Use of Healing Touch as a Nursing Intervention for Pain in Bilateral Total Knee Arthroplasty

Sunday, November 1, 2009

Mary E. Hardwick, MSN, RN
Shiley Center for Orthopaedic Research & Education, Scripps Clinic, La Jolla, CA
Pamela A. Pulido, RN, BSN
Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Clinic, La Jolla, CA

Learning Objective 1: The learner will be able to describe how a nurse initiated complimentary therapy can help manage postoperative pain and anxiety in bilateral TKA patients.

Learning Objective 2: The learner will be able to identify the initial steps to implementing a nurse initiated orthopaedic nursing research study.

Healing touch, a nurse-initiated modality with potential to improve postoperative pain control and restore balance to a patient’s energy field so self-healing can take place. The study purpose was to evaluate the effectiveness of healing touch in relieving pain and anxiety after bilateral total knee arthroplasty (TKA).

Forty-one patients were prospectively randomized to a Healing Touch (HT) group (n=20) or a no Healing Touch (NHT) group (n=21).  For the HT group, HT was administered by a certified HT nurse once daily between two daily physical therapy (PT) sessions.  Pain was assessed using a visual analog scale (VAS) before surgery, before and after HT daily (HT group), or between PT sessions daily (NHT group).  Anxiety was measured daily using State Trait Anxiety Inventory (STAI).  Narcotics received were measured by transposing them into dose equivalents (10 mg morphine intravenous = 1 DE).  Satisfaction was assessed with an institution-designed questionnaire at 1 month postoperative visit.

Groups had similar demographics with 65% females in HT group and 57% in NHT group. Majority in both groups receiving general anesthesia with intrathecal morphine injection. In the HT group pain VAS within 1 hour after HT treatment was significantly diminished compared with pre-HT VAS (p<0.05) except on the first postoperative day.  Though VAS was lower in the HT group than the NHT group, significance (p=0.046) was reached only on first postoperative day.  Anxiety and total narcotic DE was lower in HT group, but did not reach significance.  In HT group, 58% compared with 79% in the NHT group reported overall pain as moderate/severe during hospital stay. One month after surgery, 100% of HT group compared with 82% of NHT group felt their pain was adequately controlled during their hospital stay.

HT provides another tool that nurses can use to decrease pain in postoperative bilateral TKA patients.