Audio device improves experience for Northland surgical patients

When Jim Pohl had knee-replacement surgery Aug. 14, he was on a beach in Hawaii.

Not literally. But the Midway Township man credits a device that's smaller than a deck of playing cards with putting him in a better place before and after his operation.

Pohl, 67, used a guided-imagery audiobook made by Playaway before and after the operation on his left leg at Essentia Health-St. Mary's Medical Center.

The hospital has been making the Playaways available for patients facing certain kinds of surgery since January 2012 and is seeing positive results, said Donna Anderson, a nurse practitioner who instigated the program.

Bariatric patients who used guided imagery have had shorter stays, lower pain scores and have used fewer intravenous narcotics than those who didn't, she said. Orthopedics patients needed fewer pain medications.

That was true to an extreme for Pohl, who went into the hospital for his operation on a Wednesday and came home two days later.

"They gave me some pretty potent pills, and I never touched a-one of them," said Pohl, who is principal building and grounds supervisor at the University of Minnesota Duluth.

"I had the medications and I had the guided imagery, and I chose the guided imagery, and for me it worked."

Popular Playaways

The Playaways, provided by the Essentia Health Foundation, are optional but have proven popular, Anderson said. From April 1 through Dec. 31 of last year, 859 joint replacements were performed at Essentia Health-St. Mary's Medical Center, and about 700 patients chose to use the devices, she said. More than 90 percent of bariatric patients chose to use guided imagery.

All told, Essentia Health had given out more than 1,200 Playaways as of last week, Anderson said.

It works like this: After a nurse explains the process, a patient who chooses to use the Playaway is handed a 7-inch-by-5-inch plastic case. The case includes the audiobook, ear buds and an extra AAA battery. The patient is encouraged to listen to it once in the morning and once in the evening in the days leading to surgery, to bring it along to have it during surgery preparation and recovery, and to bring it home to continue listening to it in the days after surgery.

On the audiobook, soft music and sounds of nature are played behind a soft, measured voice that instructs the listener to relax, close his eyes and breathe deeply. For about 20 minutes, the voice guides the listener through an idyllic, natural scene.

Like Mama's Fish House

Pohl, who considers himself a "Type A" personality and "wound pretty tight sometimes," said he was a little skeptical when the idea of guided imagery was presented to him, but he decided to give it a try.

The Playaway guided Pohl through two scenarios, he said, and both resonated with him. One was a beach scene, and it reminded him of the time he and his wife stopped at Mama's Fish House on the north coast of Maui.

The other scenario described a walk in the woods.

"You could hear the water running and the crunching of the pine needles under your feet, and it describes northern Minnesota," Pohl said.

Anderson had used guided imagery as a nurse and as a patient, when she had an operation two years ago. She approached Ann Watkins, the hospital's vice president of surgical services, suggesting a pilot program. She noted that the technique already was in use at major hospital systems, such as the Mayo Clinic and the Cleveland Clinic, and she cited supportive research.

One study, of 905 Blue Shield of California members, was published in the journal Advances in Mind-Body Medicine in the summer of 2007. Its authors found "significantly reduced anxiety and high levels of satisfaction" for patients who used guided imagery, a trend toward shorter hospital stays, reduced pharmaceutical costs and an overall average savings of $2,003 per procedure.

'Sense of control'

Watkins approved a pilot program, and St. Mary's gradually has rolled it out. It just started using it in neurosurgery, with cardiothoracic surgery and gynecology to come. The Playaways also are available for purchase in the hospital gift shop and pharmacies.

The focus, Anderson said, is on pain management and patient satisfaction. Research shows that, after death, the thing people fear most is surgery, she said. The theory is that someone in surgery feels a loss of control.

"So the beauty of the Playaway is that it offers you that internal sense of control," Anderson said. "It will diminish the stress hormones that are coursing through your body."

Pohl, who previously had undergone several operations without guided imagery, said he noticed a significant difference.

"Previous surgeries, you woke up and you hurt," he said.

As he recovered from the knee replacement, though, "when I was in my room, instead of watching TV, I'd plug (the Playaway) in and I'd take a nap," Pohl said. "I wouldn't have to call the nurse and say, 'I need a couple of Tylenol.' "

Patients can return their Playaways after surgery if they choose, but Pohl kept his. For one thing, he has surgery scheduled on his other knee in September. And he listens to it after he gets home if he has had a bad day at work.

"It relaxes me and just takes the whole stress level way down," Pohl said.