The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [345]
Box 9.15 Simple relaxation technique script
Please note that breathing during this technique should be normal for the patient in their present condition.
Loosen any tight clothing and position yourself comfortably, either lying or sitting. Have your arms and legs uncrossed. Ensure your back and head are well supported.
Allow both your hands to rest on your abdomen, one on top of the other. It may be helpful to place a pillow on your lap for your hands to rest on.
Gently allow your eyes to close. Breathe normally in and out through your nose if you find this comfortable.
As you breathe in, be aware of your abdomen rising gently under your hands (do not force this movement).
As you breathe out, be aware of your abdomen relaxing under your hands.
Let your shoulders relax and drop down.
Let your jaw relax.
Now keep your attention softly focused on the rise and fall of your abdomen as this movement follows each breath.
Repeat steps 4–8 for between 3 and 5 minutes or longer if appropriate.
During the exercise
As you become aware of any thoughts that arise, let them go and just bring your attention back to the rise and fall of the abdomen. If you are still having difficulty focusing on the technique, try saying the following phrases: ‘I am relaxed’ or ‘I feel calm’.
To finish the exercise
Now slowly become aware of your surroundings, stretch out your fingers and toes, gently open your eyes and come back to the room.
Music
The use of taped music in the healthcare setting can also provide relaxation and distraction from pain (Beck 1991, Good 1996, Heiser et al. 1997). Setting up a library of taped music (e.g. easy listening, classical) and having personal stereos available for patient use is a simple way to provide patients with relaxing music.
Art
Art therapies have also been used to assist the patient in moving the focus of attention away from the physical sensation of pain to other aspects of the person (Trauger-Querry and Haghighi 1999). The skills of an art therapist are required to ensure the successful use of this intervention.
Physical interventions
In addition to psychological interventions, a number of physical interventions can be helpful in reducing pain.
Comfort measures
Simple comfort measures such as careful body positioning (for example, supporting a painful arm on a pillow) and the use of soft and therapeutic mattresses (Ballard 1997) can help to improve patient comfort and pain control.
Exercise
Both passive and active physical exercises may benefit patients by increasing range of motion (Feine and Lund 1997), preventing joint stiffness and muscle wasting which may further compound pain problems. Exercise should always be tailored to the patient’s tolerance and stamina. A simple exercise regimen which is practised regularly and supervised by a therapist can help patients feel better and more in control as well as having benefits in terms of pain relief.
Rest
In addition to exercise, teaching patients to rest comfortably in any position when in pain is a meaningful action and the base from which a person can learn to move more easily (O’Connor and Webb 2002). A person with a terminal illness may experience restriction of movement and neuromuscular pain with increased tension. For these patients, learning to rest and letting go of any tension can be helpful.
Transcutaneous electrical nerve stimulation
Transcutaneous electrical nerve stimulation (TENS) (Figure 9.13) is thought to work by sending a weak electrical current through the skin to stimulate the sensory nerve endings. Depending on the stimulation parameters used, TENS is thought to modulate pain