Rajiv Gandhi University of Health Sciences Karnataka, Bangalore s16

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address SREERAJ.R.K FIRST YEAR M.Sc. NURSING K.PANDYARAJAH BALLAL NURSING INSTITUTE, COLLEGE OF NURSING, SOMESHWARA ROAD, ULLAL MANGALORE- 575 020. K.PANDYARAJAH BALLAL 2. Name of the Institution NURSING INSTITUTE,COLLEGE OF NURSING, SOMESHWARA ROAD, ULLAL, MANGALORE- 575 020.

3. Course of study and subject M. Sc. NURSING MEDICAL SURGICAL NURSING

4. Date of admission to the course 10.05.2010

5. Title of the study: “ EFFICACY OF HAND AND FOOT MASSAGE IN PAIN REDUCTION AMONG POST-CAESAREAN WOMEN IN SELECTED HOSPITALS OF MANGLORE”.

1 6. BRIEF RESUME OF THE INTENDED WORK Introduction

“Pain is an elusive and complex phenomenon, and despite its universality its exact nature remains a misery”

Pain is a multi faceted phenomenon. It is an individual unique experience. Which may be difficult to describe or explain and often difficult for others to recognise, understand and assess the pain. This often led to debilitation, diminished quality of life and depression. Pain management challenges every health team members as there is no single universal treatment1.

Pain is much more than a physical sensation caused by a specific stimulation. The pain experience is a complex feeling involving physical, emotional and cognitive components. Pain is subjective and highly individualised. The stimulus for pain can be physical and or mental in nature2.

6.1 Need for the study

Surgery can lead to many problems like pain, anxiety, nausea and vomiting. Among these, pain is the major post-operative problem. Physiological responses to pain create harmful effects that prolong the body’s recovery after surgery3. Post operative pain is poorly controlled by pharmacological means alone4. 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. Complimentary strategies based on sound research findings are needed to aid in post operative pain relief, along with pain medications5.

A study was conducted in Midwest using pre-test post-test single group design to find out the effect of foot and hand massage to decrease pain among post-operative patients who had undergone gastrointestinal, gynaecological, head and neck, plastic or urological surgery. The subjects reported 56% decrease in pain intensity from 4.65 to 2.35 on numeric rating scale (NRS)6.

2 The investigator during his clinical experience observed that most of the postoperative patients rely on analgesics for pain relief. Women, who undergo caesarean section, cannot be given analgesics very often for pain control, as large doses may affect the newborn. The investigator felt that some complimentary therapy is also needed for post operative pain reduction. Studies support that hand and foot massage is effective in reducing pain among postoperative patients, hence the researcher decided to conduct this study.

6.2 Review of Literature

An experimental study, conducted among Turkish women to determine the efficiency of foot and hand massage on reducing post-operative pain in 281 patients who had undergone caesarean section using Random sampling method, 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. Although pain intensity score was 4.36+1.70 in the initial measurement, it showed increase to 5.20+1.11,90 minutes later7.

An experimental study was conducted using a pre-test, post-test study design, in which a 20 minutes foot and hand massage (5minutes to each extremity) was given among post-operative patients after 1-4 hours of pain medication. Pain perception and sympathetic responses among post-operative patients were assessed. A convenience sampling of 18 patients rated pain intensity using a 0-10 numeric rating scale. The study reported that there was decrease in the intensity of pain from 4.05 to 2.38 (t =8.154, p<0.001). Statistically there was a significant decrease in sympathetic responses to pain, heart rate and respiratory rate8.

A non-equivalent control group, pre-test post-test design study was conducted in a university hospital in Seoul Korea on forty patients who were operated under General Anaesthesia from 7th July, 2000 to 20th Feb, 2001 to investigate the effects of foot massage on pain in post abdominal operative patients. Severity of pain was checked with Visual Analogue Scale and was measured with pulse rate, Systolic BP and Diastolic BP. Controlled data were analysed by the chi-square, Fischer’s exact test, t-test and repeated measures ANOVA. The severity of pain decreased significantly in experimental group as compared to

3 control group (f=7.73, P=0.008). The Systolic BP in experimental group was lower than that in control group following foot massage. (f=25.75, P=0.001)9.

An evaluatory study was conducted to assess the effect of foot massage on the patient’s perception of care following laparoscopic sterilization in England (1999).The data was assessed by using numerical rating scale. A significant difference was found in the scores obtained over time (P=0.038); experimental group consistently reported less pain than the control group. A significant overall decrease in pain intensity over time was observed in experimental group10.

A randomized controlled trial was conducted in 2004-05 in Norway to evaluate the impact of foot massage and guided relaxation following cardiac surgery using a qualitative design in 30 hospitalised women. Data were collected using semi-structured interview and numeric pain rating scale. There was significant change on all the psychological variables like pain, anxiety and tension11.

6.3 Statement of the Problem Efficacy of hand and foot massage in pain reduction among post-caesarean women in selected hospitals of Mangalore.

6.4 Objectives Objectives of the study are to:

1. determine the level of pain among control group and experimental group.

2. evaluate the effect of hand and foot massage on level of pain in experimental group.

3. compare the level of pain between control group and experimental group.

6.5 Operational definitions

1. Efficacy: in this study ‘efficacy’ refers to the extent to which hand and foot massage

4 technique reduces the post-caesarean pain as measured by the pain scale.

2. Hand and foot massage: It is a complementary measure by which, each extremity will be massaged for 5 minutes using liquid paraffin to reduce friction.

In this study ‘massage’ 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 post- caesarean women; kneads with thumb near the heal; stretches the fingers and toes; squeezes the hands and feet of post caesarean women.

3. Pain: In this study pain refers to unpleasant sensation experienced by women after caesarean section as measured by using short form Mc Gill pain questionnaire.

4. Post-caesarean women: In this study it refers to the women after 4 hours of caesarean section to 24 hours.

6.6 Assumptions The study assumes that:

1. all the post-caesarean patients will have some amount of pain.

2. massage is a complimentary measure that will effectively reduce the pain. 6.7 Delimitations The study is delimited to:

1. women who had undergone caesarean section after 4hours and within 24 hours of surgery in selected hospitals of Mangalore.

2. women who are willing to participate.

6.8 Hypothesis

H1: There will be a significant reduction in the intensity of pain in the women who receive hand and foot massage than those who have not.

7. MATERIALS AND METHODS

7.1 Sources of data Women who have undergone caesarean section after 4hours within 24 hours of

5 surgery from the selected hospitals of Mangalore.

7.1.1 Research design Pre experimental design with two group pre test and post test.

G1 = O1 X O2 O3

G2 = O4 -- O5 O6

G1 = Experimental group

G2 = Control group

O1, O4= Assessment of pain before intervention.

X = Hand and Foot massage for 5 minutes in each extremities.

O2 = Assessment of pain after 5 minutes of hand and foot massage.

O3 = Assessment of pain after 60 minutes of hand and foot massage.

O5 = Assessment of pain after 25 minutes of pain assessment.

O6 = Assessment of pain after 80 minutes of initial pain assessment.

7.1.2 Setting The study will be conducted in the postoperative wards of selected hospitals of Mangalore.

7.1.3 Population Women who have undergone caesarean section in selected hospitals of Mangalore.

7.2 Method of data collection

7.2.1 Sampling procedure Purposive sampling technique will be used to select the sample.

7.2.2 Sample size 40 women who have undergone caesarean section, 20 in experimental group and 20 in control group.

7.2.3 Inclusion criteria

6 Post Caesarean section women.

7.2.4 Exclusion criteria

 Women who are not willing to participate

 Women who have damaged tissue and skin, inflammation, eczema on their hands or feet.

 Women who have cardiovascular, respiratory or musculoskeletal disorders.

 Women who have received analgesics within 4 hours

7.2.5 Instruments intended to be used  Base line Proforma.  Short form McGill pain questionnaire.

7.2.6 Data collection method Prior to the data collection, permission will be obtained from the institution authorities for conducting study. Subjects will be selected according to the selection criteria. Informed consent will be obtained from the subjects prior to the study. The pre-intervention pain intensity will be measured after 4 hours and within 24 hours of surgery using short form Mc Gill pain questionnaire. Hand and Foot massage will be provided for 20 minutes (5minutes in each extremity). The post test will be conducted using same questionnaire at 5 minutes and at 60 minutes after hand and foot massage. Pain intensity assessment of the control group will be measured at 25 minutes and 80 minutes after initial pain assessment.

7.2.7 Data analysis plan Data will be analysed as follows:  Level of pain will be assessed by using mean, median, standard deviation and mean percentage.  The differences between mean pre-test and post-test scores are calculated by using ANOVA among control and experimental group.

7  t- test will be used to compare the effect of hand and foot massage in pain reduction between experimental group and control group.  Data will be presented in the form of frequency tables and diagrams.

7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals?

Yes, hand and foot massage will be given to post-caesarean women.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, the ethical clearance has obtained from the ethical committee of K Pandyarajah Ballal Nursing Institute.

8. BIBLIOGRAPHY

1. Black MJ, Hawks JH, Keene AM.Medical surgical nursing clinical management for positive outcomes. Philadelphia: WB Saunders; 2001 P 329-30. 2. Potter PA, Perry AG Basic Nursing Essential for practice. 5thed.Noida: Mosby;2003. P 438-39. 3. Wikipedia foundation. Surgery [home page on Internet]. Share alike licence; [updated 2010 Nov 29]. Available from: http://en.wikipedia.org/wiki/surgery 4. Wang HL, Keck JF. A test of foot and hand massage to decrease pain among post- operative patients. J pain management Nurs. 2004 Jun;5(2): 59-65. 5. Black MJ, Howks JH. Medical Surgical nursing. 5thed. Philadelphia: Elsevier; 2007. P 238-39 6. Verginia Henderson International Nursing Library. The effect of foot and hand massage to decrease the pain among post operative patients [home page on internet]. Midwest: Vergina Henderson International Nursing Library;[cited 2002 Mar] Available from: http://www.nursinglibrary.org/portal/main.aspx/pageid=4024&pid

8 7. John KY, James TR. Efficiency of foot and hand massage in reducing post operative pain. J Applied Nursing Research. 2010 Nov;23(2): P 31-34. 8. Kooper J, Mariet C. Pain perception and sympathetic responses among post-operative patients. Pain Manag Nurs. 2004 Jan;5(2):59-65. 9. Shelten K. Waltson Z. Effect of foot massage on pain in post-operative patients. Asian Journal of Cardio Vascular Nursing 2006 Jan 14(2): 13-8. 10. Hulme J,Waterman H,Hitler VF. The effect of foot massage on patient’s perception of care following laparoscopic sterilization as day case patients. Journal of Advanced nursing 1999 Jan;30(2):460-8. 11. Hattan,J King L,Griffiths P. The impact of foot massage and guided relaxation following cardiac surgery, a randomised control trial. Issues and innovations in nursing practice. Journal of advanced nursing. 2002 Dec; 37(2);199-206.

9 9 Signature of the candidate

10 Remarks of the guide The study is feasible and recommended.

11 Name & Designation of MRS.KANUMILLI VISALAKSHI ASSOCIATE PROFESSOR (in block letters) K.P.B.N.I; COLLEGE OF NURSING, 11.1 Guide ULLAL, MANGALORE-575 020

11.2 Signature

11.3 Co-guide (if any) MISS.KAINI CECILIA LECTURER; K.P.B.N.I; COLLEGE OF NURSING, ULLAL, MANGALORE-575 020 11.4 Signature

MRS.KANUMILLI VISALAKSHI 12 12.1 Head of the Department ASSOCIATE PROFESSOR K.P.B.N.I; COLLEGE OF NURSING, ULLAL, MANGALORE-575 020

12.2 Signature

13 13.1 Remarks of the Chairman and Principal

13.2 Signature