TNAI JOURNAL

Touch is a language spo ken through the hands and understood by the heart. Together, intention and touch set the tone and provide the basis for healing. Hospitalisation and disease process can place a heavy demand on an individual’s physiological and psychological status. There is a need for a nonpharmacological intervention to address all these discomforts as an adjunct to the normal routine care and pharmacological interventions. Therefore it is necessary for the nurses to adopt some alternative holistic modalities such as yoga, meditation, guided imagery, music therapy, aromatherapy, massage therapy etc. With this background, a study was conducted (as part of post-graduate thesis in 2007) to assess the immediate effects of effleurage back massage on selected physiological and psychological components of relaxation in adult clients who were confined to bed in orthopaedic ward of St John’s Medical College Hospital, Bangalore. Effleurage back massage is a type of massage given for three minutes using long, slow, gliding strokes that is divided into light and deep strokes. Light strokes are used to sedate and deeper strokes compress soft tissues and encourage circulation.

The study sought to assess

The author is Junior Lecturer, St. John’s College of Nursing, Bangalore.

the immediate effects of effleurage back massage on selected physiological and psychological components, and compare the effectiveness of effleurage back massage with selected baseline variables (age, gender and diagnosis).

The assumptions of the study were that hospitalisation and disease process are the major stressors, which cause physiological and psychological disequilibrium in the individual, and effleurage back massage relaxes the body and mind and thereby maintains equilibrium.

The conceptual framework developed was based on Neuman’s system model. In the present study, medical and surgical conditions, pain and anxiety besides others were the stressors which cause reaction leading to change in physiological and psychological components and disequilibrium. Effleurage back massage was used as an intervention to maintain equilibrium.

Methodology
Data was obtained from 60 adult clients who were confined to bed in orthopaedic wards of St John’s Medical College and Hospital (SJMCH), Bangalore. The research design adopted for this study was one group pre-test post-test design. Purposive sampling technique was used to select the sample. The instruments used for data collection were interview schedule for

baseline information, record of physiological parameters, visual analogue scale and state trait anxiety inventory.

The patients were identified according to inclusion and exclusion criteria.

Inclusion Criteria : Adult clients of orthopaedic ward who were confined to bed, had pain and were on oral analgesics and who were able to turn and remain in lateral or prone position for 3-5 minutes.

Exclusion Criteria : Clients who were in a confused and delirious state, mentally incompetent, who were unable to answer questions, with acute cardiac disorders, with acute back problem / trauma, those not willing to participate in the study, and those on round the clock sedation and IV / IM analgesics.

The baseline demographic data was obtained by interview schedule. The physiological components, which included blood pressure (BP), heart rate (HR) and respiratory rate (RR) and psychological components like pain scale (VAS) and anxiety scale (STAI) were assessed before effleurage back massage. Next, the patients were turned to lateral or prone position and effleurage back massage was given for 3 minutes with powder used by individual patients. After the procedure the patients were repositioned comfortably. After a gap of 5 minutes, the physiological components were assessed. Again, after 30

minutes physiological and psychological components were assessed. The data was analysed using descriptive and inferential statistics.

Results

The statistical tests carried out for analysis were as follows. For objective one and two, range, mean, standard deviation, paired ‘t’ test, RMANOVA with pillia’s trace were used. For objective two, Pearson’s product moment correlation coefficient was used for age. For gender the student’s t-test was employed to compare the means of two independent groups. When distributions were significantly non-normal, quantitative variables were ranked and the t-test findings were confirmed using the Mann-Whitney test with z corrected ties. For diagnosis (trauma, back pain and miscellaneous conditions) Kruskal Wallis test was used, for comparison of the means of more than two groups.

Findings

The major findings are summarised as follows :

1. The physiological parameters - systolic blood pressure (SBP), diastolic blood pressure (DBP), HR and RR were checked before effleurage back massage and at 5 minutes and 30 minutes after effleurage back massage. Further, there was significant change in blood pressure, HR and RR following effleurage back massage at 0.001 level (Table 1).

2. The psychological parameters were measured only

Table 1 : Comparison of Physiological Components before and after effleurage back massage (n=60)

Physiological Comp.	Time	Pillai's Trace	F
Systolic blood pressure	0-5-30	0.67	60.08
Diastolic blood pressure	0-5-30	0.21	7.84
Heart rate	0-5-30	0.74	83.98
Respiratory rate	0-5-30	0.65	52.84
t (2,58) = 4.98 p=0.01

Table 2 : Comparison of pain levels before and after effleurage back massage (n=60)

	PO	P30	Test of Significance
Range	1-8	0-8	Paired t value =
Mean	4.4	2.8	13.84
SD	1.5	1.5	p<0.001
t (59) = 2.000, p=0.05

Table 3 : Comparison of anxiety levels before and after effleurage back massage (n=60)

	Anx 0	Anx 30	Test of Significance
Range	20-72	20-63	Paired t value =
Mean	45.0	42.2	8.73
SD	10.1	9.2	p<0.001
t (59) = 2.000, p=0.05

twice, pre-massage and at 30 minutes post-massage. There was significant change in pain level and anxiety level following effleurage back massage at 0.001 level (Table 2 and Table 3).

3. Association of selected baseline variables with physiological and psychological components was made.

4. With regard to gender, the effect of effleurage back massage was statistically

significant in males than in females (p<0.05).

5. As for diagnosis there was no significant difference between diagnosis and physiological and psychological components.

6. With regard to age there was a negative correlation between age and all the physiological and psychological components.

7. Subjective responses from patients provided strong evidence of the positive ef-

fects of massage

Recommendations

The results of the study can be utilised by nurses in nursing practice, nursing education and nursing administration, in considering the use of effleurage back massage as a relaxation technique.

A comparative study can be done to find out the effect of back massage and other nonpharmacological measures like aromatherapy and music therapy.

Conclusion

It was found that effleurage back massage was effective on all the physiological components - blood pressure, heart rate and respiratory rate and all psychological components - pain levels and anxiety level. This study highlights the importance of ‘hands on’ technique that brings the power of touch to therapeutic relationships. Hence nurses could plan this intervention of back massage as a relaxation technique

References

Potter PA, Perry AG (2001). Fundamentals of Nursing (First edn); St. Louis: Mosby, p 1086

Dorsey BA (1984). A wonderful pre-requisite : A relaxation method. Nursing 14(1): 42

Labyak SE, Metzer BL (1997). The effects of effleurage backrub on the physiological components of relaxation: A meta-analysis. Nursing Research 46(1): 59

Annette MW (2000). Massage therapy as a Nursing practice. Holistic Nursing Practice 14(2): 48.