By Paul Gallese, PT, MBA
Vitalacy Blog recently interviewed Linda Bennett, Ph.D., director of the hypnotherapy/guided imagery program at the Southwest Institute of Healing Arts. Ms. Bennett is a practitioner of guided imagery, also known as hypnotherapy, a non-invasive relaxation technique that helps patients and caregivers reduce stress and anxiety through visualization and mindfulness. Recently implemented by Banner Health through a team of trained volunteers, this technique has been identified as an innovative approach to assist patients to manage pain and help nurses and other caregivers avoid fatigue and burnout.
Why have caregiver fatigue, burnout and anxiety become trending topics in healthcare?
Ms. Bennett: Because of the turnover they cause, burnout and anxiety are becoming problems that hospitals must confront. The cost of turnover is staggering. According to the Nursing Solutions Inc., National Health Care Retention and RN Staffing Report, the average cost to replace a bedside registered nurse is estimated at more than $50,000, and the turnover rate for bedside RNs is 17.2 percent per year. The average hospital loses $4.4 to 6.9 million each year due to turnover (NSI, 2019).
Mother Teresa made her nuns, every four or five years, take a full year off because of burnout. Sadly, when you're a first responder in the health care field, you're trained to be tough and not let this stuff get to you. But you can't just block it all out. That doesn't work. There's still a human being inside that body that's having to process that information.
What were the goals of the Banner Health program and what did you learn?
Ms. Bennett: The original goal was to look at how guided imagery could help hospitalized patients with their pain management, stress and nausea; we achieved terrific results. After six months and working with 221 patients, we reduced pain levels by 42 percent, stress levels by 52 percent, and nausea by 56 percent. Patients were asked if they felt the guided imagery impacted their view of Banner Estrella, the medical center where the program was conducted. Seventy-five percent said it enhanced their view. Patients were asked if guided imagery should be a part of treatment procedures and 100 percent said yes. The project expanded to seven different departments, including the Emergency Department and surgery unit.
Now what's happening is we've started another pilot project with Banner Health and this one is for the nurses. We’re meeting with nurses and offering them guided imagery or another healing therapy option called Reiki for about 15 minutes per session. This involves having each nurse listen to an audio presentation that helps them to visualize and relax. We measure their discomfort when we start the process and when we finish. I'm sitting here looking at a couple of the reports, which include scores ranking stress on a one-to-10 scale. Here's one person that was suffering from stress and she went from a seven to a two. I have another person here who is a nurse suffering from fatigue, and she went from a five to a two. As with the project with the patients, we started small and now we’re on every floor and every department practically, including the emergency room.
What are some of the challenges that you've experienced in working with the caregivers?
Ms. Bennett: In the process of starting this up with the caregivers, there was a lot of pushback from them. The pushback was, "I don't have time for something else." The thought that somebody was going to offer them something to help them, they saw it as another piece to their load. So they were in resistance and they didn't understand what we were doing. Fortunately, I was in a situation where I could hold small group meetings with the nurses to explain what it was we were doing and offer them a snippet of what we were doing with the patients. And the more we did that, the more open they became. They discovered that the patients we worked with that were challenges for the nursing staff, all of a sudden they weren't hitting the call button so often. So the nurses were getting a bit of a break.
Now the whole hospital's on board. Doctors and nurses, they started to see the turnaround and they've embraced it fully. But it did take us a while to get them on board.
How did you get buy-in to lead patients and caregivers through the guided imagery sessions?
Ms. Bennett: It came about because of Dan Dziadura, the director of rehabilitation services at Banner Estrella Medical Center. He is a former student of mine. He was looking at what he could learn about pain and ways that pain could be addressed. And so then he and I got talking and we said, "What if?" We put the proposal to Banner’s management team and fortunately the management team said, "Let's give it a shot." And that was in 2015, and we’re still going.
What’s your advice to health care organizations interested in using guided imagery to help the wellbeing of their caregivers?
Ms. Bennett: It doesn't hurt; it only helps. There are many examples of leaders who have said they are more productive after taking time to meditate or practice mindfulness (DeMers, 2018). That's not news. So why not bring those concepts into the caregiver arena where burnout is a problem?
A lot of it is education. People don't understand, and they buy into all the myths and misconceptions about what hypnosis or guided imagery is. They're so afraid that they're going to lose control. And we can never control anybody. It's impossible. There's a saying in the hypnosis world that all hypnosis is self-hypnosis, meaning that how deeply someone goes into a relaxed state is up to the individual, not the facilitator. If they choose to relax and go into it, then they'll have it. That's what will happen. If they choose not to, then they won't.
In ancient Egypt, this is what they did in their hospitals. So it's not new age. It's been around for a very long time.
Do you have a sense of guided imagery’s use within health care settings in the U.S.?
Ms. Bennett: There are certain hospitals that are a little bit more forward thinking that are embracing these concepts, and others that shy away from them. And I think that depends a lot on who is leading the organization. Peter Fine, who is the head of Banner Health, was dealing with cancer, which he discussed in a Modern Healthcare interview (Burda, 2011), and he used alternative therapies including hypnotherapy to help his healing. So it depends on, again, who's calling the shots in an organization and who's willing to sit down and understand that help can come in ways that aren't in a pill bottle.
A bill was signed in June in Florida that requires the Veterans Administration to start investigating and offering alternative health services for their members. That's what we need. People willing to see something other than the way it's always been.
I’m doing anything and everything I can to get the word out. I think the opportunities are endless and people are just missing this. The mental element is so critical in any of our processes, because it's what we think about, it's what we bring about. And so often, what people don't understand is they're using their imagination to imagine worst case scenarios and that's what they draw into themselves. What we're doing is just rerouting their imagination to support them in their healing process, whether it be the burnout or whether it be the pain a patient’s going through. That's what it's about, and it doesn't have to cost a lot of money.
Vitalacy appreciates that caregiver fatigue and burnout are material issues for hospital leadership. The recently introduced Vitalacy Patient Safety Platform provides users a fatigue scoring algorithm that notifies hospital leadership when are a caregiver is experiencing symptoms of burnout caused by factors such as long shift duration, high shift frequency and miles traveled. Linda’s findings on caregiver wellbeing are so important to Vitalacy that a guided imagery/guided meditation piece is being planned as part of the daily reporting process to hospital clients.
Burda D. Transcript: Peter Fine, president and CEO of Banner Health in Phoenix, Part 3. Modern Healthcare, May 9, 2011.
DeMers J. 5 successful business leaders that have used meditation to improve productivity, creativity and business acumen. Entrepreneur, April 3, 2018.
Nursing Solutions Inc. (NSI). 2019 National Heath Care Retention and RN Staffing Report. 2019