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Integrative Medicine

Mercy's Experience With TLC (Touch, Love, And Compassion)

Durango, Colorado
February, 2004

The Wellness Center at Mercy Medical Center in Durango, Colorado first began to dream about a TLC team several years ago. We talked with several wellness centers that had such a team. Michelle Bowman from Longmont Hospital visited Mercy and told about their innovative massage program that was available both as an inpatient and an outpatient. As a next step, the Wellness Center engaged in a collaborative effort with Durango's local college, Fort Lewis, to determine the current use of massage and other complementary therapies in the community. The survey showed that the community was widely using massage on an outpatient basis. The results of the community survey and the experience of other hospitals were discussed with Administration. The Administration at Mercy decided that Mercy would offer the service free of charge as a nursing service to help alleviate pain and anxiety in inpatients.

Nurses who were also either massage therapists or holistic nurses trained in healing touch are the core of the TLC team. The team was initially available 3 hours/day for 5 days/week. Policies were developed. An evaluation form and a brochure were developed. A TLC cart was developed which contained the forms, a logbook, aromatherapy supplies, eye pillows, and music. The nurses on the TLC team spoke to the nurses about the new service. They explained to them how to order a consult. As medical director, I explained the new program to the doctors. They were initially called prior to seeing each patient, but after the successful first six weeks, most doctors chose to sign a standing permission that allowed the patient to request the service themselves and/or allowed the nurse to request the service for patients who had pain and/or anxiety. The TLC team writes a brief note in the chart about each patient that was seen. Currently, a vast majority of attending physicians have signed a "standing permission" for their patients to receive a TLC session if they are in pain or have anxiety.

As the program has developed, we have evaluated our performance on a quarterly basis and either submitted an article to the "Acute Pain Newsletter" published by the Pain committee of the hospital or sent out a letter to the individual doctors. In the 10 months since the program began, the TLC team has seen over 1500 patients. The feedback has been very positive, not only from the patients, but also from the nursing staff and from the physicians. On the average, a person's pain and anxiety scales decrease by some 2-3 points (on a scale of 0 to10) as a result of the TLC session. Consults have been used in every department of the hospital from the emergency room to the operating suite to labor and delivery to orthopedics to internal medicine. The TLC team is available for 4 hours/day seven days a week. Staff (physicians and nurses) has stated that the TLC team has contributed greatly to a positive environment for patients and staff. Patients who have received a TLC session during their stay have been contacted later. The feedback even 1-2 months after their hospital stay was that the TLC session was the most positive part of the hospitalization and that it seemed to hasten improvement from the illness or surgery.

Along with the development of the TLC team, Mercy instituted another program that has been ongoing since 2002. Dr. Carl Middleton, Vice President of Ethics of Catholic Health Initiatives (Mercy's parent organization), taught interested Mercy employees a yearlong course in "Healing Therapies" that began in May 2002. This course teaches gentle touch therapies that help with pain and anxiety and are the basis of the therapies that the TLC team is using. In order to graduate from CHI's "Healing Therapies" program, an enrollee must complete 3 long weekend courses, read three books and give a report on one book, do 100 healing therapy sessions, keep a log book, and demonstrate the techniques. There are currently 19 Mercy employee-graduates of this program. The two holistic nurses on the TLC team co-taught with Dr. Middleton and are now certified instructors in "Healing Therapies." Since their certification, these two instructors have offered introductory courses to caregivers in the community, including hospice staff and staff at Four Corners Health Care Center (an assisted living facility.) Dr. Middleton, one of the holistic nurses, and two more instructor-trainees began another year-long course in Jan., 2004. This class contains nurses in public health and nursing homes as well as Mercy inpatient employees and hospice staff. The goal is to have a hospital staff that is imbued with the principles of "Healing Therapy" and who can use techniques when their patients are having procedures or are experiencing pain and/or anxiety. A second goal is to offer this therapy to people in the community in a variety of settings.

We are currently keeping statistics on length of stay (LOS) of patients who receive TLC compared to those who do not. Mercy is a 75-bed hospital, so the accumulation of meaningful statistics for a given diagnosis is a long process. We believe that the LOS will be shortened by TLC sessions especially for those people who are in considerable pain. Without TLC, these patients might well need to stay in the hospital beyond the usual time for someone with their particular diagnosis.

What we are certain of at this time is that nurses are adamant about how the TLC team contributes to reducing their stress. In this time of nursing shortages, if a hospital has something that encourages nurses to stay at their hospital, it is a very useful thing. Recruiting new nurses is not a simple task by any means.

Adding the TLC option to patient care has also had a very positive impact on admissions to the hospital. Mercy has had patients come from neighboring towns in order to receive care at the hospital in the region that has TLC sessions. This aspect of the TLC team could be even more important to hospitals in larger towns that have more competition for patients.

Without the support of other hospitals that have developed similar programs, Mercy might not have had the vision to start a TLC program. We are pleased to give you a glimpse of our program with you in the hope that it will inspire you to develop a similar program that works for you at your hospital.


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