Encouraging healing through touch: at Wellington Hospital, the therapies of touch and massage are bringing relief from stress and pain, and promoting healing for many patients and staff.

TOUCH IS our earliest sense. Before a newborn baby can see, it can feel; its mother's contact providing the first vital bonding mechanism.

Touch as a therapy dates back over 3000 years in China. And in Greece, the grandfather of modern medicine Hippocrates talked of "rubbing" as an essential part of treatment. (1)

Benefits of massage have been seen in those suffering from chronic pain, burns victims, children suffering from post-traumatic stress disorder, paediatric asthma, depression, mothers in labour and premature infants. More than just feeling good, massage has deeper effects on anxiety and depression. Massage also helps boost the immune system and is an effective way to cope with the stress of modern society. (2)

In October 2000, a massage programme was introduced at Wellington Hospital's neonatal unit (NNU). The driving force behind this initiative was neonatal staff nurse Sarah Priday. She wanted to help reduce the inherent stress for parents with a premature or sick term baby in the neonatal unit and believed the programme would also offer benefits for staff. Support was gained from tutors at the New Zealand College of Massage, who suggested students doing the diploma of therapeutic massage and body therapies course could offer their time as part of their community clinical requirements. Initially, 24 half-hour sessions were offered each week, with bookings made in advance. Massages took place in a spare meeting or parent's room on the NNU. The initiative was originally designed to meet the needs of NNU staff and parents, but after a few months, the ante and post-natal wards were included. All staff were encouraged to talk about the massage programme to parents and notices were placed around the unit advertising the service.

The service now offers a massage service four days every week, including some weekend time. The student therapists charge a minimal cost of $5-$10 to cover travel and massage oil costs. They are aware and trained to massage women who are both pregnant and post partum, whether they have experienced a normal delivery or a caesarean section. Massages are offered in both lying and sitting positions.

Clinical nurse co-ordinator of NNU, Paul Huston, has used the service frequently over the last three and a half years, "if I can find a spare half hour". He believes it is valuable to have this form of stress relief on site, particularly in the noisy, hot and stressful NNU environment. A mixture of staff and parents use the service, though he admits some are more open to concepts of holistic health than others. A family grateful for the care their sick baby had received donated the massage table.

"The NNU is a 34-bed unit and predominantly high acuity. For the last two to three months, we've had 35-40 babies in here, with 90 percent of them premature. We've also had a lot of staff illnesses recently," he said. "Parents with babies in here are under intense stress, with a lot of fear and anxiety to deal with. Often they are first-time parents whose ideas of parenthood have been shattered now they are having to deal with a very sick baby. Some with very premature babies never had the chance to get to ante natal classes, so they have had little preparation for parenthood.

"A half-hour relaxation massage offers these parents a wonderful break and a chance for them to focus just on themselves rather than on the high-tech, stressful environment of the 'front room' [neonatal intensive care unit] where their babies may be fighting for their lives. Some parents might be here for three months or more, so we get to know them well and friendships are made."

Massage therapy student Tralee Clark began working at the unit last month. She has completed her certificate in massage therapy and is now working towards her diploma. She enjoys working at the NNU and appreciates the opportunity to extend her skills and work on different bodies. She is aware of the stress parents and staff are under and is pleased to offer a service that provides people with some relaxation therapy and valuable time away from the working environment.

Six months after the service was established in the NNU, Priday undertook an evaluation, which she presented in poster form at the annual conference of the As sociation of Neonatal Nurses in 2001. The survey revealed most clients were returning again and again, describing their relaxation massage as "good" or "excellent". Responses showed that on-site massage treatment for both parents and staff significantly decreased anxiety, tension and discomfort. Clients said they were more relaxed, with an improved mood state. The duration of these effects were reported to last up to a day after the massage. Lactating mothers, whether expressing their milk or actually breast-feeding, commented on their increased milk supply. Comments from parents included "Lovely to have the gentle touch after an invasive week", "A great all body healing experience, very balancing" and "I feel so much more positive--good feelings of physical well-being that I can now cope with my new baby."

As an extension of this service, the original massage therapists, now fully trained, have set up a commercial on-site clinic within the hospital for staff, visitors and some outpatients. Massage Therapy Services has been operating from a room at the nurses' chapel since September 2001, is supported by director of nursing Anita Bamford, and is available three days a week, with half-hour and one-hour appointments. Practitioner Helen Smith, who incorporates some holistic pulsing into her massage therapy, sees the main benefits as stress relief and being able to offer an oasis to staff and relatives in the midst of a busy day. With the majority of her clients being nurses, she enjoys being able to give to those who spend their day giving to others. "Carers need to have some time out for themselves in order to be able to keep giving to others," she said. "Massage is a maintenance routine for physical and mental well-being. My clients tell me these sessions really help keep them going."

Service for cancer patients

A massage and healing touch service is also available for cancer patients at Wellington Hospital. Registered nurse, massage therapist and healing touch practitioner Naena Chhima works four days a week in outpatients at the Wellington Cancer Centre and on the cancer ward, combining massage, healing touch and lymphoedema work with her normal nursing load. She is one of the few nurses who has been able to achieve this balance while working for a district health board. Doctors or nurses refer patients to her or she may recommend certain patients would benefit from this complementary therapy. She works in her own private practice one day a week.

Chhima trained in the area of complex lymphatic therapies in Adelaide, completing an advanced course in Hamilton earlier this year. This work is mostly done by physiotherapists, but it fits in well with Chhima's interest and skill in massage therapy. She works mostly with patients who have developed lymphatic problems following surgery or radiotherapy for cancer.

She completed the diploma course in massage therapy through the then Massage Therapy Training School in Wellington and trained in levels one and two in healing touch therapy through Wellington Hospital in 1998. Earlier this year she completed the advanced levels in healing touch.

Healing touch, says Chhima, can involve touch or no touch and is concerned with balancing and aligning a person's energy fields in order to facilitate personal healing. The goal is to restore and maintain health and wellness through harmony and balance of the body, working on physical, mental, spiritual and emotional levels. Healing touch promotes relaxation and aids the body's ability to restore and heal itself. It can tap into a patient's emotional blocks that may be hindering the healing process.

"Some patients are skeptical about the benefits of healing touch but will give it a go. I have never treated anyone who has said this therapy didn't have a benefit," she said.

Hands off healing touch therapy can be of particular benefit for haematology patients whose platelets and white cell counts can be severely compromised. Patients in the early stages of chemotherapy find benefits from massage as they face the anxiety of this new, invasive treatment. It can also benefit patients on the ward who have been there a long time and bone marrow transplant patients who are in isolation. Chhima often offers a hand, foot or neck massage to oncology patients, especially older people, many of whom may be living on their own and receive little touch in their daily lives. "These patients really appreciate the nurturing of touch. Some tell me being pampered in this way has been the best part of their hospital stay. I will sometimes teach relatives to do a light hand or foot massage, as this is a way of their connecting to their loved ones and gives them something positive to offer."

Chhima is convinced of the psychological as well as the physical benefits of massage and healing touch. "People will tell me they slept well, had less pain and felt more at peace with themselves following a therapy session. Nurses also note how patients with hypertension have reduced blood pressures following massage. Everything in the cancer treatment area is so invasive. Offering this complementary, noninvasive therapy is a way of pampering and comforting patients under stress."

Providing a massage and healing touch service for cancer patients is a special part of Chhima's normal nursing work and one she feels privileged to offer. She is grateful for the support she gets from her colleagues and charge nurse to offer such a service. She is so convinced of the benefits, that she would like to see it being offered in many more areas in the hospital. She would also like to see some research undertaken in New Zealand to assess the effects of these forms of complementary therapy, but with most research funded by drug companies, she concedes this is unlikely to happen. "Research is being done in Hawaii into the benefits of healing touch on breast cancer patients, examining the effects at every stage of a woman's treatment. Healing touch is often used before patients undergo surgery in the United States, because of the perceived benefits for patients overcoming the effects of anaesthesia."

Being able to use massage and healing touch as a normal part of her nursing practice gives Chhima a different level of connection with patients and the opportunity to have some real nurturing time with them. "This, after all, is one of the essences of being a nurse," she said.

* With thanks to former staff nurse at Wellington Hospital's neonatal unit, Sarah Priday, for her input into this article.

REFERENCES

(1) Duffton, S. (2001) Getting the Massage Across. North and South; 189: 115.

(2) The Touch Research Institutes, University of Miami School of Medicine. See http:// www.miami.edu/touch-research.