Oncology Nursing Society Newsletter articles

Use of Reiki to Reduce Stress and Alleviate Pain Spreads in Healthcare SettingsGerri Delmont, RN, MS, NCMT, CHTPhiladelphia, PAgerri440@aol.com

Reiki is an ancient form of touch therapy brought to the United States from Japan in the early 1920s. The word means universal (Rei) life force energy (Ki). This energy is transmitted through the body and into the hands of the facilitator and provides the recipient with a profound calm and relaxation that allows for healing to occur, sometimes at remarkable rates. Although many people may shy from using the words “spiritual” or “divine” or “God” when referring to the life force energy that is channeled through the practitioner, those who offer Reiki will tell you that the results from a one-hour session can only be described with such words. In the past century, particularly the past 20 years, Reiki has come to be acknowledged as a wonderfully simplistic modality that can be taught to people of all ages, including children. Individuals learn Reiki to treat themselves, as well as family members, friends, pets, and plants. Professionals, such as physicians and nurses, are bringing the art into the healthcare centers where they work, as well as into private practice.

Little research has been available concerning the effects and benefits of Reiki. Most reports are anecdotal. However, as more healthcare professionals have been exposed to Reiki, research is on the rise. The National Institutes of Health’s Center for Complementary and Alternative Medicine recently awarded a two-year, $400,000 grant to a study by the Albert Einstein Healthcare Network (Campbell, 2002). The purpose of the study, which began in April 2002, is to determine whether Reiki decreases anxiety, pain, and depression for patients with AIDS. The study also will examine whether patients’ quality of life and spiritual well-being increase.

Effects and Benefits of Reiki in Health CareThroughout the United States, Reiki is becoming a meaningful and cost-effective complementary therapy to offer patients in a variety of healthcare settings. Physicians and nurses are learning the art and offering sessions before and after surgery for pain management and to decrease stress, anxiety, and depression. In addition, patients who accept Reiki have been reported to heal more quickly and leave hospitals and rehabilitation centers earlier than those who do not (Rand, 2002). Benefits of Reiki on the mind include

A sense of calm and relaxation, feeling that all is okay. Changes in perceptions about life and life events. Decreases in stress, anxiety, fear, anger, and other self-defeating or unwanted

emotions. Openness to change. More “self-centeredness.” Clearer thinking.

Benefits of Reiki on the body include Wounds, broken bones, and other injuries that heal faster. Usefulness in treating acute infections.

Decreases in or elimination of chronic pain from musculoskeletal injury, arthritis, headaches, and diseases such as cancer.

Minimized side effects from chemotherapy, radiation, tests, and procedures. Postoperatively, patients fare better, needing less medication with decreased

complications. Improvements in sleep and appetite. Decreases in symptoms and flare-ups of chronic illnesses, such as multiple sclerosis

and fibromyalgia. For stories of documented miraculous healings, visit the International Center for Reiki Training’s Web site at www.reiki.org or call 800-332-8112.

Reiki TrainingTraditionally, Reiki has been taught by masters of the Usui Reiki method. The training has improved immensely in time and expense from the days when Dr. Mikao Usui coined the word Reiki for the art that he rediscovered in the late 1800s in Japan.

Still, teachers of Reiki all are from Dr. Usui’s lineage. Mastership is granted after individuals complete three to four levels of education and practice. After each course, practitioners are asked to practice the art before going to the next level. Individuals can practice Reiki on themselves and others after the first course level is completed.

Most courses are one or two days long, and costs vary depending on level and who offers them. Level I Reiki is about $125–$175. Level II courses for more serious Reiki practitioners cost $200–$250. Level III courses are for mastership. Again, length and cost will vary from $300–$700. Level III courses often are split into Level III and IV options. Level IV is reserved for those who would like to teach the art.

A unique feature of Reiki classes that you will not experience with other energy work involves receiving what are called attunements. Energy attunements or initiations are a part of each level. Healing channels are opened, and individuals channel the universal life force energy in the most effective way at each level. If you do not receive attunements, then you have not been trained in Reiki, but rather in some other form of energy work.

Reiki Sessions and CostsReiki is offered by lay and professional practitioners throughout the United States. A full session usually is an hour to an hour-and-a-half, but 15–20 minutes can be offered prior to procedures, surgery, or stressful events with results. Reiki is not limited to patients or people in distress. Some people request Reiki for its calming effects and its ability to balance energy fields, keeping the body primed for optimum functioning. Clients can be sitting or lying down while a practitioner places his or her hands on or over specific sites of the body. Hand positions are held for a few minutes, and then the practitioner moves to the next body part.

Recipients may report numerous feelings during sessions. All usually report a feeling of total relaxation and warmth from the hands of the practitioner. Others report a wide variety of positive experiences during and after sessions. Extreme heat or electrical movement through a body area, feelings of bliss, a persistent ache or pain suddenly gone, or an emotional burden lifted are just a few of the effects that recipients of Reiki may report.

A Reiki session can cost anywhere from no charge to $60 or more. In healthcare settings, staffs are being taught to perform Reiki, and sessions may be offered as part of the services provided by institutions. If minimal fees are charged, the Reiki practitioners are either employees of the institutions or volunteers. Maximum fees usually are requested in private practices, at private alternative therapy centers, or by wellness centers affiliated with

hospitals.

ConclusionWhere Reiki is performed, who performs it, and its purposes are limitless. Reiki is unique in that it is safe, is easy to perform, and crosses all boundaries of race, religion, age, education, and social status. It is not limited to individual healing but often is performed by groups for community and world healing. Because almost anyone who has a desire to learn the art can do so, Reiki easily can be incorporated into healthcare settings, requiring minimal time and costs to learn the art. In addition, a variety of ways to support the use of the modality exist. Many practitioners inside and outside healthcare settings are teaching lay people to perform the art for themselves, especially when the individuals have had success with sessions they have received.

Pressing questions to answer regarding Reiki are “Does it work?” and “How does it work?” Research is on the rise, and the outcomes likely will be as favorable as the reports documented in the literature by both lay and professional Reiki practitioners (Rand, 2001).

Reiki already has entered the healthcare arena despite the minimal research available, and it already is considered a viable complementary service in health care. If you never have experienced Reiki and would like to, search the Internet using the word Reiki or call author Gerri Delmont, RN, MS, NCMT, CHT, at 215-742-3200.

Gerri Delmont, RN, MS, NCMT, CHT, is a counselor, educator, massage therapist, hypnotherapist, and Reiki master in private practice in the Fox Chase area of Philadelphia, PA.

Reiki, along with other complementary therapies, is becoming an increasingly

popular modality to aid in the treatment of pain and other symptoms associated with cancer, fibromyalgia, and other diseases. The many benefits include stress reduction and faster healing. Above, Gerri Delmont, RN, MS, NCMT, CHT, performs Reiki on a client.ReferenceCampbell, K. (2002). Search for spiritual energy in Reiki. Retrieved July 23, 2003, from http://www.philly.com/mld/inquirer/news/local/4429390.htm

Rand, W.L. (2001). Reiki and the future. Retrieved July 23, 2003, from http://reiki.org/reikinews/ReikiandtheFuture.html

Rand, W.L. (2002). The healing touch: First and second level manual. Vision Publications: Southfield, MI.

Therapeutic Touch: A Nursing Art

Sister Sheila McGinnisPhiladelphia, PAchi4wellness@aol.com

Do you want an adventure in healing? Are you willing to

participate in the healing process using a tool that is ancient and new at the same time? If so, you are ready to learn about and use therapeutic touch (TT).

TT is a nursing art derived from the ancient healing practice referred to as the laying on of hands. A major difference between the two is that TT includes no requirement that either practitioner or recipient subscribe to any particular religious belief.

In the 1970s, Delores Kreiger, RN, PhD, a professor of nursing at New York University, codified the current practice and began teaching it in a course called Frontiers in Nursing. After observing groups of healers effect responses in those who came to them, she concluded that she, too, could learn the method of balancing body energies and teach it and that others could learn from her. In collaboration with Dora Kunz, a gifted healer, and others, Kreiger began a journey to bring this healing art to tens of thousands of nurses and interested laity.

TT is based on the premise that the human body has an energy field, which reflects the status of the individual, body, mind, and spirit. This energy field flows freely through a healthy organism in a balanced, symmetrical manner. During illness, after trauma, or in times of stress, the field is disordered. This field, ordered or not, can be sensed, usually with the hands. After learning to perceive the energy field, a TT practitioner uses his or her hands to affect it, either by modulating the flow, moving the congestion, or projecting energy into the system to help bring the body into energy balance.

The benefits seen by nurses using TT with patients are rapid relaxation response, significant amelioration or eradication of pain, and an accelerated healing process because of the salutary effects of the immune system (Kreiger, 1993). Because the autonomic nervous system is sensitive to the use of TT, the therapy is effective and consistent in inducing a rapid relaxation response. Its usefulness is experienced in simple first-aid measures, as well as in assisting the healing process in complicated and compromised health situations.

The ability to perform TT is a natural one that everyone possesses. Only a few classes are required to learn the basics of its use, and proficiency comes with practice. TT is practiced from a centered, grounded state in which a practitioner formulates the intent to facilitate healing in a client. The practitioner uses his or her hands to sense the energy field of the client. With practice and guidance, a practitioner can note differences in the field. Using a gentle brushing motion, the energy field can be modulated and encouraged to resume its natural and healthy flow. This repatterning is believed to stimulate the client’s own self-healing mechanisms (Quinn, 1984).

To identify an energy field, rub your hands together and then move them apart about five inches while keeping your hands relaxed. Focusing on your palms, begin to move your hands close to each other. Can you sense something between your hands? Do you feel heat, pressure, the sensation of a balloon between your hands? You may experience any of these sensations as you start to become aware of the energy field in your own hands. This is the

beginning of your TT experience.

For More InformationThe Nurse Healers—Professional Associates International, an organization for healthcare professionals involved with TT, has developed guidelines for the teaching of TT and holds seminars annually for those interested. Visit www.therapeutic-touch.org.

References

Kreiger, D. (1993). Accepting your power to heal: The personal practice of therapeutic touch (p. 13). Santa Fe, NM: Bear and Company.

Quinn, J.F. (1984). Therapeutic touch as energy exchange: Testing the theory. Advances in Nursing Science, 6(2), 42–49.

 

The Research CornerComplementary and Alternative Medicine Research Review:Reiki and Functional Recovery for Patients Poststroke

Reviewed by Pamela Potter, MA, MSN, APRN, DNSc (c)New Haven, CT

pamela.potter@mindspring.com

Designing, conducting, and reporting research with complementary and alternative medicine (CAM) therapies calls to mind the dual meaning of the Chinese character for “crisis,” which signifies both “danger” and “opportunity.” Similarly, reviewing a CAM research study suggests danger as well as opportunity. As a doctoral student, I appreciate the possibility that almost any critique can feel harsh and judgmental at first glance. However, the opportunity lies in generating insights for improving research and contributing to knowledge. With this in mind, the purpose of this article is to review a CAM intervention study, identify design strengths and limitations, suggest possibilities for building on the research, and provide a forum for discussion.

 A recently published study of a Reiki intervention given to patients in poststroke rehabilitation concluded that Reiki did not demonstrate any clinically useful effect on the speed or level of functional recovery in hospitalized patients with subacute stroke (Shiflett, Nayak, Bid, Miles, & Agostinelli, 2002). Although the study did not draw from a population with cancer, it addressed an intervention, Reiki, which has reported use among people living with cancer.

The design was described as a placebo-controlled, modified double-blinded clinical trial with an additional historical control condition. The sample consisted of 50 patients with subacute ischemic stroke who were recruited from the stroke unit of a major rehabilitation hospital. Thirty-eight patients were assigned randomly to one of three treatment conditions: Reiki master, Reiki practitioner, and sham Reiki practitioner. However, 8 of the 30 patients were lost by attrition. Additionally, 20 patients represented historical controls and were selected randomly from charts of comparable patients who were treated at the study institution within six months prior to and six months after the study. In addition to receiving standard rehabilitation treatment, subjects in the three treatment conditions received up to ten 30-minute Reiki treatments over 2.5 weeks. Two instruments measured study outcomes: the Functional Independence Measure (FIM) (Deutsch, Braun, & Granger, 1996) and the Center for Epidemiologic Studies-Depression (CES-D) scale (Shinar et al., 1986). Both instruments have demonstrated validity and reliability with the population of interest.

Shiflett et al. (2002) made a valiant attempt to meet the rigorous requirements of experimental research by designing a double-blinded study with placebo control. After a brief review of the limited Reiki research and anecdotal reports of its effectiveness for people recovering from stroke, the case was made that Reiki intervention warranted further investigation.

The three study objectives serve as a structure for this review. These are1) to evaluate the effectiveness of Reiki as an adjunctive treatment for patients with subacute stroke who were receiving standard rehabilitation as inpatients; 2) to evaluate a double-blinded procedure for training Reiki practitioners; and 3) to determine whether or not double-blinded Reiki and sham practitioners could determine which category they were in (Shiflett et al., 2002, p. 755).Evaluating the Effectiveness of ReikiThe three treatment arms compared Reiki treatments given by an experienced practitioner with treatments given by someone newly attuned to Reiki and those given by a sham Reiki practitioner. The groups then were compared with usual care historical controls. No significant effects from the intervention were demonstrated by the outcome measures.

The researchers identified three possible reasons for the results. First, outcomes from the FIM were limited to functional outcomes as a result of missing cognitive data that had not been routinely entered in the charts as anticipated. Second, the measures, although commonly used to measure outcomes for this population, may not have been adequate to detect the subtle effects of the intervention. Third, the result that Reiki has a smaller effect size than anticipated may have resulted from an insufficient sample size and the possibility of Type II error.

Evaluating the Double-Blind Procedure for Training Reiki PractitionersThe 14 practitioners in the study, both sham and Reiki, received identical instruction in the principles and practice of Reiki. However, half the practitioners did not receive the initiation procedure considered essential for becoming a Reiki practitioner. This was accomplished by adapting the initiation procedure to the second-degree Reiki distance

 healing technique. To blind the healers to whether they were among those attuned, the potential practitioners sat in a row of chairs while the master attuned half of them at a distance instead of using the traditional laying-on-of-hands initiation. Those practitioners who had not received the initiation were given it at the completion of the study.

By blinding the practitioners to their status as initiated or uninitiated, the researchers said that beliefs about practitioner status and unconscious intentionality were randomized across the new practitioner groups. Therefore, because intentionality was controlled for, it was not a factor in study results.

Practitioner Category RecognitionFrom a 41-item questionnaire about practitioner experience, only one item yielded a significant difference at the 0.05 level. Sham Reiki practitioners reported a greater frequency of feeling heat in their hands (t = 2.44, p < 0.03). Although not significant, the Reiki practitioners were less confident that they actually had been initiated than sham practitioners (t = -2.12, p < 0.06). The researchers suggested that these findings may be explained by the presence in both groups of those with natural healing abilities to sense subtle energies. The researchers concluded that initiated practitioners and sham practitioners truly were blinded because reported experience and sensation did not differ significantly between groups.

Study ConstraintsThis study has been presented along with the researchers’ conclusions about research limitations and the meaning of the findings. Four constraints stand out as warranting further discussion: predictive power, unplanned institutional issues, complexity of the research question, and the nature of assumptions about what is being studied.

Power to observe significant differences, if they truly exist, is key to any interpretation of study findings. Based on a power analysis for the FIM, to achieve a statistical power of 0.80 with a moderate effect size (an 8–10 point change), the researchers concluded that a total of 50 subjects would be needed for the study. It is unclear from the article how the power analysis was formulated and whether the number of groups was considered in that formulation. As the number of groups in a study increases, the power to detect mean differences decreases; therefore, to retain power, the sample size must be increased accordingly. Using Cohen’s conventional value for medium effect (0.06), a study with a power of 0.80 at an alpha of 0.05 suggests a sample size of 45 subjects per group in a four-group study (n = 180) (Polit & Hungler, 1999). Whether the possibility of Type II error resulted from assuming too high an effect size when calculating the study sample or from a failure to consider the number of groups when calculating the sample size, the study appears underpowered to conclude that a Reiki intervention for poststroke patients has no impact on functional status.

Unplanned for institutional issues, like poor record keeping on measures essential to evaluating study outcomes, can limit research findings. The unavailability of cognitive scores on the post FIM measure also may have contributed to a loss of predictive power. This is a hindsight lesson from a pilot study that can be applied to designing future studies either by taking steps to ensure the desired data will be available or identifying other means for evaluating the outcome variable.

Trying to answer too many questions in one study may detract from finding evidence of intervention efficacy. Assuming the study did have enough power to detect outcome differences among practitioner types, the idea of “distance attunement” added to the complexity of the study. Whether or not the distance attunement actually is comparable to the traditional initiation attunement is unknown. Alternatively, the possibility of those not

 intentionally initiated by the master practitioner receiving attunement by association with those actually attuned also is beyond apprehension.

Making assumptions about the nature of what is being studied may have further contributed to insignificant outcomes. Assumptions were made that laying-on-of-hands touch by a non-initiated practitioner is quantitatively different from an initiated practitioner when the difference may be more qualitative. It cannot be said that uninitiated touch is inert. Further, the attempt to control for intentionality through a blinded initiation procedure might have had a negative placebo, or nocebo, effect on the initiated practitioners wherein they doubted the verity of initiation.

Implications for ResearchBecause this study was labeled as a “pilot,” results must be interpreted in terms of a pilot rather than a full clinical trial. The study appeared to lack the power to conclude that Reiki is not an effective intervention for hospitalized patients with subacute stroke. Rather, lessons learned from this pilot can be applied to future research. Because little is known about responses to Reiki, researchers might want to conduct a Level I trial sufficiently powered to detect differences in cognitive and functional improvement between those with post subacute stroke who receive a series of Reiki treatments by experienced practitioners and a usual care control. Triangulation with qualitative data may yield further insights into the effect of the intervention with this population. Placebo attunement and sham practitioner treatment appear to confound because their active ingredients are unknown. This is another level of research requiring possible biological and electromagnetic measures to determine differences between practitioners.ReferencesDeutsch, A., Braun, S., & Granger, C. (1996). The functional independence measure and the functional independence measure for children. Ten years of development. Critical Review of Physical Medicine Rehabilitation, 8, 267–281.

Polit, D.F., & Hungler, B.P. (1999). Nursing research: Principles and methods (6th ed.). Philadelphia: J.B. Lippincott.

Shiflett, S.C., Nayak, S., Bid, C., Miles, P., & Agostinelli, S. (2002). Effect of Reiki treatments on functional recovery in patients in poststroke rehabilitation: A pilot study. Journal of Alternative & Complementary Medicine, 8, 755–763.

Shinar, D., Gross, C.R., Price, T.R., Banko, M., Bolduc, P.L., & Robinson, R.G. (1986). Screening for depression in stroke patients: The reliability and validity of the center for epidemiologic studies depression scale. Stroke, 17, 241–245.

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July/August 2003, Volume 7, Number 4

Integrated Care

Georgia M. Decker, MS, RN, CS-ANP, AOCN®, CN, Associate Editor

Nurturing Spirit Through Complementary Cancer Care

Rita Abdallah-Baran, ACSW, LSW

In the ever-changing world of cancer care, exploring treatment approaches that are holistic and interactive and emphasize the patient's role in the healing process is essential. According to medical oncologist Jeffrey R. Geffen MD, FACP, medicine exists for two distinct purposes: "The relative purpose of medicine is to relieve symptoms and to cure disease. But there is also an ultimate purpose, which extends beyond the physical realm to include the mind, heart, and spirit of every patient, and indeed of humanity as a whole" (Geffen, 2000, p. 13).

Complementary and integrative therapies, in conjunction with what often is termed "conventional" cancer treatment (e.g., surgery, chemotherapy, radiation, biotherapy), generate and promote a patient culture rooted in holistic healing. They provide both physical space and hands-on support for this patient culture to grow and thrive in a traditional medical environment.

The Ireland Cancer Center at Community Health Partners in the Cleveland suburb of Elyria, OH, is a community-setting affiliate of the Ireland Cancer Center at University Hospitals of Cleveland, a National Cancer Institute-designated Comprehensive Cancer Center. The center provides patients with access to cancer care and complementary therapies in one building. It incorporates radiation therapy, medical oncology, and the Center for Body, Mind, and Spirit, an innovative wellness program. Patient and caregiver services include support groups, educational programs, and complementary therapies. A healing garden includes a labyrinth (see Figures 1 and 2). For a detailed discussion of the use of labyrinths in health care, see the article by Griffith (2002).

Humor can be incorporated into care (see Figure 3). Laughter may be a useful cognitive-behavioral intervention; in one study, it was shown to reduce stress (measured by a self-completed stress scale) and stimulate immune function (measured by natural killer-cell cytotoxicity assay) (Bennett, Zeller, Rosenberg, & McCann, 2003). Other studies also have supported the therapeutic efficacy of laughter (Neuhoff & Schaefer, 2002; Rosner, 2002). Complementary therapies that are offered at the Ireland Cancer Center include tai chi (see Figure 4), yoga (see Figure 5), massage, and music and art therapy.

Through the use of complementary therapies, people touched by cancer, including patients, loved ones, and friends, find help in dealing with the psychological, emotional, spiritual, and social aspects of adapting to the life-changing illness. Staff members at the Ireland Cancer Center employ a patient-active approach that customizes a personal healing plan in conjunction with a patient's overall cancer treatment plan. Almost all of the services are made possible by support from foundations and private donors and are provided at no cost to patients and caregivers.

Dr. Belagodu Kantharaj, medical director of the Ireland Cancer Center at Community Health Partners, said, "Recent studies indicate that it is common for patients with cancer to find value in, and benefit

from, complementary therapies. Because cancer is a disease that affects not only the body but also the heart, mind, and soul, these types of therapies are believed to improve well-being and quality of life. It is most important that the oncologist is involved in and openly discussing the choices patients make in their pursuit of healthful survival strategies. These conversations enable the treatment team to be even more helpful in determining the most appropriate and least harmful options. The Center for Body, Mind, and Spirit offers a wide variety of educational programs and supportive services for patients. Before we had this center, this element was missing. Now, we have an actual place on site where patients can actively care for themselves and their loved ones."

The following are three examples of how two patients with cancer and a caregiver have incorporated holistic care into their lives.

Patient One

Marty is 57 years old and has had non-Hodgkin's lymphoma for seven years. After her diagnosis, she received six months of chemotherapy and went into remission for two years. However, in 2001, Marty's lymphoma recurred. Her spouse, friends, and church community comprise her support system, and she views the Center for Body, Mind, and Spirit as a welcome addition. "How nice it is to go someplace where I can make good memories," Marty said.

When her husband is not available to join her for a workshop or program, Marty finds a friend or relative to accompany her.

So far, I've taken tai chi classes; meditation; guided-imagery workshops; a presentation on using the labyrinth; art therapy workshops, including sketching with nature and silk scarf painting classes; and the therapeutic touch course. It's nice to be surrounded by positive people. The center is a place where we can be less afraid of cancer. I actually come here on purpose. I have more positive things to say about my cancer experience. For a long time, I felt that I had to buck up and be brave about my disease. It's more than that; it's about having a good time and living. Each day is special, and I'm trying to enjoy the moment. I find that meditation and guided imagery help me stay in the present. I choose to feel well and be happy. I like my choices.

Patient Two

Jerry was diagnosed with metastatic prostate cancer in July 2002. He receives hormonal agents and other medications. After his diagnosis, Jerry actively searched for ways to stay in good physical health and strengthen his spirit. Along with his supportive family and religious community, Jerry looked for other people and places to help him "fight his cancer."

Right now, people have a hard time believing I have cancer because my physical appearance hasn't changed much. When my thoughts get overwhelming, I reach out and open myself up to others for love and care. Cancer has brought me closer to God, my family, and myself. This diagnosis awakened me to take a new lease on life, and I'm getting the help I need to make a new reality.

Jerry heard about the Center for Body, Mind, and Spirit and called to request a program guide. After receiving the guide, he called the center for a tour and orientation. Following the tour, Jerry decided to make an appointment for a Reiki treatment. Reiki is a Japanese form of hands-on energy healing. For a detailed description of Reiki, see the article by Potter (2003).

At first, I was unsure about Reiki and how it would affect me. The Reiki practitioner gave me reading materials to review before my session. I also spoke to family members and friends and received positive encouragement. After several treatments, Reiki feels like a body massage. It's a relaxing feeling and source of healing. By the simple act of laying hands on me, I feel that the pain has diminished in my lymph nodes. I feel the energy coming into my body.

Jerry frequently uses the Multi-Media Resource Center for research and insight. He also writes in a journal as a way to open up his mind and recall childhood memories.

By understanding myself better and learning these techniques, I'm more focused on what's really important: my spirituality, my life with my wife, family, and grandkids. What we do with our lives is most important.

Caregiver

Donna is the wife of a 65-year-old man who was diagnosed with prostate cancer in April 2002. Donna was all too familiar with the word cancer because her father was diagnosed with skin cancer.

While her husband, Joe, received radiation therapy, Donna picked up a program guide for the Center for Body, Mind, and Spirit and signed up for several workshops. Donna and Joe began with a meditation course. Although she had tried meditation before, her husband was new to the experience. Now they both use meditation on a daily basis. "Before we went to the class, I would talk to him about it. He would ask me some questions and then participate. Gradually, he takes in the information and gets into the practice."

Books also are available at the Multi-Media Resource Center. "I just read The Four Agreements by Don Miguel Ruiz. It was so timely, profound, and just what I needed. While I'm at the center, it's easier for me to find the information I need instead of taking another trip out to the library."

Recently, Donna took a class in therapeutic touch (an ancient healing method similar to Reiki) that promotes the use of universal energy directed through the hands to restore balance to the energy field. For a detailed description of therapeutic touch, see the article by Potter (2003). Donna discovered that the techniques helped her and her husband relax. "I find that therapeutic touch interfaces with Reiki. In the beginning, Joe was ambivalent about it. Now he asks me for a treatment."

As a two-time cancer caregiver, Donna has benefited greatly from the many services available at the center.

Throughout these tough times, the center has strengthened my ability to cope with stress. The patient is not the only one under a lot of pressure; the family is, too. At first, I wanted to look for ways to help Joe and I ended up helping myself. That was a great discovery.

Conclusion

Holistic care blends creativity and strength into the treatment of cancer. The Center for Body, Mind, and Spirit, like other wellness centers, helps patients and loved ones encounter and explore new approaches to well-being. Healing thus becomes a journey to improve the quality of life of patient and caregiver by responding to the needs of the body as well as the mind and spirit.

References

Bennett, M.P., Zeller, J.M., Rosenberg, L., & McCann, J. (2003). The effect of mirthful laughter on stress and natural killer cell activity. Alternative Therapies in Health and Medicine, 9(2), 38-45.

Geffen, J.R. (2000). The journey through cancer: An oncologist's seven-level program for healing and transforming the whole person. New York: Crown Publishers.

Griffith, J.S. (2002). Labyrinths: A pathway to reflection and contemplation. Clinical Journal of Oncology Nursing, 6, 295-296.

Neuhoff, C.C., & Schaefer, C. (2002). Effects of laughing, smiling, and howling on mood. Psychological Reports, 91(3 Pt. 2), 1079-1080.

Potter, P. (2003). What are the distinctions between Reiki and therapeutic touch? Clinical Journal of Oncology Nursing, 7, 89-91.

Rosner, F. (2002). Therapeutic efficacy of laughter in medicine. Cancer Investigation, 20, 434-436.

Rita Abdallah-Baran, ACSW, LSW, is a social worker in the Center for Body, Mind, and Spirit of the Ireland Cancer Center at Community Health Partners in Elyria, OH.

Author Contact: Rita Abdallah-Baran, ACSW, LSW, can be reached at rita_baran@HMIS.org.

Key Words: complementary therapies, mind-body and relaxation techniques, holistic care

Digital Object Identifier: 10.1188/03.CJON.468-470

Complementary and Alternative Modalities Enrich Oncology Nursing

Geronima Cortese-

Jimenez, MPH, RN, OCN®

Fairfax, VAGeronima.Cortese-Jimenez@inova.comMost nurses start off in the hard sciences and might then gravitate towards complementary and alternative modalities (CAM) such as therapeutic touch and massage, but my experience was quite the opposite. I was a trained Reiki master; practiced meditation and breathing; studied herbs and aromatherapy; and never thought of entering into the realm of conventional medicine. I inched closer by earning a master’s in public health, but my plan was to focus on refugee children. However, when my mother, Nora, became diagnosed with inflammatory breast cancer stage IIIc, that focus was spun on its head. I realized how CAM could improve the quality of life for women with breast cancer. CAM is becoming more commonplace in Americans' lives. According to the 2002 National Health Interview Survey, 36% of U.S. adults are using some form of CAM. When megavitamin therapy and prayer for health reasons are included in the definition of CAM, that percentage rises to 62% (NCCAM, 2007). The survey found that rates of CAM use are especially high among patients with serious illnesses such as cancer. Reiki is one CAM that is becoming more accepted in the medical setting. Researchers at the University of Saskatchewan, under a grant from the National Cancer Institute of Canada, are exploring the use of Reiki to combat the side effects of chemotherapy and anxiety in patients with breast cancer (Jackson, 2004). As part of a pilot program, Washington Hospital Center evaluated the effects of Reiki on patients with

HEALING TOUCH AND REIKI: INDEPENDENT NURSING FUNCTIONS TO SUPPORT CANCER PATIENTS. Cynthia A. Teague, RN, BSN, CPON, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Touch therapies have been used for centuries to relax patients and promote healing. Therapeutic touch, from which many aspects of Healing Touch are derived, was formally introduced into nursing in the early 70’s by Delores Kreiger. She developed a research base, and taught nurses to use therapeutic touch to balance the body’s energy field and restore harmony, allowing the patient to heal. Reiki (ray-kee) is an ancient Japanese form of energy healing with the primary purpose of restoring the balance in the body to promote the individual’s ability to heal. Both of these techniques are considered forms of energy healing. Theoretical work in energy healing was pioneered in nursing by Martha Rogers who described the body as an energy field in interaction with other energy fields and the global energy field. Although these therapies are ancient, the research base for them is still in its infancy. Benor (1993) reviewed 155 studies on energy healing and concluded that energy healing can be an effective treatment, especially for immune compromised conditions. Healing touch has traditionally been a primarily nurse-initiated intervention and Reiki is becoming almost as popular among nurses who espouse energy healing. These therapies have been used with patients of all ages, including children, with a minimum effect of calming the patients, decreasing pulse rate, and increasing skin temperature. The stress reduction effect has obvious implications for cancer patients who experience stress-provoking events from diagnosis through the treatment and outcomes period. Of these therapies, healing touch and Reiki have the greatest potential as noninvasive techniques to be used on a regular basis by the clinical nurses as they provide daily care to the patient. This presentation will include an overview of Reiki and Healing Touch including the underlying tenets, available research to support its use, the techniques involved, and future directions.

6REIKI TREATMENTS FOR PEOPLE LIVING WITH CANCER. Larraine M. Bossi, RN, MS, CS, Children’s Hospital, Boston, MA; Susan DeCristofaro, RN, MS, OCN®, and Mary Jane Ott, RN, MN, MEd, CS, Dana-Farber Cancer Institute, Boston, MA.

Background: Reiki is a healing method that uses “laying on of hands” in a precise method that connects the universal energy with the body’s innate power to heal. The goal of a Reiki treatment is to restore the harmonious balance of mind, body, and spirit. Reiki has been used with both adult and pediatric populations to achieve improved quality of life. Published reports describe the benefits of Reiki, including improvement in post-surgery pain. Program: Reiki treatments have been integrated into the care of cancer patients at our institution, an NCI-designated comprehensive cancer center. Patients, who receive both standard and experimental cancer therapies, are generally self-referred for the Reiki and pay out-of-pocket. Attending physicians are notified about the scheduled treatments, allowing for dialogue with the Reiki practitioner. The treatment sessions take place in private clinic rooms and last 45–60 minutes, which differ from shorter, more impromptu Reiki treatments that may be offered during routine nursing care. Often these treatments are scheduled just before or after scheduled radiation therapy, chemotherapy, or a procedure. Description of the Reiki treatments, patient symptoms, and functional level are documented in the medical record. Evaluation: Between November 2000 and July 2001, 82+ Reiki sessions were provided. Women utilized this service more than men (93% versus 7%), and most referrals (over 80%) were for symptom management. There were no reported side effects from any Reiki treatments. However there were many benefits that were voiced and documented: decreased pain and increased mobility with peripheral neuropathy; improved sleep patterns; and decreased anxiety about treatment

options, helping with decision-making. Patients reported immediate results as well as some changes noticed hours after treatment. A formalized evaluation tool was implemented in August 2001 to provide additional descriptive data about the Reiki treatments. Discussion: Reiki is safe and appears to provide symptom relief in many cancer patients. Many cancer patients are seeking out this alternative treatment that can be easily learned by oncology nurses and readily integrated into their practice. Reiki is another tool for oncology nurses to use as they care for and comfort cancer patients.

7PATH TO HEALING WITH CANCER: AN INNOVATIVE SUPPORTIVE GROUP USING EXPRESSIVE AND CREATIVE THERAPIES, MEDITATION, AND MASSAGE. Martha W. Healey, RN, MSN, FNP, Susan Bauer-Wu, DNSc, RN, Dana-Farber Cancer Institute, Boston, MA; and Elana Rosenbaum, MS, MSW, LICSW, University of Massachusetts Medical School, Worcester, MA.

Background: Many cancer survivors want to learn new tools to enhance their recovery and live well beyond cancer. Studies have documented the benefits of support groups, mind-body techniques, massage, and expressive therapies. Traditionally these different interventions have been offered separately to patients, rather than integrating them within one therapeutic format. Recognizing the value of each of these interventions, coupled by patients’ requests for “more than a typical support group,” an innovative “supportive” group, Path to Healing With Cancer (PHWC), was created. Intervention: PHWC is a monthly group for persons with cancer. Two healthcare professionals facilitate the group; one, an advanced practice oncology nurse with training and experience in expressive therapies and meditation, the other, a clinical social worker who is also a cancer survivor and meditation instructor. The group, held at Hope Lodge, an American Cancer Society “home-away from home” for cancer patients, takes place from 6–9 pm. Cancer patients in the community as well as those at Hope Lodge attend. The evening combines guided meditation, gentle body movement, art, writing, and dialogue. Each session has a theme, usually consistent with the seasons (i.e., “planting our seeds and blossoming”). After two hours, massage, Reiki, and reflexology are offered, without charge, by certified professionals who volunteer their services. The evening ends with informal sharing and light refreshments. Evaluation: Since its inception in December 1999, the group has grown with approximately 12 participants each month, many coming since its inception. Some participants travel over an hour to attend this group. Although formal evaluations have not been conducted, consistent participation and verbal feedback are indicative of its benefits: “This is the one thing I do for myself each month that I never want to miss.” “This group gives me strength and peace of mind more than any other group I’ve attended.” Interpretation: Success of this innovative group is evident. Cancer patients are seeking group interventions that incorporate various integrative therapies to enhance their recovery. PHWC is a unique group and provides a model for oncology nurses and other professionals to refer or offer such programs to complement the care of their cancer patients.     

Spec

ial Interest Group Newsletter  August 2003   

Don’t Forget Music in the Treatment of the Whole PersonCeleste Schiller, BSN, RN, OCN®

Bensalem, PA

C_Schiller@fccc.edu

“When words fail, music speaks.” —Hans Christian Anderson

In oncology, we all have experienced moments when our words could not express the concern, care, or comfort that we desired to convey to our patients. We know that they are faced with the often overwhelming news of a cancer diagnosis or prognosis or with symptoms such as pain, nausea, vomiting, and dyspnea that may accompany disease. Medications certainly help, and procedures may relieve causes of symptoms. Education enables them to partner with their treatment teams and be actively involved in their care. Social workers also help greatly.

Yet more can be done in treating the whole person. I believe that the use of music can complement care and improve quality of life for patients and healthcare providers. How often have we turned on our car radios after a stressful day? We sing lullabies to our children to soothe them to sleep. We play songs at weddings and funerals. Throughout history, music has been used to promote wellness. Plato, Pythagoras, and Florence Nightingale saw its potential and prescribed it for health. Do we recognize music’s potential in our own practice?

Research validates the positive effects of music therapy on heart rate, blood pressure, immune response, stimulation of relaxation or sleep, and decreased anxiety with an increase in coping skills and communication (Beck, 1991). It also can decrease pain perception as follows.

Auditory stimulation occupies some of the neurologic pathways of the brain, resulting in fewer neurotransmitters being available to transmit pain messages.

Music can evoke intense emotions, thereby affecting the autonomic nervous system that triggers the release of hormones and endorphins, the body’s natural opiates.

Music may reduce muscular tension by masking sounds that are unsettling. The findings of Beck’s (1991) study support the use of music as an independent nursing intervention to relieve pain. In addition, Munro and Mount (1978) explained how the multidimensional qualities of music allow it to touch physiologic, psychological, social, and spiritual levels. With the current focus on complementary therapies, music is a great choice.

Unfortunately, despite decades of research into and evidence of the effectiveness of music therapy, trained music therapists are not common in adult acute-care settings. Such therapists are college-prepared with course work in anatomy, sociology, psychology, and physiology, in addition to music-related courses, and must complete a six-month clinical internship. They know what they are doing even though we may not understand. In their absence, how can nurses and doctors promote the use of music for patients?

First, I believe that each of us should listen intently to what our patients say to pick up cues that they may respond well to musical interventions. The nursing process of assessment, planning, implementation, and evaluation is valuable in putting a plan into action. I have found that asking patients about music style preferences when I initially admit them is

helpful. For inpatients, this information applies well to the coping section of the history form. Communicating to others via care plans whether patients found music to be helpful is important.

Fox Chase Cancer Center (FCCC) in Philadelphia, PA, has CD and cassette tape personal listening devices available to loan to patients, as well as a music library that is listed on the FCCC Web site; these are housed in the pastoral care office. Evaluation of interventions and documentation of patients’ responses are critical. Of course, if you play an instrument, patients often enjoy that also. I have had the privilege of playing guitar for patients and families for almost 20 years and have fond memories of my interactions.

For more information, please e-mail C_Schiller@fccc.edu.References

Beck, S.L. (1991). The therapeutic use of music for cancer-related pain. Oncology Nursing Forum, 18, 1327–1337.

Munro, S., & Mount, B. (1978). Music therapy in palliative care. Canadian Medical Association Journal, 119, 1029–1034.

Bibliography

Halstead, M.T., & Roscoe, S.T. (2002). Restoring the spirit at the end of life: Music as an intervention for oncology nurses. Clinical Journal of Oncology Nursing, 6, 332–336.

Lane, D. (1992). Music therapy: A gift beyond measure. Oncology Nursing Forum, 19, 863–867.

Starr, R. (1999). Music therapy in hospice care. American Journal of Hospice and Palliative Care, 7(4), 134–138.

Internet Resources

American Music Therapy Association, Inc.Music Therapy Info Link Prelude Music Therapy