Peri-Procedural Reiki Procedure Note (Pre/Post-Procedure)

Date and time of session: [Date and time]

Location/setting: [pre-op holding / procedure room / PACU / infusion suite / other: specify]

Primary procedure name: [Procedure name / Procedure not specified in chart at time of note]

Timing relationship to procedure: [Pre-procedure / Post-procedure / Peri-procedure] — [Temporal anchor]

Practitioner: [Name], [Credentials] — Reiki training level: [Level I / Level II / Master / Not specified]

Indication

[Patient-centered reason for session] (State the symptom being addressed—anxiety, procedural distress, pain, nausea, or request for relaxation support—and the source of the request: patient, nursing, consult order, integrative service rounding, or family. Frame the goal as supportive care. Keep to 1–2 sentences using neutral language without implying physiologic effects.)

Consent and Preferences

• Verbal consent: [Obtained / Not obtained — session deferred: reason]
• Touch preference: [hands-on light touch / hands-off/hovering / distance]
• Areas to avoid: [List areas to avoid / None specified]

(If consent not obtained, end the note after documenting rationale; omit subsequent sections.)

Procedural Constraints

[Patient positioning and environmental factors affecting session] (Briefly note position, devices/lines present, presence of sterile field, and constraints requiring technique modification. Keep factual and concise.)

Baseline Symptoms

• Anxiety (0–10): [Score / Not assessed: reason]
• Pain (0–10): [Score / Not assessed: reason]
• Nausea (0–10): [Score / Not assessed / Not relevant]
• Overall comfort (0–10): [Score / Not assessed] (Optional)

(Note any recent medications or sedation that may affect comparison. If time constraints prevented obtaining scales, document reason.)

Intervention

[Reiki session details] (Specify technique type: hands-on light touch, hands-off/hovering, or distance. Include start time, end time, and total duration in minutes. Describe general hand placement approach or state "standard sequence adapted to constraints." Note specific modifications due to procedural restrictions. Document any adjuncts used such as breath coaching, guided imagery, or environmental modifications. Note any interruptions and how session was resumed or concluded. Use neutral, observable descriptions; do not include unverifiable internal states or physiologic claims.)

Response

• Post-session anxiety (0–10): [Score / Not obtained: reason]
• Post-session pain (0–10): [Score / Not obtained: reason]
• Patient-reported comment: [Brief quote / Not provided]
• Observed response: [Observable behaviors] (Use neutral descriptions such as relaxed facial expression, slowed breathing, decreased restlessness, fell asleep, or no observable change.)
• Tolerance/adverse events: [tolerated well / dizziness / emotional release / session stopped early: reason]

(If post-session ratings could not be obtained, state reason and provide observable response only. Document neutrally if no improvement occurred.)

Disposition

Immediate disposition: [Disposition] (e.g., transported to procedure, remained in pre-op, remained in PACU, discharged)

Follow-up plan: [Plan / None] (e.g., offer additional session, coping strategy provided, notification to primary team if distress remains elevated)