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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