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JOURNALOF
Larden et al. / HOLISTIC
EFFICACYNURSING
OF THERAPEUTIC
/ December
TOUCH
2004
320
Larden et al. / EFFICACY OF THERAPEUTIC TOUCH 321
labor and stillbirth (Kleber, 1999). The prevalence of illicit drug use by
pregnant women in Vancouver, British Columbia is approximately
3.8% (Perinatal Substance Use Guideline Committee, 1999). About 35
chemically dependent pregnant women are admitted annually to
British Columbia Women’s Hospital in Vancouver, a tertiary-level
teaching hospital that provides referral care for women throughout
British Columbia. It is not uncommon for these women to interrupt
their treatment to leave the hospital and return to street drug use.
During pregnancy, the treatment of choice for opioid addiction is
methadone. Titration of dosage to relieve symptoms associated with
withdrawal prevents the need to return to street drugs. Intoxication
and withdrawal symptoms from all classes of illicit drugs cause vari-
able patterns of mood and anxiety disorders (Schottenfeld &
Pantalon, 1999). Anxiety, fatigue, fear, and anger augment the percep-
tion of pain in individuals with a chemical dependency (Stimmel,
1999). Anxiety and pain management is, therefore, an integral part of
the overall treatment plan for pregnant women with addictions.
Therapeutic Touch (TT), developed in 1972 by Dolores Krieger and
Dora Kunz, is believed to reduce anxiety, the perception of different
types of pain, and to promote a sense of well-being. Driven by com-
passion, and with the intent to help or to heal, the TT practitioner
moves his or her hands over the individual’s body to consciously
redirect and modulate subtle human energy. Physical contact is not
required, as one of the underlying assumptions of TT is that the uni-
versal vital energy that supports all living organisms extends beyond
the skin (Krieger, 1993; MacRae, 1987). Martha Rogers’s (1970) holistic
framework of unitary human beings offers a theoretical perspective
that supports the fundamental assumptions of TT. Rogers postulates
that an individual is a unified whole within a permeable human
energy field. Both the individual and the environment are open sys-
tems that continually interact, resulting in constant repatterning and
reorganization of the energy field. Change occurs when resonating
waves of energy, in both man and the environment, produce disrup-
tive or enhanced rhythms.
LITERATURE REVIEW
METHOD
Sample
All English-speaking pregnant women admitted to the chemical
dependency treatment ward at British Columbia Women’s Hospital
during the study period, June 1, 2000 to June 1, 2002, were invited to
participate. Among 62 women approached, 54 agreed to participate.
Allocation to trial arm was determined by randomization software
and recorded on sequentially numbered cards placed in opaque enve-
lopes that were opened after each study participant was enrolled. Par-
ticipants were randomized to receive either TT; to have a nurse be
present with them in the room either talking, playing cards, making
puzzles, or coloring (presence group); or to have standard care. Writ-
ten, informed consent was obtained from all study participants.
Women participating in the study ranged from 15 to 38 years of
age, with a mean of 27 years (see Table 1). Forty percent were married
or in a common-law relationship. Ninety-eight percent were unem-
ployed. Sixty-seven percent did not finish high school, and only 12%
had postsecondary education. Forty-nine percent were Caucasian,
43% First Nations, and the remainder were Asian. Participants in the
three trial arms did not differ significantly according to age, marital or
employment status, ethnicity, or level of education completed. Prior
drug use was similar among the three groups. Twenty-one percent
were experiencing their first pregnancy and 61% had at least one liv-
ing child. Gravidity and parity were not significantly different among
the treatment groups.
Procedures
Prior to the initial treatment, sociodemographic and pregnancy-
related data were collected from each participant, as well as initial
scores on the Symptom Checklist and the State-Trait Anxiety
324 JOURNAL OF HOLISTIC NURSING / December 2004
TABLE 1
Demographic and Pregnancy-Related Characteristics
of Participants by Treatment Group
Instruments
The STAI-X (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983)
is a 20-item scale asking participants to rate how they feel at the time
of completing the questionnaire, on a 4-point response scale. The Trait
subscale on this tool measures anxiety as an emotional state. This
scale has been validated in a number of studies and across a variety of
ethnic groups (Iwata et al., 1998). Factor analysis has indicated that
anxiety is represented as a unidimensional construct. Possible scores
range from 20 to 80, with 80 indicating high anxiety. Ayers (2001)
found that internal consistency for the State subscale ranged from .86
to .95 in pregnant and postpartum women. Test-retest reliability was
.35, which is expected as state anxiety changes over time. In the cur-
rent study, internal consistency (Cronbach’s alpha) for the STAI-X
was 90.5%, consistent with reliability indices previously published
for pregnant women (Ayers, 2001).
The Symptom Checklist was used to reflect participants’ experi-
ence of withdrawal symptoms in the prior 24-hour period. This tool
was developed at the Aurora Centre, a residential treatment center in
Vancouver, British Columbia, for women recovering from chemical
dependency (Poole, 1998). It consists of seven questions about with-
drawal symptoms, including drug cravings, physical symptoms
(headaches, shakes, sweats, body aches, nausea, and diarrhea), sleep
disturbances, anxiety, depression, concentration, and energy level.
Participants rate their perception of the symptom severity on a visual
analogue scale ranging from 0 (representing none/never) to 10 (mean-
ing severe/always). Internal consistency (Cronbach’s alpha) for this
scale in the current study was 86.2. Construct validity was demon-
strated by the ability of the tool to discriminate between women with-
drawing from substances who were exposed to acupuncture versus
no treatment. Qualitative reports from participants supported the
efficacy of acupuncture in congruence with the checklist (Poole,
1998).
The Symptom Checklist was completed prior to each TT or pres-
ence session. The STAI-X form was completed immediately following
the encounter to measure state anxiety after the intervention. Women
receiving standard ward care completed study data forms and placed
them in sealed envelopes collected daily by the study nurse. If partici-
pants left the hospital for any reason and returned, the study was
resumed. The treatments, therefore, were not provided on consecu-
326 JOURNAL OF HOLISTIC NURSING / December 2004
tive days but were interrupted for variable periods for most of the
study participants.
Demographic and pregnancy-related characteristics of the partici-
pants were analyzed using chi-square for categorical data and analy-
sis of variance for continuous data. Anxiety and withdrawal symp-
tom scores were compared among the three groups on each of 7 days
of treatment using repeated-measures linear regression (general lin-
ear modeling). This approach measures differences between groups
while taking into account change within participants over time. An
alpha level of .05 was adopted as the criterion for rejection of a null
hypothesis.
RESULTS
54 Women Randomized
No
Treatment (2) Discharged Self-discharged
(5) (6) Discharged
Discharged (3)
(5)
Returned (5)
Self-discharged Self-discharged
(6) (7)
Completed 7 Days
Completed 7 Days Of Treatment (7) Completed 7 Days
Of Treatment (12) Of Treatment (11)
Treatment
Treatment Uninterrupted Treatment
Uninterrupted (3) Uninterrupted
(5) (8)
60
50
40
TT
30 Presence
Ward
20
10
0
1 2 3 4 5 6 7 8
40
35
30
25
TT
20 Presence
Ward
15
10
0
1 2 3 4 5 6 7 8
DISCUSSION
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