Nurse Led Guided Imagery:
An Education Initiative
Abstract
The purpose of this project was to implement an education program
concerning the use of nurse led guided imagery on hospitalized adult
clients. The target group consisted of the night shift nurses of 4 Main
at Wellspan York Hospital. The efficacy of the education was
measured using a pre and post-test survey. An informational handout
was given in addition to a verbal teaching session on the benefits,
ease of implementation, and overall knowledge concerning the
intervention. A literature review of 13 studies was done to provide
current data on the subject. The review focused on the use of guided
imagery as a cost effective intervention for anxiety, stress, and pain
perception in the adult client with various disease processes. There is
currently a lack of scientific evidence to completely prove or disprove
the efficacy of guided imagery. There is however, significant statistical
data to support that it is effective in reducing anxiety, stress, and pain
in adult clients. Further systematic research to include a larger study
population is needed to persuade more to adopt guided imagery into
practice.
PICO
For nurses caring for both acute and chronic Medical-Surgical adult clients in the hospital
setting, will an education program targeting nurse led guided imagery result in an improved
understanding and potential implementation in practice?
Methodology
A total of ten night shift nurses participated in the project. A pre-test survey was given out to obtain an
unbiased knowledge on the subject. All participating nurses were then provided a verbal education session to
include a summary handout. After the teaching, a post-test survey was given to the nurses to complete. The final
post-test survey was given to assess the efficacy of the teaching and to gauge the acceptance and confidence
level of the nurses on guided imagery as a nursing intervention. All surveys collected were anonymous. See
below for an image of the handout provided.
Results continued:
The confidence level in applying the intervention also increased from “not at all”,
or “slightly” to the majority either “moderately” or “very” confident. This finding
indicates that the education was able to provide simple examples that nurses felt
they could implement without issue. Overall efficacy scores improved as well
with an average of 4 out of 5 score. The increased scores could indicate that
there was enough supporting evidence in the research that was presented, to
show more benefit than risk to clients. See below for visual graph of score
changes pre and post-test.
Nurse Self Ratings
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Background
Nursing as a whole is both part art and part science in nature.
In order to provide the best quality of holistic care, the nurse must
address both physical and psychological needs of the client (Selimen
& Andsoy, 2011). Guided imagery is a technique that can link the
psychological mind to the physical body and alter its response to
stressors when performed correctly. Guided imagery is defined as a
form of deliberate, directed daydreaming, usually consisting of words
and phrases which invoke a detailed depiction of peaceful or serene
scenery, a place of fond memories, or a fantasy location. When
effective these images can have several sensory qualities such as
visual, auditory, olfactory, and tactile (Bonadies, 2009). The purpose
of imagery is to elicit a relaxed state and allow for an increased sense
of control over the stressing symptoms the client may be
experiencing (Geidt, 2015).
Purpose
The use of guided imagery and distraction techniques can
decrease anxiety, pain perception, and stress in the adult client. This
therapeutic mind-body technique can also improve overall feelings of
well-being before, during, and/or after invasive or stress inducing
procedures such as wound care, cancer treatment, venipuncture,
surgery, and dressing changes. There is evidence to support that it
can also have an effect on those dealing with chronic conditions to
include fibromyalgia, osteoarthritis, asthma, and musculoskeletal
pain. The purpose of this project was to implement an education
program concerning the use of nurse led guided imagery on
hospitalized adult clients.
Katrina James, SN
Results
The pre-test survey results showed significant variation. Guided imagery was only defined correctly by 3
out of 10 of the survey participants, leaving the other 4 to provide only a partially correct answer and 3 to either
state knowledge deficit or an unrelated topic. Answers on implementation in the pre-test survey were also rather
dispersed. Only 3 participants were able to correctly identify how a nurse might implement the intervention
whereas 4 had a partially correct response, leaving the remaining 3 to have no knowledge on the subject. The
majority of nurses responded to confidence in using guided imagery as a therapeutic intervention with a “not at
all confident” or “slightly confident” during the pre-test. All of this data supports the need for education on guided
imagery as a simple intervention technique, that when practiced can help clients with a plethora of
symptomology to better their own experience. The post-test survey results differed greatly from the pre-test. The
occurrence of incorrect answers to knowledge based questions was less than 20 percent.
Efficacy of
guided
imagery as a
nurse led
intervention
Confidence
in using
guided
imagery
Pre-Test
Post-Test
Discussion
The educational material that was presented did improve post-test
survey scores while also showing an increase in the confidence levels of
nurses in the efficacy of guided imagery as an intervention for anxiety, pain,
and stress. This is hopeful and sheds light on the possibility of a future
protocol and wide based acceptance of this simple technique to improve the
inpatient experience. Overall, the project was a success.