1. eNews@RxForSanity.com
Email today for a complimentary
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invigorating newsletter!
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2. Create Your Spa Hospital ©
Patricia L. Raymond MD FACG
Rx For Sanity
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3. Trip to a SPA?
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4. Or Your Hospital?
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5. What’s the difference between the
two destinations?
• HPT
–Hurl
–Poop
–Toot
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8. Sometimes you have to take your
brain and stomp on it a little.
It just gets caked up.
Mark Twain
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9. Instead of just providing care,
create a customer experience.
Create experiences
so compelling to patients and their
families that their loyalty
is assured.
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10. Why Spa Hospital ? ©
• Enhances Staff Satisfaction
– Autonomous steps with positive medical
outcome
• Patients accepting, even demanding, of it
– 1998, 46.3% Americans use non-conventional
therapies, cost $27 billion dollars
• Reduction in liability exposure
– Medical outcome + service lapse to sue
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11. It doesn’t matter where you work:
But– where do you work?
• Med Surg
• Specialty floor
• Procedure unit
• ICU
• Outpatient
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12. What if everything went right?
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13. My first practice:
Orifices-R-Us
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14. Admission to
Spa Hospital ©
Gracious
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15. Admission to Spa Hospital ©
• Greeting by name, welcome
• Establish patient expectations
– What’s happening, what are the plans
• “Elevator speech”
– Rehearsal
Whens dr r expected
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16. Environmental Control
• Room Colors
– Blue, green, purple- calming, soothing
– Orange- stimulating
• Plants (artificial), water features, pictures of
nature, fresh flowers (florists donation or
from garden)
Spivey, SGNA 328
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17. Stripping of Possessions
• “the personal possessions of an individual
are an important part of the material out of
which he builds a self, but as an inmate the
ease with which he can be managed by staff
is likely to increase with the degree to
which he is dispossessed.”
~Goffman, Asylums, 1955
Dignapants, FFS
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18. Spa Hospital Visit©
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19. Modesty
• Ownership of space
• Maintain patient modesty
• Secret weapon? Warm blanket
– Coverage and comfort
• Retain control of corner or edge of sheet
• Tuck in drape
– Security and Coverage
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20. Humor
Of the people
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21. Starting the IV
• Jacobson, May, Warner
– 160 patients
– Guided imagery, self-selected music,
kaleidoscope
– assigned vs self-selected intervention
Jacobsen, May, Warner, SGNA 333
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22. Dancing in the Endo
• San Francisco VAMC, 198 vets,
– 15 min self selected music prior to colon
– 15 min no music prior to colon
• Anxiety measured with STAI
• Pre for both groups = 36
• Post for music 31, no music 35 (p=0.007)
Buffum, Hayes, Lanier
SGNA abstract 2037, 2002
Session 323
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23. Odors Modulate Pain Perception:
A Gender-Specific Effect
• Massage oil, orange water, aftershave,
distilled water, baby oil, vanilla extract,
almond extract, vinegar, perm product,
zonalin (dental product)
• Pleasant, neutral, and unpleasant odors (as
rated by subjects)- mood effect
• Subjected to odors and painful stimuli
Marchand, Phys and Beh, 2002
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24. Odors Modulate Pain Perception:
A Gender-Specific Effect
Marchand, Phys and Beh, 2002
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25. Aromatherapy
• Florence Nightingale: Lavender
• EEG studies
– Lavender: Increase alpha waves at back of
brain, c/w relaxation
– Jasmine: Increase beta waves frontal lobes, c/
w alert state
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26. Aromatherapy
• Japanese Fragrance Company
• Keyboard entry operators, monitor error
rate
– Lavender: Error rate decrease 20% (relaxing)
– Jasmine: Error rate decrease 33% (uplifting)
– Lemon: Error rate decrease 54%
(sharp and refreshing)
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27. Aromatherapy for Pain
• Lavender reduces perception of pain in
critical care settings
• Chamomile reduced perception of pain in
randomized study of 51 cancer patients
• Lemongrass has analgesic effects alone and
potentiates morphine
• Rose highly effective for pain despite PCA
• Use in midwifery common
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28. Aromatherapy 101
• 36 essential oils
• Contraindications
– Many are skin irritants
– Pregnancy, lactation, seizure disorders
– Avoid chamomile in ragweed allergic
– Avoid peppermint in arrhythmia patients
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29. Essential Oils- Properties
• Reduce Stress: Bergamot, chamomile,
lavender, lemon, melissa, marjoram, neroli,
petitgrain, rose, sandalwood, valerian.
• Reduce Anxiety: Chamomile, clary sage,
fir, geranium, juniper, marjoram, melissa,
neroli, nutmeg, orange, petitgrain, rose
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30. Essential Oils- Properties
• Mind stimulants: Angelica, basil, black pepper,
cardamom, cinnamon, clove, cypress, ginger,
jasmine, peppermint, rosemary, sage, tangerine.
• Digestive aiding: Anise, basil, cardamom,
chamomile, cinnamon, clove, coriander, dill,
fennel, ginger, juniper berry, melissa, lemongrass,
lemon, oregano, peppermint, rosemary,
sandalwood, thyme
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31. Aromatherapy
• Ask if they would like to try it
– Ask re ragweed, cardiac arrhythmias
– Ask re pregnancy and lactation, seizure disorder (not
with demonstrated aromas)
• Premix relaxation
– 1-2 oils only, one drop oil in tub of rice, sample placed
in ziplock snack bag
– No skin contact with oil (irritant)
• Post procedure
– Peppermint oil for increased mental stimulation
Aroma demo
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32. Additional Options
• Antiemetic: Peppermint, ginger, mandarin
oil
• Antispasmotics: Clary sage, lavendar,
chamomile, rosemary
• Rubefacient (5% solution in alcohol):
Clove, black pepper to ease IV starts in
difficult veins
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33. Spa Endo Procedure
©
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34. Room Lighting
• Cool white light led to more startle response
than full spectrum, even dim
– Startle: EMG of eyeblink,GSR of finger
• Start at medium level, not bright
• Ask if you can further reduce lights
• Patient contact essential as sedation takes
effect and room lights low
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35. General and Patient Contact
• Ownership of space
• Identify all who enter space, and seek
permission for activities
• Hand contact at all times by one party as
lights dim or patient becomes sedated
– Featherstroke or walk hands
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36. Positioning of Patient
• All subjects in side lying massage are
placed with extra pillow between knees
– Settles top hip in position
– Settles internal organs in position
– Spine remains in alignment
• Pillow between knees in all
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37. Can you hear me now?
• N=160, GA, headphones with different words pre and
intraop. At 5 and 25 hours later, good intra-op word
recognition. Information processing during general anesthesia:
evidence for unconscious memory. Bonebakker, Mem Cognit 1996
Nov;24(6):766-76
• N=43, GA, headphones with common facts or fictitious
nonfamous people. CF group remembered more facts
(p<.0005), NFP group more false fame (p < 0.001).
Information-processing during anaesthesia can also take
place as unconscious learning. Unconscious learning during
anaesthesia. Jelicic, Anaesthesia 1992 Oct;47(10):835-7
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38. Can you hear me now (2)?
• N=30 for CABG interview for recollections, both
aware and unaware, of intra-operative events.
Audio tape when <37 degrees suggested they
touch their chin during the postoperative interview
(p=.015). Seven patients (23%) recalled
intraoperative events, five with the aid of
hypnosis. Memory of cardiac anaesthesia. Psychological sequelae
in cardiac patients of intra-operative suggestion and operating room
conversation.Goldmann, Anaesthesia 1987 Jun;42(6):596-603
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39. Can you hear me now (3)?
• Several null studies
• Meta analysis
– “…some evidence of implicit memory for intra-
operative events, even with clinically adequate
anaesthesia.”
– “neither the anaesthetic techniques nor the paradigms
used to assess memory have been standardized.”
• Subliminal speech (learning during anesthesia) is
real…watch what you say, and how you say it.
• Overt recall operative events about 1%
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40. Touch Therapies
• Therapeutic Touch: Focus thought energy
through the hands while focusing good
intent for the well-being of the recipient
• Healing Touch: Adds to TT by redirecting
energy to the area of imbalance
• Reiki: Ancient Oriental TT
• Reflexology: Stimulate nerve ending to
activate brain receptors.
Donna wanda stroke
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41. Touch
• Heidt 1980
– Casual touch (pulse monitor), no touch, therapeutic
touch (massage, stroking) proved decreased anxiety
• Meehan 1993
– TT decreased post op pain and analgesia needs
• Daley 1996
– HT accelerated post op wound healing
• Samarel 1998
– TT reduced pre op anxiety of breast cancer patients, no
effect on pain
Additional scientifically rigorous
studies are needed.
www.RxForSanity.com

42. Touch Techniques in Endoscopy
• Abdominal Massage
• Sacrocranial Techniques
• Reflexology
– Never massage or manipulate anything with
• edema
• acute inflammation
• recent surgery
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43. Abdominal Massage
• Best left to experts, and jostles the view
• Techniques to relax spasm
– Jostling
– “Deep” Longitudinal
• Advance pressure up the rectus from symphysis
pubis
– Cresting
• Knuckles and palm
• With direction of colon
www.RxForSanity.com

44. Sacrocranial stimulation
• Anywhere you do/did have hair
• Calming/soothing
• Tugging, brushing, moving facia
– Don’t push or stroke
• Keep out of vision, on scalp
– Startle with hand in and out of vision
demo
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45. Reflexology
• Either hand, not hand with IV (in arm is ok)
• Feet (not in diabetics)
• Right organs, right hand etc
• Use finger pads, no nail contact
• Follow direction of colon
• Specific movements for effect
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48. Reflexology
• Movements
– Clockwise circular motion
• Stimulating but calming
– Vibration
• Stimulation
– Gentle pressure
• Sedating
– Featherstroke at end toward heart
Demo
Mrs.C and the music
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49. Dancing in the Endo II
• 37 patients for flex sig
• No intervention, audio only, or audiovisual
• Lower abdominal discomfort
– AV 7.1, A 9.5, None 10.8 (p< 0.05)
• Lower Anxiety ratings
– AV 2.5, None 4.4
• Attributed to distraction of patient
Am J Gastro 1998 Jul; 93(7):1113-6
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50. Dancing in the Endo III
• 64 patients for flex sig, midwest
– Music, or none
• Music group with less anxiety and
discomfort, but same satisfaction and
compliance.
Gastroenterol Nurs 2000 Jul; 23 (4):148-56
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51. Dancing in the Endo IV
• 165 patients for colonoscopy, Hong Kong
– Music + PCA, PCA alone, Music and
anesthetic if requested
• Propofol .84 mg/kg with music and PCA
– Propofol 1.15 mg/kg with PCA alone (p=.02)
Gastrointest Endocop 2002 Jan;55(1):33-6
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52. Spa Hospital ©
Discharge
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53. Parting Gifts:
Restore Control to Your Patient
• Teach Reflexology or Aromatherapy
• Education (diets, exercise, educational
pamphlets)
• Gift (CCUU, exercise bands)
• Congratulations and thank you
• Make them an agent for change
Deep fried and d
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54. Make it hard(er) to choose!
• Only differences are
HPT
• New attitude,
automony
• Restore caring and
service to patient care
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55. Almost time for a break!
• Evaluation with name and legible email
address for subscription to Rx For Sanity
eNews, a complimentary monthly eZine
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