RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGLORE
ANNEXURE-II
PROFORMAFOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 / Name of the candidate and address (in block letter) / BEULAH MAVISI YR M.SC NURSING
FATHER MULLER COLLEGE OF NURSING
MANGALORE-575002
2 / Name of the institution / FATHER MULLER COLLEGE OF NURSING
KANKANADY
MANGALORE-575002
3 / Course of study and subject / MSC.NURSING
PSYCHIATRIC NURSING
4 / Date of admission to course / 18TH JUNE 2009
5 / Title of the topic:
A COMPARITIVE STUDY TO ASSESS THE EFFECTIVENESS OF REFLEXOLOGY AND TWO MINUTE RELAXATION TECHNIQUE ON FATIGUE REDUCTION AND RELAXATION IN CLIENTS UNDERGOING HAEMODIALYSIS.
6 / Brief resume of the Intended work:
6.1 Need for the study:
Haemodialysis imposes a variety of physical and psychosocial stressors on patients with this disease which can affect patients physical functioning as well as their psychological reactions, including how they perceive their stress and how they cope with it1. Clients with ESRD who require maintenance haemodialysis often reported symptoms of fatigue and poor quality of life. Fatigue is viewed by health professionals as it is part of the disease process, thus fatigue is rarely treated medically2.
In India nearly 90,000 people develop ESRD every year. Chronic glomerulonephritis (37%), diabetic nephropathy (24%), chronic tubulointestetial disease (37%), and nephrosclerosis (13%) constitute the most frequent underlying disease. Polycystic kidney diseases represent4% of the incidence, and multisystem and miscellaneous conditions 8%3.
Most studies investigating the stressors faced by haemodialysis patients have found them to be both physiological and psychological stressors. The most common physiological stressors for these clients are limitation of fluid, limitation of food, fatigue, and sleep disturbance. The most common psychological stressors have been reported to include role disturbance, employment status, social support, stress and depression. Haemodialysis patients use various strategies to cope up with the stressors related to their disease and the procedures used in its treatment1.
People with a chronic illness especially ESRD often feel helpless in dealing with their disease. This sense of helplessness or loss of control often occurs when medical science does not have a curative treatment to offer2.
In recent days the use of complementary and alternative medicines has increased in conventional health care settings. Fear of medications side effects and desire for symptom relief are possible reasons for the increasing use of complementary alternative medicine by patients. With consumer interest in complementary, nurses have increasingly incorporated these modalities into their practice. For example reflexology has been widely used in fields such as midwifery, orthopaedics, neuroscience and palliative care4.
More than 170 studies of reflexology's effects have been conducted, with 95 controlled studies. 90% of the studies show a positive result5.
The investigator has come across many clients undergoing haemodialysis who are struggling to cope up with the various physiological as well as psychological stressors like stress and fatigue despite of these significant symptoms of the ESRD population, no interventional studies have addressed this problem. Hence keeping in view the above mentioned
Hence keeping in view the above mentioned facts in mind the investigator felt the need to develop and test interventions that effectively assist the clients in managing their fatigue and stress. This research is geared to deliver reflexology and relaxation technique and to investigate its effectiveness in reducing the stress and fatigue level among the clients undergoing haemodialysis.
6.2 / .
6.2 Review of literature
A study was conducted by Prosthetic Services, Malting Mobility Centre, England A same-subject, experimental pilot study, recording the intensity of phantom limb pain in weekly pain diaries over a 30-week period, which was divided into five phases: phase 1 gave a baseline of pain, whilst phase 3 was a resting phase. Phases 2, 4 and 5 provided the reflexology interventions Ten participants with unilateral lower limb amputations and phantom limb pain were selected from the database at the Prosthetic Centre six weekly reflexology treatments were given, which consisted of: full foot reflexology to the remaining foot and full hand reflexology to the hand of the amputated side of the body A follow-up questionnaire was carried out in 2007--12 months after the project had ended--to elicit whether the patients had suffered from phantom pain over the previous 12 months. The project indicated that reflexology treatment, teaching and self-treatment were effective in eradicating or reducing the intensity and duration of phantom limb pain, in this group of clients6.
A study was conducted by Complementary Medicine Clinic, Department of Orthopaedic Rehabilitation, Sheba Medical Centre, Tel-Has homer, Israel. Seventy-one MS patients were randomized to either study or control group, to receive an 11-week treatment. Reflexology treatment included manual pressure on specific points in the feet and massage of the calf area was given after 1.5 months of treatment, end of study and at three months of follow-up.: Fifty-three patients completed this study in the end results showed Specific reflexology treatment was of benefit in alleviating motor; sensory and urinary symptoms in MS patients7.
A study was conducted in College of Nursing, Taipei Medical University, Taiwan. : An experimental randomised controlled trial using repeated measures. The study was designed to examine the effects of progressive muscle relaxation training in reducing the anxiety of patients diagnosed with schizophrenia. Study participants were acute psychiatric inpatients in Taiwan. Eighteen patients were block randomised and then assigned to an experimental or control group. The experimental group received progressive muscle relaxation training and the control group received a placebo intervention. This study demonstrated that progressive muscle relaxation training can effectively alleviate anxiety in patients with schizophrenia. Relevance to clinical practice: Progressive muscle relaxation training is potentially an effective nursing intervention in the reduction of anxiety in patients diagnosed with schizophrenia, depending on the quality of their mental status at the time of intervention. Progressive muscle relaxation training is a useful intervention as it is proven to reduce anxiety levels across a spectrum of psychiatric disorders8.
A study was conducted by Ege University Nursing School, Izmir, Turkey. To determine the effect of progressive muscle relaxation training (PMRT) on anxiety levels and quality of life (QoL) in dialysis patients A total of 46 patients who had been treated with dialysis in the Dialysis Centre of Ege University Medical Faculty Hospital were recruited. Data were collected by means of a questionnaire. Patients' Recognition Form (PRF), State and Trait Anxiety Inventory (STAI), and QoL-index for dialysis patients (QoLI-dialysis) were used to collect the necessary data. All three forms were utilise The results of the study demonstrate that PMRT for dialysis patients helps decrease state- and trait-anxiety levels and has a positive impact on QoL9.
A study was conducted by National Taipei College of Nursing, Graduate Institute of Nursing Taiwan. investigating the effectiveness of an adaptation training programme (ATP) to help patients with end-stage renal disease (ESRD) to cope with illness-related stresses and, thus, to alleviate depression and improve quality of life The study was a randomized controlled trial using a convenience sample of 57 eligible, fully informed and consenting patients with ESRD who were assigned to experimental (ATP plus usual care) or control (usual care) groups .This showed the effectiveness of an ATP to decrease stress and depression levels, and to improve the quality of life of ATP patients receiving haemodialysis10.
. 6.3 Statement of the Problem:
A comparative study to assess the effectiveness of reflexology and two minute relaxation technique on fatigue reduction and relaxation in clients undergoing haemodialysis.
6.4 Objectives of the study:
1. To determine the level of relaxation and fatigue among clients undergoing haemodialysis before and after introduction of reflexology.
2. To determine the level of relaxation and fatigue among clients undergoing haemodialysis before and after introduction of two minute relaxation technique.
3. To compare the effectiveness of reflexology and two minute relaxation technique on fatigue reduction and relaxation.
4. To determine the association between selected demographic variables and fatigue reduction and relaxation.
6.5 Operational definitions:
1. Effectiveness:
2. It means the extent to which an action produces an intended outcome11.
In this study effectiveness refers to the extent to which practicing reflexology and two minute relaxation technique has achieved the results as expressed in terms of reduction in post test stress and fatigue level of patients undergoing haemodialysis.
Reflexology:
Reflexology is the physical act of applying pressure to the feet and hand with specific thumb, finger and hand techniques without the use of oil or lotion. it is based on a system of zones and reflex areas that reflect an image of the body on the feet and hands with a premise that such work effects a physical change to the body12. (The Complete Guide to Foot Reflexology (Third Edition) by Barbara and Kevin Kunz)
In this study reflexology refers to a non medical form of treatment in which specific spots on the surface of the body, usually on the soles or the palms of the clients undergoing haemodialysis are methodologically pressed with a view to suitably influence the internal organs of the body to bring about a state of deep relaxation, stimulate body’s own healing process and help the client to return to a state of balance and well being.
3. Two minute relaxation technique:
4. It is a simple mind and body relaxation technique which can be done in two minutes and gives an experience of instant stress relief at work, at home or anywhere and results in relaxation of the body13.
In this study it is a kind of time bound relaxation technique, where the nurse teaches the client to relax and breathe in using the diaphragm and explains him to allow the breath to reach the bottom of the lungs and let the chest and shoulders relax. The stress level of the patient is measured by a stress rating scale before and after introduction of this relaxation technique.
Relaxation
5. Relaxation means decrease in intensity of distress resulting in refreshment of the body and mind, a state of refreshing tranqulity.11
6. In this study relaxation state is assessed after delivering the reflexology and two minute relaxation technique interventions as personal expression to relaxation scale. Mental and physical relaxation a expressed by the clients on the self expressed relaxation rating scale and graded as no-relaxation, mild, moderate and minimum relaxation as per the score obtained by the subjects.
7.
Fatigue:
It can be defined as a subjective state in which an individual experiences a sustained sense of exhaustion and diminished capacity for physical and mental work that is not relived by rest11
In this study fatigue is considered as an unusual sense of tiredness which is usually not relieved by either good night’s sleep or by rest.
8. Clients:
9. An individual who is receiving needed professional services that are directed by a licensed practitioner of the complimentary therapies towards maintenance, improvement or protection of health or lessening of illness, disability or pain14.
In this study clients refer to those are diagnosed with ESRD and undergoing haemodialysis twice in a week within the age group 18-65yrs.
6.6 Assumptions
· Fatigue is a relative term and it will be experienced by different persons in different ways
· Patients who are undergoing haemodialysis will be experiencing some level of fatigue.
· Alternative therapies will help to reduce fatigue and enhance relaxation of these patients.
6.7 Delimitations
The study will be limited to patients who are undergoing haemodialysis of Father Muller Medical College and Hospital at the time of data collection.
6.8 Hypotheses
H1- The mean post interventional fatigue score of reflexology group and two minute relaxation group will be significantly lower than the mean pre test fatigue score.
H2- The mean post interventional relaxation score of reflexology group and two minute relaxation group will be significantly higher than the mean pre test relaxation score.
H3- There will be significant difference in the mean post interventional fatigue and relaxation score of reflexology group and two minute relaxation technique group.
7. Material and Methods
7.1 Source of data
Clients undergoing haemodialysis twice in a week at the dialysis unit of Father Muller Medical College hospital, Mangalore.
7.1.1 Research design
Pre Experimental research design(two group pre test post test design)
7.1.2 Setting
The study will be conducted in the dialysis unit of Father Muller Medical College Hospital; Mangalore which is a multi-speciality hospital with bed strength of 1050.Dialysis unit has bed strength of 12 and a monthly admission of approximately 80 clients including both in-patients and out-patients.
7.1.3 Population
Patients who are undergoing haemodialysis twice in a week in selected hospital at Mangalore
7.2 Methods of data collection
7.2.1 Sampling procedure
Purposive sampling
7.2.2 Sample size
Patients-50
7.2.3 Inclusion criteria for sampling
1. Clients willing to participate in the study.
2. Clients undergoing haemodialysis aged between 18 -65years.
3. Clients who are undergoing haemodialysis once in a week.
4. Clients who know to read and write Kannada and English.
7.2.4 Exclusion criteria
1. Patients incapable of giving an informed consent.
2. Physical condition that preclude participation.
3. Clients with lower extremity amputation (for reflexology group).
4. Clients who have hearing impairment (for two minute relaxation technique).
5. Patients who are seriously sick or unconscious.
7.2.5 Instruments intended to be used
1. Baseline Proforma
2. Self expressed Relaxation rating scale
3. Modified Piper Fatigue scale
7.2.6 Data collection method
The investigator will obtain permission from the concerned authority of the hospital and dialysis unit. Informed consent will be taken from the subjects. The investigator will administer the self expressed relaxation rating scale and modified Piper fatigue scale to the patients of group 1 and group2 before the intervention. The intervention will be given for 10-15 minutes in each session at the end of every session the post interventional fatigue and relaxation rating scale will be administered and results will be analysed.
7.2.7 Data analysis Plan
Descriptive statistics
Collected data will be analyzed by descriptive statistics such as mean, standard deviation, frequencies and percentages.
Inferential statistics
To evaluate the effectiveness of the reflexology and two minute relaxation technique by using‘t’ test and chi square for finding the association between relaxation, fatigue and selected variables.
Collected data will be presented by tables and diagrams.
7.3 Does the study require any investigations/interventions to be conducted on patients or the human or animal? If so please describe briefly.
Yes, the investigator will be administering the relaxation rating scale and modified Piper fatigue scale
to the clients undergoing haemodialysis.
7.4 Has the ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance will be obtained
List of references:
1. Yeh SJ, Huang C and Chou H. Relationship among coping co-morbidity & stress in patients having haemodialysis. J Adv Nurs 2008 Feb 29; 63(2): 166-74.
2. Tsay S, Chen M. Acupressure & quality of sleep in patients with end-stage renal disease- a randomised controlled trial. Int J Nurs Stud 2003; 40:1-7.
3. Logan S, Pelletier M, Hodgies M. Stressors and coping in hospital haemodialysis patients. J Adv Nurs. 2006 Nov;56(4):382-91.
4. Wang M, Tsai P, Chang W, Lee P and Yang C. The efficacy of reflexology: systematic review. J Adv NurS 2008 Jan; 62(5): 512-20.
5. Reflexology research projects. [Online].2009. [Cited on 07.04.2009]. Available from: URL: http://www.reflexology-research.com/Abstracts.html
6. Brown CA, Lido C. Reflexology Treatment for Patients with Lower Limb Amputations and Phantom Limb Pain;Compliment Ther Clin Pract 2008 May;14(2):124-31
7. Siev NI, Gamus D, Lerner GL, Archiron A.Reflexology treatment relieves symptoms of multiple sclerosis; A randomized controlled study.Mult Scler 2003 Aug;9(4):356-61.
8. Chen WC, Chu H, Lu RB, Chou YH, Chen CH, Chang YC, O’Brien AP, Chou KR.Efficacy of Progressive Muscle Relaxation Therapy in reducing anxiety in patients with acute schizophrenia; J Clin Nurs 2009 Aug;18(15):2187-96.
9. Yildirim YK, Fadiloglu C. Efficacy of Progressive Muscle Relaxation Therapy in reducing anxiety levels & quality of life in dialysis patients; Int J Nurs Stud 2004 Jan;41(1):99-106.
10. Tsay S, Chain Y, Lee Y. Effects of adaptation training programme for patients with end-stage renal disease. J Adv Nurs 2005; 50(1): 39-46.
11. Dorland’s illustrated medical dictionary. 28th ed.Philadelphia: W. B. Saunders Company;1989.
12. Barbara, Kunz K. The Complete guide to Foot reflexology.3rd ed.London. Prentice Hall company;1982
13. Benson, K. The relaxation response.6th ed. New York. Morrow Books;1975-1976
Manual of Nursing Practice.8th ed. Philadelphia: Lippincott Wilkins and Williams publication;1996
9 / Signature of the candidate
10 / Remarks of the guide
11 / Name & Designation of
(in block letters)
11.1 Guide / MRS.CHANU BHATTACHARYA M.SC. (N)
PROFESSOR
PSYCHIATRIC NURSING
FATHER MULLER COLLEGE OF NURSING
MANGALORE
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature
12 / 12.1 Head of the Department / MRS.CHANU BHATTACHARYA M.SC. (N)
HEAD OF THE DEPARTMENT
PSYCHIATRIC NURSING
FATHER MULLER COLLEGE OF NURSING
MANGALORE
12.2 Signature
13 / 13.1 Remarks of the Chairman and Principal
13.2 Signature
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