Massage, meditation, and music become tools

Complementary therapy benefits recognition 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 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 City. "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 perform some therapies, such as acupuncture and hypnosis, there are several therapies that nurses and aides can learn and perform in the home, she adds.

Learning how to give the proper touch

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 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.

Complementary therapies offer new options

Different techniques benefit patient needs

Complementary. Integrative. Alternative. Those three words often have been used interchangeably to describe nontraditional therapies to relieve pain or stress and reduce anxiety and heart rates. Before including these therapies in your services, be sure to know how to describe them, suggests Kathleen M. Wesa, MD, an internist and specialist in integrative medicine at Memorial Sloan-Kettering Cancer Center in New York City.

"An alternative therapy is an unproven treatment that is used in the place of proven, traditional medical treatment," she explains. The therapies that home health agencies are most likely to implement can be called integrative or complementary, Wesa says. "This means that they are used in addition to medications and traditional care to enhance care," she explains.

The most effective therapies for home health, according to Wesa, include:

• Self-hypnosis.

"This therapy is helpful in reducing anxiety or panic attacks," says Wesa. While it is a safe therapy, it must be taught by a staff member who is trained and certified to teach hypnosis, she points out. "This ensures that the therapy is effective for the patient," she adds.

• Massage.

"Gentle massage is appropriate for all patients, even frail patients, when done correctly," says Wesa. While most nurses or aides might not feel comfortable giving full body massages, they can easily be trained for foot and hand massages, she says. Not only does massage reduce pain and depression at the time of the massage, but the effects of a 20-minute massage can last at least 48 hours, she points out.

• Meditation.

Not all patients are comfortable with meditation, but there are several techniques that can be used to relax patients, reduce stress, and decrease heart rate and blood pressure, says Wesa. Meditation with a centering prayer and guided imagery can greatly improve a patient's emotional well-being, she says. "If the patient is not visual, the patient can focus on breath awareness instead of visual images," she points out.

• Music therapy.

Although some agencies already certified music therapists in their program, nurses and aides can use music to calm an anxious patient or prompt conversations. "If music was a part of the patient's life prior to illness, it can be a very moving therapy," says Wesa.

Be aware of state licensing requirements for different complementary therapists, suggests Wesa. "Licensing and credentialing requirements differ from state to state," she warns. If you choose to partner with a community-based therapist for acupuncture, massage, or music therapy, be sure that, in addition to the proper training, they have experience with ill, homebound, frail, or elderly patients, she suggests.

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 bedbound 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." 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 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; 2:116-124.

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

Need More Information?

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

  • Melissa Gulick, RN, Patient Care Supervisor, Community Hospice of America, 200 E. Centennial, Suite Two, 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 St. 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 Ave., 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: 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: www.musictherapy.org. The web site includes information about education and certification programs, and it 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: www.healthandhealingny.org. The web site includes a library of related web sites, books, audiotapes, and other educational material related to a variety of comple-mentary 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: www.nccam.nih.gov. Part of the National Institutes of Health, the center was established to research and evaluate complemen-tary/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, frequently asked questions, classification of CAM practices, fact sheets, consensus reports, clearinghouse, clinical trial awards data, and clinical trial opportunities.