMOND


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  • San Fran, 198 vets, 15 min self selected music prior to colon 15 min no music prior to colon Anxiety a and p music with STAI 40 item State Trait Anxiety Inventory Pre for both 36 Post for each music 31, no music 35 (p=0.007
  • 20 fem, 20 m..odors and rated mood. Then same odors with right hand immersed in hot water bath to wrist, perception of pain q 15 minutes
  • Florence Nightengale use lavender oil on the soldiers that she nursed.
  • 165 patients Music + PCA PCA alone Music, anesthetic if requested Music by headphones, CD
  • 165 patients Music + PCA PCA alone Music, anesthetic if requested Music by headphones, CD
  • 165 patients Music + PCA PCA alone Music, anesthetic if requested Music by headphones, CD
  • Spa hospitalRAYMOND

    1. 1. eNews@RxForSanity.comEmail today for a complimentarysubscription to our humorous and invigorating newsletter!
    2. 2. Create Your Spa Hospital © Patricia L. Raymond MD FACG Rx For Sanity
    3. 3. Trip to a SPA?
    4. 4. Or Your Hospital?
    5. 5. What’s the difference between the two destinations?• HPT –Hurl –Poop –Toot
    6. 6.
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    8. 8. Sometimes you have to take your brain and stomp on it a little. It just gets caked up. Mark Twain
    9. 9. Instead of just providing care, create a customer experience. Create experiencesso compelling to patients and their families that their loyalty is assured.
    10. 10. Why Spa Hospital ? ©• Enhances Staff Satisfaction – Autonomous steps with positive medical outcome• Patients accepting, even demanding, of it – 1998, 46.3% Americans use non-conventional therapies, cost $27 billion dollars• Reduction in liability exposure – Medical outcome + service lapse to sue
    11. 11. It doesn’t matter where you work: But– where do you work? • Med Surg • Specialty floor • Procedure unit • ICU • Outpatient
    12. 12. What if everything went right?
    13. 13. My first practice:Orifices-R-Us
    14. 14. Admission to Spa Hospital ©Gracious
    15. 15. Admission to Spa Hospital ©• Greeting by name, welcome• Establish patient expectations – What’s happening, what are the plans• “Elevator speech” – RehearsalWhens dr r expected
    16. 16. Environmental Control• Room Colors – Blue, green, purple- calming, soothing – Orange- stimulating• Plants (artificial), water features, pictures of nature, fresh flowers (florists donation or from garden)Spivey, SGNA 328
    17. 17. Stripping of Possessions• “the personal possessions of an individual are an important part of the material out of which he builds a self, but as an inmate the ease with which he can be managed by staff is likely to increase with the degree to which he is dispossessed.”~Goffman, Asylums, 1955 Dignapants, FFS
    18. 18. Spa Hospital Visit©
    19. 19. Modesty• Ownership of space• Maintain patient modesty• Secret weapon? Warm blanket – Coverage and comfort• Retain control of corner or edge of sheet• Tuck in drape – Security and Coverage
    20. 20. HumorOf the people
    21. 21. Starting the IV• Jacobson, May, Warner – 160 patients – Guided imagery, self-selected music, kaleidoscope – assigned vs self-selected interventionJacobsen, May, Warner, SGNA 333
    22. 22. Dancing in the Endo• San Francisco VAMC, 198 vets, – 15 min self selected music prior to colon – 15 min no music prior to colon• Anxiety measured with STAI• Pre for both groups = 36• Post for music 31, no music 35 (p=0.007)Buffum, Hayes, LanierSGNA abstract 2037, 2002Session 323
    23. 23. Odors Modulate Pain Perception: A Gender-Specific Effect• Massage oil, orange water, aftershave, distilled water, baby oil, vanilla extract, almond extract, vinegar, perm product, zonalin (dental product)• Pleasant, neutral, and unpleasant odors (as rated by subjects)- mood effect• Subjected to odors and painful stimuliMarchand, Phys and Beh, 2002
    24. 24. Odors Modulate Pain Perception: A Gender-Specific EffectMarchand, Phys and Beh, 2002
    25. 25. Aromatherapy• Florence Nightingale: Lavender• EEG studies – Lavender: Increase alpha waves at back of brain, c/w relaxation – Jasmine: Increase beta waves frontal lobes, c/ w alert state
    26. 26. Aromatherapy• Japanese Fragrance Company• Keyboard entry operators, monitor error rate – Lavender: Error rate decrease 20% (relaxing) – Jasmine: Error rate decrease 33% (uplifting) – Lemon: Error rate decrease 54% (sharp and refreshing)
    27. 27. Aromatherapy for Pain• Lavender reduces perception of pain in critical care settings• Chamomile reduced perception of pain in randomized study of 51 cancer patients• Lemongrass has analgesic effects alone and potentiates morphine• Rose highly effective for pain despite PCA• Use in midwifery common
    28. 28. Aromatherapy 101• 36 essential oils• Contraindications – Many are skin irritants – Pregnancy, lactation, seizure disorders – Avoid chamomile in ragweed allergic – Avoid peppermint in arrhythmia patients
    29. 29. Essential Oils- Properties• Reduce Stress: Bergamot, chamomile, lavender, lemon, melissa, marjoram, neroli, petitgrain, rose, sandalwood, valerian.• Reduce Anxiety: Chamomile, clary sage, fir, geranium, juniper, marjoram, melissa, neroli, nutmeg, orange, petitgrain, rose
    30. 30. Essential Oils- Properties• Mind stimulants: Angelica, basil, black pepper, cardamom, cinnamon, clove, cypress, ginger, jasmine, peppermint, rosemary, sage, tangerine.• Digestive aiding: Anise, basil, cardamom, chamomile, cinnamon, clove, coriander, dill, fennel, ginger, juniper berry, melissa, lemongrass, lemon, oregano, peppermint, rosemary, sandalwood, thyme
    31. 31. Aromatherapy• Ask if they would like to try it – Ask re ragweed, cardiac arrhythmias – Ask re pregnancy and lactation, seizure disorder (not with demonstrated aromas)• Premix relaxation – 1-2 oils only, one drop oil in tub of rice, sample placed in ziplock snack bag – No skin contact with oil (irritant)• Post procedure – Peppermint oil for increased mental stimulation Aroma demo
    32. 32. Additional Options• Antiemetic: Peppermint, ginger, mandarin oil• Antispasmotics: Clary sage, lavendar, chamomile, rosemary• Rubefacient (5% solution in alcohol): Clove, black pepper to ease IV starts in difficult veins
    33. 33. Spa Endo Procedure ©
    34. 34. Room Lighting• Cool white light led to more startle response than full spectrum, even dim – Startle: EMG of eyeblink,GSR of finger• Start at medium level, not bright• Ask if you can further reduce lights• Patient contact essential as sedation takes effect and room lights low
    35. 35. General and Patient Contact• Ownership of space• Identify all who enter space, and seek permission for activities• Hand contact at all times by one party as lights dim or patient becomes sedated – Featherstroke or walk hands
    36. 36. Positioning of Patient• All subjects in side lying massage are placed with extra pillow between knees – Settles top hip in position – Settles internal organs in position – Spine remains in alignment• Pillow between knees in all
    37. 37. Can you hear me now?• N=160, GA, headphones with different words pre and intraop. At 5 and 25 hours later, good intra-op word recognition. Information processing during general anesthesia: evidence for unconscious memory. Bonebakker, Mem Cognit 1996 Nov;24(6):766-76• N=43, GA, headphones with common facts or fictitious nonfamous people. CF group remembered more facts (p<.0005), NFP group more false fame (p < 0.001). Information-processing during anaesthesia can also take place as unconscious learning. Unconscious learning during anaesthesia. Jelicic, Anaesthesia 1992 Oct;47(10):835-7
    38. 38. Can you hear me now (2)?• N=30 for CABG interview for recollections, both aware and unaware, of intra-operative events. Audio tape when <37 degrees suggested they touch their chin during the postoperative interview (p=.015). Seven patients (23%) recalled intraoperative events, five with the aid of hypnosis. Memory of cardiac anaesthesia. Psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation.Goldmann, Anaesthesia 1987 Jun;42(6):596-603
    39. 39. Can you hear me now (3)?• Several null studies• Meta analysis – “…some evidence of implicit memory for intra- operative events, even with clinically adequate anaesthesia.” – “neither the anaesthetic techniques nor the paradigms used to assess memory have been standardized.”• Subliminal speech (learning during anesthesia) is real…watch what you say, and how you say it. • Overt recall operative events about 1%
    40. 40. Touch Therapies• Therapeutic Touch: Focus thought energy through the hands while focusing good intent for the well-being of the recipient• Healing Touch: Adds to TT by redirecting energy to the area of imbalance• Reiki: Ancient Oriental TT• Reflexology: Stimulate nerve ending to activate brain receptors.Donna wanda stroke
    41. 41. Touch • Heidt 1980 – Casual touch (pulse monitor), no touch, therapeutic touch (massage, stroking) proved decreased anxiety • Meehan 1993 – TT decreased post op pain and analgesia needs • Daley 1996 – HT accelerated post op wound healing • Samarel 1998 – TT reduced pre op anxiety of breast cancer patients, no effect on painAdditional scientifically rigorousstudies are needed.
    42. 42. Touch Techniques in Endoscopy• Abdominal Massage• Sacrocranial Techniques• Reflexology – Never massage or manipulate anything with • edema • acute inflammation • recent surgery
    43. 43. Abdominal Massage• Best left to experts, and jostles the view• Techniques to relax spasm – Jostling – “Deep” Longitudinal • Advance pressure up the rectus from symphysis pubis – Cresting • Knuckles and palm • With direction of colon
    44. 44. Sacrocranial stimulation• Anywhere you do/did have hair• Calming/soothing• Tugging, brushing, moving facia – Don’t push or stroke• Keep out of vision, on scalp – Startle with hand in and out of vision demo
    45. 45. Reflexology• Either hand, not hand with IV (in arm is ok)• Feet (not in diabetics)• Right organs, right hand etc• Use finger pads, no nail contact• Follow direction of colon• Specific movements for effect
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    48. 48. Reflexology• Movements – Clockwise circular motion • Stimulating but calming – Vibration • Stimulation – Gentle pressure • Sedating – Featherstroke at end toward heart Demo Mrs.C and the music
    49. 49. Dancing in the Endo II• 37 patients for flex sig• No intervention, audio only, or audiovisual• Lower abdominal discomfort – AV 7.1, A 9.5, None 10.8 (p< 0.05)• Lower Anxiety ratings – AV 2.5, None 4.4• Attributed to distraction of patientAm J Gastro 1998 Jul; 93(7):1113-6
    50. 50. Dancing in the Endo III• 64 patients for flex sig, midwest – Music, or none• Music group with less anxiety and discomfort, but same satisfaction and compliance.Gastroenterol Nurs 2000 Jul; 23 (4):148-56
    51. 51. Dancing in the Endo IV• 165 patients for colonoscopy, Hong Kong – Music + PCA, PCA alone, Music and anesthetic if requested• Propofol .84 mg/kg with music and PCA – Propofol 1.15 mg/kg with PCA alone (p=.02)Gastrointest Endocop 2002 Jan;55(1):33-6
    52. 52. Spa Hospital © Discharge
    53. 53. Parting Gifts: Restore Control to Your Patient• Teach Reflexology or Aromatherapy• Education (diets, exercise, educational pamphlets)• Gift (CCUU, exercise bands)• Congratulations and thank you• Make them an agent for change Deep fried and d
    54. 54. Make it hard(er) to choose! • Only differences are HPT • New attitude, automony • Restore caring and service to patient care
    55. 55. Almost time for a break!• Evaluation with name and legible email address for subscription to Rx For Sanity eNews, a complimentary monthly eZine
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