Massage, music, and meditation become extra tools for HHA staff

Recognition of complementary therapy benefits grows

The use of integrative medicine therapies continues to grow, with hospitals opening integrative medicine centers and health care providers offering massage therapy and acupuncture. Recent articles point out the use of complementary therapies by cancer patients with needs that are not met by traditional medicine1 and the use of reflexology to reduce the stress and pain of nursing home residents.2

Integrative or complementary therapies also are beneficial to home care patients, says Gayle Hasledalen, MSW, social worker at Lakeview Hospital Homecare and Hospice in Stillwater, MN. "We are working with our hospital to develop a group of home care nurses who receive healing touch training," she says.

Currently, the agency offers therapeutic massage to patients with a group of massage therapists who volunteer their time. "Most of the patients who have asked for massages are younger, in their 40s, and have had massages before," says Hasledalen.

Age is not always a predictor of a patient's willingness to try a complementary medicine approach, says Kathleen M. Wesa, MD, an internist and specialist in integrative medicine at Memorial Sloan-Kettering Cancer Center in New York. "Acceptance of an alternative therapy depends more on the personality of the patient than the age," she explains. If the patient doesn't like needles, acupuncture is not a good therapy to consider, she points out. "Other patients might not [like] sitting still to meditate, while others are not comfortable with massage," she points out. The key to successful use of complementary therapies is to match the technique to the patient.

Complementary therapies can be used to manage pain, stress, nausea, anxiety and a range of other symptoms patients might have, says Wesa. While only well trained, licensed professionals should do some therapies, such as acupuncture and hypnosis, there are several therapies that nurses and home health aides can learn and perform in the home, she adds.

Even though most health care professionals know the importance of touch, it is important that staff members learn the proper technique, says Melissa Gulick, RN, patient care supervisor for Community Hospice in Pittsburg, KS. Once staff members learn how to properly give hand or foot massages, they can teach family members, she says. "In hospice, many family members will withdraw from the patient because they are afraid of hurting them when they are fragile or increasing their pain," she explains. When taught how to give hand, back, or foot rubs gently, family members can reconnect with the patient and meet the emotional needs of both family and patient, she adds.

Family members are receptive to learning simple massage techniques, says Gulick. "They have been so busy meeting the medical and physical needs of the patient that sometimes they don't think they have time to give a back rub," she says.

Gulick's staff underwent therapeutic touch, and now clinicians and aides report positive results. "One aide happily told us about her patient who always became agitated at bath time," says Gulick. The patient had dementia and was unable to communicate, she says. The aide had been quietly singing to the patient to calm her, but after attending the therapeutic touch session, she tried rubbing her arms as they got ready for the bath. "The patient became so relaxed that she slept during the bath," she adds.

Physical therapists and nurses also can use yoga to help increase range of motion and fitness for bed-bound or homebound patients, says Wesa. "Gentle exercises that work on balance and strength are helpful for patients in many different ways," she points out. "Any time that you focus on an activity, such as exercise, you alter your brain waves," she says. Concentrating on performing an exercise can reduce stress and decrease pain because the patient is focusing on something other than the stress or pain, she adds.

Don't forget the value of meditation, suggests Wesa. Meditation can take many forms, from a centering prayer to guided imagery to breath awareness, she says. The key is to find a technique that enables the patient to completely focus on the meditation activity in order to relax. "There are great psychological benefits of meditation. It has been shown to decrease heart rate, reduce blood pressure and lessen the patient's stress response," she says.

Whichever complementary therapy nurses choose to incorporate into home care, remember that complementary therapies are not a substitute for ongoing assessments and traditional care, says Gulick. "Massage, music, and healing touch are beneficial tools that enhance our ability to meet patient needs."

References

1. Mao JJ, Palmer SC, Straton JB, et al. Cancer survivors with unmet needs were more likely to use complementary and alternative medicine. J Cancer Surviv 2008 June; 2(2): 116-24.

2. Hodgson NA, Andersen S. The clinical efficacy of reflexology in nursing home residents with dementia. J Altern Complement Med 2008 Apr; 14(3):269-75.

Sources/resources

For more information about complementary therapies in home health, contact:

  • Melissa Gulick, RN, Patient Care Supervisor, Community Hospice of America, 200 E. Centennial, Suite 2, Pittsburg, KS 66762. Telephone: (620) 232-9898. E-mail: Melissa.gulick@hospice.com.
  • Gayle Hasledalen, MSW, Social Worker, Lakeview Hospital Home Health and Hospice, 927 Churchill Street W, Stillwater, MN 55082. Telephone: (651) 275-5765. E-mail: gayleh@lakeview.org.
  • Kathleen M. Wesa, MD, Internal Medicine and Integrative Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. E-mail: wesak@mskcc.org.
  • American Holistic Nurse Association, P.O. Box 2130, Flagstaff, AZ 86003-2130. Telephone: (800) 278-2462 or (928) 526-2196. Fax: (928) 526-2752. Web site: www.ahna.org. Web site offerings include conference information, holistic nursing certification program information, and a list of other certificate programs endorsed by the association.
  • American Music Therapy Association, 8455 Colesville Road, Suite 1000, Silver Spring, MD 20910. Telephone: (301) 589-3300. Fax: (301) 589-5175. Web site: www.musictherapy.org. The web site includes information about education and certification programs, and answers frequently asked questions.
  • Beth Israel Center for Health and Healing, 245 Fifth Ave., Second Floor, New York, NY 10016. Telephone: (646) 935-2220. Fax: (646) 935-2272. Web site: www.healthandhealingny.org. The web site includes a library of related web sites, books, audiotapes, and other educational material related to a variety of complementary therapies.
  • National Center for Complementary and Alternative Medicine (NCCAM), P.O. Box 7923, Gaithersburg, MD 20898. Telephone: (888) 644-6226 or (301) 519-3153. Fax: (866) 464-3616. Web site: www.nccam.nih.gov. Part of the National Institutes of Health, the center was established to research and evaluate complementary/alternative therapies in order to determine their effectiveness and safety and to communicate this information to the public and the health care community. The web site contains information about complementary/alternative medicine (CAM), news and events, FAQs, classification of CAM practices, fact sheets, consensus reports, clearinghouse, clinical trial awards data, and clinical trial opportunities.