Saturday, July 16, 2005

Alternative Treatments?

LAT, among others, reports on a study that investigated congregational prayer, and bedside therapies using music and touch, to see if they could detect an improvement in survival after surgery.  The study was published in The Lancet.  Unfortunately, the Lancet site is down for maintenance so I can't access it now.  I can, however, put on my perpetual sophomore hat, and offer a few uninformed comments.
Healing Power of Prayer Doubted in Patient Study
[permanent Furl archive link]

Researchers say people benefited from bedside therapies like music and touch before surgery, but congregations' blessings had no effect.

By Brad Wible, Times Staff Writer
July 16, 2005 

Prayers from distant congregations did not affect patients' recovery from coronary artery procedures, but bedside therapies using music and touch before surgery reduced stress and offered a slight advantage in survival, scientists reported Friday. [...]

Christian, Muslim, Jewish and Buddhist congregations were given patients' names and prayed for them for five to 30 days.

Survival rates did not differ among those who received prayer and those who did not, the study found.

Krucoff said the study was "not a disproof of prayer," noting that most of the patients — whether or not they received prayers from the congregations — had friends and relatives praying for them.

The bedside therapy given to patients included listening to music, imagining favorite places, practicing yoga-like breathing and being touched by practitioners of alternative medicine.

Researchers said the therapeutic benefit could have resulted from the presence of a caring individual who helped reduce patients' preoperative anxiety. Stress reduction could affect physiological processes and improve survival, Krucoff said.
Nurses have known for a long time that it helps to care about patients, and to express their concern with soothing touch and words.  Unfortunately, nursing staff levels have declined in most hospitals.  In some, it now is difficult for nurses to perform these traditional functions.  Not only are they pressed for time, but sometimes they are so stressed that it is hard for them to put themselves in a frame of mind that enables them to soothe others effectively.  

Some cultures have a tradition of always having someone stay with a person who has been hospitalized.  

To illustrate: my brother, when he was studying Linguistics, went to the Philippines to do a research project.  The doctor at the International Health office did not recommend a typhoid vaccine, apparently assuming that he planned to go to the usual tourist destinations.  He did not.  He went out to remote villages, armed only with a rudimentary knowledge of Tagalog, to gather his data.  

He developed typhoid, and ended up in a hospital.  I think he was there for a few weeks, although that was twenty-five years ago and I might not remember correctly.  Every single minute, there was a nonmedical person from the community there with him.  I have no idea what the mechanism in the community was to coordinate this, since he had no family or acquaintances in the area.  

He often told them that they did not need to stay, but they insisted.  I have no idea if it actually helped him recover faster, but perhaps it did.  As an aside, I would like to thank the people of the Philippines for offering this compassion to my brother.

This is the first official flag intended to represent the country. It was created by the Katipunan at Naic, Cavite in 1897.
This is the first official flag intended to represent the country. It was created by the Katipunan at Naic, Cavite in 1897. This is a depiction of the original flag of the Philippines as it was conceived by Gen. Emilio Aguinaldo. The blue was of a lighter shade than the currently mandated royal blue, the sun had many more rays although it still had eight points, and it has a mythical face.

Some US churches and hospitals have  a volunteer program known as NODA: No One Dies Alone.  They arrange for a constant vigil in the room of patients expected to die.  This, however, is not an intrinsic part of our culture, and it is not intended to enhance survival or speed recovery.

Is there anything practical to be learned from all of this?  Sure.  Hospitals should hire enough nurses.  Another thing that I think helps, is a bit of advice I give to everyone who has a family member in the hospital.  Some families do try to have someone there all the time.  Sometimes, the family starts to get burned out.  That is not helpful.  The various family members need to cooperate so that everyone takes a turn, but not feel so obligated to provide 24-hour companionship that everyone gets worn out.  Also, it helps to personalize the patient's room, to some extent.  Put up get-well cards, mementos of community activities, and photos of family members.  Bring flowers every few days.  Bring a CD player with the patient's favorite music.

I am not a nurse, and perhaps it is presumptuous of me to day this, but I think that that those personal touches in the room make it easier for overworked nurses (and doctors) to remember that the patient is not only a human being, but a part of someone's family and community.  This might make it easier for them to provide the compassion that the patient needs, and help them provide compassion in a way that is more specific to the patient's needs, and therefore more effective.

By the way, I do not think that compassion is "alternative therapy."  It is just part of being human.

Categories: science, medicine, being nice
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As someone learning an "alternative" therapy, I'll comment.

One of the things we learn how to do is "bless" a patient. Basically, that means forming good wishes towards the patient and connecting with them on a non-verbal level.

Until you've tried it, you won't believe it, but when you do this, both you and the patient form some sort of bond, and you both feel better.

Weird but true.
I am a nurse. Yes, having adequate numbers of nurses helps improve patient survival. Part of that is the additional emotional support and teaching which can be done. Most of it, IMHO, is the additional vigilance which is possible. There have been some interesting studies done which demonstrate that adequate staffing has a very significant impact on patient outcomes. I'm glad I work in a (usually) adequately staffed unit of a hospital with a policy of striving for adequate staffing on all units.
my father received aorta and aortic valve replacement at standford medical center in '99. the surgeon, dr. miller, during the discharge process told us that, in his opinion, my father's recovery was in large measure due to our constant family presence and support. my dad was never without companionship, and although the quality of care at standord was superb, we still provided 'additional vigilance' to ensure i.v.'s didn't go dry for long and that every other basic need was always addressed.

my mom was(is?) and r.n. and she got out of nursing because of the staffing problems. she came home one night after a shift on an orthopedic ward where she was responsible for 30 patients. she knew she couldn't care for these people properly and that she was at risk for making a mistake that would haunt her for the rest of her life. that was her last night as a practicing r.n.
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