A Quasi Experimental Study to Assess the Effectiveness of Foot Massage on Incisional pain and sleep pattern among Post Caesarean Mothers admitted in selected hospitals, Hoshiarpur, Punjab
Neeta Thakur
M.Sc. Obstetrics and Gynecological Nursing, Army College of Nursing, Jalandhar, Cantt. Punjab.
*Corresponding Author Email:
ABSTRACT:
Aim: The aim of this study was to assess effectiveness of foot massage on incisional pain and sleep pattern among post caesarean mothers. Background: Cesarean section (C.S) is the birth of fetus through a trans-abdominal incision in the uterus. Persistent post-operative pain is a well- known consequence of caesarean section. Some studies have found alternative methods such as acuapressure, aromatherapy and massage therapy to be fairly effective for treatment of post caesarean pain and improve the quality of sleep pattern. Foot massage appears to be effective, in expensive, low risk, flexible and easily applied. So, foot massage was used to assess its effect on incisional pain and sleep pattern among post caesarean mothers. Design: A quasi-experimental pretest-posttest control group research design was used with non-probability purposive sampling technique to selected sample. Material and Methods: Sample of 60 post caesarean mothers from selected hospitals, 30 each in experimental group and control group were selected. Assessment of level of incisional pain was done by using standardized numerical pain rating scale whereas assessment of sleep pattern was done by using modified Groningen sleep quality index scale. Analysis was done by using both descriptive and inferential statistics. Findings: Findings showed that in experimental group, 93.24% post caesarean mothers had mild level of pain and 6.66% had moderate level of incisional pain. Whereas in control group, 40% had mild level of pain and 60% had moderate level of pain. On the other hand, 93.33 % post caesarean mothers had good sleep and 6.66% had poor quality of sleep pattern. Whereas in control group 100% post caesarean mothers had poor sleep pattern. Conclusion: Thus, the study concluded that the difference between mean pretest and posttest score was found statistically significant at p < 0.05 level in experimental group. Hence, research hypothesis was accepted and it revealed that there was impact of foot massage among post caesarean mothers in experimental group.
KEYWORDS: Foot Massage, Incisional Pain, Sleep Pattern, Post Caesarean Mothers.
INTRODUCTION AND BACKGROUND OF THE STUDY:
Reproductive life is a plan for whether, when and how to have children. In India, women of the child bearing age are 18-35 years. The plan is based on a person’s priorities and goals with regards to life and children. Reproductive life span serves as a basis for action to realize the plan.
For instance it can be helpful in selecting an appropriate both control if one is sexually active but is not ready to have children and seeking preconception counselling and care to improve the health of the mother and child. In 2006, the US centres for disease control issued a recommendation, encouraging women to formulate a reproductive life plan and to improve the health of the women and reduce adverse pregnancy outcomes. In recent years maternal and child health services in India have been integrated into the basic health services with increased emphasis on risk approach in order to improve the maternal and child health.
Cesarean section (C.S) is the birth of fetus through a trans-abdominal incision in the uterus. It is one of most common surgical procedure worldwide. It has played a major role in lowering both maternal and perinatal morbidity and mortality rates during the past century. The initial purpose of the operation was to preserve the life of the mother with obstructed labor and her newborn. Cesarean section is a prevalent operation that accounted for up to 32% of deliveries in the United States in 2007. The future of this field of pain management within the realm of nursing science, promises to be one of the rapid and significant growth; the results will directly influence the quality of patient care and promote early recovery.
Sleep is a behavioral state characterized by the temporary suspension of the state of watchful consciousness. The particular subjective nature of sleep has always stimulated philosophical thought, but the actual behavior of the sleeping organism has also attracted wide interest across all cultures. Sleep is essential for the normal, healthy functioning of the human body. The physiological phenomenon of sleep is much complicated and is defined as a state of unconsciousness from which person can be aroused. During this state, the brain is relatively more responsive to internal stimuli than external stimuli.
Foot massage I one of the most popular form of massage in all alternative therapies. the potential to aid in pain relief. It is a technique which can be mildly painful but usually is quite relaxing. The Foot Massage stimulates cutaneous mechanoreceptors that activate large primary afferents. They release GABA and endorphins, which inhibit neurotransmitters discharged from the primary nociceptive neurons and evoke depressive reactions within the receptive field in the pain pathway. Tactile stimulation produced by massage travels through the large diameter fibers. These fibers also carry a faster signal. It is necessary that pain relief be safe and effective, that it is not interfere with the mother's ability to move around and care for her infant, and that it is resulted in no adverse neonatal effects in breast-feeding women.
OBJECTIVES:
· To pre-assess level of incisional pain and sleep pattern among post caesarean mothers in experimental and control group.
· To post-assess level of incisional pain and sleep pattern among post caesarean mothers in experimental and control group.
· To compare pre and post assessment level of incisional pain and sleep pattern among post caesarean mothers in experimental and control group.
· To establish relationship of pre and post assessment level of incisional pain and sleep pattern among post caesarean mothers with selected demographic variables.
HYPOTHESIS:
H0- There is statistically no significant difference in level of incisional pain and sleep pattern among post caesarean mothers in both experimental and control group at p < 0.05 level of significance.
H1- There is statistically significant difference in level of incisional pain among post caesarean mothers in experimental group as compared to control group at p < 0.05 level of significance.
H2- There is statistically significant difference in quality of sleep pattern among post caesarean mothers in experimental group as compared to control group at p < 0.05 level of significance.
MATERIAL AND METHODS:
RESEARCH APPROACH:
A quantitative research approach was used.
RESEARCH DESIGN:
A quasi experimental pre test– post test control group research design was used.
RESEARCH SETTING:
The study was conducted in postnatal wards of selected hospitals, Hoshiarpur, Punjab.
SAMPLE AND SAMPLING TECHNIQUE:
The total sample selected were 60 post caesarean mothers from selected hospitals, 30 each in experimental and control group. Non probability purposive sampling technique was used to select the samples for study.
DESCRIPTION OF TOOL:
Tool will be prepared having following sections:
SECTION A: It included demographic variables such as age, education, occupation, ,type of family, family income, religion, parity, area of residence, and duration after caesarean section etc.
SECTION B: it included standardized numerical pain index scale.
SECTION C: it included modified Groningen’s Sleep Quality Index scale.
ETHICAL CONSIDERATIONS:
Ethical clearance was obtained from institutional research committee:
· A written letter seeking permission to conduct the study was obtained from Senior Medical Officer of the civil hospital and Director of Gurcharan Kanwal Hospital, Hoshiarpur.
· The purpose of the study was explained to the sample and written informed consent was taken from them for their participation in the study.
· Confidentiality and anonymity of post caesarean mothers was maintained
ANALYSIS AND INTERPRETATION OF DATA:
SECTION A DEMOGRAPHIC VARIABLES:
Table I Frequency and percentage distribution of post caesarean mothers according to selected demographic variables. N=60
|
Demographic variables |
Experimental group (n=30) |
Control group (n=30) |
df |
c 2 |
||
|
f |
% |
f |
% |
|||
|
Age (in years) |
||||||
|
18-24 |
16 |
53.3 |
18 |
60 |
3 |
0.7NS |
|
25-31 |
7 |
23.3 |
5 |
16.7 |
|
|
|
32-38 |
4 |
23.3 |
5 |
16.7 |
|
|
|
>38 |
3 |
10 |
2 |
6.7 |
|
|
|
Education |
||||||
|
Illiterate |
1 |
3.3 |
2 |
6.67 |
4 |
0.5NS |
|
Upto primary |
8 |
26.7 |
6 |
20 |
|
|
|
Secondary Senior Secondary |
11 7 |
36.7 23.3 |
12 7 |
40 23.31 |
|
|
|
Graduate and above |
3 |
10 |
3 |
10 |
|
|
|
Occupation |
||||||
|
Working |
7 |
23.3 |
12 |
40 |
1 |
4.0NS |
|
Non working |
23 |
76.7 |
18 |
60 |
|
|
|
Type of family |
||||||
|
Nuclear |
8 |
26.7 |
12 |
40 |
2 |
1.7NS |
|
Joint |
18 |
60 |
13 |
43.3 |
|
|
|
Extended |
4 |
13.3 |
5 |
16.7 |
|
|
|
Family income (Rs./month) ≤10000 10001-20000 20001-30000 >30000 |
24 6 0 0 |
80 20 0 0 |
12 8 6 4 |
40 26.7 20 13.3 |
3 |
4.28NS |
|
Religion |
||||||
|
Hindu |
17 |
56.7 |
11 |
36.7 |
2 |
2.5NS |
|
Sikh |
8 |
26.7 |
13 |
43.3 |
|
|
|
Other |
5 |
16.7 |
6 |
20 |
|
|
|
Area of residence |
||||||
|
Rural |
19 |
63.3 |
12 |
40 |
1 |
3.2NS |
|
Urban |
11 |
36.7 |
18 |
60 |
|
|
|
Parity |
18 |
60 |
19 |
63.3 |
1 |
0.07NS |
|
Primi |
12 |
40 |
11 |
36.7 |
|
|
|
Multi |
|
|
|
|
|
|
|
Duration after caesarean section (in hours) |
||||||
|
Upto 12 13-24 |
20 10 |
66.7 33.3 |
17 13 |
56.7 43.3 |
1 |
0.6NS |
NS-non-significant
SECTION B
OBJECTIVE 1: To pre-assess level of incisional pain and sleep pattern among post caesarean mothers in experimental and control group.
Table 2 (a) Frequency and percentage distribution of post caesarean mothers in experimental and control group according to pretest level of incisional pain. N=60
|
Level of pain |
Criterion Measure |
Experimental group (n=30) |
Control group (n=30) |
||
|
|
|
N |
% |
N |
% |
|
Mild |
1-4 |
1 |
3.33 |
1 |
3.3 |
|
Moderate |
5-7 |
23 |
76.66 |
27 |
90 |
|
Severe |
8-10 |
6 |
19.98 |
2 |
6.6 |
Maximum score = 10
Minimum score = 1
Hence, it could be concluded from the above findings that during pretest majority of the post caesarean mothers had moderate level of pain in both experimental and control group.
Hence, it could be concluded from the above findings that during pretest all post caesarean mothers had poor quality of sleep pattern in both experimental and control group.
Table – 2 (b) Frequency and percentage distribution of post caesarean mothers in experimental and control group according to pretest quality of sleep pattern. N=60
|
Quality of sleep pattern |
Criterion measure |
Experimental group (n=30) |
Control group (n=30) |
||
|
|
|
N |
% |
N |
% |
|
Poor |
0-6 |
30 |
100 |
30 |
100 |
|
Good |
>6 |
0 |
- |
0 |
- |
Maximum score = 15
Minimum score = 0
OBJECTIVE 2: To post-assess level of incisional pain among post caesarean mothers in experimental and control group
Table – 2 (c) Frequency and percentage distribution of post caesarean mothers in experimental and control group according to posttest of level of incisional pain. N=60
|
Level of pain |
Criterion measure |
Experimental group (n=30) |
Control group (n=30) |
||
|
n |
% |
n |
% |
||
|
Mild |
1-4 |
30 |
100 |
28 |
93.24 |
|
Moderate |
5-7 |
0 |
- |
2 |
6.66 |
|
Severe |
8-10 |
- |
- |
- |
- |
Maximum score = 10
Minimum score = 1
Hence, it could be concluded from the above findings that during posttest majority of post caesarean mothers had mild level of pain in both experimental and control group.
Table–2 (d) Frequency and percentage distribution of post caesarean mothers in experimental and control group according to posttest of quality of sleep pattern. N=60
|
Quality of sleep pattern |
Criterion measure |
Experimental group (n=30) |
Control group (n=30) |
||
|
n |
% |
N |
% |
||
|
Poor |
0-6 |
2 |
6.66 |
30 |
100 |
|
Good |
>6 |
28 |
93.33 |
0 |
- |
Maximum score = 15
Minimum score = 0
Hence, it could be concluded from the above findings that during posttest, majority of the post caesarean mothers had good quality of sleep pattern in experimental group and poor quality of sleep pattern in control group.
OBJECTIVE 3: To compare pre and post assessment level of incisional pain and sleep pattern among post caesarean mothers in experimental and control group.
Table 3(a) Comparison of pretest and posttest level of incisional pain among post caesarean mothers in experimental and control group. N=60
|
Group |
N |
Pretest |
Posttest |
Df |
t |
||
|
Mean Score |
SD |
Mean Score |
SD |
||||
|
Experimental Group |
30 |
6.53 |
1.07 |
4.63 |
0.92 |
58 |
7.32* |
|
Control Group |
30 |
5.16 df=58 |
1.01 t=1.98NS |
4.73 df=58 |
0.85 t=7.5* |
58 |
1.78NS |
NS=Non significant
*= significant at p<0.05 level
Hence null hypothesis was rejected and research hypothesis was accepted as difference between the mean pretest and posttest score of post caesarean mothers in experimental group was statistically significant at p<0.05 level. Therefore, it could concluded that there was effectiveness of foot massage on incisional pain among post caesarean mothers in experimental group.
Table 3(b) Comparison of pretest and posttest quality of sleep pattern among post caesarean mothers in experimental and control group. N=60
|
Group |
N |
Pretest |
Posttest |
Df |
t |
||
|
Mean Score |
SD |
Mean Score |
SD |
||||
|
Experimental Group |
30 |
3.66 |
1.07 |
2.66 |
1.09 |
58 |
3.58* |
|
Control Group |
30 |
2.80 df=58 |
1.01 t=0.99NS |
2.45 df=58 |
0.61 t=18.3* |
58 |
1.62NS |
NS=Non significant
*= significant at p<0.05 level
Hence null hypothesis was rejected and research hypothesis was accepted as difference between the mean pretest and posttest score of post caesarean mothers in experimental group was statistically significant at p<0.05 level. Therefore, it was concluded that there was effectiveness of foot massage on sleep pattern among post caesarean mothers in experimental group.
Objective 4-To establish relationship of pre and post assessment of level of incisional pain among post caesarean mothers with selected demographic variables.
Table no. 4 Relationship of mean pretest and posttest level of incisional pain with selected demographic variables in experimental group. N=60
|
Demographic variables |
|
Experimental group |
|||||||
|
Pretest |
Posttest |
||||||||
|
N |
Mean score |
SD |
Df |
Test Value |
Mean score |
SD |
df |
Test value |
|
|
Age ( In years) |
|
|
|
|
|
|
|
|
|
|
18-24 |
16 |
6.38 |
1.09 |
3,26 |
F=0.57NS |
1.5 |
1.21 |
3,26 |
F=0.25NS |
|
25-31 |
7 |
7 |
0.82 |
|
|
1.87 |
0.38 |
|
|
|
32-38 |
4 |
6.5 |
1.29 |
|
|
1.75 |
0.50 |
|
|
|
>38 |
3 |
6.33 |
1.53 |
|
|
1.67 |
0.58 |
|
|
|
Education |
|
|
|
|
|
|
|
|
|
|
Illiterate |
1 |
4 |
0.00 |
4,25 |
F=2.64NS |
0 |
0.00 |
4,25 |
F=2.41NS |
|
Upto primary |
8 |
6.75 |
1.04 |
|
|
2 |
0.53 |
|
|
|
Secondary |
11 |
6.82 |
0.98 |
|
|
1.82 |
0.98 |
|
|
|
Senior secondary |
7 |
6.57 |
0.98 |
|
|
1.57 |
0.98 |
|
|
|
Graduate and above |
3 |
5.67 |
0.58 |
|
|
0.67 |
0.58 |
|
|
|
Occupation |
|
|
|
|
|
|
|
|
|
|
Working |
5 |
6.20 |
0.84 |
28 |
F=1.05NS |
1.80 |
0.84 |
28 |
F=0.43NS |
|
Non working |
25 |
6.60 |
1.12 |
|
|
1.60 |
0.96 |
|
|
|
Type of family |
|
|
|
|
|
|
|
|
|
|
Nuclear Joint Extended |
8 18 4 |
6.5 6.39 7.25 |
1.07 1.09 0.96 |
2,27 |
F=1.06NS |
1.5 1.67 1.75 |
1.07 0.97 0.50 |
2,27 |
F=0.19NS |
|
Family income (Rs/month) |
|
|
|
|
|
|
|
|
|
|
≤ 10000 |
24 |
6.63 |
1.06 |
3,26 |
F=0.93NS |
1.80 |
0.88 |
3,26 |
F=1.96NS |
|
10001-20000 |
6 |
6.17 |
1.17 |
|
|
1.00 |
0.89 |
|
|
|
Religion |
|
|
|
|
|
|
|
|
|
|
Hindu |
17 |
6.29 |
6.29 |
2,27 |
F=3.48NS |
1.41 |
0.87 |
2,27 |
F=0.99NS |
|
Sikh |
8 |
6.38 |
6.38 |
|
|
1.75 |
1.16 |
|
|
|
Others |
5 |
7.6 |
7.6 |
|
|
2 |
0 |
|
|
|
Area of residence |
|
|
|
|
|
|
|
|
|
|
Rural |
19 |
6.37 |
1.06 |
28 |
t=1.11NS |
1.63 |
1.07 |
28 |
t=0.01NS |
|
Urban |
11 |
6.82 |
1.07 |
|
|
1.64 |
0.67 |
|
|
|
Parity |
|
|
|
|
|
|
|
|
|
|
Primi |
18 |
6.61 |
1.09 |
28 |
t=0.48NS |
1.67 |
0.84 |
28 |
t=0.24NS |
|
Multi |
12 |
6.42 |
1.08 |
|
|
1.58 |
1.08 |
|
|
|
Duration after caesarean section (in hours) Upto 12 13-24 |
20 10 |
6.65 6.30 |
1.14 0.95 |
28 |
t=0.84NS |
1.85 1.20 |
0.93 0.79 |
28 |
t=1.93NS |
NS= Non significant
Hence, according to above findings it could be concluded from the above findings that the relationship of level of incisional pain with selected demographic variables i.e. age, education, occupation, type of family, family income, religion area of residence, parity and duration after caesarean section proved statistically non-significant. Therefore, it was concluded that these demographic variables had no significant impact on level of incisional pain.
DISCUSSION :
Objective -1: To pre – assess level of incisional pain and sleep pattern among post caesarean mothers in experimental and control group.
According to the first objective i.e to pre-assess level of incisional pain and sleep pattern among post caesarean mothers in experimental and control group, result of the present study concluded that majority of the post caesarean mothers had moderate level of pain and poor quality of sleep pattern in both experimental and control group.
Objective -2: To post - assess level of incisional pain and sleep pattern among post caesarean mothers in experimental and control group.
According to the objective i.e to post- assess level of incisional pain and sleep pattern among post caesarean mothers in experimental and control group, results of the present study concluded that according to post test majority of the post caesarean mothers had mild level of incisional pain in control group. Whereas according to posttest majority of the post caesarean mothers had quality of sleep pattern in experimental and poor quality of sleep pattern in experimental and poor quality of sleep pattern in control group.
Objective -3: To compare pre and post assessment level of incisional pain and sleep pattern and sleep pattern among post caesarean mothers in experimental and control group.
According to assessment of level of incisional pain, in experimental group, mean pretest score was 6.53 and mean posttest score was 2.87. The differences between mean pretest and posttest score was statistically significant at p< 0.05 level of significance. In control group, the mean pretest score of post caesarean mothers was 6.17 and posttest score was 5.23. The difference between mean pretest and posttest score was statistically not significant at p<0.05 level of significance.
According to assessment of quality of sleep pattern in experimental group, mean pre test score was 4.66 and mean post score was 1.86. The difference between mean pre test post test score was statistically significant at p< 0.05 level of significance. whereas in control group, the mean pretest score of post caesarean mothers was 4.46 and posttest score was 3.98. The difference between mean pretest and posttest score was statistically not significant at p<0.05 level of significance.
Objective -4: To establish relationship of pre and post assessment level of incisional pain and sleep pattern among post caesarean mothers with selected demographic variables.
The objective of the study was to find out the relationship of pre ans post assessment of quality of sleep pattern among post caesarean mothers with selected demographic variables.
According to findings, only area of residence in experimental group and religion in control group had impact on quality of sleep pattern at p<0.05 level of significance.
CONCLUSION:
It was concluded that according to the difference between pretest and post test score of post caesarean mothers in experimental group was found statistically significant at p< 0.05 level of significance.
It was concluded that foot massage was effective to reduce the level of incisional pain and improve the quality of sleep pattern among post caesarean mothers.
According to the difference between pre test and post test score of post caesarean mothers in experimental group was found statistically significant at p<0.05 level. Hence, research hypothesis was accepted which stated that foot massage was effective in reducing level of incisional pain and improved the quality of sleep pattern.
REFERENCES:
1. Klaus M H, Kennel JH, Human maternal behaviour at the first contact with her young-one. Paediatrics.www.answer.com.
2. Gibbs. RS. et al. Danforth's obstetrics and gynecology. Philadelphia 10th ed. Lippincott Williams and Wilkins; 2009. Pp491-503.
3. Sousa1, L. Pitangui, A.C.R., Gomes. F.A. and et al. Measurement and characteristics of post-cesarean section pain and the relationship to limitation of physical activities. Acta Paul Enferm .2009; 22(6): Pp741-747.
4. Lorentzen. V, Hermansen. I.L. and Botti. M. A prospective analysis of pain experience. beliefs and attitudes, and pain management of a cohort of Danish surgical patients. Eur J Pain (2011), doi:10.1016/j.ejpain.2011.06.004
5. Kainu. J.P,Sarvela. J. and Tiippana, E.. et al. Persistent pain after caesarean section and vaginal birth: a cohort study. International Journal of Obstetric Anesthesia.2010; (19): Pp4–9.
6. from: http://www.jcdr.net/back_issues.asp?issn=0973-
7. Khoshtrash. M., Ghanbari. A. and Yeganeh. M. et al. Survey The Effect Of Foot Reflexolog. On Pain And Physiological Parameters After Cesarean Section In Patients Referring To Alzahra Educational Center In Rasht. The Journal of Nursing And Midwifery Faculties Guilan Medical University Fall 2010- Winter 2011; 20(64): 27-33.
8. Salvo. S.G. Massage Therapy Principles and Practice 3rd ed. Saunders Elsevier, Canada, 2009. Pp 505-52.
9. Wang. H. L. and Keck. J. F. Foot and hand massage as an intervention for postoperative pain. Pain Management Nursing. 2004; 5(2): Pp59-65.
10. Fritz S. Chaitow, L. and Synder. R. Mosby's Fundamentals of Therapeutic Massage .4th ed. Mosby Elsevier. 2009. Pp 129-335.
11. S Jenny. Reflexology. A complementary therapy in pain management; Nightingale Nursing Times. 2014; 10(1): p. 15-16
12. 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. August 2010; 23(3), Pp 153-58. http://www.appliednursingresearch.org/article/S0897-1897(08)00081-5/abstract
13. Chaudhary S, Kumar G, Singh K. Reflexology research of post-operative pain reduction. Reflexions. Mar 2006; 27(1).
14. Gibbs. R. S. Karlan, B. Y. Haney, A. F., et al. Danforths Obstetrics and Gynecology (10th ed). Philadelphia, USA: Lippincott Williams and Wilkins.2008. PP.491-503.
15. Menacker. F. and Halmilton, B. E. Recent Trends in Cesarean Delivery in the United http://www.cdc,gov/nchs/data/databriefs/db35.htm
16. Khawaja. M. Jurdi, R. and Khasholian. T. K. Rising trends in cesarean section rates in Egypt. Birth, 2004; 31 (!): Pp12-16.
17. Nabhan. A. F. long-term outcomes of two different surgical techniques for cesarean. International Journal of Gynecology and Obstetrics. 2008; 100 (1): Pp 69-75.
Received on 11.02.2021 Modified on 09.03.2021
Accepted on 16.04.2021 ©AandV Publications All right reserved
Asian J. Nursing Education and Research. 2021; 11(3):395-400.
DOI: 10.52711/2349-2996.2021.00095