RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1. / Name of the candidate and address / SILPA BABYFIRST YEAR M. Sc. NURSING
CITY COLLEGE OF NURSING,
CITY ENCLAVE,
SHAKTHINAGAR,
MANGALORE – 575016.
2. / Name of the Institution / CITY COLLEGE OF NURSING,
CITY ENCLAVE,
SHAKTHINAGAR,
MANGALORE – 575016.
3. / Course of study and subject / M. Sc. NURSING
MEDICAL SURGICAL NURSING
4. / Date of admission to the course / 02.07.2011
5. / Title of the study
EFFECTIVENESS OF HAND AND FOOT MASSAGE IN REDUCING PAIN AMONG POSTOPERATIVE PATIENTS WHO HAVE UNDERGONE ABDOMINAL SURGERY IN SELECTED HOSPITALS AT MANGALORE
6. / Brief resume of the intended work
Introduction
Pain is multidimensional phenomenon and is thus difficult to define. It is a personal and subjective experience, and no people experience pain in exactly the same manner. It is not merely as a manifestation of a medical condition. Pain often leads to debilitation, diminished quality of life, and depression. Effective pain control is best achieved through a combination of both pharmaceutical and non-pharmaceutical therapies. Pharmaceutical management has been the primary means of providing relief from pain. Analgesics have maximum effective dose; increasing the dose cannot increase pain relief, but may increase side effects. Tolerance also may occur when larger doses of medicines are needed to provide the same amount of pain relief as the previous smaller dose. Although pharmaceutical medications continue to serve as a major contributor to pain management, non-pharmaceutical techniques are increasingly used to provide pain relief.1
6.1 Need for the study
Despite the availability of analgesic drugs and pain relieving techniques, pain remains a common problem and a significant fear for the patient during the postoperative period. The new emerging measures in pain management are complimentary therapies. The complimentary interventions include cutaneous stimulation, massage, cold and hot therapies, transcutaneous electrical nerve stimulation, distractions, relaxation techniques, guided imagery, and hypnosis.1
The prevalence of postoperative pain among abdominal surgery patients in a cross-sectional group of patients after day-case surgery showed that on the day of the operation, 26% of the patients had moderate to severe pain (defined as mean VAS >40 mm). Mean VAS-scores were greater than 40 mm in 21% on postoperative day (POD) 1, in 13% on POD 2, in 10% on POD 3, and in 9% on POD.2
A quasi experimental study was conducted to determine the effectiveness of reflexology (foot massage) in reducing pain in specific urology conditions of patients
admitted in Urology Ward, CMC Vellore in 2008. A sample of 30 patients was selected from the Urology Ward where patients underwent major and minor urological surgeries. Each patient was given 30-45 minutes of foot massage, pre- and post-assessment of pain was done using visual analogue scale, using a ten-point scale with scoring 0-10 and the interview schedule using a Likert scale with scoring 0-3. Results showed after foot massage the pain level of 19 patients (63.3%) were reduced from severe to moderate and for (6.6%) was reduced from moderate mild and for 9 patients (30%) it remained in same level. A significant difference between pre and post nursing intervention in reduction of pain for 30 samples (p<0.01). The study concluded that the foot massage is the best nursing intervention and it can be introduce into nursing curriculum as a best method of pain reduction.3
Massage is an extended form of touch which results in mutual energy exchange. It soothes pain and produces relaxation. It is the most widely used complementary therapy in nursing practice. It is one of the ways nurses use to communicate caring to patients and touch is central to the nurse’s role in healing. It increases pain thresholds and thereby modifies an individual’s perception of pain.4
An experimental study was conducted to find out the effect of foot and hand massage to decrease pain among postoperative patients who had undergone gastrointestinal, gynaecological, head and neck, plastic or urological surgery in a 39-bed unit at a large teaching hospital in the Midwest between May 1, 2000 and May 1,2001. A 20-minute foot and hand massage (5 minutes to each extremity), which was provided 1 to 4 hours after a dose of pain medication and the pain intensity and distress were measured using a 0 to 10 numeric rating scale in the modified brief pain inventory. The subjects reported decrease in pain intensity from 4.65 to 2.35 (t=8.154, p<0.001) and in pain distress from 4.00 to 1.88 (t=5.683, p<0.001). The study concluded that foot and hand massage appears to be an effective, inexpensive, low risk, flexible, and easily applied strategy for pain management.5
Throughout the history of pain management the strategies used have challenged the practitioners, scientists, and nurses in all health disciplines. Meeting this challenge is a worthy and human goal when one considers the incidence and enormity of the problem. The relief of pain and suffering is a major clinical problem faced in nursing practice. So it is nurse’s duty to help patients to overcome pain and make them comfortable.3
The researcher during her clinical experience had witnessed many postoperative patients with severe pain. The investigator felt that nurses are in a position to consider the offering of foot and hand massage as option in the management of acute postoperative pain. The technique can be easily learned and applied in clinical setting. This has motivated the researcher to take up this study.
6.2 Review of literature
An experimental study was conducted to test the impact of foot massage on the level of pain heart rate and blood pressure among patients with abdominal surgery at Father Muller Medical College Hospital from August 3, 2007 to August 29, 2007. Sample comprised 30 abdominal surgery patients selected by purposive sampling method. Pre-assessment pain intensity, heart rate, and blood pressure were recorded. Foot massage with low stroke manipulations was applied on each leg of the subject for 10 minutes. Pain intensity, heart rate, and blood pressure were recorded immediately after the intervention and again after 10 minutes. The result showed that there was a significant difference between pre- and post-foot massage pain score, heart rate, and blood pressure (P<0.05). The study concluded that foot massage is an effective non pharmacologic measures in reducing postoperative pain.6
A randomised controlled study was conducted to evaluate the effects of reflexotherapy (foot massage) on acute postoperative pain and anxiety among patients with digestive cancer in Taiwan over a 10 month period in 2005. Subjects were sixty-two Taiwan patients who had received surgery for gastric cancer or hepatocellular carcinoma. Subjects were randomly allocated to an intervention (n = 30) or control (n = 31) group. Patients in the intervention group received the usual pain management plus 20 minutes of foot reflexotherapy during postoperative days 2, 3, and 4. Patients in the control group received usual pain management. Results indicated that less pain (P<0.05) and anxiety (P<0.05) over time were reported by the intervention group compared with the control group. The study concluded that foot massage is an effective intervention in reducing postoperative pain and anxiety among patients with digestive cancer.7
Acute postoperative pain and anxiety affect post-surgery recovery, resulting in more complications, longer hospital stays, greater disability and potentially chronic pain.
Reflexotherapy is thought to relieve pain by transmitting afferent impulses and close the neural gates in the dorsal horn of the spinal cord thus blocking pain transmission. Foot and hand massage appears to be an effective, inexpensive, low-risk, flexible, and easily applied strategy for postoperative pain management.7
An experimental study was conducted to determine the efficiency of foot and hand massage on reducing postoperative pain among Turkish women in 2010. Subjects were 281 patients who had undergone caesarean section. Subjects were selected using random sampling method. The study found that the difference between numerical rating scores before and after massage (p<0.01) and Numerical Rating Scale scores before and 60 minutes after the massage (p<0.001) was statistically meaningful. The findings indicated that the pain intensity levels of the patients in the intervention group were significantly different than the control group. The study concluded that foot and hand massage were useful as an effective nursing intervention in controlling postoperative pain.8
A study was conducted to examine the effectiveness of reflexology on treatment for pain and anxiety on an inpatient oncology unit in a 314-bed hospital in the south-eastern United States in 2000. A total of 23 patients were included in the study with breast or lung cancer. Patients received 30-minute reflexology treatment and a 30-minute control without reflexology using a crossover design. The researcher administered the Visual Analogue Scale (VAS) for anxiety and the Short Form-McGill Pain Questionnaire (SF-MPQ) before and following both reflexology and control condition without reflexology. All subjects were receiving regularly scheduled opioids and adjuvant medications on both the control and intervention day. The study found that there was a significant decrease in pain in these patients following foot reflexology (p=0.048), as measured by the descriptive words of the SF-MPQ. In addition, there was a significant decrease in anxiety, as measured by the VAS for anxiety.9
Complementary strategies based on sound research findings are needed to aid in postoperative pain relief. The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects as cheaply as possible. Postoperative pain relief must reflect the needs of each patient and this can be achieved only if many factors are taken into account.10
A quasi-experimental study was conducted at S and E University Hospital, Korea, to identify the effects of foot reflexology on nausea, vomiting and fatigue on breast cancer patients undergoing chemotherapy from Jan. 26, to Mar. 20, 2004. The subjects consisted of 34 patients with 18 in the experimental group and 16 in control group. A pre-test and 2 post tests were conducted to measure nausea, vomiting and fatigue. For the experimental group, foot reflexology, which consisted of 4 phases for 40 minutes, was given by a researcher and 4 research assistants. The collected data were analysed by repeated measures like ANOVA and the SPSS WIN 10.0 programme. Results showed that there was a statistically significant decrease in nausea, and vomiting in the experimental group compared to the control group over two different times. In addition, there was a statistically significant decrease in fatigue in the experimental group compared to the control group over two different time . 11
Caring is nursing and nursing is caring (Leiniger, 1984). The relief of pain is always a matter of priority for nursing action. In fact, the nurse’s role in pain management is more than the other members in the healthcare team. Reflexology (foot massage) is a complementary therapy that has great potential for use by nurse in a multidisciplinary pain management programme. It is one of the few natural therapies to be adopted by health profession, especially by the nurses in the area of pain management. 3
An experimental study was conducted in a University Hospital in Seoul Korea on 40 patients who operated under G/A from July 7, 2000 to February 20, 2001 to investigate the effect of foot massage on pain in post-abdominal operative patients. Severity of pain was checked with VAS. Collected data were analysed using Chi square, Fisher’s Exact Test, and t-test. The study showed that severity of pain decreased significantly in the experimental group as compared to the control group following foot massage (t=-3.37, P=0.002). The PR in the experimental group was lower than that in the control group following foot massage (F=7.73,P=0.008). The SBP in the experimental group was lower than that in control group following foot massage (F=25.75, P=0.000).12
6.3 Statement of the problem
Effectiveness of hand and foot massage in reducing pain among postoperative patients who have undergone abdominal surgery in selected hospitals at Mangalore.
6.4 Objectives of the study
1. To determine the level of postoperative pain among patients who have undergone abdominal surgery after hand and foot massage (experimental group) as measured by visual analogue pain scale and pain objective assessment scale (prepared by the investigator).
2. To determine the level of postoperative pain among patients who have undergone abdominal surgery without hand and foot massage (control group) as measured by visual analogue pain scale.
3. To compare the level of postoperative pain among patients in experimental group and control group.
4. To find out the association of the level of postoperative pain among patients in experimental group and control group with selected demographic variables.
6.5 Operational definitions
Effectiveness: In this study, it refers to the extent to which hand and foot massage have impact on the reduction of pain shown by the postoperative patients who have undergone abdominal surgery as measured by visual analogue pain scale and pain objective assessment scale (prepared by investigator) .
Hand and foot massage: It is a complementary measure by which, each extremity will be massaged for 5 minutes. In this study, it refers to the method of giving friction to the palms, soles and dorsum of feet; using strokes with knuckles to palms and soles of the postoperative patients who have undergone abdominal surgery and are on the second postoperative day. The massage would include kneading with thumb near the heel; stretching the fingers and toes; squeezing the hands and feet.
Postoperative pain: In this study, it is the expressed response that patient perceives due to tissue trauma during surgery and it is aching in nature, ordinarily near the surgical site. The level of postoperative pain experienced by the patient who has undergone surgery is assessed
by a visual analogue scale which measures the amount of pain and pain objective assessment scale. Pain assessment is done on the second postoperative day.
Postoperative abdominal surgery patients: In this study, it refers to the individuals who have undergone surgical procedures that involve opening of abdomen under GA/SA. The common surgeries include appendectomy, spleenectomy, cholecystectomy, haemorrhoidectomy, hysterectomy, and caesarean section and who are on the second postoperative day.
6.6 Assumptions
· Level of postoperative pain differs from patient to patient.