A Quasi Experimental Study to Evaluate the Effectiveness of Reflexlogy on Pain and Anxiety among Primi Postnatal Caesarean Mothers at Selected Hospital Kanyakumari District

 

Mrs. Arzta Sophia¹, Prof. P. Padmavathi², Dr. K. Menaka³

¹Associate Professor, H.O.D of O.B.G. Department, Christian College of Nursing, Neyyoor.

²Principal, Dhanvanthri College of Nursing, Pallakkapalyam, Namakkal District.

³Principal, Padmasree College of Nursing, Kanchepurum.

 

ABSTRACT:

Title: Effectiveness of reflexology on pain and anxiety among primi post natal caesarean mothers at selected hospital Kanyakumari. Introduction: Caesarean is a surgical procedure done to save the life of the mother and the baby. Due to this mother experience pain and anxiety during the postnatal period which affects daily activities as well as comfort and well being. To relieve pain and anxiety non pharmacological methods can be used, such as reflexology. Purpose: To evaluate the effectiveness of reflexology on pain and anxiety among post natal caesarean mothers at selected hospital, kanyakumari District. Method: A quasi experimental pretest, post test control group design was adopted for this study. 60 primi postnatal caesarean mothers who met the inclusion criteria were selected using non probability (Purpose sampling technique) from C.S.I. hospital Neyyoor. Paired‘t’ test was used to evaluate the effectiveness of reflexology. Chi square test was used to find out the association between pretest pain and anxiety with   selected demographic variables. Result: in the pretest out of 60 primipostnatal mothers 30 in interventional group and 30 in the control group. 27(90%) had severe pain the interventional group 28((93%) had severe pain in the control group. In the post test 2 (7%) had severe pain, (1%) had moderate pain and 27 (90%) has mild pain. The‘t’ value 9.539 was compared with tabulated value at the level of p<0.001 was significant. This showed that reflexology was effective in reducing pain among caesarean primi postnatal mothers. Regarding anxiety in the pretest 23 (76.6%) had severe anxiety, 7(23,3%) had moderate anxiety in the interventional group. In the control group 27(90%) had severe anxiety the ‘t’ value 16.09 was compared with tabulated value at p< 0.001 was significant. Conclusion: The findings of the study concluded that reflexology was effective in reducing pain and anxiety among primipostnatal caesarean mothers.

 

 

 

INTRODUCTION:

Caesarean section is done which caused pain and anxiety to the mother. Pain is an unpleasant feeling which the mother has to undergo through the postnatal period, effective pain relief and reduction in anxiety will promote the comfort of the mother, promote health, less hospital stay and promotes the wellbeing of both the mother and the baby. Today apart from pharmacology non pharmacological measures are taken to reduce pain and anxiety. Many studies have shown that non pharmacological measures like yoga, meditation, reflexology are inexpensive easy to administer and less side effects. Reflexology reduced   both pain and anxiety .when pressure is applied to reflex points and zones in the feets and hands it triggers circulation and improves the physiological relaxation response in the body.

 

A blind clinical trial was conducted by Movarid Irani, Masoumehkordi, Fatemeh Tera, Hamid riza Bahrami, Kievan Shariati Nejad (2015) on the effect of foot massage on post caesarean pain and anxiety in Omalbania hospital. The samples were 80 pregnant women who have undergone elective caesarean section were selected by convenience sampling. The subjects were assigned randomly to 2 groups. Visual analog scale was used to assess the level of pain and anxiety. Foot massages were given on each foot and hand for 5 minutes and the post test were done immediately 60 and 90 minutes after intervention. The study results showed reduction in pain and anxiety among postnatal caesarean mothers.

 

Padmavathi P (2013) did a study on foot reflexology on pain among postnatal caesarean mothers. A quasi experimental non equivalent pretest and posttest design was adopted. The study was conducted in V. K Hospital and T.P.N. Hospital Erode, Tamilnadu, India. Samples were selected by non probability convenient sampling. 30 postnatal caesarean mothers who fulfilled the inclusion criteria were selected. Pretest was conducted using visual analog scale then intervention was given once a day for 5 days. On the 6^th day posttest was conducted. The findings imply foot reflexology was effective in reducing the post operative pain among post caesarean mothers.

 

OBJECTIVES:

·       To assess the pretest and posttest level of pain among postnatal caesarean mothers.

·       To assess the pretest and posttest level of anxiety among postnatal caesarean mothers.

·       To evaluate the effectiveness of reflexology on pain and anxiety among postnatal caesarean mothers.

·       To explore the association between selected demographic variables.

 

HYPOTHESIS:

H₁:         There is a significant effectiveness of reflexology on pain and anxiety among postnatal caesarean mothers in intervetinal group than control

H₂:         There is a significant association between pain and anxiety with selected demographic variables.

 

MATERIALS AND METHODS:

Research approach:

Quantitative approach was adopted for this study.

Research Design:

Quasi- experimental pretest posttest control group design.

 

Setting:

The study was conducted in C.S.I hospital Neyyoor.

 

Population:

The population for the present study is postnatal caesarean  mothers at C.S.I. hospital Neyyoor.

 

Sample Size:

The sample comprised of 60postnatal mothers who fulfilled the inclusion criteria were selected (30 in control 30 in interventional group).

 

Sampling Technique:

Non probability purposive sampling techniques were used to select the samples.

 

Criteria for Sample Selection:

Inclusion Criteria:

·       Postnatal mothers who has under gone caesarean section.

·       Free from complications.

·       Who have given consent to participate in this study.

 

Exclusion Criteria:

·       Mothers with acute or chronic illness.

·       Mothers with normal delivery

·       Any other complications after surgery.

 

Description of the tool:

The instrument was classified into 2 parts.

 

Part I:

It consists of demographic variables of the postnatal caesarean mothers such as age, education, occupation, type of family, religion and support system.

 

Part II:

The data was collected through visual analog scale for pain, zung self rating anxiety scale was used to rate the anxiety of postnatal caesarean mothers. A score was given as 1, 2, 3, 4and negative statements were given reverse scoring .Through interview schedule the datas  were collected.

 

Validity:

The content validity of the tool was obtained from research experts in the field of obstetrics and gynaecology.

 

Reliability of the tool:

Reliability of the tool was checked by split half method, reliability score for zung self anxiety scale was r = 0.9

Data collection procedure:

The study was conducted in C.S.I. hospital Neyyoor. The investigator introduced herself to the mother and developed a good rapport after collecting the demographic varaiables pretest was conducted on the 2^nd day with the help of the tool. After the pretest, reflexology was given to the primi postnatal caesarean mothers in the interventional group for 20 minutes. 5 minutes in each foot  and hands for 5 days . on the 6^th day posttest was conducted by using the same tool. Based on the collected data effectiveness was found by comparing the pretest and posttest scores in the interventional and control group.

 

Score Interpretation:

Visual Analog Scale

                 0%                - 0 – No Pain

               (10%-30%)  – 1-3 –Mild Pain

               (40% -60%) – 4-6 – Moderate Pain

               (70%-100%) – 7-10 – Severe Pain

 

Based on the information datas were classified as follows

        Normal                                  - 20-44

        Mild anxiety/Moderate anxiety- 45-59

        Severe Anxiety                                   - 60-74

 

DATA ANALYSIS AND INTERPRETATION:

The frequency and percentage distribution of demographic variables of primi postnatal caesarean mothers (54%) were between 21-25 yrs, (64%) were graduates, (47%) were unemployed, (50%) had 5000 to 14000 income, (53%) were Christians, (75%) support system husband and family.

 

The pain score were assessed using visual analog scale in the pretest and posttest among 60 mothers in both groups. In the pretest 27(90%) had severe pain in the interventional group, 28(93%) had severe pain in the control group. In the posttest 2(7%) had severe pain, 1(3%) had moderate pain, 27(90%) had mild pain on the 6^th postnatal day in the interventional group.

 

The anxiety score using zung self anxiety scale in the pretest 23(76.6%) had severe anxiety, 7 (23.3%) had moderate anxiety in the interventional group, 27(90%) had severe anxiety 3(10%) had moderate anxiety in the control group. In the posttest 1(3.3%) had moderate anxiety, 28(9.3%) had mild anxiety in the interventional group.

 

The mean standard deviation in the pretest pain 7.8 and 0.97 in the interventional group, 8.3 and 0.9 in the control group posttest mean and standard deviation 4.9 and 1.37 in the interventional group, 7.1 and0.9 in the control group. The calculated ‘t’ value is 9.539 which is greater than the table value at 0.001. this shows that reflexology is effective in reducing pain among primi postnatal mothers.

 

The mean, standard deviation in the pretest anxiety 64.7and 3.3, 60.7 and 3.1 in the interventional and control group, posttest 49.97, 3.8 and 59.7, 2.9. interventional and control group the calculated ‘t; value is 16.09 which is significant at 0.001 level.  Hence it shows that reflexology is effective in reducing anxiety among postnatal caesarean mothers. There was no association between pain, anxiety with selected demographic variables.

 

RESULTS AND DISCUSSION:

The mean postnatal caesarean pain score of interventional group before and after reflexology were 7.8 + 4.9 and 0.97+0.9. The mean reduction were 2.96+ 1.59. The mean anxiety score of postnatal caesarean mothers 64.73+3.3.

 

The mean reduction in anxiety was (10.73+1.59). The calculated ‘t’ value were significant at the level of p< 0.001. So it has been concluded that reflexology was effective in reducing the pain and anxiety among postnatal caesarean mothers.There was no significant association between the demographic variables, pain and anxiety.

 

RECCOMENDATIONS:

Based on the study findings

·       The same study can be replicated on a larger samples in difficult settings.

·       A comparative study can be done between postnatal caesarean mothers in the rural and urban area.

·       A descriptive study can be done on the coping mechanism and adaptation of pain and anxiety of postnatal caesarean mothers.

·       A Comparative study can be done between primi and multi postnatal caesarean mothers.

 

CONCLUSION:

The present study findings concluded that there is a reduction in pain and anxiety in primipostnatal caesarean mothers in the interventional group than control group.

 

REFERENCES:

1.       Degirmen N, Ozerdogan N, Sayiner D, Koseroglu N, Ayraci, (2010) “Effectiveness of foot and hand massage in post caesarean pain control in a group of Turkish pregnant women, Applied Nursing research, 23(3):153-158.

2.       Kim J H, Park K.S., (2002) “The effect of foot massage on postoperative pain in patients following abdominal surgery, Korean Academy adult Nursing, 14(1), 34-43.

3.       Latifi S H, Ratice O H, Seyfish,(2012) “The effect of hand massage on post caesarean section” Anasthesiolory and pain Medicine journal, 2(7), 102-107.

4.       Morvarid Irani, Masoumeh Kordi, Fatimeh Tera, Hamid Reza Bahrami, Kievan Shariati Nejad,(2015) “The effect of hand and foot massage on post caesarean pain and anxiety” Iranian journal of Nursing and midwifery Research, 3(5), p 465-471.

5.       Najarsh, Akbari M, Abbaspoorz, Haghighi Zadeh m A, (2011) “The effect of hand and foot massage on painintensity after caesarean section, scientific journal of Ilam University of Medical Sciences, 20(4): 39-48.

6.       Padmavathi P (2013) A study to assess the effectiveness of foot reflexology on pain among postnatal caesarean mothers in selected hospitals at Namakkal District.

7.       Wang HL, Keck JF (2004)”A test of foot massage to reduce pain among potoperative patients “Journal of pain management, 5(2); 59-60.

 

 

 

 

 

Received on 16.11.2016           Modified on 25.12.2016

Accepted on 16.01.2017         © A&V Publications all right reserved