Nursing and Hypnosis – A Perfect Combination

by Ron Eslinger, RN, CRNA, MA, APN, BCH

In her book, Notes on Nursing, published in 1859, Florence Nightingale said, "Volumes are now written and spoken upon the effect of the mind upon the body." She discussed in detail how nurses should help patients vary their thoughts. Florence Nightingale was more in tune with complementary therapy in 1859 than most nurses and physicians are today. She spoke at length in her book on the benefits of music, color, aroma, physical activity, fresh air, and exercise. She understood the power of words and how using hypnosis to help patients change their thoughts helped them heal.

Another nurse, Alice Magaw, a pioneer in nurse anesthesia wrote an article in 1906 titled, A Review of Over Fourteen Thousand Surgical Anesthesias. The anesthesia death rate was one in one hundred anesthetics at the time. In the article she states, "In 14,380 anesthetics given by me, I have yet to see a death directly from the anesthetic." Magaw wrote that, "Suggestion is a great aid in producing a comfortable narcosis and the subconscious or secondary self is particularly susceptible to suggestive influence." When patients were told what to expect and how to respond, the amount of stress was decreased to such an extent that she was able to use only 10% of the normal anesthetic dose. Many anesthesiologists and thousands of nurse anesthetists use hypnosis as a part of their anesthesia. Blue Shield of California reported in a research study that patients listening to guided imagery and hypnosis CDs prior to surgery saved Blue Shield an average of $2000 for each surgical patient. Makes you wonder why hospitals don't offer this service to their patients, doesn't it?

Hypnosis is an altered state of consciousness. Patients entering hospitals, clinics or physician's offices for procedures are in an altered state, which makes them more susceptible to suggestions by health care workers. No health care worker spends more time with the patient than the nurse; therefore, it makes sense that hypnosis and nursing are a perfect combination.

Nurses trained in hypnosis greatly enhance patient satisfaction and outcomes because they understand how to use positive and therapeutic language. Unfortunately, for every nurse trained in hypnotic techniques there are thousands who aren't. The nurse can say, "this won't hurt." The patient is only hearing the last word - hurt. Another nurse trained in hypnotic language may say, "Take an abdominal breath and think about your happy place. You will probably be surprised at how much more comfortable this will be than you thought."

You probably know someone who was told they had three months to live, or someone with pain being told they would have to endure it. Perhaps you've heard of a patient getting an MRI, being told it is dark, loud and scary in there, or when getting an injection being told to hold still, this is going to hurt. There are thousands of small comments that can greatly affect a patient's response. That response will be either positive or negative. It is the nurse's responsibility to know the difference between negative toxic language and therapeutic positive language.

An elderly lady, during her first cataract operation, was told to hold completely still or her eye could be damaged. She refused to have the second cataract replaced, because she was afraid she would move and the eye would be destroyed. To counteract this, she was given a self-hypnosis CD and the nurse was instructed to tell her that she would hold her hand and it was OK to move if she let the nurse know ahead of time by a squeeze of the hand. Her second surgery went without incident.

Of all professions, nursing is the most trusted. This is because nursing care is based on rapport with the patient. For the nurse, rapport is gaining trust and confidence. For hypnotists, rapport is a light stage of hypnosis in which the client or patient accepts suggestions. Research shows that when rapport (hypnosis) between the patient and the health care provider is optimal, the healing process is enhanced. According to The New Medicine, which aired March 2006 on PBS, the Public Broadcasting System, many medical schools are making a course in bedside manner (rapport) mandatory. In the same manner that Alice Magaw used the extraordinary benefits of hypnotic techniques with her anesthesia, all nurses can achieve the same benefits by understanding how they already use hypnosis as a nursing tool.

Unfortunately, as many nurses and nurse anesthetists talk to their patients, they are not aware of how their words impact the patient in their hypnotic rapport state. Words can be toxic or therapeutic, therefore to use hypnosis, suggestion and rapport effectively, it is important for the nurse to understand that a simple question can have either a positive or negative effect on the patient. For example: "How bad is your pain?" is suggesting there is pain and that it is bad. JCAHO 2000 standard states all patients are to be asked their pain scale. At Beaufort Naval Hospital, instead of asking, "What is your pain level?" health care workers ask, "What is your comfort level?" A different perception gives a different physical response which in turn has shown to actually lessen the patient's pain.

• Hundred's of nurses use hypnosis to work with patients in:
o Pediatrics – children are the easiest to hypnotize
o Surgery for faster recovery with less N/V and pain
o Diabetes to enhance compliance
o Dermatology to lessen skin reactions
o Gastroenterology to decrease IBS by 90%
o Burn units to decrease pain and to increase the immune system
o HIV and AIDS counseling
o Wellness such as smoking cessation, stress, and weight management
o Insomnia to enhance sleep
o Childbirth (Below)
o Pain (Below)
o Cancer survival "I can-cer-vive" groups (below)

• Work with patients in oncology using hypnosis to:
o Create time distortion making chemotherapy seem much faster
o Help patients have less N/V and hair loss when using chemotherapy
o Make IV insertion easier and more comfortable.
o Help maintain the function of the immune system, decreasing possible opportunistic infections.

HYPNOSIS FOR CHILDBIRTH
Nurses can use hypnosis easily with other natural childbirth techniques such as Lamaze, Bradly, and Grantly Dick-Reed. It is a great adjunct to chemotherapy and regional anesthesia during C-sections. The author has used hypnosis as a stand-alone or an adjunct in hundreds of childbirths. Its value lies in the fact that it is noninvasive and can be used as an adjunct to epidurals and either do away with or greatly reduce the use of chemoanesthesia.

Research shows that hypnosis reduces pre-labor anxiety and can result in a pain free birth. Hypnosis both reduces the amount of first trimester nausea and vomiting and is also a proven treatment for hyperemesis gravidarum. It can prevent premature labor by prolonging pregnancy by 18% and decrease hospitalization for pregnancy-induced hypertension by 50%. There has never been a reported incidence of post-partum blues when hypnosis was used for childbirth. In 2001, Navel Medical Center in Portsmouth, Virginia saw the value of hypnosis and had all their Obstetric and Post Partum nurses trained in hypnosis.

PAIN MANAGEMENT
The 2000 Joint Commission for Accreditation of Health Care Organizations (JCAHO) listed pain management as the 5th Vital Sign and that specific emphasis should be placed on the non-pharmacological management of pain. The National Institutes of Health's research supports using hypnosis and relaxation therapy in the treatment of pain as well as sleep disorders.

THERE IS NO PAIN UNTIL IT REACHES THE BRAIN
"I don't know how this works, but it does" Bill said, twelve weeks after his first visit to Healthy Visions Hypnosis Wellness Center, where hypnosis was used to teach him how to control his Phantom Limb Pain. Bill had a 15-year history of taking pain medicine two to three times a week with occasional visits to the emergency room for intravenous pain medication. Bill is now pain free. Why and how does this work? No one really knows. However, when we do something that creates pain, such as a burn or a cut, the pain is sent by an electrical signal to the brain. There is no pain until that electrical signal gets to the brain. Stop the signal and you stop the pain. A local anesthetic or spinal anesthetic is an example of stopping the pain signal chemically. The body has the ability to create its own anesthetic by releasing endorphins, the body's natural morphine. Amputees have pain memories that loop from site to brain. The subconscious mind cannot tell the difference from a memory of pain and a real pain. However, in hypnosis the memory can be changed, which changes the brains response. The signal can also be turned down or off by the subconscious mind with hypnosis.

HYPNOSIS IS AN EXTENSION OF NURSING
Most hypnotists enjoy empowering others by teaching them to examine how their feelings and thoughts affect their lives. Nurses and Nurse Anesthetists are in a perfect position to use words to change thoughts. They can say to patients, as they enter general anesthesia, "You will wake up feeling better than you thought you would - feeling pleasantly hungry." And when the patient is emerging from anesthesia, they can say, "You should be comfortable; if not let us know." It makes such a difference that Post Anesthesia Care Unit (PACU) nurses can tell you which anesthesia providers use hypnotic language and which ones do not.

When patients are rolled into PACU or returned to their hospital room, they are asked, "On a scale of 0-10, how bad is your pain, or are you nauseated?" It would have been just as easy and better for the nurse to ask, "On a scale of 0-10; 0 being very comfortable and 10 the most uncomfortable you have ever been; what number are you?" If nurses ask if there is pain, the patient's interpretation is that there should be pain and they will comply with the nurse's or suggestion.

The nurse could also say, "It has been a long time since you have eaten. I bet you are hungry." A person cannot be nauseated and hungry at the same time. The brain can only handle one thought at a time. Therefore, the nurse by channeling the patient's thoughts, also channels the patient's responses. Positive channeling of thoughts gives a good response and negative channeling gives a bad response. Keep in mind that the medicines used in anesthesia and conscious sedation are classified as hypnotics, which means suggestions, made while anesthesia drugs are onboard, are post hypnotic suggestions and can make a world of difference in the patients recovery.

Patients in an altered state of consciousness respond to words as hypnotic suggestions. An example is a 34-year old lady referred for hypnosis with a two-year history of painful chronic cystitis, post-abdominal hysterectomy. She woke up in the PACU two years earlier, screaming in pain. The treatment plan was to admit her for three days of drug detoxification followed with hypnosis. The first session would be followed in three days by the second while she was still in the hospital. She would then be discharged from the hospital with follow up sessions at one week intervals as needed. She emerged from her first session asking, "Why didn't they send me to you two years ago? My pain is gone!"

One session and the pain was gone. During a later hypnosis session, the patient was asked if she was willing to uncover the cause of the pain. She stated she was and during the session she learned that while her surgeon was dissecting the uterus from the bladder, she had heard someone say. "This will be one hurting bladder when she wakes up!" She had no conscious memory of those words but her subconscious heard and did what it was told to do and she hurt for two years. She had only four sessions of hypnosis and many years have passed and the pain has not returned.

CONCLUSION
Every thought we have affects some organ or gland in our body. Imagine you are eating a lemon and you experience the salivation and the tart tanginess in your parotid gland. In the same way negative thoughts (worry) can make us sick and positive thoughts can make us well. Florence Nightingale directed nurses to use words to help patients to change their thoughts. Words are still the most powerful tool a nurse has.

About the Author: Michael R. "Ron" Eslinger, Captain, U.S. Navy, Retired is a Board Certified Hypnotherapist, Advanced Practice Nurse, Certified Master Hypnotherapy Instructor and Certified Registered Nurse Anesthetist. Fellow the National Council of Hypnotherapy (United Kingdom). He is the Past President, Virginia Association of Nurse Anesthetists and President Elect the Tennessee Nurses Association District 2. He is the Founder/Director of Healthy Visions Wellness Center in Oak Ridge, TN USA. For more information regarding hypnosis as an adjunct therapy, call 865-220-0777 or www.eslinger.net.