When patients experience pain, anxiety, or other concerns, nurses have a new drug-free tool that helps patients while making the nurses more productive. The nurses puts a special compact disc (CD) in the patient's personal CD player provided by the facility, gently places the earphones over the patient's ears, and turns it on. After listening to a CD from The Tranquilities Hospital Series-a unique blend of Guided Imagery, scriptural reassurance, environmental sounds, and traditional hymns-patients are often less anxious, less worrisome, and much more comfortable.

Guided Imagery is a self-help technique many people find effective in reducing mental and physical stress. By following suggestions on the CD, patients will create their own mental images to help them relax and learn to manage mental and emotional stress or specific physical symptoms. For example, a wall symbolizes fear. On the CD, a soothing voice guides the individual to picture images of the wall being knocked down by ocean waves, symbolizing the individual's ability to free himself/herself of fears and anxieties. Environmental sounds, sophisticatedly recorded with binaural microphones, dramatically involve the listener in the visual imagery. This imagery is quite effective in helping patients deal with the many fears often experienced in a hospital setting.

Nurses can use these nightly. Patients may be apprehensive as to whether the CDs will be beneficial though the apprehension typically fades. "I can see the anxiety disappear and the calm set in right before my very eyes," said Kathleen Shirk, RN, night supervisor at Ephrata Community Hospital.

The Tranquilities series has been effective in a wide variety of settings, including:

* relief of pain or anxiety before surgery,

* helping patients relax and sleep during evening hours,

* easing pain after surgery, and

* lowering blood pressure and helping patients adjust to breathing/respiratory devices.

Shirk said the effect of the CDs is most dramatic in helping ease the anxiety of "sundowners" and other aging-related conditions.

The elderly respond very well to the CDs. Some older patients become very confused, particularly after surgery. It is beyond their control and is an after effect of the anesthesia. "Playing the CDs works better than sedation in easing their confusion," said one nurse for 28 years. "The CDs are more effective than a lot of medications." When Alzheimer's patients become confused, haldol was the medication of choice. Now nurses place a CD and hold the patient's hand. This can be a better resort than medication.

One nursing assistant said the CDs made her job less stressful. She said it was particularly helpful with one patient who frequently pressed the patient call button. This assistant suggested the woman listen to a Tranquilities CD. "In 15 minutes, she had rang six times. She was told that we could not come in each time because she may be taking us away from others. The CDs worked." The patient did not ring the call button for 90 minutes.

A chaplain at the hospital helped develop the Guided Imagery series. It was inspired, in part, by her own encounter with breast cancer. She believed the development of a Guided Imagery series would help patients access their faith resources and be an effective healing tool. The chaplain recognized the importance of integrating faith and spirituality into the healing process and sought to facilitate this through the use of the CDs.

Clergy from various denominations reviewed the materials and enthusiastically endorsed the project. Each CD has three tracks; each track is approximately 20 minutes in length. The first track includes scripture and an invitation of God's presence. Track two omits these references. Track three includes only the music and environmental sounds for relaxation. The CDs do more than just help patients to relax. They empower them to invite a reassuring and comforting presence into their own personal struggle. The principles this series utilizes, such as timeless Scripture readings and traditional hymns, are very powerful. The hymns are tunes that resonate with many people-ones that virtually everyone, regardless of faith, will recognize.

Each bedside contains a packet of CDs and a CD player with earphones. Each of the CDs focuses on a major component of a successful hospital stay. These include:

* Health & Healing, which enables patients to picture and imagine themselves well, actually "jumpstarting" the healing process;

* Comfort, which focuses on easing pain through soft gentle music and the sounds of the rain;

* Peaceful Rest, which helps patients overcome the hospital setting and to find rest;

* Courage, which empowers patients to address fears often associated with illness,

* injury, or surgery; and

* Serenity, which helps patients overcome their worries.

All of the staff nurses, therapists, social workers, managers, and housekeeping personnel are trained in the use of the CDs. When a patient is restless or concerned, staff or physicians often suggest that the patient listen to the CDs. Typically, the patient is more calm and relaxed (and often asleep) after listening to one of the Tranquilities CDs in the privacy of his/her own hospital bed. The staff and the hospital are beneficiaries as well. Because many studies have shown that relaxed patients heal faster, the hospital may generate financial savings. The staff are able to direct more of their attention where it is needed because anxious or stressed patients turn to the CDs for help instead of calling on them. The nurses feel more productive because they view the CDs as an extension of their care.

The hospital is supportive because the CDs are more cost-effective than any drug and reflect very positively on the hospital's image. For example, a recent group of surveyors were extremely impressed with the program because it reflected positively on the hospital's commitment to quality care and demonstrated an added dimension of that care.

More information about the Tranquilities Series for Hospital Patients is available online at http://www.tranquilities.com, via e-mail at [email protected], or by contacting the author at (717) 721-6998.

Key word: Imagery