A Study to Assess the Effectiveness of Foot Reflexology on Pain among Post Caesarean Mothers in Selected Hospitals at Namakkal District

Prof. P. Padmavathi

Principal, Dhanvantri College of Nursing, Ganapathypuram, NO – 1 Ranganoor Road, Muniyappan Kovil, Pallakkapalyam (PO), Tiruchengodu (TK), Namakkal District – 637 303

*Corresponding Author Email:

ABSTRACT:

Background: Child birth is one of the greatest events in every woman’s life. Though it is the happiest moment, the process of child birth is physically painful. Caesarean section is one of the common methods of delivery with incidence of 32.6% documented from South India. Post operative pain and insomnia are the major concerns for the mothers. Objectives: To assess the effectiveness of foot reflexology on pain among post caesarean mothers. Design: Quasi experimental Non equivalent pre test and post test design was adopted for the study. Setting: VK hospital and TPN hospital, Erode. Participants: 30 post caesarean mothers fulfilling the inclusion criteria were selected by convenient sampling. Methods: A pre test was conducted by using Visual Analogue scale. Immediately after pre test foot reflexology was given one time a day for 5 days and 6th day post test was conducted to assess the effectiveness of foot reflexology. Collected data was analysed by using descriptive and inferential statistics. Results: In control group, the mean score of the sample was 5.9 (SD= 0.67)) and the experimental group mean score was 4.1 (SD = 0.24) with Paired‘t’value of 6.42 and Unpaired‘t’ value 3.43. This showed that the foot reflexology was effective in enhancing the practice of the sample regarding pain perception. There was a statistically no significant association found between the post test scores of the sample with their demographic variables. Conclusion: The findings imply the need for educating post caesarian mothers on effective management of pain perception. Foot reflexology is a non pharmacological, cost effective and simple intervention without any adverse effects. The results proved that the foot reflexology was effective in reducing the post operative pain among post caesarean mothers.

KEYWORDS: Effectiveness, reflexology, pain perception, post caesarean mothers.

NEED FOR THE STUDY:

Child birth is one of the greatest events in every woman’s life. Though it is the happiest moment, the process of child birth is physically painful. Caesarean section is one of the common methods of delivery with incidence of Thirty-two percent of all births in the United States. India is also experiencing a rapid increase in C-section deliveries with incidence of 32.6% documented from South India. Post operative pain and insomnia are the major concerns for the mother. Some alternative therapies are in the early empirical stage in reducing post operative pain and improving quality of sleep. (Klaus M H, Kennel JH)

The WHO report mentions that in India overall, the caesarean section rate is 18%. The rate of caesarean section is relatively higher in Goa (15.3%) and Kerala (13.7%).

In India caesarean section rates have skyrocketed especially in private sector where caesarean section rate was found to be 47% in contrast to 38% in charitable hospitals and 20%in public hospitals according to a population –based cross sectional study in Chennai, India. In the early 1970s researchers reported that pain was seriously undertreated aspect after surgery. (Fyfe EM, 2011)

A study to find the Effect of foot and hand massage in post cesarean pain control in a group of Turkish mothers revealed that the reduction in pain intensity was significantly meaningful in both intervention, when compared to the control group (Nuriye Degirmen, 2010).

A study done in New Delhi, India to know the effectiveness of foot reflexology on pain among post-operative patients showed that there was a 50% reduced use of analgesics in the experimental group where foot reflexology was used for pain control, against the control group were only analgesics were administered. The study concluded that foot reflexology was effective in reducing post operative pain (Chaudhary S, 2006).

Caesarean section is one of the most commonly performed abdominal surgeries on the woman throughout the world with incidence of 20-25% in many developed countries. The result showed that Mean PSQI were found to be significantly lower in the intervention group (p<0.001) than in the control group. The post test mean score of pain of an experimental group was significantly lower than of a control group (X = 4.75, X =7.65, t = -10.627, p< 0.001). Also, there was a significant difference between groups in terms of the pain intensity and requesting for analgesic (p < 0.001). The research hypothesis was accepted which indicates that after receiving foot reflexology therapy, the subjects showed significant pain relief and improved quality of sleep. The findings of the study support the need of implementing foot reflexology to post operative pain and improve the quality of sleep among post caesarean mothers. Foot reflexology is a non pharmacological, cost effective and simple intervention without any adverse effects. The results proved that the foot reflexology was effective in reducing the post operative pain among post caesarean mothers. (Jipi Varghese, 2014)

The researcher during her experience in maternity ward observed that mothers who underwent caesarean section experienced discomfort and pain during their post operative period. Pain affects the appetite, sleep, energy and inability to do things. So the researcher intended to do Reflexology to reduce pain and thereby promote comfort to post operative caesarean section mothers.

Statement of the problem

A study to assess the effectiveness of foot reflexology on pain among post caesarean mothers in selected hospitals at erode.

Objectives

} To assess the pain among post caesarean mothers before and after foot reflexology in control and experimental group.

} To determine the effectiveness of foot reflexology on pain among post caesarean mothers in control and experimental group.

} To find out the association between the post test scores of pain among post caesarean mothers in control and experimental group with their selected demographic variables.

Hypotheses

H₁There will be significant effectiveness of foot reflexology on pain among post caesarean mothers in control and experimental group.

H₂There will be significant association between the post test scores of pain among post caesarean mothers in control and experimental group with their selected demographic variables

MATERIALS AND METHODS:

Research approach

An evaluative approach was considered as the appropriate measure to evaluate the effectiveness of foot reflexology on pain among post caesarean mothers.

Research design

Quasi experimental where Non equivalent pre and post test design was used

Post caesarean mothers	Pre test	Intervention	Post test
Experimental group	O₁	X	O₂
Control group	O₁	-	O₂

Research setting

The study was conducted in VK Hospital and TPN Hospital, Erode.

Sample

The sample consisted of 30 post caesarean mothers (15 control group and 15 experimental group)

Sampling technique: Non probability convenience sampling technique was used to select the samples

Development of tool

Section A: Socio demographic variables of the samples

Section B: Intensity of pain was measured by visual analogue scale (VAS)

Data Collection procedure

1. Preparation before reflexology

a) For mother: - Clean and warm the feet soak the feet in warm water for 10 minutes with the temperature the mother can tolerate and dry the feet. Lie down or sit in a comfortable position

b) For therapist:-Explain the procedure and make her to relax. Hands should be free of trauma.

c) Techniques used in the study:-Thumb walking and finger walking.

2. Ethical clearance obtained from hospital research committee

3. Followed by informed consent of 30 post caesarean mothers from 1st-3rd post operative day. 15 mothers from each group. Baseline data was obtained from both the groups.

4. Participants in both groups received the same care except for reflexology.

5. Intervention group received a single 15-minute foot reflexology session at the same time each evening for five consecutive days. After 5 days of treatment, intensity of pain was measured by visual analogue scale (VAS)

Plan for data analysis

The data were analysed by using both descriptive and inferential statistics

Ø Back ground information of the subject were described by percentage distribution

Ø Mean, standard deviation, Paired ‘t’ and Un paired ‘t’ test was used to find the relationship between pre-test and post test assessment scores on pain among post caesarean mothers.

Ø Chi square test was used to find out the relationship between selected variables of post caesarean mothers with their post test scores.

RESULTS:

Section A:

The study findings showed that in control group, majority (60%) of the sample were in the age group of 26 – 30 years, 60% were higher secondary education, 73% were private employee, 67% were no previous history of LSCS and all (100%) the mothers had regular antenatal check-up.

The study findings showed that in experimental group, majority (73%) of the sample were in the age group of 21 – 25 years, 80% were higher secondary education, 67% were private employee, 67% of mothers had previous history of LSCS and all (100%) the mothers had regular antenatal check-up.

Section B: Assess the pain among post caesarean mothers

Pre test assessment:

The level of pain in control group, majority 8 (53%) of them had very severe pain and 7 (47%) of them had severe pain and experimental group, majority 9 (60%) of them had very severe pain and 6 (40%) of them had severe pain. The unpaired ‘t’ test value was 1.61 which did not show any statistical significance.

Post test assessment:

The level of pain in control group, majority 9 (60%) of them had severe pain and 6 (40%) of them had moderate pain and experimental group, majority 12 (80%) of them had mild pain and 3 (20%) of them had moderate pain. The unpaired ‘t’ test value was 3.43 which was statistically highly significant at p< 0.05 level.

Section C:

In pre test the mean score was 7.9 (SD= 1.22) and the post test mean score was 4.1 (SD = 0.24) which indicated an reduction of pain level of the post caesarean mothers after intervention of foot reflexology.

Paired ‘t’ test value was computed to evaluate the effectiveness of foot reflexology on pain. The obtained value was 6.42, which was significant at 0.01 levels indicating the effectiveness of foot reflexology.

Section D:

Chi square was computed to determine the association between post test scores of the respondents with their demographic variables such as age, education, occupation, antenatal check up and previous history of LSCS.

DISCUSSION:

Highly significant difference found between pre test and post test scores of post caesarean mothers regarding level of pain.

There is no significant relationship was found between post test scores of the samples with their age (2 = 1.45), education (2 = 3.23), occupation (2 = 2.82), antenatal check up (1 = 2.14) and previous history of LSCS (1 = 1.84).

RECOMMENDATIONS:

On the basis of the findings of the study it is recommended that,

§ The study can be replicated on a larger sample to generalize the results

§ The comparative study can be conducted with more than one intervention

§ The same conducted with primi and multi post caesarian mothers

§ Non pharmacological pain management should be emphasized in nursing curriculum

§ Training programmes Nurses can be given on complementary therapies

LIMITATIONS:

Ø Intervention was limited to 15 minutes.

Ø Study was conducted only on post caesarean mothers.

Ø Relatively small sample size.

CONCLUSION AND SUMMARY:

· Foot reflexology following caesarean section significantly improved the reduced the intensity of pain.

· Nurses interested in alternative therapies should be encouraged to obtain training in alternative therapy especially reflexology and to apply it in clinical settings if it is allowed.

· As this study has opened up a new zone for independent nursing practice, its potentiality requires further exploration.

REFERENCE:

1. Klaus M H, Kennel JH, Human maternal behaviour at the first contact with her young one. Paediatrics, www.answer.com.

2. Nuriye Degirmen, Nebahat Ozerdogan, Deniz Sayiner. Effectiveness of foot and hand massage in postcesarean pain control in a group of Turkish pregnant women. Applied Nursing Research volume 23, Issue 3, Pages 153-158. August 2010

3. Chaudhary S, Kumar G, Singh Reflexology research of post operative pain reduction. Reflexions 2006 Mar:27(1).

4. Fyfe EM, Anderson NH, North RA, Chan EH, Taylor RS, Dekker GA, McCowan LM; Consortium Risk of first-stage and second-stage cesarean delivery by maternal body mass index among nulliparous women in labor at term. . Obstet Gynecol. 2011 Jun; 117(6).

5. Jipi Varghese, Jobby George , Yathikumara Swamy Gowda, A Randomized Control Trial to Determine the Effect of Foot Reflexology on Intensity of Pain and Quality of Sleep in Post Caesarean Mothers, Journal of Nursing and Health Science Volume 3, Issue 1 Ver. IV (Jan. 2014), PP 39-43

Received on 17.04.2014 Modified on 22.05.2014

Int. J. Adv. Nur. Management 2(2): April- June, 2014; Page 67-70

Post caesarian mothers	Max. Scores	Level of Pain						Difference in mean %
		Pre test scores			Post test scores
		Mean	SD	Mean %	Mean	SD	Mean %
Control group	10	7.7	1.01	77	5.9	0.67	59	18
Experimental group	10	7.9	1.22	79	4.1	0.24	41	38