Teach patients to imagine better health; it happens

Imagery and visualization can improve outcomes

The mind can be a powerful tool for reducing stress and anxiety, which can result in decreases in pain, side effects, and even length of stay, according to experts in imagery and visualization. To harness the mind’s power, people must learn to draw upon the resources of the right-hand side of the brain, says Susan Ezra, RN, HNC, co-director of Beyond Ordinary Nursing, a Foster City, CA-based certificate program in imagery for nurses.

"We go to a physician or practitioner to receive some intervention, which is good, but we can also tap into our inner resources. We can tap into the power of the mind and the body’s natural intelligence in healing," says Ezra. For example, the body already knows how to repair a bone or heal a wound.

Imagery and visualization are based on the idea that people often have a lot of the answers to their health problems, but they don’t relax and become quiet enough to go inside and find the information. Sometimes they don’t know they have the information. The right side of the brain is the bridge between the conscious and subconscious mind and holds the key to bringing this buried information to bear on the illness. (To learn more about training in imagery visualization techniques, see Editor’s note at the end of this article.)

There are two types of imagery. Guided imagery is the therapeutic process that harnesses the imagination to improve mental attitude and achieve positive outcomes and innate healing within the body. The process is scripted and can be directed by either a practitioner or an audio tape.

Integrative imagery takes this therapeutic process to a deeper level by eliciting and working with a person’s own images, both positive and negative. A trained practitioner guides this process in order to help the person bring to mind an image that symbolizes something such as healing. The practitioner directly engages the image, often in dialogue. For example, if the image symbolizes healing, it may reveal what is needed for the body to heal while the discussion is taking place with the practitioner.

Imagery and visualization can be used in many ways in a health care setting. They’re useful in moving people past barriers that block a successful recovery, says Fran London, MS, RN, health education specialist at Phoenix Children’s Hospital. Often, goals are difficult to achieve because people can’t even imagine success.

For instance, a patient who cannot imagine walking again after hip surgery will have trouble getting out of bed. If this patient imagines walking, the images are filled with pain and falling, thoughts that become a barrier to success. "Patients need to know they must visualize only positive images and that visualization is most effective when done in great detail, involving as many senses as possible," says London.

The steps begin with identifying the goal, deep breathing for relaxation, and imagining success in detail. It’s not a one-time activity, but something that should be done once or twice a day until success is achieved.

Because patients can take guided imagery audiotapes home with them and listen to them frequently at their convenience, tapes are good tools to help people relax and develop a positive state of mind before surgery or a procedure, says Diane L. Tusek, RN, founder of Guided Imagery, Inc., in Willoughby Hills, OH. Tapes help patients who struggle with chronic disease such as diabetes as well as patients who face life-threatening diagnoses such as cancer.

"I don’t believe in using guided imagery tapes that are disease-specific, because I don’t want to focus on the disease. I focus on grasping the adversity we have in life and becoming a better person, then actually moving forward," says Tusek. For full benefit of the process, patients are encouraged to listen to the tapes one to two times each day. (For information on guided imagery tapes, see resource list at right.)

When used as a relaxation technique before a procedure, guided imagery can be a single event. Patients going to the lab for an electrophysiology study (EPS) at Deborah Heart and Lung Center in Browns Mills, NJ, are given their choice of medication to relax or guided imagery. "The mind is such a wonderful instrument. You can relieve your pain and anxiety just by focusing on other things and putting other images in your mind," says Patricia Stanford, RN, BSN, manager of the EPS department at Deborah.

To prepare a patient for guided imagery, she describes what the lab room will be like in order to lessen the chance of distraction. She also teaches the patient how to breathe, which helps in the relaxation process. It helps to take them through a relaxation and imagery exercise before they go to the lab because it is easier for them to get into the process when they have done it before, says Stanford.

Imagery and visualization have many benefits, says Ezra, including an increased ability to cope and an enhanced sense of well-being. These techniques are particularly timely in the current health care climate that focuses on patient empowerment. "The more we can empower patients to tap into their inner resources, the more we will maximize their ability to either get well or stay well, and imagery is one modality to do that," says Ezra.

For more information, contact:

Susan Ezra, RN, HNC, Beyond Ordinary Nursing, Foster City, CA. Telephone: (415) 479-4712. E-mail: NCPII@aol.com. World Wide Web: members.aol.com/ NCPII/NCPII.html.

Fran London, MS, RN, health education specialist, Phoenix (AZ) Children’s Hospital. Telephone: (602) 239-2820. Fax: (602) 239-4670. E-mail: flondon@phxchildrens.com.

Patricia Stanford, RN, BSN, manager, EPS Department, Deborah Heart and Lung Center, Browns Mills, NJ. Telephone: (609) 893-1200, ext. 5134. Fax: (609) 893-8888. E-mail: stanford@deborah.org.

Diane L. Tusek, RN, BSN, Guided Imagery, Willoughby Hills, OH. Telephone: (440) 944-8929. Fax: (440) 944-1830. E-mail: imageryg@stratos.net. World Wide Web: www.guidedimageryinc.com.

(Editor’s note: Beyond Ordinary Nursing is a 110-hour certificate program that provides in-depth, hands-on training in therapeutic imagery for nurses. The fee is $150. Courses are offered throughout the year on the East and West Coasts and in the Midwest. Contact Beyond Ordinary Nursing for a brochure and calendar.

Also, Diane Tusek offers staff training in guided imagery and consulting on how to initiate a guided imagery program. Guided imagery tapes and CDs are also available. Two adult tapes or the CD cost $16.99 plus $4 shipping and handling. The children and adolescent tape is $11.99, and the CD is $16.99 plus $4 shipping and handling.)