COLLEGE OF MOUNT SAINT VINCENT

INDEPENDENT STUDY
NURS460 SPRING 2010

RESEARCHER: MAGGIE HAVRANEK

PARTICIPANT: N.A.D.

DATE OF SESSION:_________

PAIN ASSESSMENT PRIOR TO SESSION : (0-10 SCALE) _____

PAIN ASSESSMENT AFTER SESSION: (0-10 SCALE) _____

PARTICIPANT'S INPUT AND FEELINGS ABOUT SESSION : (HOW DID THE TREATMENT FEEL? DO YOU THINK THE
SESSION WAS HELPFUL AS A TOOL IN PAIN REDUCTION? DID YOU NOTE ANY DIFFERENCES IN THIS SESSION WHEN
COMPARED WITH A PREVIOUS SESSION?)

COLLEGE OF MOUNT SAINT VINCENT

INDEPENDENT STUDY
NURS460 SPRING 2010

RESEARCHER: MAGGIE HAVRANEK

PARTICIPANT: N.A.D.

DATE OF SESSION:_________

PAIN ASSESSMENT PRIOR TO SESSION : (0-10 SCALE) _____

PAIN ASSESSMENT AFTER SESSION: (0-10 SCALE) _____

PARTICIPANT'S INPUT AND FEELINGS ABOUT SESSION : (HOW DID THE TREATMENT FEEL? DO YOU THINK THE
SESSION WAS HELPFUL AS A TOOL IN PAIN REDUCTION? DID YOU NOTE ANY DIFFERENCES IN THIS SESSION WHEN
COMPARED WITH A PREVIOUS SESSION?)
 PRE SESSION QUESTIONNAIRE:
“ENERGY THERAPIES IS A COLLECTIVE TERM USED TO REFER TO A VARIETY OF ALTERNATIVE AND COMPLEMENTARY
TREATMENTS BASED ON THE USE, MODIFICATION, OR MANIPULATION OF ENERGY FIELDS” (ENCYCLOPEDIA OF MENTAL
DISORDERS).

• ARE YOU FAMILIAR WITH ANY TYPES OF ENERGY HEALING/THERAPY?

• WHAT ARE YOUR THOUGHTS ON ENERGY HEALING?

• Have you ever participated in any types of energy therapy in the past (reiki, therapuetic touch)?
 POST SESSION QUESTIONNAIRE:

• WHAT ARE YOUR THOUGHTS ON ENERGY HEALING?

• DO YOU FEEL THAT THE SESSIONS WERE BENEFICIAL?

• DID YOU EXPERIENCE AN INCREASE/DECREASE IN PAIN FROM THE SESSIONS?

• Would you recommend this treatment,or other types of therapeutic touch, to others?