The Effects of Healing Touch on Post Operative Pediatric Patients
Condition: Surgery; Stress; Pain; Children; Post-Traumatic Stress Disorder
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      The goal of this study is to assess the benefits of Healing Touch, an energy based therapy on
      post-operative discomfort and the rate of recovery in children. The aims of this study are to
      measure the effect of Healing Touch on post-operative: 1) anxiety, 2) emergence agitation/
      emergence delirium (EAD), 3) pain, 4) time to wake-up, 5) time to meet PACU's departure
      criteria, 6.) maladaptive behaviors 2 weeks following surgery & 7)readmissions for
      complications 2 weeks following surgery.

      This is a triple blinded randomized controlled trial with three parallel groups. 240
      subjects, ages 3 or 4 will be randomly assigned to receive the usual post-operative care, the
      usual care plus a post-operative Healing Touch treatment, or the usual post-operative care
      plus a sham Healing Touch treatment done by an untrained research assistant. The participants
      & parents, the evaluators, and the principle investigator will be blinded to study group
      assignment.
    

Detailed description: 
      ABSTRACT:

      Tonsillectomies and adenoidectomies (T&A) are the most commonly performed pediatric surgeries
      (NIH, 2010). Surgery is understandably anxiety provoking for children and for their families.
      Research has shown that anxiety influences post-operative recovery (Kain, 2004, 2012; Lynch,
      1998; Schisler, 1998; Vaurio, 2006). Anxiety, emergence agitation and emergence delirium
      (EA/D) and pain during recovery from general anesthesia have been identified as frequent
      problems in the pediatric population, particularly with younger children (Key, 2010) and
      these have been related to increases in length of stay. Perioperative stress often has
      prolonged effects. After surgery, 88% of all children develop new-onset post-operative
      maladaptive behavioral changes. These changes refer to developmental regression and behaviors
      that interfere with daily functioning such as general anxiety, nighttime crying, enuresis,
      separation anxiety, night terrors, temper tantrums etc). Alarmingly, 54% of all children
      demonstrate maladaptive behaviors 2 weeks following surgery and 20% of these children
      continue to demonstrate negative behaviors 6 months postoperatively. Research has shown that
      younger children are at even higher risks (Kain, 2004; Watson, 2003).

      Healing Touch is a biofield therapy that has been shown to decrease pain and anxiety in
      adults (Im, 2009; Jain, 2010) and in premature infants (Hanley, 2008; Im, 2009, Whitley,
      2008). For several years Holistic Health Specialist Nurses trained in Healing Touch have been
      doing Healing Touch in Cincinnati Children's Hospital Medical Center's Post Anesthesia Care
      Unit (CCHMC's PACU). Nurses anecdotally have noted that patients who receive Healing Touch
      seem to wake up calmer, often need less pain medication and are less stressful after their
      surgeries. CCHMC nurses have reported that Healing Touch is especially useful with anxious
      children and younger children. Healing Touch (HT) is a complementary therapy that is a
      non-invasive, low-cost therapy without known side effects that can easily be incorporated
      into post-operative care routines.

      The desired study outcomes in the Healing Touch treatment group are:

        1. Lower anxiety levels, measured by differences in the Perioperative Adult Child
           Behavioral Interaction Scale(PACBIS) scores pre & postoperatively. This is a behavioral
           assessment of the child's coping and distress and the parents positive and negative
           behavior. Parent will also self evaluated their distress and anxiety. The Healing Touch
           group will have a lower sympathetic response as measured by preoperative and sequential
           post-operative B/P, Pulse, Respirations, & pulse oximetry

        2. Less emergence agitation and delirium measured by the Pediatric Anesthesia Emergence
           Delirium (PAED)scores, an observational scale which will be done sequentially once they
           enter the recovery room

        3. Less pain as measured by the Faces, Legs, Activity, Cry, and Consolability (FLACC) scale
           and significantly less pain medication usage

        4. Waking up more slowly once they enter the PACU

        5. Shorter length of stay in the PACU, measured by meeting PACU's discharge criteria.

        6. Significantly less regression and maladaptive behaviors measured by the Post-Hospital
           Behavior Questionnaire (PHBQ) 2 weeks following surgery.

        7. Fewer readmissions for complications 2 weeks following surgery as identified by family
           guardian in the 2 week follow up call.

      The significance of this study is that its outcomes will add to the body of knowledge about
      the practice of Healing Touch with children, and may provide evidence substantiating the
      benefits of Healing Touch on post-operative pediatric patients. This may lead to the
      incorporation of Healing Touch into pediatric nursing practice. Preschool children are at
      higher risk for extended stressful responses to surgery, i.e. regression and maladaptive
      behaviors (Vernon, 1966). Preschoolers have vivid imaginations and magical thinking. They may
      have trouble telling fantasy from reality. The often develop fears related to new places and
      experiences and separation from parents. There have been no identified effective supportive
      measures to improve this protracted stress outcome. Healing Touch may be a tool that can
      comfort and support this vulnerable population and may be helpful with other hospitalized
      children.
    

Intervention name(s): Healing Touch; Healing Touch Sham Treatment
Intervention type(s): Procedure; Procedure
Intervention description(s): When enter PACU + usual standard of care.
The Healing Touch practitioner will be at the bedside when the patient is first brought to the PACU. The HT practitioner will center and then attune with the child, connecting their energy with the child and setting the intention for healing for the child's highest good. The practitioner will then place one hand on the center of the patient's chest in the "high heart" area. The practitioner will hold this position until they feel a deep connection and "quieting" within the patient's energy. When the patient is awake and parents have been called to the bedside the HT practitioner will energetically ground and release the patient,; The untrained in energy work study staff will be at the bedside when the patient is first brought to the PACU. The practitioner will then place one hand on the center of the patient's chest in the "high heart" area. This will continue until parents are called to the bedside
Other intervention name(s): Energy Therapy; Reiki; Presence
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Healing Touch; Pediatrics; surgery; stress; pain; Pediatric Stress; maladaptive behaviors; energy medicine; emergence delirium; emergence agitation; length of stay; ease of wake up; distress parents; distress pediatric patients; Pediatric Post-Traumatic Stress Disorder