Preparing Patients / Clients for Surgery with Hypnosis Ron Eslinger RN, CRNA, APN, MA, BCH, CMI, FNCH

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


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!!


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


India 300 major operations 3000 minor operations in India using Mesmerism

James Esdaile, M. D.James Esdaile, M. D.


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


“Words are, of course, the most powerful drug used by mankind.”

Rudyard Kipling


Hypnosis Phenomenon Hypnosis Phenomenon That Aids in SurgeryThat Aids in Surgery

Glove anesthesia Time distortion Relaxation Dissociation Distraction Immune system Decrease Cortisol


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


SuggestibilitySuggestibility

ConsciousAnalytical

SubconsciousLiteral


SuggestibilitySuggestibility

ConsciousAnalytical

SubconsciousLiteral


Suggestibility in Hypnosis

ConsciousAnalytical

SubconsciousLiteral


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


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.


• 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


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


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


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


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.


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


Kind words can be short or long to speak, but their echoes are truly endless.

Mother Theresa

EstablishEstablish RapportRapport


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.


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


“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


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


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


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)


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.


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



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


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.


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.


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


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


Questions

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Preparing Patients / Clients for Surgery with Hypnosis Ron Eslinger RN, CRNA, APN, MA, BCH, CMI, FNCH