Effectiveness of Acupressure on improving the Quality of Sleep among Cancer Patients

Prof. Dr. J. Vijaya Raja Kumar¹, Mrs. Uma M.²

¹Vice Principal, Chithirai College of Nursing, Madurai

²Assistant Professor, Chithirai College of Nursing, Madurai

*Corresponding Author Email: vijaynurse@gmail.com

ABSTRACT:

Introduction: Sleep disorders, such as difficulty falling asleep, problems maintaining sleep, poor sleep efficiency, early awakening, and excessive daytime sleepiness, are prevalent in patients with cancer.

Method: A Pre experimental study was done to evaluate the effectiveness of acupressure on improving the quality of sleep among cancer patients in H.C.G cancer center at Erode. The conceptual framework of the study was based on the “Neuman’s System Model“. The research design used was pre experimental one group pre test post test design. Non probability purposive sampling method was used to select the 60 samples for the study. The tool used for this study was Pittsburg Sleep Quality Index (PSQI) scale before and after intervention. Acupressure is given at 3 points (back of the ear, wrist and calf muscle for 3min /acupoint on the same day after completion of pre test and it was given for 7 days continuously before bedtime. The data gathered was analyzed using descriptive and inferential statistics. Acupressure self instructional module was given after post test to make use of acupressure at home setting.

Result: Major findings of the study were, after intervention majority 50(83.33%) had good sleep and 10(16.67%) of cancer patients had fairly good sleep. The mean score of sleep after intervention is lower than the mean score of sleep before intervention. The ‘t’ value is 23.6 (1.960), which was significant at 0.05 level and shows there is a significant improvement in the quality of sleep.

Discussion: Acupressure is used by millions of persons around the world. Incorporating this technique into nursing care plans will unite us in the commonality we share –the desire to relieve human suffering.

KEYWORDS: Acupressure, Quality of sleep, Cancer patients, Pittsburg sleep Quality index, Self-instructional module

INTRODUCTION:

All cancer survivors knowing what complication to expect after cancer treatment and the interventions to alleviate those complications would help them to make plans for life style changes. It is an accepted fact that modern day anti-cancer strategies are highly correlated with insomnia. Complementary and alternative medicine has therefore made significant inroads as an accessory modality in cancer care, providing a feasible option for improvement in general wellbeing, palliation or occasionally cures.

The stimulation just by the pressure of hand at some of meridian points, it is called acupressure treatment and has been found to give surprising results for insomnia¹. Sleep problem among cancer patients may be often overlooked because so many other issues, such as surgery, radiation or chemotherapy, arise so urgently. Studies found that when it comes to overall impact upon quality of life, sleep disruption is highly significant¹⁴. It also needs to recognize that patients feel that high quality sleep is an important factor in their fight against cancer. There is a growing body of literature addressing the effectiveness of treatments for fatigue. However, less evidence is available to guide the management of insomnia in patients with cancer. As health care providers, we can do better. This is definitely an area that needs more attention.

NEED FOR THE STUDY:

Cancer patients are at great risk for developing insomnia and disorders of the sleep- wake cycle. Insomnia is the most common sleep disturbance in this population and is most often secondary to physical and/or psychological factors related to cancer/cancer treatment. Sleep disorders are reported to be very prevalent in patients with cancer but often unrecognized.¹⁹

The stimulation, just by the pressure of hand of some of the meridian points, is called acupressure treatment and has been found to give surprising results. Knowledge of acupressure points comes handy when regular medical aid is not available. Problems like acute head ache, back ache, stomach ache, nausea, etc. can be easily but effectively dealt with by using acupressure.¹

Through acupressure has the additional advantage of being completely without any side effects. With a simple pressure at a particular point on the body one can give relief to the patient, or to oneself, and that is why this variation of the system of Chinese acupressure is becoming very popular these day.¹

A study looking at 115 cancer patients, the researcher found that during the period of chemotherapy 52% of patients had poor sleep quality (PSQI score more than 5) as compared to during their period without chemotherapy. During chemotherapy, patients had a longer sleep latency, poorer sleep efficiency and shorter sleep duration. The patients described various reasons for their sleep difficulties during chemotherapy including getting up to go to the bathroom, wake up in the middle of night and waking up too early. Only 9-10% complained of pain as the reason for their sleep problems.²⁰

STATEMENT OF THE PROBLEM:

A study to evaluate the effectiveness of acupressure on improving the quality of sleep among cancer patients in H.C.G Cancer center at Erode.

OBJECTIVES:

§ To assess the quality of sleep among cancer patients before intervention.

§ To assess the quality of sleep among cancer patients after intervention.

§ To evaluate the effectiveness of acupressure on improving the quality of sleep among cancer patients.

§ To find the association between the quality of sleep after intervention among cancer patients with their selected demographic variables.

HYPOTHESES:

H₁: The mean score of sleep after intervention is significantly lower than the mean score of sleep before intervention among cancer patients.

H₂: There will be a significant association between the quality of sleep after intervention among cancer patients with their selected demographic variables

Assumptions:

§ Majority of cancer patients experience sleep disturbances during the course of illness and treatment.

§ Acupressure helps in improving quality of sleep among cancer patients.

§ Nurses have an important role on improving quality of sleep by applying acupressure.

Delimitations:

The study is delimited to

· Sample size is 60

· Data collection period is 5 weeks.

· Patients who are admitted in the wards and remain for 8-10 days.

Projected outcome:

Acupressure improves the quality of sleep of cancer patients who have sleep disturbances. Promotion of sleep helps in physical as well as psychological wellbeing. Proper amounts of sleep enhance the ability to concentrate, make judgments, participate in daily activities and decrease in irritability. It also conserves energy and aids in healing and recovery from illness which helps the cancer patients to promote compliance with treatment protocol and promoting quality of life.

REVIEW OF LITERATURE:

Chen M. L., (2007) conducted study on “sleep disturbances and quality of life in lung cancer patients undergoing chemotherapy” at Taiwan and the findings showed that patients mean PSQI global scores for days with chemotherapy (6.86±3.83) and for days without chemotherapy (6.23±3.47) were both higher than the cutoff of 5, indicating poor quality of sleep during the fourth cycle of chemotherapy.²⁰

Gooneratne N.S., (2008) conducted study on “Complementary and alternative medicine for sleep disturbances in older adults” and found that Complementary and alternative medicines (CAM) are frequently used for the treatment of sleep disorders, but in many cases patients do not discuss these therapies directly with their health care provider. There is a growing body of well-designed clinical trials using CAM that have shown the following: (1) Melatonin is an effective agent for the treatment of circadian phase disorders that affect sleep; however, the role of melatonin in the treatment of primary or secondary insomnia is less well established. (2) Valerian has shown a benefit in some, but not all clinical trials. (3) Several other modalities, such as Tai Chi, acupuncture, acupressure, yoga, and meditation have improved sleep parameters in a limited number of early trials. Future work examining CAM has the potential to significantly add to our treatment options for sleep disorders in older adults¹⁴Romanelli M.N, (2008) conducted study on “Efficacy of wrists overnight compression (HT-7 point) on insomniacs”. The study is conducted with 40 patients for 20 nights. Data obtained indicate that the device HT7 – Insomnia control is efficacious to ameliorate quality of sleep and reduce anxiety levels in insomniacs, at a higher extent than in the placebo group.³⁰

Sok S.R et.al., (2005) conducted study on “Effects of auricular acupuncture on insomnia in Korean elderly” at Korea among 40 elderly who were 65 years and over. The experimental group had higher significant sleep scores than that of the control group (t=32.739, p=.001). The experimental group had higher significant self- satisfaction scores on sleep than that of the control group (t=30.049, p=.001)²³

Tsay S.L et. al., conducted study on “Acupressure and Transcutaneous Electrical Acupoint Stimulation in improving fatigue, sleep quality and depression in hemodialysis patients” at Taiwan. The study was a randomized controlled trial; 106 qualified hemodialysis patients were randomly assigned to acupressure, TEAS Transcutaneous Electrical Acupoint Stimulation (TEAS) or control groups. Patients in the acupressure and TEAS groups received 15 minutes of treatment 3 times a week for 1 month, whereas patients in the control group only received routine unit care. The results indicated that patients in the acupressure and TEAS groups had significantly lower levels of fatigue, a better sleep quality and less depressed moods compared with patients in the control group based upon the adjusted baseline differences.²⁵

Tsay S.L et.al., conducted study on “Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease” at Taiwan. The study was a randomized control trial. A total of 98 end-stage renal disease patients with sleep disturbances were randomly assigned into an acupressure group, a sham acupressure group, and a control group. Acupressure and sham acupressure group patients received acupoints or no acupoints massage three times a week during haemodialysis treatment for a total of 4 weeks. The results indicated significant differences between the acupressure group and the control group in Pittsburgh Sleep Quality Index subscale scores of subjective sleep quality, sleep duration, habitual sleep efficiency, sleep sufficiency, and global Pittsburgh Sleep Quality Index scores²⁷Ummareddy M.,(2005) Conducted a study on “the effect of acupressure on quality of sleep among 50 cancer patients” at Vellore and the study results showed that there was a significant improvement in the overall quality of sleep 21 (84%) in the experimental group after acupressure than the control group_.²⁹

METHODOLOGY:

Research Approach:

The evaluative approach was used to evaluate the effectiveness of acupressure on improving the quality of sleep among cancer patients.

Research Design:

The research design used in this study was pre-experimental (one group pre test- post test) design.

Criteria for Sample Selection:

Inclusion Criteria:

· Patients between 35- 50yrs of age.

· Patients who stays in the hospital for 8-10 days.

· Both male and female patients receiving radiation therapy chemotherapy and surgery patients.

Exclusion criteria

· Patients who are critically ill.

· Patients who had undergone surgery and on drugs for sleep.

· Patients who are not willing to participate.

Sample Size:

A sample of 60 cancer patients who met the inclusion criteria were selected for the study.

Sampling Technique:

Non Probability purposive sampling method was used to select the samples for the study.

RESULT AND DISCUSSION:

The data gathered was analyzed using descriptive and inferential statistics. Major findings of the study were, prior to implementation of acupressure, 7 (11.67%) of cancer patients only had good sleep and 46 (76.66%) had fairly good sleep and 7 (11.67%) had bad sleep. After intervention majority 50 (83.33%) had good sleep and 10 (16.67%) of cancer patients had fairly good sleep. The mean score of sleep after intervention is lower than the mean score of sleep before intervention. The ‘t’ value is 23.6 (1.960), which was significant at 0.05 level and shows there is a significant improvement in the quality of sleep. No significant association was found between the sleep scores after intervention with their selected demographic variables except educational status.

NURSING IMPLICATIONS:

Nursing Services:

· Acupressure therapy can be made accessible to all patients to induce sleep, as it does not have any adverse effects.

· Acupressure can be made to practice as a routine nursing care.

Nursing Education:

Nursing students should be educated on various system of alternative therapies to alleviate the sufferings of hospitalized cancer patients.

Nursing Administration:

The nurse – educator can provide in service education to nursing personnel to update their knowledge about the method of treatments like acupressure and its valuable benefits to the patients community.

Nursing Research:

Nursing research should be directed to further explore and update knowledge of oncology unit nurses towards patients during hospitalization and treatment which enhances the quality of life.

RECOMMENDATIONS:

· Similar study can be carried out using experimental and control group to control the extraneous variables.

· Study can be carried out to compare the effectiveness of acupressure with other complementary and alternative methods or technique.

· This study can be done by maximizing the time and duration of acupressure therapy.

· Various other benefits of acupressure such as reducing pain nausea and vomiting among cancer patients can be carried.

CONCLUSION:

This study revealed that there is a significant improvement in the quality of sleep among cancer patients after acupressure. Sleep disturbances lead to a lower quality of life and may even lead to immune dysregulation and increased mortality in these patients. Nurses can incorporate acupressure into the care of patients to elucidate the effectiveness of alternative therapies on their quality of life and outcome.

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Received on 28.04.2015 Modified on 12.05.2015

Asian J. Nur. Edu. and Research 5(4): Oct.- Dec.2015; Page 513-517

DOI: 10.5958/2349-2996.2015.00105.6

Sl.No	Variable	Mean	Standard deviation	Mean Difference	Paired ‘t’ test value	Table value	Remarks
1	Before Intervention	138.16	3.23	107.65	23.06	1.960	Significant
2	After Intervention	30.51	2.30	107.65	23.06	1.960	Significant