PATIENT EXPERIENCE GRANT PROGRAM SERIES RESEARCH REPORT

Transcription

1 PATIENT EXPERIENCE GRANT PROGRAM SERIES RESEARCH REPORT The Effect of Soothing Sound Machines and Meditation Using CD Players on Relaxation in Acute Care Orthopedic Patients Barbara Bauer, RDN, Carolyn Mitchell, RDN, CNSC, Erin McHugh, RN,BSN,ONC Sharp Coronado Hospital

2 ABOUT THE BERYL INSTITUTE PATIENT EXPERIENCE GRANT PROGRAM The Institute s annual grant program is designed to broaden the dialogue on the value of focusing on the patient experience and to increase the volume of data-driven research supporting this critical topic. Healthcare personnel engaged in managing or improving patient experience, doctoral students and/or university faculty are encouraged to apply. The mission of the program is to encourage and support research and inquiry on the following: The value of focusing on patient experience before, during and after care (e.g. access to care, quality encounters, service improvement, reduction of readmissions, ROI of service, etc.) The impact service efforts have on patient and family experience The influence of culture on the overall healthcare experience and/or performance outcomes An integrated review of the impact these factors have in supporting a positive healthcare experience To learn more about the grant program, visit The Beryl Institute

3 3 INTRODUCTION BACKGROUND The focus of our research was on improving relaxation for acute care orthopedic patients during hospitalization. Our relaxation program for patients provided lavender aromatherapy, massage, and listening to relaxing music to provide a calming experience. To enhance this experience the use of meditation CD s and soothing sounds machines was studied for the ability to enrich the relaxing experience for patients. The aim of our research was to determine: Preferences of patient s use for meditation using CD players or a soothing sounds machine Whether differences exist between gender or age in preference for either meditation or soothing sounds machines Level of relaxation rated by patient survey question after using meditation CD player (active process) as compared to level of relaxation when using soothing sounds machines (passive process) Sharp Coronado Hospital strives to practice patient centered care and maximize relaxation for acute care patients during their hospitalization to promote healing and decrease pain. Patient s comfort is always first on our minds so adding guided meditation using a CD player and soothing sounds machines was a natural progression of our relaxation experience. A staff meditation program was started to decrease work place stress in caregivers. Staff found the meditation experience beneficial and wanted to bring meditation to patients to enrich the relaxing process to decrease their patient s pain. Since meditation to quiet the mind is not practiced by all our patients, staff was not sure what a surgical patient s response would be to meditation. It was decided to offer either guided meditation using a CD player or a soothing sounds machine.

4 4 METHODOLOGY AND RESEARCH PROCESS Several touch points were used to acquaint patients with the relaxation experience enhancement. In a preadmission phone interview, patients were asked if they were interested in integrative therapies such as guided meditation CD players or soothing sounds machines to improve relaxation experience. Orthopedic patients were also introduced to the availability of soothing sounds machines and guided meditation CD players at the preadmission orthopedic class. The orthopedic joint class is a class attended by patients prior to surgery where meditation and soothing sounds machines as well as other patient centered care modalities are introduced to the patient. (This introduction was intended only to educate about the availability of relaxation methods, not determine the subjects for the study or obtain consent). Once the patients were admitted, they were asked if they would like to use a soothing sound machine or meditation CD. Identification of patients in the hospital utilized patient lists printed off the electronic medical record system for the orthopedic unit. This patient list was used daily by the dietitians involved in patient care to review diagnosis, room number, name, date of birth, age, sex, admit date/time, and allergies on hospitalized patients. For this research study, the list was used to identify patients with an orthopedic diagnosis of knee osteoarthritis or hip fracture. Patients with these diagnoses were asked if they would like to use a soothing sound machine or meditation CD. Patient lists were saved for 24 hours and then placed in a Cintas Security Container for shredding. Patients choosing to use a soothing sounds machine or meditation CD were asked if they were willing to participate in a study. Patients consenting to participate rated any change in relaxation response with the use of a soothing sounds machine or meditation CD on a 1-5 scale with 1=no change in relaxation, 2=mild change in relaxation, 3=moderate change in relaxation, 4=good change in relaxation and 5=very good change in relaxation. Participation in the study was voluntary. Patients declining to participate in the study were not restricted from using a soothing sounds machine or meditation CD. Each patient participating in the study received a number (from 1 to 50) coordinating with the numbered sound machine or meditation CD used. No personal patient identifiers were collected. Data was collected in age groups rather than the exact age of the participant: 40-50, 51-60, 61-70, and >70 and gender, male or female, was identified. Patients using soothing sounds machines were placed in group one and patients using meditation CD s were in group two. Patients requesting to use both meditation CD and soothing sounds machine were placed in group three. The final sample size was 50. The data collected was analyzed to determine the preference of patient use of a meditation CD or soothing sound machine. This was determined by the number of patients using each resource and reviewed in the following segments: Differences in gender (number of female patients/ number of participants) and (number of male patients/number of participants). Number of patients participating with either a meditation CD or soothing sounds machine (each age range choosing a soothing sound machine/number of patients participating) and (number of patients participating in each age range choosing a meditation CD/number of patients participating). As part of the process, participants rated the level of relaxation change when using a soothing sounds machine (level of relaxation change/number of patients participating) and rated the level of relaxation change when using a meditation CD (level of relaxation change/ number of participants).

5 5 The soothing sounds machines and meditation CD s and CD players were housed in a storage cabinet unit at the medical surgical unit. When soothing sounds machines were used by the patient they were placed on the bedside table in the patient s room. When listening to meditation CD s, patients used CD players with headphones. Participation consent was obtained by the PI and coinvestigator from the patient in their room, using simple language without any undue influence or coercion and inviting questions. Soothing sounds machines and CD players were battery operated, reusable, and cleaned after each patient use. Standard hospital cleaning practices were used. Ear pieces on head phones were disposable and not reused. Patients requiring isolation precautions were evaluated to determine if precautions allowed participation. At the same time that the program started using guided meditation CD s and soothing sounds machines, our hospital embarked on a major renovation that involved jack hammering and loud noises. A patient was quoted as saying, Thank you for the soothing sounds machine. I turned it up full blast to block the noise! Another patient stated to the investigator, my first night I was in a large amount of pain and couldn t sleep but the soothing sounds machine put me and my husband, who was in the room with her, right to sleep. When staff observed patients peacefully sleeping while the soothing sounds machine played, we felt rewarded for our effort in developing the program. The surgery schedule listing patients who requested the soothing sounds machines and guided meditation CD players was reviewed at the daily interdisciplinary integrative meeting so that after surgery the patient would have access to their relaxation request. Nurses and dietitians offered the soothing sounds machines, providing the choice of six peaceful sounds, and guided meditation CD players to patients providing a total patient care team effort. Patients were asked if they were willing to consent to answer a question evaluating their use of guided meditation using a CD player or a soothing sounds machine. Our focus for data collection was on acute care elective orthopedic surgery patients with the hope that improved relaxation would ease pain. Patients with other medical problems were offered the guided meditation CD players and soothing sounds machines if staff felt it would benefit the patient.

6 6 RESEARCH RESULTS 50 participants answered one of these questions: 1. Rate the level of relaxation change after using a soothing sounds machine, or; 2. Rate the level of relaxation change after using a meditation CD player The same scale was used for each question Key Findings Patient rating of level of relaxation change after using a soothing sounds machine 9 No change=1 Mild change=2 Moderate change=3 Good change =4 Very good change = None Mild Moderate Good Very Good Study Participants Significantly more women participated: 78% female compared to 22% male. Most participation occurred in both men and women at >60 years of age with a slight increase in females >70 yrs. old participating and a slight decrease in males >70 yrs. males participating. Sex 39 Female (78%) 11 Male (22%) Patient choices yrs. 2 (5.1%) 2 (18.2%) yrs. 9 (23.1%) 2 (18.2%) yrs. 13 (33.3%) 4 (36.4%) > 70 yrs. 15 (38.5%) 3 (36.4%) None and mild change was limited to 17% of our patients Moderate, good and very good responses were received from 82% of our patients. The highest group was good response 36.5% and followed by very good 27% Patient rating of level of relaxation change after using a meditation CD Resource selections of participants broke down as follows: 0 None Mild Moderate Good Very Good Sex Soothing Sounds Only Meditation CD Player Only Both Soothing Sounds & Meditation CD Player Female Male Total 41/50 6/50 3/50 Guided meditation was a sample size of only nine but only one person had less than a moderate response, 11%, which was lower than the soothing sounds group. Moderate, good and very good responses were received from 8/9 (88.8%) which was higher than the 82% received with the soothing sounds group. The highest group was very good response 44%. Total % 82% 12% 6%

7 7 ANALYSIS Our study indicated that both soothing sounds and guided meditation CD players can provide relaxation to patients with more than 80% rating the change as moderate or better. Significantly more patients selected soothing sounds machines 82% (passive process) over 18% selecting guided meditation CD players (active process). Three patients selected both soothing sounds machines and guided meditation CD players rating soothing sounds machines good and very good and guided meditation mild and very good. Comparison of age ranges in our study indicated that 70% of participants were over 60 years of age and 30% less than 60 years of age. This age representation is typical for orthopedic hospitalized patients with hip and knee surgical procedures. Comparison of gender differences in selecting either a soothing sounds machine or guided meditation CD was more divided among women with 76% selecting a soothing sounds machine and 8% selecting a guided meditation CD. Men selected a soothing sounds machine more frequently 82% and only 4% selected guided meditation CD. A patient was quoted as saying before going home, I m coming back to get my other knee surgery at your hospital because the hospital has a special charm about it. During follow up with patients after using a soothing sounds machine or guided meditation CD player they often said, I loved it. Soothing sounds machines were chosen by more than 80% of participants with 36.5% rating a good response and 27% rating a very good response, which contrasts with the guided meditation CD group rating of good response of 22% and 44% rating of very good, the highest response category. No response also differed between groups. The guided meditation CD participants all rated their response as mild to very good, but 7% of the soothing sounds participants had no response in relaxation. The three patients who chose to use both the soothing sounds machine and guided meditation CD followed these gender differences with two women choosing both and only one man choosing both, however, the sample size was larger for women than men. Both male and female patients reported a positive experience.

8 8 CONCLUSION Surgical patients anticipate that the experience will be painful but along with common pain medication, the use of integrative therapies including guided meditation and soothing sounds machines enhanced our relaxation program. The results suggest overall soothing sounds machines were preferred by over 80%. Soothing sounds machines provided a relaxation response with 93% of the participants. The good response rating was the largest category selected (36.5%). The guided meditation CD group had a 100% relaxation response with the very good rating the largest category selected (44%). Our patients rated improvement in relaxation after surgical procedures with either a soothing sounds machine or meditation CD player. More patients choose the soothing sounds machines but the guided meditation CD players were rated by patients higher in relaxation response. Patients as well as families and visitors observe the benefits of the soothing sounds machines and guided meditation CD players for their loved ones. Many patients and families ask how to purchase the device to use at home. To assist patients, families, visitors and staff who have observed the benefits of this program, we now have made these products available for purchase in our gift shop, so the relaxation experience can continue at home. This program was easily accepted by the organization. We were fortunate to receive a small grant from The Beryl Institute so supplies could be purchased without cost to the unit. It was easy for the nursing staff to provide the soothing sounds machines or guided meditation CD players during their usual care of the patient. Improving the relaxation response for patients with the addition of soothing sounds machines and meditation CD s provided positive benefits and improved the patient experience. Due to the success of the use of soothing sounds machines and meditation CD players, our program has been expanded to include all acute care patients. Additional soothing sounds machines and meditation CD players have been purchased and are now housed on a mobile activity cart allowing the team easy access for patient s bedside use. The preadmission phone interview and orthopedic class continue to be touch points to acquaint patients of the availability of soothing sounds machines and meditation CD players for use during their hospital experience. Our team has embraced offering these products to patients after observing their relaxation benefits. Improving the Patient Experience