We've all felt worried, stressed or tense at some time in our lives, wishing we could just get away from it all. Well, whether you've simply had a hard day at work or you're a patient preparing for surgery, guided imagery may be your ticket to relaxation.

Terry Reed, HNC, RN, and Susan Ezra, HNC, RN, certified holistic nurses and guided imagery practitioners at the Institute for Health and Healing at Mills-Peninsula Health Services, San Mateo, CA, believe the implementation of guided imagery is long overdue in health care facilities. According to these nurses, imagery is becoming a popular complementary service in institutions across the country. In fact, Ezra explained, it is one therapy that is most accepted in the healthcare industry because it is cost effective, empowering to the patient, doesn't require needles or equipment and is very powerful.

What Is It?

Guided imagery is using the power of the imagination as a therapeutic process to help people learn how to relax and tune into themselves by accessing positive images, thoughts and inner resources, described Ezra. At Mills-Peninsula, guided imagery is used for healthcare, pain management and surgery preparation.

Both Reed and Ezra have a passion for holistic nursing as well as experience in the field. In fact, in the early 1990s Reed was an employee at Mills-Peninsula but decided to leave to develop a training company in imagery for nurses and health professionals with Ezra as her partner.

"I took a workshop 25 years ago called the Turning Point, which was a 3-day holistic program for nurses. It spoke to me and I decided I would like to teach it," Reed said of her first experience with this type of nursing.

A little more than a year ago, Reed was asked to return to Mills-Peninsula to begin imagery services and programs.

Similarly, Ezra has been doing some form of holistic nursing for approximately 15-20 years and also has experience in hospice nursing.

"What brought me into it was the desire to help individuals access their healing rather than have me do it," Ezra explained. "[We do this work to help] people empower themselves and tap into the healing capacity that the mind and body naturally has."

Guided Imagery at Mills-Peninsula

With guided imagery becoming integrated in mainstream medicine, Reed explained that most hospitals offer scripted audio tapes that can be used for stress, anxiety, surgery preparation and also for oncology patients undergoing cancer treatments.

What is different about the Mills-Peninsula program is that Reed and Ezra create tapes especially for the patients during one-on-one sessions. For example, if patients are using guided imagery for surgery preparation, either of the two practitioners will request to see them several days before their surgery for a session, which will be recorded for the patient's use.

This form of guided imagery begins with progressive muscle relaxation. Patients are instructed to sit or lie down, free from distractions and noise, and should not plan to be interrupted for at least 30 minutes. They are asked to close their eyes and begin to notice the rate and rhythm of their breathing patterns. The progressive relaxation starts at the head (or feet if the patient prefers).

If starting at the head, patients are asked to release any tension as they concentrate on moving down over the face. They should allow their shoulders to drop and the relaxation should progress down the body by consciously noticing tension and releasing it in all parts of the body. A soft voice guides the patient through these motions. Soothing music may or may not be present in the background.

The patients are then asked to go to a special place that is very peaceful, beautiful and safe that they have been before or have always wanted to visit. In this place, there are no worries and nothing needs to be done. They are asked to describe the place they have imagined. The guided imagery practitioner asks specific questions to make it more real for the patients so they use all their senses through imagination. Some of the questions include: What is the temperature like? What do you see? and Do you notice any smells?

"Imagery moves you from negative worry to the place where you want to be and you get into that state," Reed noted. "It changes the chemicals [in the body] because you go from a stressed to a peaceful state."

Imagery for Surgery Patients

Research has documented that imagery is a legitimate and effective therapy for surgery patients, Reed said. It has helped with the healing process and has lowered patients' use of pain medication following the procedures. In fact, Reed and Ezra have completed their own surgery pilot program with guided imagery.

They took 30 patients who were interested in using imagery services before and after surgery, and 32 patients who were not interested. Those not interested served as a control group, going through the surgery process normally. Patients having knee and hip surgery were chosen because this was the largest surgery population in the hospital. The program ran from Sept. 30, 2003 to Jan. 30, 2004.

Pre- and post-surgery pain and medication use was measured and reported by the patients. The results were in favor of guided imagery.

"For pain and narcotic use, we received positive results for the imagery group," Ezra reported.

Patients were not encouraged to use imagery practices in place of medication, but in conjunction with it. This project was completed to determine if relaxation and imagery could help relieve pain with the potential of using fewer narcotics.

"When you engage people in their own healing abilities as well as utilizing the medical system, you are using both internal and external resources for the individual," Ezra commented. "It helps people have a deeper sense of self control because when patients are going through surgery or illness, there is a great propensity for feeling out of control."

A Tool for Life

Guided imagery is more than simply receiving a tape with soothing sentiments. With this process, patients learn a practice they can use in many situations.

"The fact that we are there helping them focus, being in their presence and guiding them [is extremely important]," Reed noted. "It isn't just the tape. They learn a process. It isn't just a one time thing for surgery; it is a life skill they now have - the tools to deal with anxiety and stress."

Imagery Is for Everyone

So far, Reed and Ezra have seen approximately 100 patients. Sharing a full-time position, they are available 5 days a week. They can be seen on the floors visiting patients interested in using guided imagery. At the moment, these services are part of the standard of care for patients, but are also offered to staff members. Reed and Ezra conduct presentations to the community to educate the public about the program, which has a three-pronged approach - education to staff, patients and community.

"We try to cover all [our bases] because it is not just patients, but the staff as well who need to be relaxed and deal with stress [to handle the daily challenges of their occupations]," Reed explained.

Patients who have completed the sessions and received a tape are proponents of the program. Some of the patients have responded by saying the therapy helped them "get away," "breathe properly" and "relax." One patient's relative suggested the hospital have a "drive-thru window" for patients to pick up a tape because of the positive impact it has on the listener.

Both Reed and Ezra feel guided imagery is beneficial for patients because it helps the mind and body's ability to heal itself while also tapping into deeper levels of spirituality.

"The difference in this work is that it is not a 'fix-it model' like medicine, but more of a 'turn-it-over' model," Reed explained. "We plant the seeds and the patients can go on to tend their own blossoms."

Stephanie De Ritis is an ADVANCE contributing editor. <% footer %>