INTRODUCTION:

Pain is a signal from ailing tissues to indicate that there is something wrong. It is often difficult to describe pain, because everyone reacts so differently to it. Today pain has become the universal disorder, a serious and public health issue and a challenge for healthcare providers.¹Post-surgical pain is a complex response to tissue trauma during surgery that stimulates hypersensitivity of the central nervous system. The result is pain in areas not directly affected by the surgical procedure.² Analgesics are not always effective in eliminating post operative pain. Utilization of non pharmacological interventions like massage therapy, ice therapy, music therapy may assist in altering post operative pain.³

Received on 06.06.2014 Modified on 25.06.2014

Asian J. Nur. Edu. & Research 4(3): July- Sept., 2014; Page 337-341

Massage is the simple way of easing post operative pain as well as aiding relaxation, promoting a feeling of well being and a sense of receiving good care. ⁴ It soothes pain and provides relaxation. Hand and foot massage has the potential to aid surgical pain relief. It is a complementary or adjunctive medical technique, yet there is a scant research related to use of massage therapy in post operative management.⁵Hysterectomy rates are strongly influenced by age, reaching 150 per 10,000 for ages 45–49 years. The corresponding corrected hysterectomy rate is 196. Probability of hysterectomy approaches slightly above 35% over the life span, whereas the corrected hysterectomy probability approaches 43%. Probability of hysterectomy in the next 10 years is 12.9% for women aged 35 years and 11.7% for women aged 45 years. Corresponding corrected hysterectomy probabilities are 14.3 and 15.1.⁶

MATERIAL AND METHODS:

Sr. Callista Roy’s Adaptation Model was used to provide conceptual framework for this study. Roy’s model focuses on the concept of “Adaptation of man.” Interrupted time series design was selected for the study. Ethical clearance was obtained prior to the study. The study was conducted in two hospitals: Athena Hospital and Govt. Lady Goschen hospital located at Mangalore. A written permission was obtained from the concerned authorities. The tools used were Demographic Proforma (consisting of 9 items), Short form Mc Gill Pain Questionnaire, Average Pain Intensity Scale and Current Pain Intensity Scale. The scoring done by using of mean and mean difference, frequency and percentage. For validity the observational checklist, was submitted to seven experts along with the objectives, reliability was calculated by Cronbach alpha method. The internal consistency of the observational checklist was, r=0.97. Hence, the tool was found to be reliable. The study was conducted in the gynaecological ward of the selected hospitals on 40 women who had undergone abdominal hysterectomy selected by purposive sampling technique. Informed consent was obtained from each women for participating in the study. Here the investigator did the pre-test on post-operative day 2 at 8 am by using short form Mc Gill Pain Questionnaire, average pain intensity scale and current pain intensity scale. After the pre-test, hand and foot massage with Gingely oil was given for 20 minutes (8:40 am to 9:00 am). Then the post-test was done 3 hours after the intervention(12:00 noon) using the same scale. This was repeated for three consecutive post-operative days. The collected data was analyzed using descriptive and inferential statistics.

RESULTS:

Description of the sample characteristics

In the experimental group, majority 25% were in the age group between 50-55 years and in the control group, majority 35% were in the age group between 45-50 years. The highest percentage of the subjects in the experimental group (60%) were educated up to primary education and in the control group (70%) were up to the primary education. The highest percentage of the subjects in the experimental group (65%) and in the control group (80%) were coolies..In the experimental group, majority 40% were belonged to nuclear family and in the control group, majority 50% were belonged to joint family. In experimental group, majority 60% were Hindus and in the control group, majority 75% were Hindus. In experimental group, majority 50% had an income level between 5,001- 10,000; and in the control group, majority 45% had an income level between 5,001 – 10,000.. In experimental group majority 65% had undergone normal vaginal delivery and in the control group majority 40% had undergone caesarean section..In experimental group, majority 65% had two children and in the control group majority 70% had two children. The highest percentage of the subjects in the experimental group (100%) had not undergone any abdominal surgery and in the control group (100%) had not undergone any abdominal surgery.

Table 1: F value of pain scores of experimental group by using SFMPQ. N=20

Experimental group	Sum of squares	Df	Mean square	‘F’ value
Between group	4406.85	3	1468.95	20.73*
Within group	5385	76	70.85
Total	9791.85	79	1539.8

F(3,76)=2.68;p<0.05 *significant

The data depicted in table 1 shows that there is a significant difference between the pre and post test pain scores in the experimental group [F_(3,76)= 2.68 ,p< 0.05 ]. Thus null hypothesis H0₁is rejected and research hypothesis H₁ is accepted.

Table 2: F value of pain scores of experimental group by using average pain intensity scale. N=20

Experimental group	Sum of squares	Df	Mean square	‘F’ value
Between group	186.2	3	62.06	18.92*
Within group	249.99	76	3.28
Total	436.19	79	65.34

F(3,76)=2.68;p<0.05 *significant

The data depicted in table 2 shows that the there is a significant difference between the pre test and post test pain scores (F₍_3,76) =18.92) at 0.05 level of significance. Hence the null hypothesis H0₁ is rejected and research hypothesis is accepted.

Table 3: F value of pain scores of experimental group by using current pain intensity scale. N=20

Experimental group	Sum of squares	Df	Mean square	‘F’ value
Between group	78.65	3	26.21	17.70*
Within group	112.95	76	1.48
Total	191.6	79	27.69

F(3,76)=2.68;p<0.05 *significant

The data depicted in table 3 shows that the there is a significant difference between the pre test and post test pain scores (F₍_3,76) =17.70) at 0.05 level of significance. Hence the null hypothesis H0₁ is rejected and research hypothesis is accepted.

Table 4: Unpaired ‘t’ test showing the difference between the post test pain scores of experimental and control group subjects on SFMPQ scale. N=20+20

	Gro-up	Mean score	Standard deviation	Mean difference	‘t’ value
Post test 1	E	30.700	1.780	1.9	2.503*
Post test 1	C	32.600	2.891
Post test 2	E	20.950	2.544	2.05	2.259*
Post test 2	C	23.000	3.162
Post test 3	E	12.050	2.305	1.75	2.258*
Post test 3	C	13.800	2.587

t₍₃₉₎= 1.960 ,p<0.05 *significant E=experimental group C=control group

Data in table 4 shows that the mean pain scores of the experimental group (30.700, 20.950 and 12.050) were significantly lower than the mean pain scores of control group(32.600, 23.000 and 13.800) in post tests 1, 2 and 3 respectively. Thus H0₂ was rejected and the research hypotheses was accepted. i.e ; after providing nursing interventions the post operative pain of abdominal hysterectomy women was reduced.

Table 5: Unpaired ‘t’ test showing significant difference between the post test pain scores of experimental group and control group subjects on average pain intensity scale. N=20+20

	Group	Mean score	Standard deviation	Mean difference	‘t’ value
Post test 1	E	7.300	0.826	0.15	2.608*
Post test 1	C	7.450	0.571		2.608*
Post test 2	E	5.900	0.912	0.25	2.949*
Post test 2	C	6.150	0.745		2.949*
Post test 3	E	3.400	0.821	1.2	3.815*
Post test 3	C	4.600	1.142		3.815*

t₍₃₉₎= 1.960 ,p<0.05 *significant E=experimental group C=control group

Data in table 5 shows that the mean pain scores of the experimental group (7.300, 5.900and 3.400) were significantly lower than the mean pain scores of control group(7.450, 6.150 and 4.600) in post tests 1, 2 and 3 respectively. Thus H0₂ was rejected and the research hypotheses was accepted. i.e ; after providing nursing interventions the post operative pain of abdominal hysterectomy women was reduced.

Table 6: Unpaired ‘t’ test showing significant difference between the post test pain scores of experimental group and control group subjects on current pain intensity scale. N=20+20

	Group	Mean score	Standard deviation	Mean difference	‘t’ value
Post test 1	E	4.050	0.657	0.25	2.177*
Post test 1	C	4.300	0.686
Post test 2	E	2.900	0.718	0.55	2.476*
Post test 2	C	3.450	0.686
Post test 3	E	1.750	0.639	0.45	2.131*
Post test 3	C	2.200	0.696

t₍₃₉₎= 1.960 ,p<0.05 *significant E=experimental group C=control group

Data in table 6 shows that the mean pain scores of the experimental group (4.050, 2.900 and1.750) were significantly lower than the mean pain scores of control group(4.300, 3.450 and 2.200) in post tests 1, 2 and 3 respectively. Thus H0₂ was rejected and the research hypotheses was accepted. i.e; after providing nursing interventions the post operative pain of abdominal hysterectomy women was reduced.

Table 7: Association of the post-test post operative pain scores in experimental group with the demographic variables using SFMPQ scale through chi-square test. N=20

SI. No

Variables

Χ² value

Table value

Inference

Age

Educational status

Type of family

Occupation

Religion

Income of the family

Type of delivery

Number of children

Any history of previous surgery

0.299

0.444

0.154

0.303

0.257

0.058

0.154

0.684

0.339

3.673

0.586

2.031

3.639

2.716

5.683

2.031

0.761

2.166

Not significant

Not significant; p › 0.05

The data depicted in table 7 shows that the calculated chi-square value of demographic variables like age, educational status, type of family, occupation, religion, income of the family, type of delivery, number of children and any history of previous surgery is less than the table value at 0.05 level of significance. So , the researcher accepted the null hypotheses (H0₃). Hence there is no significant association of post-test post operative pain scores in the experimental group with the demographic variables at 0.05 level of significance.

Table 8: Association of the post-test post operative pain scores in experimental group with the demographic variables using average pain intensity scale through chi-square test N=20

SI. No

Variables

Χ² value

Table value

Inference

Age

Educational status

Type of family

Occupation

Religion

Income of the family

Type of delivery

Number of children

Any history of previous surgery

0.332

0.456

0.081

0.821

0.406

0.399

0.081

0.257

0.476

3.413

0.556

3.039

0.920

1.804

1.837

3.039

2.720

1.486

Not significant

Not significant; p › 0.05

The data depicted in table 8 shows that the calculated chi-square value of demographic variables like age, educational status, type of family, occupation, religion, income of the family, type of delivery, number of children and any history of previous surgery is less than the table value at 0.05 level of significance. So , the researcher accepted the null hypotheses (H0₃). Hence there is no significant association of post-test post operative pain scores in the experimental group with the demographic variables at 0.05 level of significance.

Table 9: Association of the post-test post operative pain scores in experimental group with the demographic variables using current pain intensity scale through chi-square test. N=20

SI. No

Variables

Χ² value

Table value

Inference

Age

Educational status

Type of family

Occupation

Religion

Income of the family

Type of delivery

Number of children

Any history of previous surgery

0.528

0.251

0.357

0.343

0.127

0.594

0.357

0.652

0.469

2.222

1.319

0.848

3.333

4.127

1.043

0.848

0.855

1.513

Not significant

Not significant; p › 0.05

The data depicted in table 9 shows that the calculated chi-square value of demographic variables like age, educational status, type of family, occupation, religion, income of the family, type of delivery, number of children and any history of previous surgery is less than the table value at 0.05 level of significance. So, the researcher accepted the null hypotheses (H0₃). Hence there is no significant association of the post-test post operative pain scores in the experimental group with the demographic variables at 0.05 level of significance.

DISCUSSION:

In the present study, 40 clients (20 in the experimental group and 20 in control group) who had undergone abdominal hysterectomy between the age group of 40 – 60 years were selected using the purposive sampling technique. The majority of the subjects in the experimental group (35%) and in the control group (35%) were in the age group 46-50 years. The highest percentage of the subjects in the experimental group (60%) and in the control group (70%) were up to primary education. The highest percentage of the subjects in the experimental group (65%) and in the control group (80%) were coolies. The highest percentage of the subjects in the experimental group (40%) belonged to nuclear family and in the control group (50%) belonged to joint family. The highest percentage of the subjects in the experimental group (60%) and in the control group (75%) were Hindus. The highest percentage of the subjects in the experimental group (65%) and in the control group (60%) had undergone normal vaginal delivery. The highest percentage of the subjects in the experimental group (100%) and in the control group (100%) had not undergone any abdominal surgery.

A similar study was conducted to assess the impact of foot massage on the level of pain, heart rate and blood pressure among patients with abdominal surgery. The findings were it is evident that 43.3 of the subjects were in the age group of 21-30 years and only 3.3% were in the age group more than 60 years. 40% of the subjects had secondary education followed by primary education (33.3%) and graduation (20%). Among the subjects only 6.7% were illiterate. Majority of subjects were unemployed (60%), 23.3% were self-employed and 16.7% were employed. Majority of subjects had caesarean section (53.3%), 36.7% had hysterectomy and 10% had laparotomy. Majority (56.7%) had no previous surgical experience and 33.3% had previous surgical experience.⁷

The present study was conducted on 40 samples of abdominal hysterectomy women between the age of 40-65 years by purposive sampling technique. The calculated F value by using SFMPQ in the experimental group was 20.73.. The calculated F value by using Average Pain Intensity Scale in the experimental group was 18.92. The calculated F value by using Current Pain Intensity Scale in the experimental group was 17.70. There is significant reduction of pain in the experimental group than the control group and can be concluded that the hand and foot massage was effective in reducing the pain of women who had undergone abdominal hysterectomy [F (3,76)= 2.68 ; p<0.05].

Similar study was conducted to support the present study. The findings showed that the pain intensity scores in the experimental group was high before the intervention and the scores showed a significant decrease in the measurements recorded at 0th minute (immediately after the massage), 60th minute and 90th minute after the intervention and also there is significant reduction of pain in the experimental group than the control group (t39 = 1.960; p<0.05) and can be concluded as the hand and foot massage was effective in reducing the pain of women who had undergone abdominal hysterectomy. ⁷

In the present study, findings showed that the mean pain scores of the experimental group (30.700, 20.950 and 12.050) were significantly lower than the mean pain scores of the control group(32.600, 23.000 and 13.800) in post tests 1, 2 and 3 respectively by using SFMPQ. The mean pain scores of the experimental group (7.300, 5.900and 3.400) were significantly lower than the mean pain scores of the control group(7.450, 6.150 and 4.600) in post tests 1, 2 and 3 respectively by using average pain intensity scale. The mean pain scores of the experimental group (4.050, 2.900 and1.750) were significantly lower than the mean pain scores of the control group(4.300, 3.450 and 2.200) in post tests 1, 2 and 3 respectively. Thus H0₂ was rejected and the research hypotheses was accepted. i.e; after providing nursing interventions the post operative pain of abdominal hysterectomy women in the experimental group was reduced than in the control group.

Similar study was conducted to assess the effectiveness of foot massage in reducing post operative pain among abdominal surgery patients. The findings of the study showed that the mean pain scores of experimental group(19.7, 12.8, 8.4) were significantly lower than the mean pain scores of control group(20.9, 15.5, 12.7) in post test 1,2,3 respectively. There was no significant difference between experimental and control group post test 1 pain scores since the calculated ‘t’ value(t_{1 =}1) was less than the table value(t₅₈₌1.67)at 0.05 level of significance thus H₀2 was accepted and the research hypotheses was rejected in post test 1. There was significant difference between experimental and control group post test 2 and 3 pain score since the calculated values(t₂₌2.67, t₃=5.2) were more than the table value(t₅₈=1.67) at 0.05 level of significance thus H₀2 was rejected and the research hypotheses(H₁) was accepted in post test 2 and 3.i.e., foot massage was effective in reducing the post operative pain of abdominal surgery patients.⁸

The findings of the present study showed that the calculated chi-square value of demographic variables like age, educational status, type of family, occupation, religion, income of the family, type of delivery, number of children and any history of previous surgery is less than the table value at 0.05 level of significance. So, the researcher failed to reject the null hypotheses (H0₃). Hence there is no significant association of post-test post operative pain scores in the experimental group with the demographic variables at 0.05 level of significance.

A similar study which supported the findings was that, there was no significant difference between the socio demographic characteristics of the control group and the intervention group except the educational status (p>0.05). There were relatively large number of women with higher degrees of education in the control group in contrast to the intervention group.⁷

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3. Bicek, Erin. Nurses attitude, knowledge and use of non pharmacological pain management technique & therapies.2004 Jun:45-48

4. Ferral .T, Glick O.J .The use of therapeutic massage as a nursing intervention to modify anxiety & the perception of cancer pain, 1993 Jun:16(2);93-101.

5. Won J.S. Effect of foot massage on sleep, vital sign and fatigue in their home. Mar 1992(2):45-49

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Received on 13.05.2014 Modified on 02.07.2014

Asian J. Nur. Edu. & Research 4(3): July- Sept., 2014; Page 334-336