Preparing Patients / Clients for Surgery with Hypnosis Ron Eslinger RN, CRNA, APN, MA, BCH, CMI,...
-
Upload
grant-park -
Category
Documents
-
view
215 -
download
0
Transcript of Preparing Patients / Clients for Surgery with Hypnosis Ron Eslinger RN, CRNA, APN, MA, BCH, CMI,...
Preparing Patients / Clients for Surgery with Hypnosis
Ron EslingerRon Eslinger
RN, CRNA, APN, MA, BCH, CMI, FNCHRN, CRNA, APN, MA, BCH, CMI, FNCH
www.eslinger.netwww.eslinger.net
Copyright 2008 M. Ron Eslinger 2
Learning Objectives
Understand
• Why Hypnosis
• The phenomena of hypnosis
• Pioneers in hypnosis for surgery
• Suggestions pre-op, intra-op, post-op
Copyright 2008 M. Ron Eslinger 3
Why Hypnosis??Why Hypnosis??
Mind/Body Therapy Changes Stress
Response Improves Healing Facilitates Rapid
Recovery Gives the Patient
Control
Endorsed by the AMA in 1958
Around since the beginning of time
Simple
It Works!!It Works!!
Copyright 2008 M. Ron Eslinger 4
Hypnosis is a Normal State
Daydreaming Fantasizing Reflection Going within (meditating) Focused awareness (concentrating, contemplating) TV/movie viewing Reading Sitting in front of your computer
Copyright 2008 M. Ron Eslinger 5
India 300 major operations 3000 minor operations in India using Mesmerism
James Esdaile, M. D.James Esdaile, M. D.
Copyright 2008 M. Ron Eslinger 6
Florence NightingaleFlorence Nightingale
Notes on Nursing, Published in 1859 Volumes are now written on the effects of
the mind upon the body Music and color have a beneficial effect on
the patient (Riely)
Help the sick to vary their thoughts
Copyright 2008 M. Ron Eslinger 7
“Words are, of course, the most powerful drug used by mankind.”
Rudyard Kipling
Copyright 2008 M. Ron Eslinger 8
Hypnosis Phenomenon Hypnosis Phenomenon That Aids in SurgeryThat Aids in Surgery
Glove anesthesia Time distortion Relaxation Dissociation Distraction Immune system Decrease Cortisol
Copyright 2008 M. Ron Eslinger 9
20% can reach a light stages of Hypnosis
80% can reach the medium stages of Hypnosis
20% can reach the deeper stages of hypnosis
Hypnosis
An Altered State of ConsciousnessAn Altered State of Consciousness
Copyright 2008 M. Ron Eslinger 10
SuggestibilitySuggestibility
ConsciousAnalytical
SubconsciousLiteral
Copyright 2008 M. Ron Eslinger 11
SuggestibilitySuggestibility
ConsciousAnalytical
SubconsciousLiteral
Copyright 2008 M. Ron Eslinger 12
Suggestibility in Hypnosis
ConsciousAnalytical
SubconsciousLiteral
Copyright 2008 M. Ron Eslinger 13
Alice MagawAlice Magaw
A Review of Over Fourteen Thousand Anaesthesias
Without an anesthesia death for Mayo Brothers
Suggestions is a great aid in producing a comfortable narcosis
The subconscious or secondary self is particularly susceptible to suggestive influence
Patients are told what to expect
The Mayo BrothersThe Mayo Brothers
How they became such famous surgeons
Copyright 2008 M. Ron Eslinger 15
Suggestibility
A person in pain, fear or panic, is in an “altered state of consciousness.” At such times, healing suggestions can be spoken to the mind/brain/body and accepted more readily.
Copyright 2008 M. Ron Eslinger 16
• Left to its own devices, in fight or flight, the mind returns to earlier negative experiences
• Every image we have in our minds creates a chemical in our bodies
• Hypnosis can help the body produce chemicals that calm
• Having a picture of a better or alternative future allows the mind to be open to possibilities of healing
Copyright 2008 M. Ron Eslinger 17
Fear is the EnemyFear is the Enemy Fear causes tension Tension causes pain Fear comes from
Lack of education Negative comments
Family Friends Hospital staff
Catecholamins are released in large quantities which causes resistance which causes pain
Copyright 2008 M. Ron Eslinger 18
What are the fears?What are the fears?
Not waking up Pain Needles Nausea & Vomiting Claustrophobia Waking up during surgery
When does the fear start?When does the fear start?
Two weeks prior to the procedureTwo weeks prior to the procedure
Copyright 2008 M. Ron Eslinger 20
Find your Happy Place, Pre-Op …
November-December 2002Health Tips, Page 14
Patients who listened to Guided Imagery tapes/CDs 2 weeks prior to surgery saved $654.
PBS program New Medicine reported a $2000 savings.
My Generation : My Generation : An AARP PublicationAn AARP Publication
Copyright 2008 M. Ron Eslinger 21
AANA Abstract
20 minute CD in Holding Area
Conclusion: The utilization of Guided Imagery in the ambulatory surgery setting, even when initiated just prior to surgery, can significantly reduce preoperative anxiety which can result in less postoperative pain and earlier PACU discharge times.
Copyright 2008 M. Ron Eslinger 22
Preparing Patients at PresbyterianPreparing Patients at Presbyterian
New York Presbyterian Hospital offers complementary therapies to its heart surgery patients.
Hypnosis is encouraged. Less pain Less N/V Less hospital days
MRIShorten procedure
with better quality product
Cardiac Catherization Shorten procedure
by 17 minutes with 85% decrease in resedation
Special ProceduresSpecial Procedures
Copyright 2008 M. Ron Eslinger 24
Kind words can be short or long to speak, but their echoes are truly endless.
Mother Theresa
EstablishEstablish RapportRapport
Copyright 2008 M. Ron Eslinger 25
RapportRapport
Excellent rapport is one of the most important components of this process. It is crucial that good rapport be established and maintained. If not, all the work and trust that you strive for could be futile.
Copyright 2008 M. Ron Eslinger 26
Gaining Rapport
• Develop a relationship based on trust, compliance, and positive expectation
• Hypnosis helps form an alliance• The Informed Consent• What it means
• Let them know what to expect
Ask the QuestionAsk the Question
Copyright 2008 M. Ron Eslinger 28
“During periods of great stress, words that seem immaterial or are uttered in jest might become fixed in the patient’s mind and cause untold harm.”
American Academy of Orthopedic Surgeons
Copyright 2008 M. Ron Eslinger 29
How to Talk to Patients
Your surgical team will be with you the entire time
You will wake up feeling better than they thought they would
You will wake up pleasantly hungry Take a nice deep breath “when” teach how Think of a place you would rather be You should wake up comfortable - if not let your
nurse know
Copyright 2008 M. Ron Eslinger 30
Suggestibility and Semantics
Negative Words Hurt or pain Doctor is cutting Putting you to sleep Labor pains It won’t be long Are you having pain? Are you feeling sick? Little Bee sting
Positive Words Comfort Incision or getting started Drifting off to sleep Contractions / labor process In a short time Are you comfortable? You will be hungry Feel a little pinch
Words are tools - Keep them positiveWords are tools - Keep them positive
Copyright 2008 M. Ron Eslinger 31
Pre-operative Techniques
Establish Rapport Appropriate
introduction Listen carefully Respond appropriately Create a positive
environment Focus completely and
PAY ATTENTION
Foster Patient Control Give appropriate
information Prepare patient for
noxious stimuli (IV start, noise, cold) and use positive suggestion
Tailor to patient’s coping style (age, intellect, physical limitations)
Copyright 2008 M. Ron Eslinger 32
Pre-operative Techniques
• Would you rather be here or someplace else? GO• Getting an IV –
– Do not hear Little Bee Sting
– Think water hose to increase vein size!
– Area cold to create anesthesia/numbness
– Tourniquet may make arm fall asleep
– Here is what you may feel (pinch area or pull hair)
– Think about your other arm (temperature, texture, color)
• Some people feel the IV but many do not – you choose which you want.
Copyright 2008 M. Ron Eslinger 33
Intra-operative Techniques
Control their Thoughts Focus on their happy place
– Think of waking up feeling pleasantly hungry
– Imagine they have already healed – Head phones with Suggestions &
Music Keep all thoughts positive
Copyright 2008 M. Ron Eslinger 34
Copyright 2008 M. Ron Eslinger 35
Memory & Hearing Formation
Patients Eavesdrop on Surgeons Research shows that 80% of patients
hear while under general anesthesia They have had a hypnotic drug MAC less than 0.5 with a
halogenated agent is a major factor Implicit Memory may show up as a
positive affect or as a adverse response
Timothy Smith Ph.D. University of Memphis 1999
Copyright 2008 M. Ron Eslinger 36
Intra-op SuggestionIntra-op Suggestion I am relaxed and comfortable.
My surgery is going well.
I am healing more quickly than I thought I would.
I am feeling better than I thought I would.
My stomach is warm and comfortable.
My bleeding is under control.
All my body functions are normal.
Everyday I’ll feel a greater feeling of personal well being, a greater feeling of personal safety and security than I have felt for a long long time.
Copyright 2008 M. Ron Eslinger 37
Intra-op SuggestionIntra-op Suggestion
I am healing much more quickly than I thought I would.
I am much more comfortable than I thought I would have.
My surgical side is more comfortable than I thought it would be.
My surgery is going well, I am feeling well.
I am feeling much better than I thought I would.
I am comfortable and I am happy.
I will cough and deep breath easily and comfortably.
I am relaxed, calm, peaceful and at ease.
My blood pressure and pulse are normal.
Copyright 2008 M. Ron Eslinger 38
Post-Operatively
You should be comfortable if not - let the staff know
If you feel something in your mouth you can spit it out
You will be pleasantly hungry, etc You will be happy with your surgery You will sleep good at night after your
procedure
Copyright 2008 M. Ron Eslinger 39
What can be accomplished?
Decrease in preoperative anxiety
More positive attitude toward surgical experience
More cooperative patient and family
Greater rapport and trust
Diminished blood loss Better wound healing Decreased pain Decreased PONV Better overall
experience and outcome
Copyright 2008 M. Ron Eslinger 40
Questions
www.roneslinger.com