Life as they see it - members of AfPP write on issues that concern or ii,, , , ;cm

E R F F
helping you I

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.

n With my theatre practitioner hat on I

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 nurses, obviously for a fee, which made me
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).
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
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

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


a well respected theatre practitioner turned
hypnotherapist, who also taught this
subject at the BSMDH. Things were coming
together, I spoke to this person, who was
very infectious in her enthusiasm for
hypnosis and its uses, and she gave me
the dates for the training sessions at a
local hospital. All I needed now was the
funding for the training.
I approached my manager who was
sceptical at first, but passed me onto his
manager, who said 'No, it has nothing to do
with theatres'. Undeterred, I made phone
calls to medical company representatives
that offer education grants {this should be
muary 2008 / Volume 18 / Issue 1 / ISSN 1467-1026
The benefits, cos
our number one lesson: how to beg for
funding). Nothing seemed to happen very
quickly. I then contacted the Association for
Perioperative Practice (AfPP), The person I
spoke to was very helpful and I was
advised I could apply for funding through
the Education. Research Fellowship Fund
(ERFF), although there were no guarantees.
I got to work writing a supporting statement
and filling in the application which I
submitted via email the following day.
To my surprise, three weeks later I received
news that i had been given the funding
requested, enough to cover the costs of
each of the three training modules being
offered.
My first course began in October 2006 and
I, along with approximately 40 other like-
minded individuals were in for a weekend
of training, practical demonstrations and
theory - so much of it, my head was
bursting at the close. My scepticism had
dissolved into wonder, I had so many
questions about what we were witnessing
during the demonstrations, in which we all
took part. We practised on each other and
the results for most were amazing. There
really was something in this after all.
Hypnosis works by tapping into the
unconscious mind: that part of our mind
which works in the background, and over
which we rarely exercise control. By
bypassing the conscious mind or critical
faculty: that part of us which persuades us
that 'black is black', we can tap into a
thought process which allows us to accept
that 'black' might in fact be 'white', or that
pain is not felt as pain but as a
pleasurable experience or at least one we
are indifferent about, so we do not react in
the normal manner
During the following weeks I continued
practicing as advised, and managed to get
a few colleagues interested enough to let
me try the basic methods out on them,
with great results, I was well and truly
hooked. Modules two and three followed in
later months, reinforcing my interest and
desire to practice.
This was when the realisation came. I
spoke to the senior manager with a view to
using hypnosis as part of my daily work,
mostly for patients who were very stressed
out prior to surgery I had to put together a
proposal for its use within the department,
covering where, when, how and why It could
be used. The benefits, costs involved and
perceived risks all had to be addressed.
Following a lot of networking for ideas on
how I should present this, I got help from
clinical colleagues across the hospital and
the research and development department.
This was eventually done together with a
mock-up of a patient information sheet and
submitted to the manager with certificates
of training. Unfortunately this was
submitted at a time of great change in the
divisional structure within our hospital. It r'
15
 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. 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.
It was a very frustrating time knowing that
this therapy could be good for the patients,
helping them to relax preoperatively and
cope with needle phobias. As it was a time
saving, cost effective and non-invasive
procedure, so many benefits could be lost
if the proposal were rejected. I had to
become quite persuasive in dealing with
the new people involved in pushing it
forward, I am sure I became regarded as
something of a nuisance but had to ensure
it was not forgotten. Unfortunately the
wheels of change move very slowly.
Eventually, sonne three months later, the
new senior manager included it in the
agenda for the divisional matrons'
meeting, at which it was agreed to support
the proposal, but it was also suggested
that it should be put forward to another
meeting with the clinical director to get his
views.
The clinical director was eventually pinned
down and persuaded to read my proposal.
After reading the title he uttered the word
'hypnosis' rather incredulously but he was
encouraged to continue reading. After this,
he confessed he had no objections to it in
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 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. He
considered it could be a good adjunct to
anaesthesia.
It is intended that evaluation of this service
would be included as part of the routinely
undertaken patient satisfaction survey
performed twice yearly.
Future
Initially, only those patients who are
considered to be really in need of help will
be offered the opportunity of hypnosis. The
logistics of incorporating the time involved
into an already over-worked schedule still
have to be addressed, but the world of
nursing is in a changing and challenging
time. We as practitioners have to fight our
corner to succeed in the introduction of
new ideas into our daily working practice, in
the hope that we, and our patients will see
the benefits of our endeavours - only time
will teli.
Patients look to practitioners for guidance
and support when they are at their most
vulnerable. This places practitioners in an
idea! situation to help patients in the
perioperative setting as the patient already
and are therefore in an 'altered state",
making them already receptive to our
suggestions. 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. •
Further reading
Kettertiagen D. Vandevusse L, Bemer M 2002 Self-
hypnosis: alternative anesthesia for childbirth
American Journal of Matemal/Child Nursing 27
(6) 335-341
NJckelson C, Brende JO, 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
Websites
www.channel4.com/more4/event AH/hypnosui^ry/
hypnosurgeryyve.html
British Society of Clinical and Academic Hypnosis
www.bscah.com
About the author
Patricia A Fern
RN, ODP
Theatre Staff Nurse. Day Surgery Unit.
Royal Wolverhampton NHS Trust

principle and left to think it through. trusts that we know how to best help them.

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. For BSCAH course enquiries contact either
Mary Hyland Mrs Helen Sutton
29 Melstock Road Postgraduate Administrator
Kings Heath Faculty of Health
Birmingham Blackheath Lane
B14 7ND Staffond
ST18 0AD
0121 624 2306
EmaiL bscahmidlands@yahoo.com 01785 353756
Email; h.sutton@staflsac.uk

16 Januat^ 2008 / Volume 18 / Issue 1 / ISSN 1467-1026