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PERFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION
1. Name of the
candidate and
address
:
Ms. Archana .B
1st Yr M.sc Nursing
(2008-2009)
JSS college of Nursing,
I st Main, Saraswathipuram
Mysore.
2. Name of the
institution
:
JSS College of Nursing , I st Main
Saraswathipuram
Mysore
3. Course of study
& subject
:
M.sc Nursing in
Medical- Surgical Nursing
4. Date of admission
to the course
:
5. Title of the topic
:
A study to assess the effectiveness of Reflex Zone Therapy on
selected distressing side effects related to chemotherapy among
cancer patients at selected hospital of Karnataka.
1
6.0.
BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
Cancer is the 2nd leading cause of the death in US and the scenario of
cancer shows the different treatment modalities like chemotherapy, radiation
therapy and many more adjuvant therapies. Palliative care is an important
aspect as the cancer patient’s suffering is common, in which there are new
emerging therapies which provides a great sense of feeling and self control and
on among these one is the Reflex Zone Therapy.
6.1 NEED FOR THE STUDY :
“The Nursing Research is concerned with whole of the Nursing”
Cancer is a group of more than 200 diseases characterized by
uncontrolled and unregulated growth of cells. It can occur in person of all ages
and all ethnicities and is a major health problem. Chemotherapy is used in the
treatment of many solid tumors and is the primary therapy for leukemia and
lymphomas. Chemotherapy as a treatment option has evolved as a palliative care
“last – ditch efforts” treatment modalities to one that can offer cure for certain
cancer, control other cancer for long periods of time and offer palliative relief of
symptoms when cure or control no longer is possible1.
Being Nurses one should be able to understand the condition of
cancer patients who are undergoing the chemotherapy. This treatment has an
effect on both the psychological and physiological aspects of human life viz. pain,
sleep disturbances, nausea, vomiting, stress, anxiety ,Gastrointestinal disturbances
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etc., these side effects could be so intense in nature which pose a challenge to
health personals to keep these side effects at their minimal levels.
There are 3 main approaches to cancer prevention
1. Education
2. Regulation
3. Host modification.
A client health beliefs can be vital determinants of learning readiness when
information is made available.
Host modification aims to alter the body’s internal environment to decrease
the risk of cancer or to reverse a carcinogens process which includes the
chemoprevention and complementary and alternative approaches along with the
nursing care.
The use of Complementary and Alternative Therapies (CAT) by public is
growing, Estimates suggest that up to 82% of clients have used the CAT
sometimes in their lives. Complementary approaches often combine one or more
elements such as :
1.
Spiritual, Psychological, Nutritional, Physical, Pharmacological, Herbal
electromagnetic or psychic approaches.
2.
Traditional medicines
3.
Unconventional uses of conventional therapies
4.
Unconventional instruments.
5.
Human approaches
6.
Massage therapy
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It is also found that the use of CAT increase clients sense of control and well –
being2.
Reflex zone therapy comes under one of the CAT where in Reflexology is a
zonal therapy and a science in the skillful manipulation is applied to the individual
identified on the body points to stimulate the individual functional system or parts
of the body. This stimulation area is mainly the feet and hands. It can help
alleviate many of problems in a natural way. The reflexes are generated through
the manipulation of response focal points in the body for each system, the
resulting reactions.
This reaction node can be used effectively in the liberation of large numbers
of complaint taking no chance with the unwanted side effects, otherwise inevitable
in the chemotherapy. It has proves to be beneficial reducing stress pain, anxiety
and nausea. It acts by quick and claming feeling. Besides this these are validated
by the great relief of patients with positive results in the treatment of cancer with
no chance of any kind of adverse effect. As reflexology eliminates toxins in the
body it is reported that patient get the ability to deal with chemotherapy and the
related side effects.3
The impact of these studies can be utilized in the Nursing practice for
rendering effective care in counteracting the side effects of chemotherapy.
Palliative care is an important aspect to be delt with the cancer patient. Hence, any
therapy which helps to reduce there distressing side effect will be a boon to the
patient and so as to the effectiveness of nursing care in enhancing comfort to the
patient.
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As the reflex zone therapy is an emerging field in the health care
delivery system the researcher found dearth in the applicapability of Reflex Zone
Therapy in Indian setting/Contest when compare to abroad setting. Hence in
order to explore the effect reflex zone therapy can produce in reducing in the
distressing side effects related to chemotherapy among the cancer patients, the
researcher has planned to do this study.
6.2 REVIEW OF LITERATURE :
A study was conducted to determine the therapeutic effect of foot massage
on pain, pulse rate and respiratory rate among 50 patients suffering from cancer
pain. The tool used for data collection was the interview technique, VAS,
Observation record and the result revealed that 66.7% had moderate pain and
remaining had mild pain, Pulse rate was noticed to be more than 100 and
respiratory rate was above the normal respiration among 97 % .4
A study was conducted on the effect of foot massage combine with foot
bath on 28 clients with nausea induced by chemotherapy. The intervention was
introduced on 3rd day of chemotherapy to the 5th day. The duration of each foot
massage was for 10min after foot bath for 7min. An ECG was taken to find out
the variability in heart rate, VAS score was used measure the nauseating
perception. A comparisons was made immediately, before care and 30 minutes
after care and results revealed that 86% of subjects experiencing achieving
reduction in perception of nausea and suggested that foot massage combined with
a foot bath leads to the relaxation response and improves the perception of delay
of nausea induced chemotherapy5.
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A study was conducted to examine the effectives of foot reflexology among
the hospitalized cancer patients undergoing 2nd and 3rd cycles of chemotherapy.
The study was conducted on 30 patients admitted to the oncology unit at scientific
research hospital in Italy Among 30, the 15 patients received the therapeutic
massage and the data collection techniques was self report of anxiety which as
recorded before, after and 24hr after the intervention. The results revealed that
there was an average decrease of 7.9 point on anxiety scale in the treatment group
and 0.8 point in the control group6.
An empirical study was conducted on the use of foot massage as a nursing
intervention among hospitalized patients with cancer, in view to provide relief
from pain nausea and anxiety. 87 patients participated in the study and each
received a 10min foot reflexology (5min per foot) and the result revealed that it
had a significant and immediate effect on the patient’s perception of pain, anxiety
and nausea7.
A study was conducted by Korean nursing school on the menopausal
women between the age of 40 – 64yrs, to find the effectiveness of self foot
reflexology on depression, stress and immune function of women; The subjects
were assessed for initial 4 weeks (control period) without any intervention.
Followed by this, they were trained for 2 weeks and then they continued with self
treatment for a period of 6 weeks. Pretest to post test comparison revealed that the
women not only achieved significant decrease in depression and perceived stress,
even their immune system got boosted as there was increases in levels of natural
killer cells and immunoglobulin.8
6
A study was conducted about the effect of foot reflexology on nausea and
vomiting related to chemotherapy. The participants were 34 patients with breast
cancer undergoing chemotherapy. The group was divided into 18 experimental
and 16 control group. A Pretest-posttest control group design was used and the
result revealed that there was a significant decrease in the level of nausea, vomiting
and fatigue in the experimental group who received foot reflxology9.
A study was conducted on 23 patients with breast cancer and lung cancer
about the effect of foot reflexology in relieving the pain and anxiety, A within
group design was used and the results obtained before and after intervention
revealed that their was a significant decrease in pain and anxiety among the
patients who received foot reflexology.10
A study was conducted on the effect of foot reflexology and placebo foot
treatment, for patients in palliative cancer care. 12 participants were randomly
assigned to either reflexology or placebo foot treatment with the same therapist
administering the two interventions and the outcome was measured through a
linear self assessment scale of quality of life. Both groups indicated improvement
but the group with reflexology showed significantly positive results in the quality
of life.11
A study was conducted to investigate the benefits of reflexology on sleep
problems among 50 elderly nursing home residents.
The study design was
experimental, pre-post design .The subjects were divided into interventional and
control groups. The sleep disturbances, depression and physiological indices of
serotonin and cortisol levels were assessed before and after intervention the.
7
Results revealed that comparison of control group with the experimental group.
Showed improved quality of sleep, decreased depression and increase serotonin
levels in experimental group .12
STATEMENT OF THE PROBLEM
A study to assess the of effectiveness of Reflex Zone Therapy on selected
distressing side effects related to chemotherapy among cancer patient at selected
hospitals of Karnataka.
6.3 OBJECTIVES:
1. To assess the distressing side effects ( pain , nausea ,anxiety and sleep
disturbance )related to chemotherapy before and after Reflex Zone Therapy
among the cancer patients.
2. To find out the effectiveness of Reflex Zone Therapy in terms of reduction
in distressing side effects related to chemotherapy among cancer patients
3. To find the relationship between cancer patient’s;
 Pain and anxiety
 Pain and Nausea
 Pain and Sleep disturbance(insomnia)
 Anxiety and Nausea
 Nausea and Sleep disturbance(insomnia)
 Anxiety and sleep disturbance(insomnia)
8
4. To find out the association of the distressing effects related chemotherapy
among cancer patients with their selected personal variables viz age, gender,
chronicity (duration) of the condition stage of cancer, type of Cancer, type
of Chemotherapy, and number of Chemotherapy cycles received.
CONCEPTUAL THEORITICAL FRAMEWORK :
Roger’s Health Belief Model
OPERATIONAL DEFINITION :
1.
Reflex Zone Therapy(RZT) – Also known as foot reflexology:
Is a therapeutic method of reliving pain by stimulating the
predefined pressure points on the feet.
In this study it refers to relieving the distressing side effects of
chemotherapy
by providing a 15min daily foot massage and foot
acupressure for each extremity for a duration of 1week for the
cancer patients undergoing chemotherapy.
2.
Selected Distressing side effects related to chemotherapy
2a)
Distress: Feeling of discomfort or an extra, unwanted, unusual
effect
or unexpected result of situation or course of action that
happens along with the results you are aiming for.
2b)
Selected side effects : it refers to the side effects Occurring due
to chemotherapy viz..
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 Pain - Bodily suffering caused by illness, pressure, injury, as
measured through Standardised Visual Analogue Scale.
 Anxiety – Troubled state of mind or worries as measured by
Standardised Anxiety Scale
 Nausea – Inclination to vomit as measured by standardized
Visual Analogue Scale
 Sleep disturbance (Insomnia) – Sleeplessness as measured
through observation checklist.
The selected distressing side effects refers to the side effects (
pain , nausea, anxiety and sleep disturbance )causing
discomfort or suffering to cancer patients.
* please note : the term reflex zone therapy will be refered to as RZT throughout
the study
3.
Chemotherapy – Refers to one of the treatment modalities of
cancer using chemical substances.
4.
Cancer Patients – Refers to patients who are suffering from one or
other type of cancer and are undergoing chemotherapy.
5.
Effectiveness – Means quality of being able to bring about an
effect/Intended Outcome.
10
In this study it refers to the effectiveness of reflex zone therapy in
bringing about reduction in the distressing side effects related to
chemotherapy as perceived by the cancer patients and is measured
through standardized scaled (above details are given along with
the distressing side effects ).
HYPOTHESIS :
H1:
The mean post test scores of distressing side effects related to
chemotherapy among cancer patients receiving RZT will be
significantly higher than the mean post test scores of cancer
patients who did not received the RZT.
H2: The mean post test scores of distressing side effects related to
chemotherapy among cancer patients receiving RZT will be
significantly higher than their mean pretest scores.
H3: There will be significant relationship between the cancer patients
level of ;
 Pain and anxiety
 Pain and Nausea
 Pain and Sleep disturbance(insomnia)
 Anxiety and Nausea
 Nausea and Sleep disturbance(insomnia)
 Anxiety and sleep disturbance(insomnia)
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H4: The mean pre test scores of distressing side effects related to
chemotherapy among cancer patients will be significantly
associated with their selected personal variables viz. age, gender,
chronicity
(duration) of the condition stage of cancer, type of
Cancer, type of Chemotherapy, and number of Chemotherapy
cycles received.
ASSUMPTIONS :
 Chemotherapy leads to certain side effect which causes suffering
to the patients receiving it.
 The reflex zone therapy has the ability to increase the blood
circulation and relax the whole body and induce sleep
 It can also remove the toxins from the body and reduce pain.
 Relaxation of body and mind will reduce the Pain, Anxiety,
Nausea and induce sleep.
 Cancer patients will have positive attitude to undergo reflex zone
therapy.
DELIMITATION:
Study is delimited to cancer patient undergoing chemotherapy who are
admitted in
the selected hospital.
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7.0 MATERIALS AND METHODS :
RESEARCH APPROCH/DESIGN :
Quasi Experimental Study, Non equivalent experimental control group
before and after design with repeated post test .
Experimental group
:
O 1 X O2 O 3 O 4
Control group
:
O1 - O2 O3 O4
VARIABLES OF THE STUDY:
Independent variable
:
Reflex zone therapy
Dependent Variable
:
Distressing side effects of
chemotherapy pain, nausea, anxiety and
sleep disturbance (insomnia)
Other Variables
:
Age, gender, chronicity (duration) of
the condition stage of cancer, type of
Cancer, type of Chemotherapy, number
of Chemotherapy cycles receiving.
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7.1 SOURCE OF DATA
SETTING
:
Selected Oncology hospitals
of Karnataka
POPULATION
:
Cancer patients undergoing
chemotherapy.
7.2 METHOD OF COLLECTION DATA
SAMPLE & SAMPLING CRITERIA:
SAMPLE
:
Cancer patients undergoing
chemotherapy
SAMPLING CRITERIA :
(A) Inclusion criteria
:
Cancer patients undergoing
chemotherapy who are;
 willing to participate ;
 above 18yrs of age.
 Who can comprehend and speak
Kannada and English
(B)Exclusion criteria
:
Cancer Patients undergoing
chemotherapy who are ;
 Not willing participate
 In debilitating condition.
 Patients on combine treatment.
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:
Non probability, purposive sampling
SAMPLE SIZE
:
30 each in experimental and control group.
DATA COLLECTION
:
Interview, Observation technique
:
* Standardised VAS, for (Pain and Nausea)
SAMPLING
TECHNIQUE
TECHNIQUE
METHOD OF DATA
COLLECTION
* StandardisedAnxiety scale
* Observational check list for insomnia
DATA COLLECTION PROCEDURE:
Group
Experimental
Group
Control group
Pretest
Day1
Assessment of
 Pain
Intervention
Day 1 to 7
Receives Reflex
Zone Therapy
Post test
Day 8 & Day15
Assessment of
 Pain
 Nausea
 Nausea
 Anxiety
 Anxiety
Receives
 Sleep Disturbance Routine Care
 Sleep Disturbance
PLAN OF DATA ANALYSIS:
 Data will be analyzed using descriptive and multivariate statistics
Descriptive and inferential statistical analysis is used to describe the
characteristics of sample of frequency and percentage.
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 Chi square test for association among the variables
 Karl Pearson’s Coefficient of correlation used for finding the
relationship
 ‘t’ test to find the effectiveness
7.3
Does the study require any investigation or intervention to be
conducted on patients or other human or animals? If so, Please
describe briefly.
Yes, Patients are exposed to Reflex zone therapy as mentioned
in the methodology.
7.4
Has ethical clearance been obtained from your institution in
case of 7.3.
Yes ,the ethical clearance has been obtained from concerned oncology
institute and the college.
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8.0 BIBILIOGRAPHY
1. Lewis Sharon, Heitkemper, Dirksen .Medical Surgical Nursing:
Assessment and management of clinical problems. 6th ed. Washington
:Mosby ;2004 .p 290,311
2. Black Joyce M, Jacob Esther Matassarin. Medical Surgical Nursing
:clinical management and
positive outcomes ; 7th ed. Elsevier
publications .2004 .p 311
3. Dudi . All you should know about the reflexology and chemotherapy,.
[serial online]. 2008 [cited 2008 july 2nd ];1 (1) :[5 screen] available from
http:/www. Artilebase.com/ cancer articles
4. Ratna prakash ; Elsa santhobi; Moly . Easing cancer pain and anxiety.
Journal of Nursing Times .2008.september ( ) 36-39.
5. Nitta Norie ; Aso Yoky; Hayama Yuka ; Nakhira mieko ,Numanami
setsuko .”the effect of relaxation on foot massage combined with foot
bah for delayed nausea induced by chemotherapy” . Japanese Journal of
nursing research .2004 vol.37 (6) 517-528
6. Quattrin,R .Zanini ,A.Buchini,S. “use of reflexology foot massage to
reduce anxiety in hospitalized cancer patients in chemotherapy treatment
methodology and outcomes”. Journal of nursing management.2006
march vol 14 (2) 96-105.
17
7. Grelish, L ,Lomasney,A, Whiteman,B “Foot massage; A nursing
intervention to modify the distressing symptom of pain and nausea in
patients hospitalized with cancer” . Cancer nurse . 200, June vol 23 (2) ;
237 -243.
8. Y.M.Lee, “Effect of Self-Foot Reflexology Massage on Depression, Stress
Reponses and Immune Functions of Middle Aged Women,” Taehan Kanho
Hakhoe Chi 36, no.1 (2006): 179-88.
9. J.H.Yang , “the effects of foot reflexoloty on nausea, vomiting and fatigue
of breast cancer patients undergoing chemotherapy “, Taehan Kango
Hakhoe chi 35,no 1 (2005) : 177-85.
10. N.L..Stephenson, S.P.Weinrich and, A.S. Tavakoli, “the effect of foot
reflexology on the pain and anxiety in patients with breast and lung
cancer” , oncology nursing forum 27 no 1 (2000):67-72.
11. H.Hodgson , “Does reflexology impact on cancer patients quality of life ?”
nursing standard 14, no .31 (2000): 33-38.
12. R.H. Song and H. Kim do, “The effects of foot reflexion massage on sleep
disturbances ,depression disorders and the the physiological index of the
elderly” ,Taehan Kanho Hakhoe chi 36 no.7 (2006):15-24.
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9.0
SIGNATURE OF THE CANDIDATE :
10.0
REMARKS OF THE GUIDE :
11.0
NAME AND DESIGNATION OF (in block letters )
11.1
GUIDE
Dr. BHARTI .M.
Professor & principal, JSS College Of Nursing
Ist Main, Saraswathipuram, Mysore .
11.2
SIGNATURE :
11.3
CO- GUIDE (if any ):
11.4
SIGNATURE :
11.5
HEAD OF THE MEDICAL SURGICAL NURSING
Nil
DEPARTMENT :
Dr. BHARTI.M .
Professor & Principal, JSS College Of Nursing
Ist Main, Saraswathipuram, Mysore.
11.6
SIGNATURE :
19
12.1
REMARKS OF THE CHAIRMAN AND PRINCIPAL:
Recommended and forward
Dr. BHARTI.M .
Professor & Principal, JSS College Of Nursing
Ist Main, Saraswathipuram, Mysore
12.2 SIGNATURE :
20
SYNOPSIS PROTOCOL/OUTLINE
SUBMITTED BY :
ARCHANA .B
1 Year MSc Nursing
J.S.S College of Nursing
Mysore
ST
SUBMITTED ON
28/11/08
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