Running Head: GUIDED IMAGERY: IMPROVING CLIENT CARE IN ADULTS
Nurse Led Guided Imagery Education and Improving the Adult Client Experience:
A Pre and Post Test Study
Katrina James
Pennsylvania State University
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GUIDED IMAGERY: IMPROVING CLIENT CARE IN ADULTS
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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 was 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. Several databases were searched to
include ProQuest Nursing and Allied Health Journals, PubMed (Medline), and CINAHL
(Cumulative Index for Nursing and Allied Health). 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.
Keywords: guided imagery, distraction, anxiety, pain, non-pharmacological, stress, adult
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Introduction
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).
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. Guided imagery is a cost
effective, non-pharmacological intervention that can be utilized by nurses in and out of the
hospital setting. This project discusses the following question; 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?
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Background
Anxiety and stress are two commonalities that present when an individual is ill or
experiencing pain. This especially holds true for those individuals who are experiencing an acute
illness or health related event such as being scheduled for an unexpected surgery or losing a limb
in an accident. Also affected, are those being treated for chronic illnesses such as receiving
chemotherapy treatment for cancer, or being hospitalized for an asthma exacerbation or
worsening of fibromyalgia or osteoarthritis symptoms. In addition to the stress related to the
disease process itself, the client is usually in an unfamiliar setting and is experiencing feelings of
hopelessness, worry, powerlessness, and role conflict (Lewandowski & Jacobson, 2013). It is
the body’s natural response to such stressors to activate the sympathetic nervous system via the
release of adrenal-medullary hormones such as adrenaline and noradrenaline, which can in turn
cause vasoconstriction increasing the respiratory rate, heart rate, blood pressure and body
temperature (Lin, Hsieh, Hsu, Fetzer, & Hsu, 2011). The anxiety response can decrease
immunity and delay wound healing and can alter the client’s thoughts and behaviors (Selimen &
Andsoy, 2011).
Guided imagery as a complementary and alternative medicine (CAM) therapy can
improve the patient’s emotional state and in turn lessen the effects of the stress response when
used consistently. Due to the benefits that have been associated with guided imagery, a review of
literature will be completed to answer the following question; can nurse led guided imagery and
distraction techniques during invasive procedures lessen the perception of pain, anxiety, and
discomfort of the adult patient?
Review of Literature
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Method
The following databases were accessed through the Penn State Library Nursing Research
Center; PubMed (Medline), CINAHL (Cumulative Index for Nursing and Allied Health), the
Cochrane Library, and ProQuest Nursing and Allied Health Journals. The publication dates of
these studies ranged from the years 1997 to 2015. The article published in 1997 was chosen to
be included in this study due to its relevance and background information on the topic. The other
12 articles were published within the past 10 years. All articles were available in English but
some studies were performed outside of the United States to include Turkey, Greece, Spain,
United Kingdom, and China. Articles chosen for this review were found using various
combinations of the following search terms; guided imagery, distraction, adults, nursing, nonpharmacological, CAM therapies, pain, anxiety, depression, stress, and intervention. A total of
25 studies was originally found and then narrowed down to 13 using specific inclusion and
exclusion criteria.
Inclusion Criteria
The inclusion criteria consisted of adults, both male and female aged 18 and older. To be
included in the review the study participants had to have been experiencing anxiety, stress, or
pain (both chronic and acute) in relation to either a disease process such as cancer, osteoarthritis,
fibromyalgia, or asthma. Burn patients, cardiac surgery patients, and arthroplasty patients were
also included in the collection of research. Combination of guided imagery and other CAM
therapies were included due to the close relationship of the type of intervention.
Exclusion Criteria
All studies that included children or infants were excluded. Also, outpatient or strictly
home based interventions without close monitoring were excluded from this pool of data.
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Studies not provided in an English translation were also excluded.
Guided Imagery Methodology and Holistic Care of Clients
Guided imagery as a nursing intervention uses the principle of psychoneuroimmunology
(PNI) in order to relieve the client of the stressing symptoms they are experiencing (Giedt,
1997). The theory behind this technique is based upon the connection between mind and body
and how a person’s perceptions influence their interactions between both the external and
internal environments. As stated by Bonadies (2009), care planning and practice by both the
nurse and client are integral in the efficacy of the guided imagery intervention. Guided imagery
involves more than just the visual sense and nearly anyone can use it as an intervention as
adjunct to various types of pain and anxiety responses. The psychological changes that one
experiences in the stress response such as fear of an upcoming procedure need to be treated
according to that client’s specific personality, which encompasses the need for holistic care
(Selimen & Andsoy, 2011). In the peri-operative setting, nurses are entrusted with creating a
therapeutically calm environment in order to assist in decreasing the client’s fear, tension, and
overall stressors. Studies have shown that by providing an additional intervention as simple as
recalling a happy event from the past can assist in decreasing the stress response and physical
symptoms that come along with it (Selimen & Andsoy, 2009).
Guided Imagery and Acute Illness or Stressors
In the systematic review done by Posadzki and Ernst (2011), clinical trials were reviewed
involving both musculoskeletal pain and guided imagery intervention. They included a total of 9
studies involving 201 patients from various countries. The population ranged in the middle age
category and included fibromyalgia syndrome (FMS), elderly osteoarthritis (OA), postoperative
patients, and those suffering from chronic pain. The control groups received standard care, sham
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guided imagery, placebo and standard care, or no intervention. The total number of patients that
benefitted from the guided imagery technique was 115 (Posadzki & Ernst, 2011).
In the instance of burn clients, the stress response can be detrimental in that it places
them in a hypermetabolic response state, further increasing their need for nutritional support.
Enteral or parenteral feedings are usually required due to the difficulty most post burn clients
have consuming the needed 20-100% increase in caloric consumption (Hoffman & Klein, 2010).
In order to see what the effect guided imagery would have on the hypermetabolic state of these
clients a pilot study was performed to include 10 subjects. Six subjects were in the control group
and received usual care and 4 subjects were in the treatment group and to receive the guided
imagery intervention. To gather the baseline data the subjects were monitored using a
computerized system which measured heart rate, blood pressure, and respirations. The resting
energy expenditure was also measured as a method to record the caloric expenditure. Patients in
the intervention group received intervention daily and were asked to imagine a place where they
felt safe and comfortable (Hoffman & Klein, 2010). Subjects were encouraged to use the
intervention throughout the day, especially during times of dressing changes and any type of
active therapy sessions.
In the study done by Thomas and Sethares (2010), they included 121 patients scheduled
for elective total joint arthroplasty. A 2-group quasi-experimental design was used. The
interventional group of 69 clients listened to a guided imagery CD that promoted harmony and
peacefulness, while the control group of 52 clients received usual care. The theoretical
framework used in this study was the gate control theory developed by Melzack and Wall in
1965. The focused concentration related to the use of guided imagery may possibly interrupt the
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negative sensory stimulus, causing the perception of pain and therefor help to alleviate the
client’s symptoms and provide relief.
In regards to the efficacy of guided imagery on clients undergoing cardiac surgery, a
study was done by Casida and Lemanski (2010), which analyzed how pre and post-operative
pain could be reduced by using this as an intervention. There was a total of 7 articles included in
their study and both the control groups received usual care and the intervention group received
guided imagery. The topics of interest were length of stay, anxiety/tension, and pain reduction.
Numeric, open-ended, and visual scales were used to measure anxiety and pain while length of
stay was gathered from hospital data.
Guided Imagery and Chronic Conditions
Fibromyalgia pain is a chronic condition that can in turn affect the quality of life of those
suffering from it. A study was done to evaluate the effects that guided imagery can have on pain
perception of clients diagnosed with the condition. The use of Marth Rogers’ science of unitary
beings was used in this study in order to correlate the holism involved in the health dynamic
connecting both mind and body (Onieva-Zafra, Garcia, & del Valle, 2015). One of the many
benefits of guided imagery is that it is a self-management technique and once taught the client
can continue to utilize it to improve their symptoms. This study consisted of 55 participants
aged 18-70 years old. A 2 group experimental design was used. There were 28 clients in the
intervention group who listened to 15-minutes of a relaxation CD daily and the remaining 27
received usual care as the control group. There were significant changes in the depression ratings
reported by participating subjects indicating that the guided imagery was effective.
A study done by Lahmann et. al (2009) indicated that a strong relationship existed
between the use of functional relaxation and guided imagery and a reduction of seriousness of
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asthma related illness. In this study a total of 64 participants, 16 of which received functional
relaxation as an intervention, 14 who received solely guided imagery, 15 who received both
interventions, and a control group who received a placebo relaxation technique. The findings
from this study indicated that the process of functional relaxation was more effective than the
guided imagery intervention in having a positive effect on respiratory parameters. Another study
by Charalambous, Giannakopoulou, Bozas, and Paikousis (2015), studied the effects of
progressive muscle relaxation and guided imagery have on cancer patients suffering from
prostate or breast cancers. There was a primary emphasis on the anxiety and depression suffered
by those who are receiving treatment for these disease processes. The study itself was well done
in that it was randomized, the accessors were blinded, and a scientific methodology was
followed. The Zung Self rating anxiety (SAS) was used to measure anxiety while the Beck
depression interview (BDI) was used to measure depression. Measurements were acquired both
at baseline and throughout the length of the study. The results of this study provided strong
evidence of the correlation between the decreased anxiety and depression in the intervention
group. This is yet another positive outcome of the use of guided imagery as an effective
intervention.
In a systematic review in relation to orthopedic pain and the use of non-pharmacological
interventions, Büyükyýlmaz (2015) found that there was a decrease in perception of pain while
using a combination of both pharmacological pain medicines and CAM therapies. It was agreed
there was no reason to not implement the intervention in more settings to help reduce the need
for increased analgesics and to improve the clients’ quality of life.
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Discussion
The findings from the Casida and Lemanski (2010) study were significant in that not only
did 3 of the studies show a decreased length of stay, but fatigue was reduced, sleep was
improved, pain required less analgesic, and anxiety was reduced. One of the many benefits of
guided imagery is that it is a self-management technique and once taught the client can continue
to utilize it to improve their symptoms. Each person is unique in that the imagery modality may
work for a 39 year old woman with cancer related pain but not for another with the same age and
disease process. We must keep this in mind in that the study of CAM therapies such as guided
imagery will never be a clear cut study. Statistical analysis of variability can decrease this level
of human error. Overall, the practice of nurse guided imagery has a hopeful future in the care
facilities of tomorrow.
Implications for Practice
Although there is not a significantly large group of data that has been collected to
strongly support the claims that guided imagery is in fact effective, in decreasing clients’
perceptions of pain, anxiety, and stress the research is promising that there will soon be an
implementation of this intervention in the near future. With no evidence of client harm the
research will continue. As the trends continue in that clients are more interested in holistic and
non-pharmacological interventions I see a push for the implementation of guided imagery
protocols in the research led institutions within the next decade.
In order to better the practice of today, simple implementation should be applied in the
inpatient setting with all mentally capable patients. The first step in this implementation is to
create a basic script that contained several different approaches. An educational meeting would
be scheduled where all staff go over basics and practice the script with one another. After the
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rehearsal and education process, the nurse would choose the script containing the topic that best
fits the patient. The next step would be to lead the patient in creating the mental image or topic
of their choosing. If the evidence based practice committee would want to do a pilot study to
measure effectiveness and acceptance by both patients and staff, a study would be planned and
implemented. If the pilot study were a success then a protocol would be suggested and created.
Limitations
There was a lack of large group randomized controlled trial studies that specifically look
at guided imagery and distraction techniques for adult clients in both acute and chronic health
situations. A majority of the adult focused research on the topic is now outdated and needs to be
recreated using more reliable scientific methods. There is a significant amount of research on
distraction and guided imagery focusing on children, but there is a research gap when applying it
to an adult population. Also there are few concrete studies done on the implementation of
nursing based interventions in these settings using a blinded and randomized methodology.
There is much to be done to further support the use of guided imagery into evidence based
practice.
Conclusion
The use of guided imagery and distraction techniques in both the acute and chronic
treatment of stress, anxiety, and pain is a cost effective adjunctive therapy with promising
results. Although there is a need for further research most studies have found statistically
significant differences in the intervention versus control groups in that there was a decrease in
one of the aforementioned symptoms. With the support that there is no negative impact to
implementing distraction techniques or guided imagery interventions with clients of any of the
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mentioned conditions, there is no harm in completing more studies to better support this
alternative therapy.
Project Plan: Part 1
The guided imagery educational project plan was completed and was initiated from
October 2015 to November 2015. The focus of this project was to educate nurses on the basics
of guided imagery, with a focus on patient benefits, and ease of implementation. The unit
involved was the 4 Main medical-surgical telemetry unit at Wellspan York Hospital. Deneen
Harbold, RN was the project coordinator. Sheila Perry, RN also assisted in the educational
process of this project. Current research from well-known databases such as PubMed, and
ProQuest Nursing and Allied Health Journals, present guided imagery as an effective nonpharmacological intervention to decrease anxiety, stress, and patient pain perception. Due to its
ease of nurse led implementation as well as it being cost effective, there was an opportunity to
test the current staff’s knowledge on the topic, acceptance of the intervention, and confidence
level of implementation.
Purpose of Project
There is substantial evidence describing the use of guided imagery to improve patients’
overall hospital experience, to include prolonged health benefits through use of this learned
technique in the outpatient setting. From the aforementioned research and areas of interest, the
following PICO question was formed to guide this project; 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? The purpose of this initiative was to provide an overview of guided imagery to the
nursing staff on 4 Main to increase awareness of the technique and to encourage use and possible
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implementation of a guided imagery protocol. The scope of this initiative is vast in that it could
transfer to a variety of hospital and outpatient settings to include numerous acute or chronic
conditions. Any area of practice in which there are clients who are able to comprehend verbal
direction, execute simple commands, and are in a sound state of mind.
Logistics and Methodology
The key leader of the project, Katrina James, SN was assisted by both Deneen Harbold,
RN and Sheila Perry, RN two night shift nurses on 4 Main, Wellspan York Hospital. The
research, educational material, and pre and post-test surveys was completed by Katrina James,
SN. All surveys collected were anonymous. Ten night shift nurses were given a pre-test survey
to assess their baseline knowledge on the topic of guided imagery. The staff was then given
verbal instruction about the use and research regarding the topic as well as given an informative
handout. 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.
The survey and handout material was dispersed by all three team members while the teaching
was completed by Katrina James, SN only.
Results
The pre and post-test surveys can be found in Appendix A and B. The informational
handout can be located in Appendix C. 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
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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. 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.
Project Plan: Part 2
The changes that took place as a result of the education initiative, were in the minds of
and attitudes of the nursing staff. Their overall knowledge on the topic increased and they were
also more encouraged to try guided imagery as a nursing intervention. The process measure
were pre and post-test surveys which were comprised of multiple choice, open ended, and Likert
Scale questions. The frequency of measures were weekly. The data collection process lasted
three weeks after October 30 and was ongoing. The overall outcome measures were centered on
staff surveys. The pilot area barriers included staff non-compliance, feelings of increased
workload and inability to find time for survey, and lack of interest. The facilitators included
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Deneen Harbold, RN (preceptor), Sheila Perry, RN (staff nurse) and Katrina James, SN (project
leader).
Implementation
The communication for this project consisted of peer coach meetings. The education was
targeted for the 4 Main night shift nurses at Wellspan York Hospital from October 2015November 2015. Teaching was reinforced through peer coaching and handouts. Peer feedback
was collected and overall acceptance levels were high.
Modifications/ Limitations
In order to provide more sound results a larger sample would have been preferred. Also,
if this project were to not have any limitations, it would have been preferred that it was done on a
variety of different floors with various client bases. A larger poster board that could have been
hung in several nursing lounges would have provided more education than a simple handout
alone. If management or educational committees were to get involved and express interest then a
possible pilot study to include an actual implementation of guided imagery on the floor plus an
added client survey on their perception of the intervention would have provided excellent data.
Overall for a starter project the results were few but gave a good insight into the knowledge and
acceptance of nurses at this health care facility.
Discussion
The PICO question, “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?” was answered to
a degree. 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
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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.
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References
Bonadies, V. (2009). Guided imagery as a therapeutic recreation modality to reduce pain and
anxiety. Therapeutic Recreation Journal, 43(2), 43-55.
Büyükyýlmaz, F. (2014). Non- pharmacological intervention in orthopedic pain: A systematic
review. International Journal of Caring Sciences, 7(3), 718-726.
Casida, J., & Lemanski, S. A. (2010). An evidence-based review on guided imagery utilization
in adult cardiac surgery. Clinical Scholars Review, 3(1), 22-30. doi:10.1891/19392095.3.1.22
Charalambous, A., Giannakopoulou, M., Bozas, E., & Paikousis, L. (2015). A randomized
controlled trial for the effectiveness of progressive muscle relaxation and guided imagery
as anxiety reducing interventions in breast and prostate cancer clients undergoing
chemotherapy. Evidence-Based Complementary and Alternative Medicine, 1-10.
http://doi.org/10.1155/2015/270876
Giedt, J. F. (1997). Guided imagery: A psychoneuroimmunological intervention in holistic
nursing practice. Journal of Holistic Nursing, 15(2), 112-127.
doi:10.1177/089801019701500204
Hoffman, C. A., & Klein, J. M. A. (2010). Relaxation and visual imagery techniques: Do they
work? Can they really help burn clients? MedSurg Nursing, 19(3), 169-174.
Lahmann, C., Nickel, M., Schuster, T., Sauer, N., Ronel, J., Noll-Hussong, M., Loew, T. (2009).
Functional relaxation and guided imagery as complementary therapy in asthma: A
randomized controlled clinical trial. Psychotherapy and Psychosomatics, 78(4), 233.
doi:10.1159/000214445
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Lewandowski, W., & Jacobson, A. (2013). Bridging the gap between mind and body: A
biobehavioral model of the effects of guided imagery on pain, pain disability, and
depression. Pain Management Nursing: Official Journal of the American Society of
Pain Management Nurses, 14(4), 368. doi:10.1016/j.pmn.2011.08.001
Lin, M., Hsieh, Y., Hsu, Y., Fetzer, S., & Hsu, M. (2011). A randomised controlled trial of the
effect of music therapy and verbal relaxation on chemotherapy‐induced anxiety. Journal
of Clinical Nursing, 20(7‐8), 988-999. doi:10.1111/j.1365-2702.2010.03525.x
Onieva-Zafra, M. D., García, L. H., & del Valle, M. G. (2015). Effectiveness of guided imagery
relaxation on levels of pain and depression in clients diagnosed with fibromyalgia.
Holistic Nursing Practice, 29(1), 13-21. doi:10.1097/HNP.0000000000000062
Posadzki, P., & Ernst, E. (2011). Guided imagery for musculoskeletal pain: A systematic
review. The Clinical Journal of Pain, 27(7), 648-653.
doi:10.1097/AJP.0b013e31821124a5
Selimen, D., & Andsoy, I. I. (2011). The importance of a holistic approach during the
perioperative period. AORN Journal, 93(4), 482-490. doi:10.1016/j.aorn.2010.09.029.
Thomas, K. M., & Sethares, K. A. (2010). Is guided imagery effective in reducing pain and
anxiety in the postoperative total joint arthroplasty client? Orthopaedic Nursing, 29(6),
393-399.
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Appendix A: Capstone Pre-test Survey
Clinical Capstone Project: Pre-test Survey
Katrina James, SN
The Pennsylvania State University
Fall 2015
1. What is guided imagery?
2. Guided imagery is a type of ____ (circle one)
A. Examination
B. Deep sleep
C. Meditation
D. Yoga
3. What are some patient benefits of nurse led guided imagery?
4. How might a nurse implement the use of guided imagery?
5. As a nurse, how confident do you feel using guided imagery to decrease anxiety and
discomfort in your patients during invasive procedures or stress inducing care tasks?
Using a scale of 0= Not at all confident to 5= Very effective, please circle your answer
A. Not at all confident (0)
B. Mildly confident (1)
C. Moderately confident (2)
D. Very confident (3)
6. How well do you think that guided imagery as a nursing intervention would be as an
effective means of decreasing overall patient anxiety, pain, and/or stress? *Using a scale
of 0=Not at all effective to 5=Extremely effective, please circle your answer.
0
1
2
3
4
5
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Appendix B: Capstone Post-test Survey
Clinical Capstone Project: Post-test Survey
Katrina James, SN
The Pennsylvania State University
Fall 2015
1. What is guided imagery? (circle one)
E. An ultrasound or visually-assisted/guided procedure
F. Helping a recently blind individual to imagine or visualize images
G. A relaxation technique using words to evoke positive mental images, feelings, and
thoughts with the purpose of reducing stress, anxiety, and pain perception
H. Using a magnifying device to examine a patient
2. Guided imagery is a type of ____ (circle one)
A. Examination technique
B. Dreaming
C. Guided relaxation
D. Yoga
3. An example of using guided imagery would be____? (circle one or more)
A. Talking with a patient to describe a setting in which the patient feels is relaxing
B. Telling a client to think of their favorite food while NPO
C. Having a client describe a favorite vacation spot while performing wound care
D. Discussing with the patient whether to keep the TV on during assessment
4. As a nurse, how confident do you feel using guided imagery to decrease anxiety and
discomfort in your patients during invasive procedures or stress inducing care tasks?
Using a scale of 0= Not at all confident to 5= Very effective, please circle your answer
A. Not at all confident (0)
B. Mildly confident (1)
C. Moderately confident (2)
D. Very confident (3)
5. Which of the following are benefits of using guided imagery? (circle one or more)
A. Decreased stress for the patient
B. Improved patient experience
C. Decreased use of analgesics
D. Reduced self-rated anxiety
E. Decreased length of stay in the hospital
6. How well do you think that guided imagery as a nursing intervention would be as an
effective means of decreasing overall patient anxiety, pain, and/or stress? *Using a scale
of 0= Not at all effective to 5= Extremely effective, please circle your answer.
0
1
2
3
4
5
GUIDED IMAGERY: IMPROVING CLIENT CARE IN ADULTS
Appendix C: Education Summary Handout
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