INTRODUCTION:

Cancer is the result of uncontrolled cell growth. Our bodies are composed of trillions of cells, all working together. In cancer, one of those cells stops paying attention to the normal signals that tell cells to grow, stop growing or even to die. Cancer cells still share many of the same needs and properties of normal cells but they become independent of the controls that make our body function smoothly. The process by which a normal cell changes into one that behaves so abnormally can take a long time and is often triggered by outside influences¹.

Cancer is actually a general term that describes a large group of related diseases very case of cancer is unique, with its own set of genetic changes and growth properties. Some cancers grow quickly while others can take years to become dangerous to the patient. The many differences between cases of cancer, even of the same organ (i.e. different cases of breast cancer) is one of the main reasons that treatment is so difficult despite the differences between different types of cancer, all cancers do share some common features, and these shared properties are the basis for many cancer treatments and research efforts. It is important to understand the basic shared features of cancer. This will allow for an understanding of detection, diagnosis and treatment options².

Insomnia or sleeplessness is the term refers to the difficulty in falling asleep, or waking up often during the night and having trouble going back to sleep, or waking up too early in the morning. There are different variety of insomnias, primary insomnia, secondary insomnia, acute insomnia, chronic insomnia etc. Insomnia can occur because of wide variety of reasons. Such as use of psychoactive drugs, withdrawal from antipsychotics, heart diseases, pain, mental disorders, neurological impairment, lack of physical exercises, emotional stress etc. Insomnia is often thought as both medical sign and a symptom that can accompany several sleep, medical, and psychiatric disorders characterized by a persistent difficulty falling asleep and or staying asleep or sleep of poor quality³.

There is variety of medical interventions to reduce insomnia problem among cancer patients. It includes: Pharmacological remedies and Non pharmacological remedies. Pharmacological remedies consisting of benzodiazepines, non pharmacological remedies includes aromatherapy, hypnosis, biofeedback, relaxation techniques, herbal remedies, massage, acupuncture, meditation and exercise emerge. Water is a basic resource and a primal natural remedy. In all of its states; steam, liquid and ice, water can provide a wide range of treatment for health problems. For example, ice packs can relief pain, while steam can overcome many symptoms of respiratory problems, such as nasal congestion. We can also dip clothes into herbal infusion and place them on cramped or stiff muscles, which can thwart sleep³. Hot water bath can help in giving us a good sleep, because it relaxes body and mind. It works by slightly raising our body temperature and after 15 minutes, it starts to drop slowly. This can promote sleep indirectly. Gradual drop of body temperature can make us feel drowsy and therefore we feel more prepared for sleep. Warm footbath is one of the effective methods for inducing sleep. Thermoregulation exhibits powerful interaction with sleep. A warm footbath warms the skin, which causes vessel dilation and induces heat dissipation. Intervention that enhances heat dissipation prior to sleep will improve the sleeping pattern of the patients⁴.

Based on evidence of the relation between body temperature and sleep, a warm bath (passive body heating) in the evening may promote sleep onset and improve overall sleep quality. A warm foot bath may increase peripheral blood flow and temperature gradient to facilitate heat loss without increasing core body temperature and hereby improve sleep onset and quality.

NEED FOR THE STUDY:

Insomnia or trouble sleeping is a common problem for patients with cancer. Insomnia can present as difficulty falling sleep, multiple awakening during sleep, or early morning awakening with the inability to get back to sleep. Patients may have one or all these complaints. A general consensus have developed from population from population based studies that approximately 30% of variety of adults samples drawn different countries report one or more of the insomnia symptoms. Conclusion from the NIH state of the science conference held in June 2010 indicate that there is sleep impairment or distress as a function of the insomnia symptoms results in approximately 10%. Finally the DSM-IV estimation of worldwide distribution of prevalence rate of insomnia is about 33%. The potential causes behind insomnia in cancer are many. Chemotherapy, radiation treatment, damage of normal tissues in body secondary to drug therapy, anxiety related to disease condition and environment and family. Approximately 30% -50% of the cancer population are suffering from insomnia⁵.

A survey by Davidson conducted in 1000 cancer patients with different types of cancer and at different treatment phases found that 31% reported insomnia, 28% reported excessive sleepiness, and 41% complained of restless legs. In this study, the prevalence of sleep problems varied among different types of cancer: lung cancer patients had the highest or second-highest prevalence of sleep problems in general, whereas breast cancer patients had a high prevalence of insomnia and fatigue. Another survey found that the amount of insomnia in cancer patients was as high as the amount of insomnia in depressed patients⁶.

Savard et al. Looked at the prevalence of insomnia in 300 women with breast cancer and found that 19% met the diagnostic criteria for insomnia, with 95% of the cases being chronic insomnia. In addition, in 33% of the cases the onset of insomnia followed the breast cancer diagnosis, and 58% of the patients reported that cancer either caused or aggravated their sleep problems⁷.

A health treatment that is not classified as standard western medical practice is referred to as “alternative”. It encompasses a variety of disciplines that include everything from diet and exercise to mental conditioning and life style changes^.For some time now, non-drug strategies have been recommended as first line treatment in the management of some disease especially in case of insomnia. Although medications are equally effective for helping people with insomnia to sleep, they cannot cure the condition and prolonged use regularly resulted in dependency. The findings indicate that non pharmacological interventions produce reliable and durable changes in the sleep patterns of patients with insomnia⁸.

An Australian study found 93.5% of insomnia problems were being managed with benzodiazepines, with the majority as ongoing treatment. A study in Norway revealed that 82% of prescription for hypnotics was repeat prescriptions. The extensive use of these drugs will produce the adverse effect of over sedation, ataxia, confusion, respiratory depression, short-term memory impairment, hallucination and depression.

A study conducted the effect of foot bathing on distal proximal skin temperature gradient in elders have shown that decreased core temperature and increased distal temperature are associated with shortened sleep onset latency NREM sleep. A warm footbath warms the skin, which causes vessel dilation and induces heat dissipation. Intervention that enhances heat dissipation prior to sleep will improve the sleeping pattern of the subjects. Footbath can be an effective method of relaxation, since it induces both significant increases in parasympathetic activity and significant decrease in sympathetic activity. In addition, footbath increases white blood cells count and natural killer cells cytotoxicity. Since these physiological changes are likely to be, beneficial to health⁸.

A study conducted in New Delhi, gives the information as sleep disturbance has been noted to be frequent clinical problem for cancer patients that are often the target of pharmacological intervention. Department of nursing, Hindustan Hospital conducted a study on “Quality of sleep and related factors during chemotherapy in patients with stage 1/11 breast cancer revealed the poor sleep quality and day time sleepiness in patients with cancer during the active phase of chemotherapy⁸.

The investigator during his clinical experience has come across cancer patients with inadequate sleep and measures to induce sleep have been found ineffective. It was noticed that sleep habits is easily changed by hospital routines as well as due to existing Illness From the findings of literature, the researcher realized that the importance of promoting sleep by nursing interventions, and designed a study to assess the effectiveness of warm footbath on sleep onset time of cancer patients.

OBJECTIVES OF THE STUDY:

1) To assess the insomnia among cancer patients with General Sleep disturbance scale.

2) To determine the effectiveness of warm footbath on sleep onset time among cancer patients.

3) To find the association between duration of sleep onset times of cancer patients with selected demographic variables.

HYPOTHESIS:

H1: Warm foot bath will be effective in improving sleep onset time among cancer patients.

H₂: There will be a significant association between duration of sleep onset time among cancer patients with selected demographic variables

MATERIAL AND METHODS:

Research approach: Quantitative approach.

Research design: Pre experimental one group pretest posttest design.

Target population: Cancer patients.

Accessible population: Cancer patients with insomina.

Sampling technique: non probability purposive sampling technique

Sample size: 40antenatal mothers

Data collection procedure: GSDS-General Sleep Disturbance Scale

Data analysis: Descriptive statistics and Inferential statistics

Criteria measure: level of insomnia

MAJOR FINDINGS OF THE STUDY:

· The demographic characteristics of the samples revealed that

1. The majority of the respondents 13(32.5%) belongs to the age group of 40-50 years.

2. The majority of the respondents 29(72%) were males.

3. The majority of the respondents 18(45%) were illiterate.

4. The majority of the respondents 38(95%) were married.

5. The majority of respondents 19(47.5%) were labourers.

6. The majority of respondents 31(77%) were admitted in general ward.

7. The majority of Respondents 23(57.5%) were receiving radiation therapy.

8. The majority of Respondents 27(67.5%) were taking normal diet.

9. The majority of Respondents 20(50% were staying in hospital 2-3weeks.

10. The majority of Respondents 25(65%) were not using any comfort devices.

· Findings related to effectiveness of warm footbath on insomnia among cancer patients:

With regards to effectiveness of warm foot bath on reducing insomnia and improving sleep onset time, the obtained “F” Value in ANOVA test for the level of insomnia was 81.5 that was very highly significant at P level >0.001.

· Findings related to association between demographic variables and post test.

With regards to the association between the level of insomnia with their selected demographic variables, among that all the variables were non significant. The study shows that the calculated chic square value is less than tabulated value at the level of 0.05 for all the selected variables, which shows there is nil significant association between effectiveness of warm footbath and selected demographic variables.

CONCLUSION:

The main conclusion from this present study is that most of the cancer patients with had severe ,moderate level of insomnia in pre test and mild, moderate in post test I,II,III,IV,V,VI,VII. This shows the imperative need to understand the purpose of warm foot bath regarding reduction of insomnia levels and improvement in sleep onset time of cancer patients with insomnia and it will improve the quality of life which includes the stability in physiological, psychological, sexual, vocational and lifestyles aspects.

REFERENCES:

1. Brunner. Suddharth. Textbook of medical surgical nursing. 12 thedition. New Delhi. Wolter Kluver publications; 2010, 230-285.

2. Sreeram: Insomnia narrow look (online). Available from:http://healthline.net. (accessed on 20 thjune 2014).

3. Micheal J. Breus. John. Behavioural method include insomnia: Journal Nursing. 2004; 12(2); 45-49.

4. Johid. Das. Warm foot bathing- A treatment for insomnia; Health Journal. 2005;40(11); 20-21

5. Wen Chun Lia. Carol A. Effect of foot bath on distal –proximal skin temperature; International journal Nursing Studies. 2005; 42(7); 71-73.

6. Carolyn Vachani. Sleep problems in the cancer; Journal for nurses. 2014; 23(2); 23-24.

7. LaviniFiorentino. Sleep dysfunctions in patients with cance;. Cancer journal. 2000; 30(4); 17-19.

8. Savard. Insomnia rates and ratios among cancer; Medical club magazine. 2000; 27(10); 18-21.

Received on 27.07.2016 Modified on 10.08.2016

Asian J. Nur. Edu. and Research.2017; 7(2): 231-234.

DOI: 10.5958/2349-2996.2017.00048.9

Mr. Suneesh P.M, Ms. Kavitha Thangavel, Mr. Jeenath Justin Doss K

Shri Anand Institute of Nursing, Rajkot