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Hypnosis to alleviate perioperative anxiety and stress:
a journey to challenge ideas
by Patricia A Fern

Mention the possibility of surgery to a patient and most wili react with a feeiing of apprehension at best. Some wiil be horrified at the mere thought of being 'cut open'. For others, it will be the suggestion of entering a hospital for anything longer than an out patient appointment. Newspaper reports of healthcare-acquired infections (HAIs) may spring to mind: 'lV/7/ / leave with more than I came in for?'; 'What if it goes wrong?'; 'Who will look after the family?'. All this worrying leads to increased anxiety and stress, and the patient has not even been put on the waiting list yet, let alone been admitted.
With my theatre practitioner hat on I became intrigued by this title. I assume most practitioners/doctors would view this with at least a modicum of interest, and even more scepticism - and they don't come any more sceptical than me. I proceeded to watch this live presentation, which followed a male patient throughout the pre-, intra- and postoperative phases of the repair of his umbilical hernia using nothing other than hypnosis as the "anaesthef/c'. This sparked my imagination, and I decided to look into this in more depth. Scepticism had been replaced by questions about whether this could benefit our patients, and a range of uses sprang to mind. My mind was full of possibilities and I needed answers. When I asked colleagues the next day, no one else had seen it. None of the anaesthetists had any real knowledge of hypnosis, other than they had heard of it. Searching the World Wide Web. I came across a link to the The British Society of Clinical and Academic Hypnosis (BSCAH), which offered courses in hypnotherapy to the medical profession, dentists and nurses, obviously for a fee, which made me sceptical. A friend of mine knew of someone who had shown an interest in the subject, and I was able to make contact with her. It turned out that this person was

n As healthcare professionals we come into contact with patients in this situation on a daiiy hasis. The reduction of preoperative anxiety and stress in surgical patients is a routine part of quality patient-centred nursing care. The techniques usually employed to heip in this area range from having the person accompanying the patient (this could be a practitioner, student. HCA. ODP and so on) hold the patient's hand or talk to the patient in an attempt to take their mind off the situation. While these methods can be beneficial for some of our patients, there are others who get so stressed that they are unable to be helped by these simple distractions. These patients will jump every time they see someone look at them, they cannot sit or lie still for the fear of someone creeping up on them. Some patients tell us they hate needles. Some, if they are having a general anaesthetic, are frightened they will not wake up. Other people may have told the patient who is having a local anaesthetic for the first time that it did not work for them and how awful it was. They ask for reassurance that they won't fee! anything. Working as a theatre practitioner within a busy day surgery unit, I meet patients with such thoughts and questions on a daily basis. An alternative to hoping the patient will just let us get it done, or the use of preoperative sedation to alleviate patient anxiety, might be the use of hypnosis. Ctinical hypnosis has been used across the world for many years and has been employed for the use of relieving anxiety, acute and chronic pain relief including childbirth pain, postoperative pain and for patients with cancer pain/nausea, and to help patients with a variety of phobias. It has been successfully used in other countries in place of a general anaesthetic for a number of major surgeries, and as an adjunct to local and general anaesthetic surgery. I'm sure most of us have seen staged hypnosis sessions on TV, which send members of the audience running around squawking like chickens for a laugh. However, used in a hospital environment, it can have real and positive benefits for patients.

I My first serious encounter with the concept of hypnosis was on a television programme entitled Hypnosurgery (www.channel4.com/ more4/event/H/hypnosurgery/index.html).

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January 2008 / Volume 18 / Issue 1 / ISSN 1467-1026

I spoke to the senior manager with a view to using hypnosis as part of my daily work. and over which we rarely exercise control. Things were coming together. a well respected theatre practitioner turned hypnotherapist. my head was bursting at the close. The person I spoke to was very helpful and I was advised I could apply for funding through the Education. costs involved and perceived risks all had to be addressed. three weeks later I received news that i had been given the funding requested. so we do not react in the normal manner During the following weeks I continued practicing as advised. My first course began in October 2006 and I. along with approximately 40 other likeThis was when the realisation came.so much of it. who was very infectious in her enthusiasm for hypnosis and its uses. we can tap into a thought process which allows us to accept that 'black' might in fact be 'white'. Following a lot of networking for ideas on how I should present this. It r' I approached my manager who was sceptical at first. cos minded individuals were in for a weekend of training. I had so many questions about what we were witnessing during the demonstrations. it has nothing to do with theatres'. I was well and truly hooked. and managed to get a few colleagues interested enough to let me try the basic methods out on them. There really was something in this after all. I spoke to this person. To my surprise. who also taught this subject at the BSMDH. reinforcing my interest and desire to practice. mostly for patients who were very stressed out prior to surgery I had to put together a proposal for its use within the department. our number one lesson: how to beg for funding). when. who said 'No. We practised on each other and the results for most were amazing. I got help from clinical colleagues across the hospital and the research and development department. practical demonstrations and theory . Hypnosis works by tapping into the unconscious mind: that part of our mind which works in the background. The benefits. Modules two and three followed in later months. Unfortunately this was submitted at a time of great change in the divisional structure within our hospital. This was eventually done together with a mock-up of a patient information sheet and submitted to the manager with certificates of training. but passed me onto his manager. My scepticism had dissolved into wonder. with great results. enough to cover the costs of each of the three training modules being offered. covering where. I got to work writing a supporting statement and filling in the application which I submitted via email the following day. Nothing seemed to happen very quickly. in which we all took part. or that pain is not felt as pain but as a pleasurable experience or at least one we are indifferent about. Undeterred. All I needed now was the funding for the training. I then contacted the Association for Perioperative Practice (AfPP). By bypassing the conscious mind or critical faculty: that part of us which persuades us that 'black is black'. Research Fellowship Fund (ERFF). I made phone calls to medical company representatives that offer education grants {this should be muary 2008 / Volume 18 / Issue 1 / ISSN 1467-1026 15 . and she gave me the dates for the training sessions at a local hospital.The benefits. how and why It could be used. although there were no guarantees.

He surprised me by saying he had no problems with me utilising hypnosis as long as I worked in close contact with the anaesthetists and gained surgeon approval to work with their patients. Unfortunately the wheels of change move very slowly. I had to become quite persuasive in dealing with the new people involved in pushing it forward. He considered it could be a good adjunct to anaesthesia. Patients look to practitioners for guidance and support when they are at their most vulnerable.bscah.html British Society of Clinical and Academic Hypnosis www. at which it was agreed to support the proposal.sutton@staflsac. After reading the title he uttered the word 'hypnosis' rather incredulously but he was encouraged to continue reading. h. and our patients will see the benefits of our endeavours .com/more4/event AH/hypnosui^ry/ hypnosurgeryyve. Eventually. only those patients who are considered to be really in need of help will be offered the opportunity of hypnosis. sonne three months later. but it was also suggested that it should be put forward to another meeting with the clinical director to get his views. I am sure I became regarded as something of a nuisance but had to ensure it was not forgotten.uk 16 Januat^ 2008 / Volume 18 / Issue 1 / ISSN 1467-1026 .IN THEIR OPINION Hypnosis to alleviate perioperative anxiety and stress: a journey to challenge ideas Continued had been well received by the outgoing manger and passed onto the new manager. Then it was lost in the internal email system. Brende JO. ODP Theatre Staff Nurse. helping them to relax preoperatively and cope with needle phobias.com About the author Patricia A Fern RN. This places practitioners in an idea! situation to help patients in the perioperative setting as the patient already trusts that we know how to best help them. and are therefore in an 'altered state". We as practitioners have to fight our corner to succeed in the introduction of new ideas into our daily working practice. The clinical director was eventually pinned down and persuaded to read my proposal. cost effective and non-invasive procedure. It is intended that evaluation of this service would be included as part of the routinely undertaken patient satisfaction survey performed twice yearly. It was a very frustrating time knowing that this therapy could be good for the patients. so many benefits could be lost if the proposal were rejected. Simple hypnosis techniques can be learned and deployed easily and quickly. and hypnosis can be an effective tool for any practitioner who wishes to lessen anxiety and stress for patients within the perioperative setting. Websites www. but the world of nursing is in a changing and challenging time. The logistics of incorporating the time involved into an already over-worked schedule still have to be addressed. the new senior manager included it in the agenda for the divisional matrons' meeting.only time will teli. As it was a time saving. Vandevusse L. Bemer M 2002 Self- hypnosis: alternative anesthesia for childbirth American Journal of Matemal/Child Nursing 27 (6) 335-341 NJckelson C. in the hope that we. After this. • Further reading Kettertiagen D. Gonzalez J 1999 What if your patient prefers an alternative pain control method? Self-hypnosis in tiie control of pain Southern Medical Journal 92 (5) 521-523 Future Initially. For BSCAH course enquiries contact either Mary Hyland 29 Melstock Road Kings Heath Birmingham B14 7ND Mrs Helen Sutton Postgraduate Administrator Faculty of Health Blackheath Lane Staffond ST18 0AD 0121 624 2306 EmaiL bscahmidlands@yahoo. Royal Wolverhampton NHS Trust The British Society of Clinical and Academic Hypnosis (BSCAH) nationally run training courses in clinical hypnosis and stress management The Midlands Branch course is validated by Staffordshire University to Advanced Diploma level These courses are open to health professionals and taught by health professionals. Day Surgery Unit.channel4. making them already receptive to our suggestions.com 01785 353756 Email. The consequence of this was the timescale involved in getting it looked at by the right people who could accept or decline the proposal was getting longer and longer. Following a few more weeks of inactivity I bumped in to our clinical director and asked him how he thought I could proceed with this. he confessed he had no objections to it in principle and left to think it through.

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