Unique "Comfort Cart" Program Puts Easy, Complementary Therapies in Hands of Nurses
Karen Haigh, RN, BSN, CCRN (left), and Donna Fahey, RN, BSN, CCRN, use the Comfort Cart's alternative therapies to help patients and their families in Our Lady of Lourdes Medical Center's critical-care unit to reduce stress and achieve greater calmness and sense of well being.
"This patient almost died, but what she remembers, when we ask her about her stay later, is how much she enjoyed the scent of lavender oil that night and sounds of the ocean playing in her room," says Karen Haigh, RN, BSN, CCRN, Nurse Manager for Lourdes' ICU.
The experience of receiving care in an ICU, or having a loved one in intensive care, can produce enormous distress and anxiety. To respond, Lourdes has developed a simple, inexpensive strategy to help alleviate and distract from these
An Adjunct Tool for Nurses
Donna Fahey, RN, BSN, CCRN a Lourdes intensive-care nurse who championed and built the program, originally heard about the use of the concept in a pediatric unit. Fahey began accumulating materials, largely through staff donations, and gradually worked on ways to introduce the interventions with a staff of busy co-workers.Haigh, who supervises the nursing team, recalls, "Though my heart was in this, I initially had my doubts that it would catch on with the staff. How quickly any clinical staff member picks up on this kind of thing can depend on his or her orientation toward integrative care."
Delivering first-rate service, every day, in the ICU environment already places substantial challenges and time constraints on staff members. But Fahey, who has her Masters of Fine Arts and a nursing Certification in Complementary & Integrative Therapy, pressed on quietly, demonstrating everything from color therapy to massage to water crystal cards with her teammates and setting an example for use of these comfort therapies with patients.
An Add'l Path to Relaxation
"These therapies all serve to calm the sympathetic nervous, an essential component of healing and coping," explains Fahey, who published a paper on the Comfort Cart concept in the July/August 2009 issue of Holistic Nursing Practice.Patients and family can review the cart's "comfort book", which catalogues the interventions and the basis behind them. They can fill out a familiarization form where they can indicate preferences for this and other matters.
Normally, the unit nurses take the lead in suggesting and using one of the therapies. Not surprisingly, in an effort that addresses psycho-social issues, the most used Comfort Cart interventions have tended to be those with more immediate effect, such as aromatherapy, music therapy, and therapeutic touch.
The Lourdes nurses make notes on use of the therapies and the patient's status before and after participation. Anecdotally, the nurses have observed that the interventions dependably produce these benefits:
- decrease in patient pain and anxiety;
- improved ability by patients to sleep through the night;
- enhanced nurse satisfaction with having another tool to use in difficult situations;
- and substantial appreciation from the patient and family for this added dimension of personalized care.
Blending Relaxation into Care
Family members of patients in the intensive care unit often feel significant distress at their loved one's circumstances. Some families may visit on the unit for hours each day for weeks."The key is to introduce or suggest these stress-reduction therapies in a low-key way and to involve the family," says Fahey. "The approach provides comfort to the family as well."
And to the staff, which also enjoys the scents, music and other therapies. The Lourdes staff makes greatest use of these interventions in the evenings, when recordings of ambient nature sounds are popular, although patients can also choose their favorite type of music from the cart. Aromas have a calming effect, and the nurses report that Comfort Cart interventions often prove effective for patients with dementia that grows worse in the evenings.
"These strategies provide social, emotional, physical, and spiritual support," says Haigh. "While the techniques may sound soft in a highly technical acute-care setting, they are in fact life-giving and
Potential to Expand Broadly
Now approaching a year since its launch, the ICU's Comfort Cart program has gained acceptance and broader use. "It's amazing how staff attitude and buy-in to this has changed," says Haigh. "It's gathered its own momentum."Her unit is raising funds through the Lourdes Health Foundation to bring Comfort Carts to the other floors and units throughout Lourdes, including the emergency departments. Fahey and co-workers believe in the potential of the model to expand broadly among the nation's hospitals, and are working to document and report possible length-of-stay effects.
"Patients contend with great physical and emotional challenges. These therapies are a nice option for nurses and a welcome opportunity for inpatients to focus on pleasant stimuli," says Fahey. "It helps to lift them out of where they are. And it's not a difficult resource to put together."
The year's experience has reinforced to the Lourdes nurses that the comfort therapies are properly nursing interventions, delivered through the nursing model and evaluated through nursing care. Haigh and Fahey will present on the Comfort Cart program at the American Academy of Critical-Care Nursing's Trends in Critical Care conference in Philadelphia in October 2009.
