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Abstract

Touch therapy for human being is a wonderful and therapeutic gift in this era of continuous stress, tension and sickness. Massage is an art of touch with bare hands. It is considered as an important therapy in Indian system of Medicine for pain, muscle pull and some of the orthopaedic conditions and especially in palliative care. Considering the importance of touch in nursing and incorporating cheap and acceptable complementary therapies is essential for broadening the scope of nursing.Aim: To assess the effectiveness of slow stroke back massage on quality of sleep among patients admitted in ICU. Material and Methods: A study was conducted using non-equivalent pre-test post-test control group design in the year 2011 -12. .60 samples, between age group of 25 to 70 years were selected and divided into two groups, control group and experimental group. The quality of sleep of all the samples was assessed by Modified Groninger's sleep quality assessment scale and recorded with checklist. After routine night nursing care, the intervention was done for 10 to 12 minutes on experimental group and the control group was not given massage. This was done for three consecutive nights and every morning quality of sleep of all the samples was assessed and recorded. Findings: The majority of the samples were exposure to massage therapy. However due to sickness and environment in ICU they were not able enjoy quality sleep. The massage therapy was helpful in inducing sleep and improving the quality of sleep. CONCLUSION: There were significant differences on the quality of sleep before and after slow stroke back massage. This shows that there was gradual improvement in the sleep quality after back massage on 3 consecutive days. The back massage has effect on quality of sleep among ICU patients.
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Volume 3 Issue 3, March 2014
www.ijsr.net
Effectiveness of Slow Back Massage on Quality of
Sleep among ICU Patent’s
Mahadeo B Shinde1, Shabana Anjum2
1Professor, Krishna Institute of Medical Sciences Deemed University’s
Krishna Institute of Nursing Sciences Karad (M.S.) India 415539
2Professor and Head Deparment of Medical Surgical Nursing
Jabalpur Institute of Nursing Sciences and Research, Jabalpur (M.P.) India
Abstract: Touch therapy for human being is a wonderful and therapeutic gift in this era of continuous stress, tension and sickness.
Massage is an art of touch with bare hands. It is considered as an important therapy in Indian system of Medicine for pain, muscle pull
and some of the orthopaedic conditions and especially in palliative care. Considering the importance of touch in nursing and
incorporating cheap and acceptable complementary therapies is essential for broadening the scope of nursing.Aim: To assess the
effectiveness of slow stroke back massage on quality of sleep among patients admitted in ICU. Material and Methods: A study was
conducted using non-equivalent pre-test post-test control group design in the year 2011 -12. .60 samples, between age group of 25 to 70
years were selected and divided into two groups, control group and experimental group. The quality of sleep of all the samples was
assessed by Modified Groninger’s sleep quality assessment scale and recorded with checklist. After routine night nursing care, the
intervention was done for 10 to 12 minutes on experimental group and the control group was not given massage. This was done for
three consecutive nights and every morning quality of sleep of all the samples was assessed and recorded. Findings: The majority of the
samples were exposure to massage therapy. However due to sickness and environment in ICU they were not able enjoy quality sleep.
The massage therapy was helpful in inducing sleep and improving the quality of sleep. CONCLUSION: There were significant
differences on the quality of sleep before and after slow stroke back massage. This shows that there was gradual improvement in the
sleep quality after back massage on 3 consecutive days. The back massage has effect on quality of sleep among ICU patients.
Keywords:Massage therapy, Quality of sleep
1.Introduction
Sleep is a behavioral state characterized by the temporary
suspension of the state of watchful consciousness. Sleep and
rest are basic human needs essential to all individual’s
physical and psychological well-being. About one third of
our lives spent in sleeping. The purpose of sleep is a
mystery; however it is necessary to health and a sense of
well-being. A lack of sleep will quickly cause irritability,
grogginess, the inability to make decisions or follow through
with cognitive functions. It will cause hallucinations, dozing
off during activities and even throughout the day, etc. A
continued lack of sleep can contribute to weight gain,
anxiety, depression, lethargy and fatigue. These
inevitabilities clearly show the importance of sleep.
Although one day of sleep deprivation is not fatal, it will
indeed cause alterations in mood, physical well-being, and
overall cognitive function. Severe sleep deprivation can
ultimately lead to death. There are several measures like
massage therapy, music therapy, pharmacotherapy, bright
light therapy, behavior therapy and Yoga etc. to treat
sleeplessness, of which the therapeutic massage is
considered one of the effective methods used to induce
sleep.
Therapeutic massage is an ideal way to deal with stress and
health disorders naturally. A massage provides both physical
and emotional wellness. The massage sessions can vary from
single sessions to a regular massage for a short span, over a
period of time. Therapeutic massage is usually rendered to
treat certain health conditions, boost overall immunity or as a
distressing mechanism. Therapeutic massage provides varied
benefits such as improved blood circulation, release of
endorphins that reduce pain, speedy recovery from injuries
or chronic illness and improvement in sleep [1].
Therapeutic massage employs various features such as use of
essential or aromatherapy oils, different types of strokes and
massage technique to help the person receiving the massage
achieve the expected benefits from massage. Massage
techniques vary from a single type to a combination of
different strokes. The key movements in massage are
effleurage (stroking), petrissage (kneading), percussion, and
friction and vibration techniques to relieve the stressed
muscles. [1]
The three main physical effects of therapeutic massage are
release of muscle tension, increased blood circulation and
initiation of relaxation response. The release of muscle
tension will improve balance and co-ordination, resulting in
more restful sleep and lesser the need for pain medication.
The increased circulation will improve nutrition to the
tissues and will remove waste products from tissues, reduce
swelling, improve skin tone, and relieve dryness and itching
and favours speedy healing etc. Therapeutic massage is an
ideal way to deal with stress and health disorders naturally.
A massage provides both physical and emotional wellness.
The massage sessions can vary from single sessions to a
regular massage for a short span, over a period of time.
Therapeutic massage is usually rendered to treat certain
health conditions, boost overall immunity or as a distressing
mechanism. Therapeutic massage provides varied benefits
such as improved blood circulation, release of endorphins
that reduce pain, speedy recovery from injuries or chronic
illness and improvement in sleep.
Paper ID: 020131124
292
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Volume 3 Issue 3, March 2014
www.ijsr.net
2.Need of the Study
Sleep disruption has been recognized as a complication of
acute. It is characterized by reduced nocturnal sleep
efficiency and altered sleep architecture with increased
wakefulness and stage 1 Non–Rapid Eye Movement
(NREM) sleep, together with reduced slow wave and rapid
eye movement (REM) sleep. Sleep disruption in critically ill
and mechanically ventilated patients may have a multi
factorial cause. Acute illnesses are associated with abnormal
sleep architecture. The ICU environment, in which loud
noises and frequent care-related interruptions are prevalent,
may interfere with continuity of sleep. Medications
commonly prescribed for patient comfort also have marked
effects on sleep. It is possible that dyssynchronous patient–
ventilator interactions may result in sleep disruption.[2]
Stressors experienced by hospital patients include excessive
noise, lack of sleep, social isolation, enforced immobility,
and pain from procedures. Anxiety and stress during cardiac
catheterization can lengthen the hospital stay and increase
the use of sedative medication before and during the
procedure [3]. Hamel’s did a randomized clinical trial with
46 participants demonstrated that a 20-minute back massage
successfully reduced blood pressure before cardiac
catheterization and improves sleep [4]. When patients have
higher postoperative mobility due to massage, they may also
have fewer serious postoperative complications, as
demonstrated by Mitchinson and his colleagues in a
randomized controlled trial of 605 veterans undergoing
major surgery at Department of Veterans Affairs hospitals.
[5]
Massage therapy can produce a reaction response that
creates a calm state and enhances the ability to rest, qualities
that are so essential for healing to occur. [6] “The majority
of studies show that back massage induces a physiological or
psychological relaxation response and that it is not injurious
for critically ill patients with heart disease”. [7] Massage
therapy is becoming more widely accepted in the medical
community as a credible treatment for many types of back
pain and insomnia and/or as an adjunct to other medical
treatments. Research shows that massage therapy has several
potential health benefits for back pain sufferers, including
increased blood flow and circulation, which brings needed
nutrition to muscles and tissues. This aids in recovery of
muscle soreness from physical activity or soft tissue injury
(such as muscle strain) and decreased tension in the muscles.
This muscle relaxation can improve flexibility, reduce pain
caused by tight muscles and even improve sleep. Increased
endorphin levels--the "feel good" chemicals in the brain.
This mood enhancer can ease depression and anxiety, which
can help reduce pain and speed recovery--particularly
important for those suffering from chronic back or neck
problems [8].
Another study shows how critically ill patients reported
having improved sleep patterns, both in the quality and
quantity of sleep, due to slow stroke back massage compared
to those who received only relaxation exercises. Many
people report that they have much deeper and more restful
sleep after receiving a massage or reflexology session [9].
Superficial stroking is reported to stimulate and relax mood,
relieve anxiety, reduce muscle tension and facilitate
regression of sensory analgesia. Stroking is often used as an
introductory or closing technique during a massage routine.
Its effect on arousal in reportedly dependent upon the speed
of the stroke: a slow stroke may have a more relaxing effect
whereas a fast stroke tends to stimulate [10].
One particular method of superficial stroking is known as the
slow stroke back massage. The slow stroke back massage is
a specific nursing protocol which consists of slow, gentle,
rhythmical strokes using two hands simultaneously over the
client approximately 5 centimeter out from the spine, from
the crown of the head to the sacral area and has been used in
nursing care since the mid 1960s. Several studies have used
slow stroke back massage and have found it to be a
successful nursing intervention for promoting relaxation and
thus promoting sleep [11].
3.Review of Literature
3.1 Studies related to insomnia in critically ill patients
They concluded that sleep, as it is conventionally measured,
was identified only in a subgroup of critically ill patients
requiring mechanical ventilation and was severely disrupted.
They proposed specific criteria to select patients for future
studies to evaluate potential causes of sleep disruption in this
population [12]. A longitudinal observational study The
knowledge of insomnia predictors might help in planning
preventive strategies to improve patients’ global health status
and quality of life [13]. Sleep deprivation and subsequent
effects on health restoration have been documented in the
literature. The purpose of this experimental pilot study was
to examine the feasibility of implementing specific nursing
interventions to promote sleep in hospitalized older adults.
Experimental group patients identified preferences such as
personal hygiene, awareness of normal bedtime, receiving a
back rub, straightening bed linens, and receiving a bedtime
snack. This pilot provides initial support for the feasibility
and utility of implementing a sleep protocol in an acute care
setting [14].
3.2 Studies related to effect of back massage in critically
ill patients
Critically ill patients are deprived of sleep and its potential
healing qualities, although many receive medications to
promote sleep. No one has adequately evaluated holistic non
pharmacological techniques designed to promote sleep in
critical care practice. Descriptive statistics showed improved
quality of sleep among the back-massage group. They
concluded that back massage is useful for promoting sleep in
critically ill older men [7].
A study was concluded that A combination of relaxation and
imagery is effective in improving the sleep of the critically
ill adult, with men responding immediately to relaxation and
imagery with improved sleep, and women taking more time
to respond to the intervention [15].
Recent publications have questioned the efficacy of
therapeutic touch (TT). The focus of attention has been on
Paper ID: 020131124
293
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Volume 3 Issue 3, March 2014
www.ijsr.net
substantiating the existence of the recipient's energy field
rather than on the physiologic and psychodynamic responses
to TT. In this article the physiologic and psychodynamic
responses during and following the administration of TT is
described. The project involved the implementation of a time
series design in which the physiologic and psychodynamic
responses were measured. It is acknowledged that critical
care environments are stressful for patients in terms of
invasive medical and nursing procedures. Continuous bright
lighting and excessive noise prohibits the potential for
relaxation and sleep. Within this context, the control of
confounding variables was not possible, and therefore not an
object of concern in the study. Rather the responses to TT in
the natural setting were of importance to discern. Statistical
repeated measures analysis of variance (one way) indicated
there was no significant difference between pre-, during and
post-physiologic variables in response to TT. However
psychodynamic responses demonstrated significant
correlation in terms of relaxation and sleep. The non
significance of physiologic change in variables pre-, during
and post-administration of TT indicates critically ill patients
remained physiologically stable. Significant correlations of
psychodynamic responses demonstrated it is possible for
critically ill patients to experience periods of relaxation and
sleep in an otherwise stressful environment. TT was found to
be a useful therapy to enhance relaxation and sleep in
critically ill patients [16].
The efficacy of complementary and alternative therapies for
sleep promotion in critically ill patients is largely
unexamined. A number of studies, however, have shown that
massage, music therapy and therapeutic touch promote
relaxation and comfort in critically ill patients, which likely
leads to improved sleep. Massage, music therapy, and
therapeutic touch are safe for critically ill patients and should
be routinely applied by ICU nurses who have received
training on how to administer these specialized interventions.
Environmental interventions, such as reducing noise, playing
white noise such as ocean sounds, and decreasing
interruptions to sleep for care, also are safe and logical
interventions that ICU nurses should use to help patients
sleep. Progressive muscle relaxation has been extensively
studied and shown to be efficacious for improving sleep in
persons with insomnia; however, progressive muscle
relaxation requires that patients consciously attend to
relaxing specific muscle groups and practice these
techniques, which may be difficult for critically 11 patients.
The review does not currently recommend aromatherapy and
alternative sedatives, such as valerian and melatonin, for
sleep promotion in critically ill patients because the safety of
these substances is unclear. In summary, it was
recommended that ICU nurses implement music therapy,
environmental interventions, therapeutic touch, and relaxing
massage to promote sleep in critically ill patients. These
interventions are safe and may improve patient sleep,
although randomized controlled trials are needed to test their
efficacy. Aromatherapy and alternative sedatives require
further investigation to determine their safety and efficacy
[17].
Critically ill patients are deprived of sleep and its potential
healing qualities, although many receive medications to
promote sleep. The results support that back massage, as an
alternative or adjunct to pharmacological treatment, is a
clinically effective nursing intervention for the promotion of
sleep [7]. Integrative therapies such as massage have gained
support as interventions that improve the overall patient
experience during hospitalization. Massage therapy may be
an important component of the healing experience for
patients after cardiovascular surgery [18].
Effect of selected nursing interventions in promoting sleep
of patients with congestive heart failure was studied by Pinto
(2001) at KEM Hospital, Mumbai. The intervention group
received back massage for 10 minutes and deep breathing
exercise for 6 minutes and results of the study that 80% of
the sample in the study group slept well and their quality of
sleep in the control group only 50% slept well. The quality
of sleep in the control group was 45% lower as compared to
the study group [19].
3. 3 Studies related to effect of slow stroke back massage
on quality of sleep
All studies using slow-stroke back massage and hand
massage showed statistically significant improvement on
physiological or psychological indicators of relaxation. The
most common protocols were three-minute slow-stroke back
massage and 10-minute hand massage. Physiological and
psychological indicators suggest the effectiveness of slow-
stroke back massage and hand massage in promoting
relaxation in older people across all settings. Studies are
needed to analyze the feasibility and cost effectiveness of
massage to develop best practices for massage interventions
in older people [20].
Another study explores the effect of slow-stroke back
massages on anxiety and shoulder pain in hospitalized
elderly patients with stroke. An experimental quantitative
design was conducted, comparing the scores for self-
reported pain, anxiety, blood pressure, heart rate and pain of
two groups of patients before and immediately after, and
three days after the intervention. The intervention consisted
of ten minutes of slow-stroke back massage (SSBM) for
seven consecutive evenings. One hundred and two patients
participated in the entire study and were randomly assigned
to a massage group or a control group. The results revealed
that the massage intervention significantly reduced the
patients’ levels of pain perception and anxiety. In addition to
the subjective measures, all physiological measures (systolic
and diastolic blood pressures and heart rate) changed
positively, indicating relaxation. The prolonged effect of
Slow Stroke Back Massage was also evident, as reflected by
the maintenance of the psycho-physiological parameters
three days after the massage. The patients’ perceptions of
Slow Stroke Back Massage, determined from a
questionnaire, revealed positive support for Slow Stroke
Back Massage for elderly stroke patients. The authors
suggest that Slow Stroke Back Massage is an effective
nursing intervention for reducing shoulder pain and anxiety
in elderly patients with stroke. From a nursing perspective,
this nursing practice provides a challenge and an opportunity
for nurses and family caregivers to blend alternative
therapies with technology to provide more individualized
and holistic patient care [21].
Paper ID: 020131124
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International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Volume 3 Issue 3, March 2014
www.ijsr.net
Slow Stroke Back Massage was associated with decreases in
systolic blood pressure, diastolic blood pressure and heart
rate and with an increase in skin temperature and
improvement of sleep and relaxation. Slow Stroke Back
Massage was shown to produce modest clinical, but
statistically significant changes in vital signs which were
indicative of relaxation. It is a cost-effective treatment which
adds to the comfort of hospice clients [23].
4.Research Question
To Assess the Effectiveness of Slow Stroke Back Massage
on Quality of Sleep among ICU Patients in Selected
Hospitals, Jabalpur City (M.P)”
4.1 Objectives
To assess the quality of sleep among experimental group
and control group before and after slow stroke back
massage.
To find out the association between pre-test levels of
quality of sleep and selected demographic variables among
both the groups.
4.2 Assumptions
Good sleep is essential for good health and recovery from
illness
Patients admitted in ICU have disturbed sleep.
Slow Stroke Back Massage helps in improving the quality
of sleep
5.Research Methodology
Research Approach experimental approach, Non
Equivalent pretest-post-test control group design.
1. Independent variable: In this study the independent
variable is Slow Stroke Back Massage.
2. Dependent variable: In this study the dependent variable
was Quality of Sleep.
5.1 Setting of the Study
Study was conducted in a intensive care unit of hospitals of
Jabalpur Hospital and Research Centre, Bhandari Hospital.
5.2 Population
The population of the present study comprises of ICU
patients between age group 25-70 years.
5.3Sample Size
The total sample size of present study consists of 60 patients
comprising of 30 samples in experimental group and 30
samples in control group.
5.4 Sampling Technique
In this study, purposive sampling technique was adopted to
select the subjects who have inadequate sleep.
5.5 Inclusion Criteria
Patients who are
Admitted in the intensive care unit.
Having inadequate sleep.
between age group of 25-70years
Who are conscious and able to communicate in English
and Hindi.
5.6 Exclusion Criteria
Patients with phlebitis or cellulitis, blood clots,
contagious skin conditions, eczema and other skin
lesions, high fever, mental impairment.
Patients on mechanical ventilators and unconscious
5.7 Data Collection Tool
The tool consists of;
Socio-Demographic information Schedule.
Modified Groningers Sleep Quality Scale to assess the
sleep quality level of the ICU Patients.
Observation Checklist to assess the sleep quality level of
the ICU Patients.
5.8 Data Collection Procedures
The Main study was conducted by the investigator from 12th
April to 15th May 2013 in Jabalpur Hospital and Research
Centre and Bhandari Hospital, Jabalpur. A formal
permission was obtained from the concerned authorities of
the hospitals and from samples prior to the study. Keeping in
mind the selection criteria, 60 ICU patients who are having
sleep disturbances (30 each for experimental and control)
were selected for the study. The investigator introduced her
and explained the purpose of the study; consent was
obtained from each patient. The demographic data was
directly collected from the patients and also from hospital
records. Investigator assessed the quality of sleep among
ICU patients by using modified Groningen’s sleep quality
scale and observation checklist. The first 30 subjects were
assigned to Experimental group and second 30 for Control
group. A comfortable position was given to the patient
followed by a ten minutes session of low stroke back
massage between 8-9-pm for experimental group. The
control group received only usual night time nursing care.
The quality of sleep was assessed and recorded for each
group. This was continued for three consecutive days.
5.9 Plan for data analysis
Analysis was done by using both descriptive and inferential
statistics
Paper ID: 020131124
295
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Volume 3 Issue 3, March 2014
www.ijsr.net
6.Findings
6.1 Deal with distribution of subjects according to Socio
demographic variable.
Majority of the patients 15(50%) in experimental group were
in the age group of 56-70yrs, 9(30%) were in the age group
of 41-45yrs, 6(20%) were in the age group of 25-40 yrs. In
control group, the majority of the patients 13(43.3%) were in
the age group of 56-70yrs, 12(40%) were in the age group of
41-45yrs, 5(16.7%) were in the age group of 25-40 yrs.
while the majority of the patients 20(66.7%) in experimental
group were female and 10(33.3%) were male. In Control
group, the majority of the patients 16(53.3%) were female
and 14(46.7%) were male. majority of the sample 26(86.7%)
in experimental group are married and 4(33.3%) are
unmarried. In control group, majority of the sample
23(76.6%) are married and 11(23.3%) are unmarried.
majority of the sample 11(36.7%) in the experimental group
are home makers, 7(23.3%) are self-employees, 5(16.7%)
are Govt. employees , 4(13.3%) are labors, 3(10%) are
private employees. In the control group, majority of the
sample, 9(30.3%) are self-employees, 7(23.3%) are home
makers, 5(16.7%) are labors, 5(16.7%) are private
employees,4(13.3%) are Govt. employees. majority of the
sample19 (63.3%) in the experimental group have monthly
income above 10,000, 6(20%) have monthly income
between Rs. 1000-5000, 5(16.7%) have monthly income
between Rs.5000-10,000. In control group, majority of the
sample 13(43.3%) have monthly income between Rs.5000-
10, 000, 12(40%) have monthly income above 10,000,
5(16.7%) have monthly income between Rs 1000-
5000.majority of the patients 24(80%) in the experimental
group are medical condition and 6(20%) are surgical
condition .In control group, majority of the patients 27(90%)
are medical condition and 3(10%) are surgical condition.
Most of the patients 25(83.3%) in the experimental group
did not have any past history of sleep disorders and
5(16.7%) had past history of sleep disorders. In control
group, majority of the patients 26(83.7%) did not have any
past history of sleep disorders and 4(13.3%) had past history
of sleep disorders. majority of the sample 28(93.3%) in the
experimental group did not have previous exposure to
alternative and complementary therapies and 2(6.7%) had
previous exposure to alternative and complementary
therapies. In the control group, majority of the sample
27(90%) did not have previous exposure to alternative and
complementary therapies and 3(10) had previous exposure to
alternative and complementary therapies. It deals with the
analysis of data related to quality of sleep among
experimental and control group in the experimental group
majority 20(66.7%) patients had disturbed sleep, 10(33.7%)
patients had moderate disturbed sleep and there was no
sound sleeper (0). In experimental group posttest, majority
25(83.3%) patients had sound sleep, 5(16.6%) had moderate
disturbed sleep and there was no disturbed sleeper. In control
group pretest 15(50%) patients had disturbed
sleep,15(50%)patients had moderate disturbed sleep and
there was no sound sleeper(0).In control group posttest,
18(60%)patients had sound sleep,12(40%) had moderate
disturbed sleep and there was no sound sleeper.
In experimental group, the pre-test mean score was 7.20 and
S.D was 3.40. The post-test mean score was 21.28 and S.D
was 3.55.This indicates, there were improvements in the
sleep quality level of the ICU patients. In control group, the
pre-test mean score was 9.07 and S.D was 4.26.The post-test
mean score was 8.79 and S.D was 2.44. This indicates, there
were no improvements in the sleep quality level of the ICU
patients.
Description of difference between pre-test and post-test
sleep quality score of experimental group
Experimental Group Control Group
Mean S.D t P Mean S.D t P
P
retest
P
ost test
7.20
2
1.28
3.40
3.55
18.4 .012 9.07
8.79
4
.26
2
.44
.4360 .612
Data in the above table, shows higher mean post-test
knowledge score (x2=21.28 ) with that of the mean pre-test
knowledge score (x1 =21.28). The computed’ value
(‘t’=18.4) is higher than the table value ('t’= 2.05, P< 0.05).
So the research hypothesis was accepted at 0.05 level of
significance, that is, the mean difference between pre and
post-test knowledge score was a true difference and not a
chance difference. This indicates the significant
effectiveness of back massage on improving the quality of
sleep among experimental group.
The association between pretest sleep qualities score of
patients with demographic variables in experimental group is
statistically tested by applying chi-square test. In
experimental group, the variables marital status, family
income, diagnosis, past history of sleep disorders and
previous exposure to alternative and complementary
therapies are found significant. Another variable are not
significant.
7.Discussion
The present study showed that the majority of the patients
are 56-70 years (46.70%) in both experimental and control
group. Most of the subjects were females 66.7% and
53.3%in experimental and control groups respectively. This
is supported by the study conducted by Kaye AD ETAL
[22]. AGE AND SEX Study conducted a Tucson
Epidemiologic study, in order to determine the prevalence of
reported sleep disturbances in a general adult population and
the relationship of these complaints to age, gender. At least
one symptom of disturbed sleep was present in 41.4 percent
of all subjects. Women generally reported a significantly
higher prevalence of both disorders of initiating and
maintaining sleep (DIMS) and nightmares (NM) (p less than
.001). Before age 64 years, the prevalence of complaints of
excessive daytime sleepiness (EDS) among men and women
were similar. However, the frequency of EDS was
significantly higher in men than women after age 64 years...
They conclude that, in the general adult population, sleep
disorder symptoms increase with age and usually are greater
in women.
Paper ID: 020131124
296
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Volume 3 Issue 3, March 2014
www.ijsr.net
8.Marital Status, Occupation and Family
Income
Kelly [22] conducted a study: Who sleeps better?
Socioeconomic differences in reports of sleep disturbance.
Results indicate that individuals with higher socioeconomic
status and education levels sleep better than those of lower
socioeconomic status. Findings show that 26% of individuals
earning less than $10,000 a year reported sleep problems,
whereas only 8% of those earning $75,000 or more annually
reported sleep problems. People who were employed
reported the best sleep, followed by those who were retired,
homemakers and students. Of the individuals who were
unemployed for less than a year, 32% reported sleeping
problems; 52 % of people who were unable to work due to
injury, illness or disabilities reported sleep problems.
Married people slept better than single individuals; those
who were separated had the worst sleep.
9.Conclusion
From the study findings it is concluded that there is
significant differences on the quality of sleep before and
after slow stroke back massage. This shows that there is
gradual improvement in the sleep quality after back massage
on 3 consecutive days. The present study also proved that
there was a significant difference on the quality of sleep
between experimental and control group. So it may be stated
that the back massage has effect on quality of sleep among
ICU patients.
10. Future Scope
10.1 Nursing Practice
The findings of this study regarding effectiveness of back
massage for improving sleep indicates that there is a need to
administration of back massage to improving sleep quality
level among ICU patients. To make the health care workers,
especially nurses and doctors aware of it by in service
education programme and interdisciplinary collaboration.
Complementary therapies are gaining popularity and finding
more substantial place in health care. Holistic nursing
regards and treats the mind, body and spirit of the client.
Nurses use holistic nursing interventions such as relaxation
therapies, simple touch and massage. Such interventions
affect the whole person and are effective economical, non-
invasive non pharmacological complements to medical care.
Back massage are one of the sources that nurses can adopt in
the patient care, which through this study has been proved to
improve quality of sleep among ICU Patients. Theories like
that of King’s Goal attainment theory, on whose theory this
study based its conceptual framework can be applied in
practice set up. There by increasing evidence based practice
and this practice enhance the autonomous role of nursing
intervention. Touch used during the intervention improves
the nurse patient relationship, attaining higher level of co-
operation from both the nurse and the patient. There is a
need to implement the research findings in the clinical field,
so as to avoid the wide gap between research studies and
clinic practices.
10.2 Nursing Education
Nursing education is developing rapidly in India and nurse
from our country can be found all over the world providing
care and education. The education curriculum must include
imparting knowledge about the use of various audio-visual
aids and teaching strategies. Several implications can be
drawn from the present study for nursing education. A
curriculum incorporating the recent trends and demands of
the changing society is needed for the progress of nursing
education. The nursing curriculum of medical-surgical
nursing include learning experience for the students to
assess, plan, implement and evaluate nursing intervention
based on back massage to improve the quality of sleep patter
.Various complementary therapies including Low Stroke
Back massage is already included in the nursing curriculum,
which also can be given importance to use as alternative
therapy in patients with insomnia. The nurse educators have
the additional responsibilities to update themselves with the
changing trends. The back massage procedure manual can be
provided as ready reference for the students, nurse educators
and practicing nurses. Post graduates must implement and
emphasis on clinical application of nursing theories based on
evidence as in this study.
10.3 Nursing Administration
As a part of administration, the nurse administrator plays a
vital role in educating clients and student nurses. To bring
about any changes in nursing, administrator should take the
responsibilities and take up the challenges, which will
improve ,standard of nursing care. Effective strategies to
improve the understanding of complementary therapies
especially the back massage should be considered by a nurse
administrator when designing the materials, policies, forms
and procedures for obtaining effective, economical, non-
invasive non pharmacological complements to nursing care.
The procedure manual for back massage can be prepared
with pictures and written explanations and can be made
available in each unit of the hospital as a ready reference for
better understanding. The nurse administrator should also
see that the student and practicing nurses are well equipped
with the knowledge and skill through in-service
programmes. Nurses may be empowered with facilities to
use the complementary therapies. In-service educations on
applied theories in clinical practice based on evidence are
important for autonomy and professional image.
10.4 Nursing Research
Nursing research is an essential part of nursing as it uplifts
the profession and develops new nursing norms and a body
of knowledge. It is important to conduct studies which test
the effectiveness of complementary therapies in order to add
to the evidence based practice in nursing. There is need for
promoting research based practice and use of evaluation
methods to measure the effectiveness of care to maintain
quality and cost effectiveness. This study is an investigation
into the area of complementary therapies, which has
contributed to the body of knowledge in nursing field.
Health care research studies needs to concentrate on the
importance of complementary therapies. Many more
research studies could be done to assess and compare the
Paper ID: 020131124
297
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Volume 3 Issue 3, March 2014
www.ijsr.net
effectiveness of complementary therapies in various disease
conditions. Research can also focus on specific areas like
pain, physiological and psychological parameters, relaxation
and assess the impact of foot and back massage. Similar
studies in this area can be done, so that interventions based
on the study findings can be provided for improving the cost
effectiveness, and quality care. There is still a lot of scope
for exploring more on this area taking variety of patients
with different disease processes.
11. Limitations of the Study
The study findings could not be generalized because of the
following reasons:
1. The study was confined to a specific geographical area
(Jabalpur), which imposes limits to any larger
generalization.
2. The sample was selected only from ICU.
3. The sample size was relatively small, thus restricting the
statistical inferences of results..
4. The study was conducted within a limited time of period
of 4 weeks.
5. After the third day of treatment no follow up was made of
the selected samples.
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Author Profile
Mahadeo B Shinde is working as Professor, Krishna
Institute of Medical Sciences Deemed University’s Krishna
Institute of Nursing Sciences Karad (M.S.) India 415539
Shabana Anjum is working as Professor and Head
Department of Medical Surgical Nursing Jabalpur Institute
Of Nursing Sciences And Research, Jabalpur (M.P.) India
Paper ID: 020131124
298
... Massage therapy as alternative and complementary medicine has been used throughout history, both as a sedative and as a treatment (14). SSBM is a specific and successful nursing protocol that has been used in nursing (15) as non-invasive and applied on the surface of the body, so does not have complications such as bleeding or infection (16) and reduces anxiety, fatigue and promoting relaxation and sleep (15,17). ...
... Massage therapy as alternative and complementary medicine has been used throughout history, both as a sedative and as a treatment (14). SSBM is a specific and successful nursing protocol that has been used in nursing (15) as non-invasive and applied on the surface of the body, so does not have complications such as bleeding or infection (16) and reduces anxiety, fatigue and promoting relaxation and sleep (15,17). ...
... -Piper Fatigue Scale (PFS) (1998): Is a 22-item numeric rating scale that evaluates subjective fatigue. All items were coded on a 0 -10 Likert scale and are categorized by mild (1 -3), moderate (4 -6), and severe (7 -10) (15,16,17). Piper Fatigue Scale is a valid tool, and its reliability has been proven in international studies (28,29). ...
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... The Bates method has never been shown to improve eyesight in a substantial or long-term way. 18 Bates therapy is useful to restore visual acuity. 19 Bates therapy is a sequence of steps involving stretching, blinking, swinging, palming or cupping, and sunning. ...
... A massage is beneficial because it increases oxygen flow in the blood, facilitating the removal of metabolic waste, and it increases wellbeing due to the increase in endorphin production, as well as making the skin more radiant and textured (Shinde & Anjum, 2014;Westman & Blaisdell, 2016). A study by Setiani (2014) found that effleurage massage can increase levels of comfort and wellbeing and can minimise the occurrence of infections and PUs. ...
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... No study has so far investigated the effect of foot reflexology massage on duration of last day's sleep in patients with burns; however, some studies have been conducted on patients with other diseases. For example, in a study, 10min of back massage for three consecutive days effectively reduced general ICU patients' need for daytime sleep [40]. ...
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... Nonetheless, the results of the studies by In another study done by Ramesh chandrababu et, al who demonstrated the effect of massage therapy improving the heart rate, blood pressure and post-operative outcomes of patients who underwent cardiac surgery but he suggested that an additional research is need to improving for the use of massage therapy (Ramesh, C. et al., 2015). Amol sable et al., and Mahadeo B Shinde et et al., who observed that back massage technique is effective in improving the sleep quality (Sable, A. et al., 2017;Shinde, M. B., & Anjum, S. 2014). The present study did not observe the sleep quality and recommended to conduct the similar study with large number of samples by assessing the other parameters like inflammatory markers anxiety, stress, sleep quality and quality of life. ...
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Recent publications have questioned the efficacy of therapeutic touch (TT). The focus ofattention has been on substantiating the existence of the recipient's energy field rather than on the physiologic and psychodynamic responses to TT. In this article the physiologic and psychodynamic responses during and following the administration of TT are described. The project involved the implementation of a time series design in which the physiologic and psychodynamic responses were measured. It is acknowledged that critical care environments are stressful for patients in terms of invasive medical and nursing procedures. Continuous bright lighting, and excessive noise prohibits the potential for relaxation and sleep. Within this context, the control of confounding variables was not possible, and therefore not an object of concern in the study. Rather the responses to TT in the natural setting were of importance to discern. Statistical repeated measures analysis of variance (one way) indicated there was no significant difference between pre-, during and post-TT physiologic variables in response to TT. However psychodynamic responses demonstrated significant correlations in terms of relaxation and sleep. The non-significance of physiologic change in variables pre-, during and post-administration of TT indicates critically ill patients remained physiologically stable. Significant correlations of psychodynamic responses demonstrated it is possible for critically ill patients to experience periods of relaxation and sleep in an otherwise stressful environment. TT was found to be a useful therapy to enhance relaxation and sleep in critically ill patients.
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Some acute and long-term care facilities are instituting massage therapy programs to support their patients' health, healing, and quality of life. Evaluation of the impact of these programs from the perspective of patients, providers, and therapists is important for administrative decision making and the design of future outcomes research. To uncover and elucidate a range of patient outcomes of a therapeutic massage program within an acute care setting. Descriptive and qualitative evaluation. Surveys and narrative reports were completed by 70 patients, 14 healthcare providers, and 4 massage therapists. A large university hospital. 113 hospitalized patients received 1 to 4 massages during the course of their hospital stay. Massage therapy. Narrative data were coded into 8 categories (pain, sleep, tension/anxiety, body awareness, physical functioning, psychological support, enhancing healing, and value). Selected patient responses were included to elaborate the meanings of these categories. The most frequently identified outcomes were increased relaxation (98%), a sense of well-being (93%), and positive mood change (88%). More than two thirds of patients attributed enhanced mobility, greater energy, increased participation in treatment, and faster recovery to massage therapy. Thirty-five percent stated that benefits lasted more than 1 day. The study supported the value of this hospital-based massage therapy program and uncovered a range of benefits of massage therapy for hospitalized patients that should be studied further.
Recent publications have questioned the efficacy of therapeutic touch (TT). The focus of attention has been on substantiating the existence of the recipient's energy field rather than on the physiologic and psychodynamic responses to TT. In this article the physiologic and psychodynamic responses during and following the administration of TT is described. The project involved the implementation of a time series design in which the physiologic and psychodynamic responses were measured. It is acknowledged that critical care environments are stressful for patients in terms of invasive medical and nursing procedures. Continuous bright lighting, and excessive noise prohibits the potential for relaxation and sleep. Within this context, the control of confounding variables was not possible, and therefore not an object of concern in the study. Rather the responses to TT in the natural setting were of importance to discern. Statistical repeated measures analysis of variance (one way) indicated there was no significant difference between pre-, during and post-physiologic variables in response to TT. However psychodynamic responses demonstrated significant correlation's in terms of relaxation and sleep. The non significance of physiologic change in variables pre-, during and post-administration of TT indicates critically ill patients remained physiologically stable. Significant correlations of psychodynamic responses demonstrated it is possible for critically ill patients to experience periods of relaxation and sleep in an otherwise stressful environment. TT was found to be a useful therapy to enhance relaxation and sleep in critically ill patients.
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A quasi-experimental design was used to determine the effects of three consecutive days of slow stroke back massage (SSBM) on adult patients in a rehabilitation setting. This study used the Huckstadt Touch Instrument to assess physiological and psychological responses to touch, as well as the recipients' perceptions of touch. The convenience sample comprised 24 adult patients in a rehabilitation hospital in southeastern North Carolina. Subjects' ages ranged between 52 and 88 years with a mean of 71.8 years. There was a significant decrease in systolic and diastolic blood pressure after SSBM on all 3 days. There was a statistically significant decrease in mean heart rate and mean respiratory rate on Days 1 and 3. There was no psychological change in any of the patients. Perception scores, however, indicate a positive response to SSBM. Patients perceived it as being comfortable, good, pleasant, and warm. On all occasions, their responses indicated that the intervention made them feel cared for, happy, physically relaxed, less anxious, calm, restful, and gave them a feeling of closeness with the nurse.
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The purpose of this study was to determine the effects of relaxation and imagery on the sleep of critically ill adults. The study was an experimental clinical trial with random assignment to two groups. Analysis used repeated measures ANOVA. Thirty-six adults (17 males and 19 females) with a variety of physical diagnoses in three critical-care units in two large metropolitan hospitals were studied. Outcome measures were scores on a visual analog sleep scale, measured on three mornings. The intervention was a combination of relaxation and imagery, delivered on two evenings. All subjects' sleep improved over time. There were significant interaction effects between the intervention, gender, and time, with males' scores improving rapidly, and females' scores first dropping, then improving rapidly. A combination of relaxation and imagery is effective in improving the sleep of the critically ill adult, with men responding immediately to relaxation and imagery with improved sleep, and women taking more time to respond to the intervention.
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The efficacy of complementary and alternative therapies for sleep promotion in critically ill patients is largely unexamined. We found only seven studies (three on environmental interventions and one each on massage, music therapy, therapeutic touch, and, melatonin) that examined the effect of complementary and alternative therapies. A number of studies, however, have shown that massage, music therapy. and therapeutic touch promote relaxation and comfort in critically ill patients, which likely leads to improved sleep. Massage, music therapy, and therapeutic touch are safe for critically ill patients and should be routinely applied by ICU nurses who have received training on how to administer these specialized interventions. Environmental interventions, such as reducing noise, playing white noise such as ocean sounds, and decreasing interruptions to sleep for care, also are safe and logical interventions that ICU nurses should use to help patients sleep. Progressive muscle relaxation has been extensively studied and shown to be efficacious for improving sleep in persons with insomnia; however, progressive muscle relaxation requires that patients consciously attend to relaxing specific muscle groups and practice these techniques, which may be difficult for critically 11 patients. We do not currently recommend aromatherapy and alternative sedatives, such as valerian and melatonin, for sleep promotion in critically ill patients because the safety of these substances is unclear. In summary, we recommend that ICU nurses implement music therapy, environmental interventions, therapeutic touch, and relaxing massage to promote sleep in critically ill patients. These interventions are safe and may improve patient sleep, although randomized controlled trials are needed to test their efficacy. Aromatherapy and alternative sedatives require further investigation to determine their safety and efficacy.