Available via license: CC BY 4.0
Content may be subject to copyright.
476 European Journal of Clinical and Experimental Medicine 2023; 21 (3): 476–482
This article is an open access article distributed under the terms andconditions of the Creative Commons Attribution (CC BY 4.0) license.
http://www.ejcem.ur.edu.pl
European Journal of Clinical and Experimental Medicine
Eur J Clin Exp Med 2023; 21 (3): 476–482
The eect of foot baths on foot pain and leg edema of nursing
students during clinical training
Sevim Çelik , Gülbahar Cerrah , Berşan Gürel , Cavide Sağlık , İrem Albayrak
Department of Nursing, Bartin University Faculty of Health Sciences, Bartin, Turkey
ABSTRACT
Introduction and aim. Edema and pain may occur in the lower extremities due to the long-term standing work of nursing stu-
dents and the stress they experience. In this study, the aim was to determine the eect of foot baths applied after clinical prac-
tice on foot pain and leg edema in nursing students.
Material and methods. This randomized controlled study was carried out with second year nursing students. The intervention
group received a foot bath (including immersion in water and massage). No intervention was performed on the control group.
The data was collected using a survey form, edema follow-up form, visual analog scale, and foot bath equipment.
Results. Edema levels in the right tibia decreased statistically on the 1st and 2nd days after the foot bath compared to the val-
ues measured after nurses performed clinical practice, while the edema level in the left tibia decreased signicantly in the rst
and fourth weeks (p<0.05). The right and left foot pain scores in the intervention group increased in the evening of the day af-
ter the clinical practice compared to before clinical practice, and pain scores decreased statistically signicantly after foot bath
(p<0.001). The foot pain scores expressed by the students in the rst week increased continuously (p<0.001).
Conclusion. The study showed that a foot bath performed after clinical practice were eective for easing foot pain and leg
edema.
Keywords. clinical training, foot pain, foot bath, leg edema, massage, nursing student
ORIGINAL PAPER
Wydawnictwo UR 2023
ISSN 2544-1361 (online)
doi: 10.15584/ejcem.2023.3.5
Corresponding author: Sevim Çelik, e-mail: sevimakcel@gmail.com
Received: 5.04.2023 / Revised: 5.05.2023 / Accepted: 9.05.2023 / Published: 30.09.2023
Çelik S, Cerrah G, Gürel B, Sağlık C, Albayrak İ. e eect of foot baths on foot pain and leg edema of nursing students during clinical
training. Eur J Clin Exp Med. 2023;21(3):476–482. doi: 10.15584/ejcem.2023.3.5.
Corresponding author:
ORCID
SC: https://orcid.org/0000-0002-2016-5828
GC: https://orcid.org/0000-0002-0817-7551
BG: https://orcid.org/0000-0002-1134-0006
CS: https://orcid.org/0000-0003-1545-3136
IA: https://orcid.org/0000-0002-7528-0129
10.15584/ejcem.2023.3.5
Introduction
Nursing education in our country includes theoretical
and applied education. is nursing education covers at
least four years or 4600 hours of theoretical and prac-
tical training. Students complete half of this training
(2300 hours) under clinical settings.1 ey begin full-
time clinical practice in order to use the knowledge they
have acquired in order to gain the skills required for pa-
tient care of nursing education.2,3
Clinical settings are environments made up of a va-
riety of physical, psychological, emotional and organiza-
tional factors that can aect student learning. In most of
the clinical environments, the environments where stu-
dents can rest are insucient. e students experience
physiological, psychological, social and environmental
stress because they have to work for a long time in clini-
cal learning environments and apply treatment and care
practices for the rst time in the clinical setting.2-6
Problems such as edema and pain may occur in the
lower extremities due to the long-term standing work of
the students and the stress they experience. Eyi and Eyi
found that second-year students (62.9%) experienced sta-
tistically signicantly more stress during clinical practice
than third-year students (37%) (p=0.002).7 Elyased stated
that 71.1% of students experienced pain in the ankle or
foot (43.9%) over the a 12 month period in their study in-
vestigating musculoskeletal disorders of students during
their clinical training. In the same study, the prevalence
477
The eect of foot baths on foot pain and leg edema of nursing students during clinical training
of musculoskeletal problems was found to be statistical-
ly signicantly higher in students who performed clinical
practice 2 days a week (p=0.05).8 Similarly, Moodley et al.
reported that 63.6% of nursing students experienced foot
and ankle pain in the last 12 months.9 Kamalruzaman et
al. stated that clinical education is an important risk fac-
tor for students to experience musculoskeletal problems
(p=0.047) (95%CI: 0.035, 5.526).10
Today, foot baths and foot massages are two popular
applications because they are easy, applicable, inexpen-
sive, safe, and non-invasive method of relieving foot pain
and fatigue. Hot foot baths can increase peripheral tem-
perature and peripheral blood ow without increasing
body temperature and can be eective in relieving fatigue
by reducing tension in the brain and muscles.11 In foot
massage, mental and psychological relaxation is provided
by manipulation of so tissues and muscles, thus increas-
ing healing and relaxation.12 In a study conducted by Lee
et al. in previous years, it reported that edema, physical
stress and fatigue in the lower extremities signicantly re-
duced by immersing the feet in hot water at 40 degrees for
20 minutes 12 times a day in operating room nurses who
stood for long period.13 Oh and Gang also stated that a
foot bath, including a 20-minute foot massage, is eective
in reducing fatigue and stress.14 Rahmani et al. reported
that the sleep quality of the patients decreased signicant-
ly on the second and third nights with a 20-minute foot
bath and massage.12 In previous years, there were very few
studies on the subject and these studies focused more on
the eect of footbath on fatigue and sleep on the patients
and nursing. Studies on nursing students are rare. In our
country, there is no study on the subject among nurses
and nursing students.
Aim
In this study, unlike other studies, the aim was to deter-
mine the eect of foot baths and foot massage applied
aer clinical applications on foot pain and leg edema in
nursing students.
Materials and methods
Ethical approval
First, permission was obtained from the University’s
Social and Human Sciences Ethics Committee (deci-
sion no. 10, dated 18.03.2020). Written permission was
obtained from the Rectorate of the university where the
study conducted. Informed consent obtained from the
students by stating that the purpose of the research, the
data will used for scientic purposes, and that participa-
tion in the study was based on volunteerism.
Design and sample
e study adopted a randomized controlled study to de-
termine the eect of foot baths applied aer clinical ap-
plications on foot pain and leg edema in nursing students.
is study was carried out with second year students
studying in the nursing department of the faculty of health
sciences and practicing clinical for 12 hours a week in the
2021-2022 academic year. Forty-four students were in-
cluded in the sample with a medium eect size of 0.25,
atype 1 error of 0.5, and a power of 80%, which Cohen de-
termined for repeated analysis of variance in the G power
program. Since there may be students who can leave the
study, the number of sample was increased by 50% and the
sample group consisted of 66 students.
e block randomization method used in the study.
Sixty-six students were enumerated and assigned to two
block sizes, each of which determined by the research-
ers as the intervention and control group with a ratio of
1:1 (www.randomizer.org). e sample group was deter-
mined as 33 students in each block. e study complet-
ed with 27 intervention and 21 control group students
(Fig. 1).
e inclusion criteria: (1) no hearing or vision prob-
lems, (2) continuing clinical training, (3) have no di-
agnosed leg problems, (4) have a smart phone and (5)
wearing sports shoes, (6) studying in the second year,
(7) agreed to participate.
Fig. 1. CONSORT ow diagram
Instruments
e data collected using a survey form, edema fol-
low-up form, visual analog scale, foot bath equipment,
tape measure and smart phone.
e survey form
is form consist of items on students’ age, gender,
height, weight, daily sleep time, daily standing time,
smoking and alcohol use, daily salt use, daily coee con-
sumption, general health denition status, foot health
478 European Journal of Clinical and Experimental Medicine 2023; 21 (3): 476–482
denition status, working status, chronic disease, chron-
ic disease, clinical setting, and exercise status.
Edema measurement and follow-up form
In the evaluation of edema, the patient’s tibia bone is
pressed with a nger for 3-5 seconds, and if there is a pit
in the area, the depth of the pitting and how long it takes
to come back are determined, and the edema is grad-
ed. If the godet’s sign comes back in 2 mm and 15 sec, 1
positive, 4 mm and if it comes back in 15-30 sec, 2 pos-
itive, 6 mm and if it comes back in 30-45 sec, 3 positive,
8 mm and longer than 45 sec. If it comes back in time, it
is expressed as 4 positive edema.15
Before going to the clinical practice every week, the
students record the level of edema in their lower ex-
tremities on the edema follow-up form on the rst eve-
ning of the clinical practice and the last evening of the
clinical practice.
Pain follow up form
is form is a form in which students evaluate and re-
cord the level of pain in their lower extremities every
week before going to clinical practice, on the rst eve-
ning of clinical practice and on the last evening of clin-
ical practice.
Visual analogue scale
It is a reliable and easily applicable scale used to measure
the severity of pain in patients, accepted in the world lit-
erature. For pain intensity over a 10cm line, “no pain” is
usually rated 0 points and “worst pain imaginable” 10
points.
Materials for the footbath and foot massage
A bucket used to put the water in the foot bath, a water
thermometer to measure the temperature of the water,
a foot towel, and pH neutral baby oil suitable for use on
the skin used for foot massage.
Smartphone
It was used to send the training video prepared by the
researchers to the students for the application of the
footbath, the follow-up of the edema.
Data collection
Data was collected between 06.12.2021 and 31.12.2021.
e intervention group was shown the application of
foot bath in the skill laboratory, and follow-up of ede-
ma. In addition, the making of these applications video-
taped, and the video recording sent to the students via
smartphones so that they could watch the applications
again. Data collection forms introduced to all students
and given to completed aer the applications, and they
were collected from them at the end of a month.
Application of footbath
Application was performed by students in the interven-
tion group in accordance with the application steps. e
footbath done two hours before bedtime and lasted for
20 minutes. For this application, you should stand in a
sitting position on a chair or bed, and the feet should
hung down. First, the feet should kept for 6 minutes in a
bowl lled with 40 degrees water up to 10 cm above the
ankle. en a foot massage should done for 8 minutes,
and then kept in a bowl lled with 40 degrees water for
6 minutes.6,13
Application of foot massage
For foot massage, when the feet removed from the water,
they should dried with a towel and the feet should ex-
tended by placing a towel under the feet in the bed. Mas-
sage should started by lubricating the hands with baby
oil. For foot massage, rstly, the toes should rubbed with
the help of the hands and stretched towards the nger-
tips. e feet should grasped by the heel and ankle and
turned clockwise and counter clockwise once. Slight
pressure should applied to the feet with circular move-
ments from the sole of the foot to the toes. en one
hand should held on the ankle so that the other hand
grasps the toes, the toes should pushed forward slow-
ly. Foot massage should last 4 minutes for each foot. 6,13
Statistical analysis
Descriptive statistics such as number, percentage, mean
and standard deviation used in the evaluation of the
data obtained. Whether the data showed normal distri-
bution or not evaluated with the Kolmogorov-Smirnov
(K-S) test. Data did not normally distributed. Data eval-
uated with Chi-square test, Fisher’s exact test, Friedman
test and Mann Whitney U test. Pairwise comparisons
were examined using the Wilcoxon sign-rank test. A p
value less than 0.05 considered statistically signicant.
Results
ere was no statistically signicant dierence in the in-
tervention and control groups, and the groups were ho-
mogeneous (Table 1).
In table 2, right and le tibia edema levels of the
students in the intervention group are compared before
and aer the clinical practice for four weeks. Accord-
ingly, the edema levels measured from the right and le
tibia of the students before and aer the foot bath before
and aer the clinical practice varied between 0 and 2+.
e edema levels measured from the right and le tibia
before the evening foot bath on the 1st day aer the clin-
ical practice every week increased. In the follow-up for
one month, the edema levels in the right tibia decreased
statistically on the 1st and 2nd days aer footbath com-
pared to the values measured aer the clinical practice,
while the edema level in the le tibia decreased signi-
479
The eect of foot baths on foot pain and leg edema of nursing students during clinical training
cantly in the rst and fourth weeks (p<0.05). In the four-
week follow-up, the edema levels of the students in the
right and le tibia showed a statistically signicant dif-
ference (p<0.001).
Table 1. Comparison of the characteristics of the studentsa
Characteristic Intervention
Group
Control
Group
Statistics test *
Mean (SD) Mean (SD)
Age 20.59 (1.64) 19.95 (0.78) Z=-1.328 p=0.184
Height (cm) 168.37 (7.94) 168.05 (7.18) Z=-0.212 p=0.832
Weight (kg) 65.44 (23.99) 60.18 (10.20) Z=-0.111 p=0.912
Sleep time (hour/day) 7.19 (1.03) 7.73 (1.07) Z=-1.737 p=0.832
Standing time (hour/day) 8.04 (3.20) 8.91 (3.50) Z=-0.587 p=0.557
n (%) n (%) Statistics test
Gender Female
Male
21 (77.8)
6(22.2)
16 (72.7)
6 (27.3)
**c2=0.167
p=0.747
Working status working
not working
1 (3.7)
26 (96.3)
1 (4.5)
20(95.5)
**c2=0.033
p=1.000
Smoking Yes
No
4 (14.8)
23(85.2)
4 (19.0)
17(81.0)
**c2=0.152
p=0.715
Salt consumption
(daily)
More
Middle
Little
3 (11.1)
16 (59.3)
8 (29.6)
-
13 (61.9)
8 (38.1)
***c2=2.601
p=0.272
Coee
consumption
(daily)
Not consume
One cup
Two cups
11 (40.7)
10 (37.0)
6 (22.2)
13 (61.9)
2 (9.5)
6 (28.6)
***c2=4.825
p=0.090
Perceived
general health
status
Excellent
Very good
Good
1 (3.7)
9 (33.3)
17 (63.0)
-
6 (28.6)
15 (71.4)
***c2=0.990
p=0.609
Perceived foot
health status
Excellent
Very good
Good
Poor
2 (7.4)
10 (37.0)
13 (48.1)
2 (7.4)
2 (9.5)
8 (38.1)
11 (52.4)
-
***c2=1.665
p=0.645
Exercise status Not doing
Irregular
Regular
7 (25.9)
17 (63.0)
3 (11.1)
7 (33.3)
14 (66.7)
-
***c2=2.581
p=0.275
Clinical learning
setting
General services
Intensive care
Private practice
rooms
16 (59.3)
2 (7.4)
9 (33.3)
19 (90.5)
-
2 (9.5)
***c2=6.056
p=0.048
a *Z – Mann Whitney U test; **c2 – Fisher’s Exact test; ***c2 –
Chi-square test
In pairwise comparisons performed using the Wilcox-
on signed ranks test, the degree of edema in the right tibia
signicantly increased (p=0.034) before and aer clinical
practice on the evening of the rst day without foot bath, in
the rst week (p=0.034), third week (p=0.034) and fourth
week (p=0.008). However, there was no statistically signif-
icant dierence in the evaluated edema degrees on the rst
and second evenings aer clinical practice (p>0.05). e
degree of edema in the le tibia was found to increase sig-
nicantly (p=0.003) on the rst day of the evening without
performing a foot bath aer clinical practice compared to
before clinical practice in the rst week, while there was
no statistically signicant dierence between the degree
of edema for other pairwise comparisons (p>0.05). ese
ndings were clinically signicant.
ere was no signicant dierence between the
degrees of edema in the right and le tibia in all com-
parisons made for the second, third, and fourth weeks
(p>0.05). However, the degree of edema in the le tibia
was found to increase signicantly (p=0.003) between
the fourth week before clinical practice and the rst day
of the evening before performing a foot bath, whereas it
decreased signicantly (p=0.008) aer the foot bath on
the same day. ese ndings were clinically signicant.
Table 2. Comparison of right and left tibia edema levels of
students in the intervention group before and after clinical
practice a
Measurement time 1st week 2nd week 3rd week 4th week Statistics
test
Mean (SD) Mean(SD) Mean (SD) Mean (SD)
Right
Pre-clinical evening 0.67 (0.62) 0.70 (0.60) 0.70 (0.60) 0.70 (0.60)
c2= 54.683
p<0.001
Evening of the 1st day
after clinical practice
(before foot bath)
0.89 (0.75) 0.89 (0.75) 0.96 (0.80) 0.96 (0.80)
Evening of the 1st day
after clinical practice
(after foot bath)
0.70 (0.60) 0.70 (0.60) 0.70 (0.60) 0.74 (0.65)
Evening of the 2nd day
after clinical practice
(after foot bath)
0.70 (0.60) 0.74(0.65) 0.74 (0.65) 0.74 (0.65)
Statistics test c2= 11.000
p=0.012
c2= 8.500
p=0.037
c2= 12.356
p=0.006
c2= 17.571
p=0.001
Left
Pre-clinical evening 0.63 (0.56) 0.74 (0.65) 0.70 (0.60) 0.67 (0.55)
c2=125.928
p<0.001
Evening of the 1st day
after clinical practice
(before foot bath)
0.96 (0.80) 0.89 (0.75) 0.89 (0.75) 1.00 (0.83)
Evening of the 1st day
after clinical practice
(after foot bath)
0.70 (0.60) 0.78 (0.75) 0.74 (0.65) 0.74 (0.65)
Evening of the 2nd day
after clinical practice
(after foot bath)
0.70 (0.60) 0.74 (0.65) 0.74 (0.65) 0.74 (0.65)
Statistics test c2= 20.778
p<0.001
c2= 5.824
p=0.121
c2= 7.080
p=0.069
c2= 20.778
p<0.001
a c2 – Friedman test; SD – standard deviation
In table 3, right and le tibia edema levels of the
students in the control group compared before and af-
ter the clinical practice for four weeks. Accordingly, the
edema levels measured by the students from the right
and le tibia before clinical practice increased at the end
of each week. However, the increase in edema levels in
the right and le tibia only in the rst week showed a
statistically signicant dierence (p<0.05). In addition,
the changes in the edema levels in the le tibia of the
students during the follow-up for four weeks showed a
statistically signicant dierence (p<0.05).
In pairwise comparisons, the degree of edema in
both the right (p=0.046) and le (p=0.046) legs before
clinical practice showed a statistically signicant in-
crease on the evening of the second day aer clinical
practice.
480 European Journal of Clinical and Experimental Medicine 2023; 21 (3): 476–482
Table 3. Comparison of right and left tibia edema levels of
students in the control group before and after clinical practice a
Measurement time 1st week 2nd week 3rd week 4th week Statistics
test
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Right
Pre-clinical evening 0.90 (0.30) 0.95 (0.38) 0.90 (0.30) 0.90 (0.30)
c2= 19.417
p=0.054
Evening of the 1st
day after clinical
practice
0.95 (0.38) 0.95 (0.38) 0.95 (0.38) 1.00 (0.44)
Evening of the 2nd
day after clinical
practice
1.10 (0.53) 1.05 (0.49) 1.00 (0.44) 1.00 (0.44)
Statistics test c2= 6.500
p=0.039
c2= 2.000
p=0.368
c2= 3.000
p=0.223
c2= 2.267
p=0.264
Left
Pre-clinical evening 0.90 (0.30) 0.90 (0.30) 0.95 (0.38) 0.90 (0.30)
c2= 21.342
p=0.030
Evening of the 1st
day after clinical
practice
0.95 (0.38) 0.95 (0.38) 0.95 (0.38) 0.95 (0.38)
Evening of the 2nd
day after clinical
practice
1.10 (0.53) 1.05 (0.49) 1.05 (0.49) 1.00 (0.44)
Statistics test c2= 6.500
p=0.039
c2= 4.467
p=0.097
c2= 2.000
p=0.368
c2= 3.000
p=0.223
a c2 – Friedman test; SD – standard deviation
When table 4 was examined, the right and le foot
pain scores in the intervention group increased in the
evening of the day aer the clinical practice compared to
before clinical practice, and pain scores decreased statis-
tically signicantly aer footbath (p<0.001). In addition,
the changes in the pain scores of the students in the right
and le legs showed a statistically signicant dierence
in the follow-up for four weeks (p<0.001).
On the rst day of the rst week aer clinical practice
the level of pain in the right foot was found to increase
signicantly compared to before clinical practice both be-
fore (p=0.008) and aer (p<0.001) the foot bath. Howev-
er, there was no statistically signicant dierence in the
level of pain in the right foot between before the foot bath
on the rst day and aer the foot bath on the rst and
second days (p>0.05). All pairwise comparisons except
for the level of pain in the right foot showed statistical-
ly signicant dierences during the second week, third
week, and between before clinical practice and aer the
foot bath on the second day (p<0.05). e application of
foot bath before and aer the second day of clinical prac-
tice in the 4th week did not have a signicant eect on
the level of pain in the right foot (p>0.05). Similarly, there
was no signicant eect of foot bath applied aer the rst
day of clinical practice and aer the second day of clinical
practice on the level of pain in the right foot (p>0.05). All
other pairwise comparisons made on the right foot were
statistically signicant (p<0.05). In the pairwise compar-
isons conducted to evaluate the level of pain in the le
foot, except for the foot bath performed on the rst day
aer the clinical practice, all other pairwise comparisons
had a signicant eect on foot pain (p<0.05). ese nd-
ings were clinically signicant.
Table 4. Comparison of right and left foot pain levels of
students in the intervention group before and after clinical
practice a
Measurement time 1st week 2nd week 3rd week 4th week Statistics
test
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Right
Pre-clinical evening 1.00 (1.25) 0.92 (1.31) 0.88 (1.29) 1.16 (1.65)
c2=152.410
p<0.001
Evening of the 1st day
after clinical practice
(before foot bath)
3.84 (2.41) 3.58 (1.81) 3.54 (2.43) 3.16 (2.32)
Evening of the 1st day
after clinical practice
(after foot bath)
2.24 (2.20) 2.00 (2.04) 1.75 (1.64) 1.76 (1.66)
Evening of the 2nd day
after clinical practice
(after foot bath)
2.28 (2.33) 1.96 (1.62) 2.17 (2.05) 1.76 (1.73)
Statistics test
c2=
46.070
p<0.001
c2=
38.242
p<0.001
c2=
33.292
p<0.001
c2=
22.929
p<0.001
Left
Pre-clinical evening 0.92 (1.24) 0.96 (1.57) 1.08 (1.55) 1.04 (1.39)
c2= 84.194
p<0.001
Evening of the 1st day
after clinical practice
(before foot bath)
3.63 (2.12) 3.63 (2.12) 3.48 (2.36) 2.92 (2.26)
Evening of the 1st day
after clinical practice
(after foot bath)
2.13 (1.54) 2.13 (1.54) 2.16 (2.01) 1.83 (1.68)
Evening of the 2nd day
after clinical practice
(after foot bath)
1.67 (1.43) 1.67 (1.43) 1.84 (1.88) 1.67 (1.81)
Statistics test
c2=
39.192
p<0.001
c2=
35.220
p<0.001
c2=
29.145
p<0.001
c2=
21.672
p<0.001
a c2 – Friedman test; SD – standard deviation
Table 5. Comparison of right and left foot pain levels of
students in the control group before and after clinical
practice a
Measurement time 1st week 2nd week 3rd week 4th week Statistics
test
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Right
Pre-clinical evening 0.86 (1.95) 1.05 (1.39) 1.10 (1.37) 0.90 (1.37)
c2=
127.493
p<0.001
Evening of the 1st
day after clinical
practice
3.62 (1.83) 3.90 (2.27) 4.29 (2.19) 3.71 (1.84)
Evening of the 2nd
day after clinical
practice
3.67 (1.90) 3.76 (1.92) 3.52 (2.18) 3.57 (1.93)
Statistics test c2= 25.241
p<0.001
c2= 26.732
p<0.001
c2= 28.587
p<0.001
c2= 26.297
p<0.001
Left
Pre-clinical evening 0.95 (1.35) 1.05 (1.35) 1.10 (1.22) 0.95 (1.20)
c2=
131.322
p<0.001
Evening of the 1st
day after clinical
practice
3.62 (1.43) 3.81 (2.25) 4.19 (2.01) 3.76 (1.75)
Evening of the 2nd
day after clinical
practice
3.90 (1.70) 3.57 (1.96) 3.81 (1.86) 3.57 (1.66)
Statistics test c2= 31.444
p<0.001
c2= 21.658
p<0.001
c2= 28.987
p<0.001
c2= 27.029
p<0.001
a c2 – Friedman test; SD – standard deviation
In Table 5, the right and le foot pain scores of the
students in the control group increased in the evening of
the day aer clinical practice compared to the day before
481
The eect of foot baths on foot pain and leg edema of nursing students during clinical training
clinical practice. e pain scores expressed by the stu-
dents in the right and le foot in the rst week increased
continuously, unlike the other weeks, and the scores that
increased in the evening of the day aer clinical prac-
tice in the other weeks decreased in the evening of the
2nd day compared to the 1st day (p<0.001). In the four-
week follow-up, the changes in the pain scores of the
students in the right and le foot showed a statistically
signicant dierence (p<0.001). All pairwise compari-
sons made using the Wilcoxon signed ranks test showed
statistically signicant dierences (p<0.05).
Discussion
In this study, the eect of foot bath and foot massage ap-
plied aer clinical practices in nursing students on foot
pain and leg edema was evaluated for four weeks be-
fore and aer weekly clinical practice. It was determined
that the level of tibia edema in the right and leg, which
increased aer clinical applications of the 20-minute
foot bath and 8-minute (total for both feet) foot mas-
sage applied before going to bed by the nursing students
decreased at the end of each week (p<0.05). Although
tibia edema in the le leg decreased at the end of each
week, this decrease was signicant in the 1st and 4th
weeks (p<0.05). is result showed that when foot bath
and foot massage were applied together, it had a signi-
cant eect on lower extremity edema. It is seen that this
nding is compatible with studies conducted in previ-
ous years. In the studies of Seo et al., they were reported
that footbath performed for 20 minutes 3 times a week
before going to bed was eective in reducing edema in
both legs in nursing students (p<0.001).6,11 Lee et al. re-
ported that footbath applied for 20 minutes reduced tib-
ia edema in operating room nurses who stood for long
periods of time (p<0.05).13 Oh and Yoon also found that
leg massage applied by the nurses for 10 minutes re-
duced leg edema.16
In this current study, it was found that the footbath
and foot massage applied by nursing students were ef-
fective in reducing the increasing foot pain aer clinical
practice (p<0.001). e foot pain score, which increased
to an average of 3 points on the evening of the rst clin-
ical practice every week in the intervention group, fell
below 3 points at the end of the week. e foot pain
score, which increased aer clinical practice in the con-
trol group, was still above 3 points at the end of the week
(p<0.001). A single study was found to reduce the in-
creased pain sensation aer clinical practice of foot bath
and foot massage in nurses or nursing students. In this
study conducted by Oh and Yoon, it was reported that
the foot pain score, which was 5 on average aer work-
ing in the clinic, decreased to an average of 4 points af-
ter the leg massage performed by the nurses themselves,
and this result was statistically signicant.16 Also, in the
literature, it is emphasized that foot bathing by immers-
ing the feet in water reduces foot pain by stimulating
tactile sensations and reducing sympathetic nerve ac-
tivity.12,17
Study limitations
This study had three main limitations. First, the study
conducted only with second-year nursing students. Sec-
ond, participants may not have lled out the forms cor-
rectly because they made the measurements themselves.
Third, participants may not have watched or worked on
the video adequately.
Conclusion
In this study, it was determined that nursing students
experienced foot pain and leg edema aer clinical prac-
tice. In addition, the study showed that foot bath and
foot massage performed before bedtime aer clinical
practice were eective in reducing students’ foot pain
and leg edema. Foot baths may applied as an eective
intervention to decrease leg edema and foot pain among
nursing student during clinical training. e limit-
ed number of studies on the subject in previous years
makes the results of this study important.
Acknowledgments
e authors would like to thank the nursing students
who participated in the study.
Declarations
Funding
This study supported by the Scientic and Technologi-
cal Research Council of Turkey (TUBITAK) within the
scope of 2209-A - University Students Research Proj-
ects Support Programme.
Author contributions
Conceptualization, S.Ç. and G.C.; Methodology, S.Ç.
and G.C.; Software, S.Ç.; Validation, S.Ç; Formal
Analysis, S.Ç; Investigation, G.C., B.G., C.S., İ.A..;
Resources, S.Ç. and G.C; Writing – Original Draft
Preparation, S.Ç., G.C., B.G., C.S., İ.A.. Visualization,
S.Ç. G.C.; Supervision, S.Ç. and G.C.; Project Admin-
istration, S.Ç. and G.C.; Funding Acquisition, S.Ç. and
G.C.
Conict of interest
The authors report no conicts of interests.
Data availability
The data that support the ndings of this study are
available from the corresponding author upon reason-
able request.
482 European Journal of Clinical and Experimental Medicine 2023; 21 (3): 476–482
Ethics approval
Study was approved by the University’s Social and Hu-
man Sciences Ethics Committee (decision no. 10, dated
18.03.2020).
References
1. Bahçecik N, Alpar SE. Nursing education in Turkey: from
past to present. Nurse Educ Today. 2009;29(7):698-703. do-
i:10.1016/j.nedt.2009.05.008
2. Arkan B, Ordin Y, Yılmaz D. Undergraduate nursing stu-
dents’ experience related to their clinical learning environ-
ment and factors aecting to their clinical learning pro-
cess.Nurse Educ Pract.2018;29:127-132. doi:10.1016/j.
nepr.2017.12.005
3. Bilgiç Ş, Çelikkalp Ü. Assessment of nursing students’
stress levels and coping strategies during rst clinical
experience. Clin Exp Health Sci. 2021;11(3):437-443. doi:
10.33808/clinexphealthsci.777904
4. Bodys-Cupak I, Ścisło L, Kózka M. Psychosocial deter-
minants of stress perceived among polish nursing stu-
dents during their education in clinical practice.Int J
Environ Res Public Health. 2022;19(6):3410. doi:10.3390/
ijerph19063410
5. Khater W, Akhu-Zaheya L, Shaban I. Sources of stress and
coping behaviours in clinical practice among baccalaureate
nursing students. Int J Human Soc Sci Res. 2014;4(6):194-
202.
6. Seo S, Han H, Yeon S. Contribution of foot bath to fatigue
relief measured by using smart phone applied question-
naires. Int J Adv Sci Eng Inf Technol. 2018;113:113-122.
doi:10.14257/ijast.2018.113.12
7. Eyi S, Eyi İ. Nursing students’ occupational health and
safety problems in surgical clinical practice.SAGE Open.
2020;10(1):2158244020901801.
8. Elsayed AA. Work-related musculoskeletal disorders
among nursing students during clinical training.Am J
Nurs. 2019;7(6):952-957. doi: 10.12691/ajnr-7-6-7
9. Moodley M, Ismail F, Kriel A. Work-related musculoskel-
etal disorders amongst undergraduate nursing students at
the University of Johannesburg. Health SA Gesondheid.
2020;25:a1460. doi: 10.4102/hsag.v25i0.1460
10. Kamalruzaman NSA, Tengku Sabri TA, Isa SNI. Musculo-
skeletal disorders and quality of life among undergraduate
health sciences students: A cross-sectional study.Health-
scope. 2021;4(1):99-105.
11. Seo S, Yoon M, Yeon S. Eects of foot bath on leg edema
and fatigue among college students. J Korean Soc Sch Health.
2017;30(1):21-28. doi: 10.15434/kssh.2017.30.1.21
12. Rahmani A, Naseri M, Salaree MM, Nehrir B. Comparing
the eect of foot reexology massage, foot bath and the-
ir combination on quality of sleep in patients with acute
coronary syndrome. J Caring Sci. 2016;5(4):299-306. doi:
10.15171/jcs.2016.031
13. Lee SY, Kyung PH, Jea KH, Hee JY. Eects of foot therapy
on operating room nurses’ lower extremities edema, stress,
and fatigue. J Korean Acad Nurs. 2014;20(1):102-112. doi:
10.22650/JKCNR.2014.20.1.102
14. Oh S, Gang GH. Eects of footbaths on stress and exa-
hustion for high school senior students-a comparative
study on the aroma oil and fermentation extract. Jour-
nal of the Korea Academia-Industrial Cooperation Society.
2010;11(1):402-408. doi:10.5762/KAIS.2010.11.1.402
15. Sert H, Olgun N. Yoğun bakımda ödem ve dehidratasy-
on.Yoğun Bakım Hemşireliği Dergisi. 2016;20(1): 24-36.
16. Oh J, Yoon CM. Lower extremity edema and pain of nur-
ses and the eect of self leg massage. J Korean Acad Nurs.
2008;38(2):278-286. doi: 10.4040/jkan.2008.38.2.278
17. Koraş Sözen K. [e eect of foot massage on postopera-
tive pain level]. Kahramanmaraş Sütçü İmam Üniversitesi
Tıp Fakültesi Dergisi. 2020;15(2):110-115. doi: 10.17517/
ksutfd.67335
