PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

A STUDY TO ASSESS THE EFFECTIVENESS OF FOOT REFLEXOLOGY ON HYPERTENSIVE PATIENTS IN DISTRICT HOSPITAL AT TUMKUR CITY.

SUBMITTED BY MR. NATWARLAL PATIDAR FIRST YEAR M.Sc.NURSING (MEDICAL SURGICAL NURSING) AKSHAYA INSTITUTE OF NURSING SCIENCES TUMKUR - 02

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DESSERTATION MR. NATWARLAL PATIDAR 1 NAME OF THE CANDIDATE AND ADDRESS FIRST YEAR, M.Sc. NURSING AKSHAYA INSTITUTE OF NURSING SCIENCES, S.I.T. MAIN ROAD, TUMKUR 572102 AKSHAYA INSTITUTE OF NAME OF INSTITUTE 2 NURSING SCIENCES, TUMKUR. FIRST YEAR, M.Sc. NURSING MEDICAL SURGICAL NURSING

COURSE OF STUDY AND SUBJECT DATE OF ADMISSION TO COURSE TITLE OF THE STUDY

28-6-2008 A STUDY TO ASSESS THE

EFFECTIVENESS OF FOOT REFLEXOLOGY ON HYPERTENSIVE PATIENTS IN DISTRICT HOSPITAL AT TUMKUR CITY.

6. BRIEF RESUME OF INTENDED WORK INTRODUCTION In a world of ever-increasing technology and machine controlled medical interventions, people are beginning to feel the need for a human, individual touch; for a more natural approach to health that seeks to enhance life rather than dissect illness into more and more obscure diseases. Fortunately, there are a number of natural therapies which have just such a positive, holistic approach, and have also stood the test of time, to emerge as the most rational way to sustain our health into the twenty-first century. We have become accustomed to thinking of medicine as a crisis treatment for when we are sick, but one of the strengths of these therapies is their value in countering the effects and helping to actually prevent illness. By reducing the impact of worries and stresses, many natural systems of treatment work to restore our vital energy and inner harmony. Many Eastern cultures, such as those of China and India, have retained a strong tradition of therapies aimed at balancing energy, and in recent years these have gained increasing attention in the west. Hypertension is a major cause of heart failure, stroke, kidney failure and other vascular conditions. Once it is developed it is a life time condition and about 20% of the adult population develops hypertension. Hypertension carries the risk of premature morbidity and mortality which increases as the systolic and diastolic pressures rise. It is one of the major risk factor for cardiovascular disorder mortality which accounts for 20 to 50%. It is commonest cardiovascular disorder posing a major public health challenge and a world wide health disorder. In the modifiable risk factor of hypertension environmental stress is a major factor as hypertension it self implies a disorder initiated by tension or stress. It is an accepted fact that psychosocial factors operate through mental processes consciously or unconsciously to produce hypertension.1
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Researcher has came across some relatives, friends and patients those who were almost lost there hope and thinking life is no more easy for them and few days after found that they were doing well when asked they were all like to share their experience about the change brought in their life after adopting the foot reflexology. Investigator observed that many people due to the side effects and discomforts stop taking treatment and land in to serious complications and also he observe in clinical area that foot reflexology is effective in many diseases. So he wanted to test the effect of foot reflexology on the hypertensive patient.

6.1 NEED FOR THE STUDY Now a days several researches has done on effectiveness of natural therapies or alternative treatment on various diseases and found effective and cost beneficial along with improvement in quality of life. In alternative treatment, reflexology is a technique of diagnosis and treatment, in which certain areas of the body, particularly the feet are massaged to improve the functioning of the internal organs and to reduce the pain sensation. Reflexology has been used to treat a number of common aliments including back pain, digestive problems, migraine, menstrual problems, sinus problems, and general stress and tensions. It has also been used for more serious aliments such as heart disorders and multiple sclerosis. Reflexology has quiet powerful effects. The basic concept behind reflexology is that the whole body, indeed the whole person, is interconnected and that imbalances in one part of the body are reflected in changes elsewhere. There are probably some historical connections between the basis for reflexology and other systems, such as acupuncture or
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acupressure, and writings from ancient Egypt and Rome seem to describe healing points that correspond with reflex zones. It is certainly apparent that both the Incas and the Native Americans used forms of foot massage that are related to reflexology treatments.2 Dr Fitzgerald was an American doctor, pioneer of reflexology treatment and specializing in the ear, nose and throat area, who practiced in the early part of the twentieth century in various hospitals in the US and England. Nobody is quite certain how he arrived at his ideas. But he discovered that pressure, or massage, on certain part of the body helped to improve the functioning of internal organs, or else helped to reduce pain sensations in 1913. he announced his findings, outlining his theory of interconnecting zones within the body these can be visualize; simply as ten vertical strips running the length of the body with any problems arising in one of these zones being affected by the rest of that zone.3 In 1917, Dr Fitzgerald, with his colleague Dr Edwin Bowers, published his ideas and the system of reflex zone therapy was established. It spread among doctors and others in the US, notably a Dr Eiley who created a high/ successful practice and expanded on the theories behind reflexology and now a day very effectively they are practiced to improve the quality of life. There is a drastic change in life style of the surrounding society the researcher is observing and as fad of fast food, stressful environment, many workaholic people go home just to take bath and change cloth is commonly seen picture.3 In nuclear family the simple tough of sympathy is also become very rare fact. Foot reflexology is a healing touch therapy. Many researches have proven that in stress, tension and disease a touch of near and dear one and confidence give relief and fasten the healing. Hence, the investigator got interested in finding out the effectiveness of foot reflexology on the hypertension in hypertensive patient.

6.2 REVIEW OF LITERATUR: A review of related literature gives an insight into the various aspects of the problems under study. The review serves as an integrated function that facilitates the accumulation of knowledge. Hence, review of literature is important to a research in order to know what has been established and documented. (Polit & Hungler, 1991) The reviewed literature for the present study is 1. A study in the nursing journal of India, says that hypertension is the single most important predictor of cardiovascular risk. Increased blood pressure level is related to increased severity of atherosclerosis, stroke, nephropathy, peripheral vascular disease, aortic aneurysm and congestive heart failure. The fifth report of Joint National Committee on Detection, Evaluation and Treatment of hypertension notes the remarkable changes in the control of hypertension since the mid 1970's Members of the public are more Knowledgeable about high blood pressure, more likely to visit a healthcare provides for hypertension and more likely to follow medical advice.4 2. African Americans have a greater severity and higher prevalence of hypertension than other minorities and Whites. In addition, the rate of control and treatment of hypertension in the United States is actually worsening. Twenty-six African Americans with a mean age of 59 years were randomly assignee to one of the three groups and monitored for 3 months. Both the HT and the CMB group had clinically and statistically significant drops in systolic and diastolic blood pressure over the 3-month period.5

3. Studies show higher morbidity and mortality from cardiovascular events in hypertensive patients. mentions that the decrease in BP to 120/80mmHg reduces the incidence of heart failure by up stroke by between 35% and 40%, and of coronary artery disease by between 20% and 25%, with the overall mortality. Starting from 115/75mmHg, every 20mmHg increase in the systolic pressure. 1OmmHg increase in the diastolic pressure doubles the risk of cardiovascular events.6 4. A study has been done to determine the effect of 10 min. foot massage on two phases of postoperative coronary artery bypass graft (CABG) patients from the findings it is concluded that there is a significant reduction of heart rate, respiratory rate and the blood pressure measurements between the pre and post treatment at 0.001 level this shows that there is gradual reduction in the vital parameters after foot massage.7 5. A study in the nursing journal of India says about Reflexology that it is a field of therapy where a practitioner applies pressure to certain parts of the feet to relive stress in other parts of the body. It attempts to create a balance in the body, which will help reduce stress and enhance natural healing. Nurses can practice this therapy in reducing the discomfort of patients.8 6. A case of menstrual disorder has successfully treated with the foot reflexology treatment at the onset of treatment patient was having strong pain in the lower abdomen that appear one day prior to the onset of menstruation and continue until the end of the cycle, Different treatments tried included psychotherapy and psychiatric
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medications neither had any effect on the condition. Foot reflexology treatment over a period of half a year was comprised of 50 continuous treatments. The patient reported that there was a positive change in her sexual functioning, and felt better emotionally.9 7. Reflexology is a technique of treating conditions via stimulating some areas on a human body, called reflex zones. A reflex zone is associated with an organ, gland or body part. When a reflex zone is stimulated, its corresponding organ, gland or body part can be stimulated thus be treated. A reflexologys can, through knowledge of the body map on the feet, perform a manipulation on feet to stimulate internal organs, muscles and glands. Disorders of an organ can be restored by stimulating its related reflex zones. According to the research and practice of reflexologists, many conditions can be treated by reflexology.10 8. Good health for the future Reflex-zones are nerve-points, each of which is in communication with other, distant parts of the body. They are found throughout the body. Most of the reflex-zones are found in the feet. The area our feet have to work on is now no longer rough and uneven, but has become smooth, rolled flat, and asphalted over. Reflexology is a scientific technique of massage, which has a definite effect on the normal functioning of all parts of the body.11 9. Reflexology is based on the principle that the hands and feets are mirrors of the body and that they have reflex points that correspond to each of the body's glands, structures, and organs When a reflex area is massaged, it stimulates the corresponding organs in that zone. The actual massage technique varies impending on the purpose of the treatment.5
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10.Hand and foot reflexologies a self-help guide write about reflexology that it should not only be a treatment of symptoms but also eliminate the disturbances at their roots. So we should always be interested in the original cause. And it's been shown that, in the human body, never just one organ is weak. Since all organs are dependent upon each other, a disturbance in one will cause one in another, further away.12 11.Good health for the future, (1996) writes about her three case studies done on the hypertensive patients Mrs. L had heard that high blood-pressure could be changed by reflex-zone massage. she massaged the reflex-zones of the kidneys, ureters and bladder daily for an hour. After 5 days, all of a sudden, she didn't feel well at all, and as she still didn't feel any better on the 6th day, she went to see her doctor. He immediately checked her blood-pressure: 100/60. Low But at her last check-up it had still been up at 200/95. Mrs. S had been taking tablets for high blood-pressure for over 10 years, stabilizing it at 220/120. Through treatment of the reflexzones, she took it down within a year to 140/80 without tablets. A female 42 years having hypertension for 8 years started with third pregnancy, and since that time has remained high 190/110. There is no clear physiological cause for the condition. With reflexology immediately following the first treatment, dizziness and weakness; blood pressure was measured and registered 90/60. Immediately after the 2nd treatment, which was devoted mostly to relaxation, blood pressure fell to 110/70.11

6.3 STATEMENT OF THE PROBLEM A study to assess the effectiveness of foot reflexology on hypertensive patients in District Hospital at Tumkur city. 6.4 OBJECTIVES OF THE STUDY 1. To assess the blood pressure among the hypertensive patient before administration of foot reflexology. 2. To assess the blood pressure among the hypertensive patient after administration of foot reflexology. 3. To compare the blood pressure among the hypertensive patient before and after foot reflexology. 4. To find the association between the selected demographical variables and findings of the study. 6.5 OPERATIONAL DEFINITION ASSESS: According to oxford dictionary assess means appraisal or evaluation. In this study assess means appraisal of the effect of foot reflexology on the hypertension.

FOOT REFLEXOLOGY: reflexology is a technique of diagnosis and treatment; feet are massaged to improve the functioning of the internal organs. In this study as per the protocol foot reflexology treatment is given morning and evening continues for seven days.
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 HYPERTENSIVE PATIENT: According to oxford dictionary abnormal high blood pressure is called as hypertension. In this study persistently high blood pressure in adults, when the resting supine arterial systolic pressure is equal or greater than 140 mmHg and the diastolic blood pressure is equal or greater than 100 mmHg. EFFECTIVENESS: According to the Cambridge learners

dictionary, (2003) effectiveness refers to achieving the result that you want. In this study effectiveness means the foot reflexology treatment effect on the hypertensive patients blood pressure. 6.6 ASSUMPTIONS The study is based on the following assumptions. The Foot reflexology may prove in reducing blood pressure level of hypertensive patients. 6.7 HYPOTHESIS The level of significance chosen for the entire hypothesis was 0.01 level of significance. Ho: There is no significant effect of Foot reflexology on the blood pressure of hypertensive patient. H1: There is significant effect of Foot reflexology on the blood pressure of hypertensive patient.

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7. MATERIALS AND METHODS OF THE STUDY: 7.1 SOURCES OF DATA: The data will be collected from Hypertensive Patients who are willing to participate in the study. 7.1.1 RESEARCH DESIGN: Quasi experimental. One group pre test and post test design 7.1.2 STUDY SETTING: The study will be conducted in In-patient department of district hospital at Tumkur city. 7.1.3 POPULATION: The target Population of the study will be hypertensive male and female patients of the In-patient department of the District Hospital at Tumkur city. 7.2 METHODS OF DATA COLLECTION The data collection procedure will be carried out for a period of 6-8 weeks. The study will be conducted after obtaining permission from concern associates. At first a good rapport will be established with the 30 samples and the purpose of study will be explained to them to get the co-operation in the procedure of data collection.

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7.2.1 SAMPLING TECHNIQHE: Simple random sampling. 7.2.2 SAMPLE SIZE : The sample size of this study is 30 hypertensive patients of the Inpatient department of the District Hospital at Tumkur city. 7.2.3 INCLUSION CRITERIA: Hypertensive patient above 30 years Hypertensive patients those who are willing to participate in study. Patient with hypertension who has been diagnosed. Hypertensive patient who can understand English, kannada and Hindi. 7.2.4 EXCLUSION CRITERIA Hypertensive patients those who are bedridden and psychologically unstable Severe hypertensive patients those who are hospitalized. Patient who are already on other naturopathy. Hypertensive patients those who have other associated disease like TB, DM, Asthma etc.

7.2.5 DATA COLLECTION TOOL The tool consisted of 2 sections First section consists of demographic data of the samples about information of Age, sex, religion, marital status, educational status,
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occupation etc. Second sections consist of Assessment profile observation check list for blood pressure, pulse, respiration and symptoms of hypertension. 7.2.5 DATA ANALYSIS PLAN: The data analysis plan includes descriptive and inferential analysis. The plan of analysis will be made with the opinion of experts. All the analysis will be presented in the forms of tables, charts, and figures.

7.2.6 TIME AND DURATION: 6-8 weeks 7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVATION TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY. Yes, foot reflexology treatment will be given to the hypertensive patients. The patients will be observed every morning and evening for the Blood Pressure, pulse, respiration, and other hypertensive symptoms before and after the treatment for 7 days and then will be observed for the BP, pulse, respiration, and other hypertensive symptoms on the day of 14th and 21st consistency of the effect. 7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? The pilot study and main study will be conducted after the approval of research committee. Permission will be obtained from the patients. The purpose and details of the study will be explained to the study subjects and an informed consent will be obtained from them. The study subject
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will be assured for the confidentiality of the data collected from them. 8. LIST OF REFERENCES: 1. 2. 3. K. Park Preventive and social medicine, 18th edition,

publisher Jaypee, 2005, p.no.293-297. Mark evens - Natural therapies what they are what they do, publisher anness publishing pvt. Ltd. 2001, p.no.80-83. Mcglone, foot notes a step by stape guide to the practice of foot reflexology, 2st edition, P.B. Addison Vesley publisher, 2005, p. no.25 27. 4. Shakuntala koul, The Nursing Journal of India, publisher TNAI, , march, 2007, P. no. 10-12. 5. Barbara Koziar et. al -Fundamental of nursing, 7th edition, New Delhi: Dorling publisher, 2006, p. no. 266 - 270. 6. Leddy Susan, et. al. - conceptual basis of professional nursing, 4th edition, Washington, lippincode Publisher, 2003, p. no. 142 145. 7. Deepa Chugh, January, a study to determine the effect of 10 min. foot reflexology on 2 phases of postoperative coronary artery bypass graft (CABG)patients of selected variables, Asian Journal of Cardiovascular Nursing, vol. 14th, no. 1, 2006, p. no. 24 28. 8. Regina Xavier, January, facts on foot reflexology, Nursing journal of India, vol. 1, 2007, p. no. 11 12. 9. Dewit C. Susan, Essentials of Medical surgical Nursing, 3 rd edition, W.B.savnders company London, 1992, p. no. 174 176. 10.Gala, () Be your own doctor with foot reflexology, 1 st edition, Mumbai, Navneet publication, 1995, p. no. 85 87. 11.Hedi Masafret, Good health for the future, 1st edition, Vaduz, Trema publisher, 1986, p. no. 26 28.

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12.Kevin and Barbara Kunz, - Hand and foot reflexology, A self help Guide, 1st edition, New York, prentice holl publisher, 1982, p. no. 110 210.

Signature of Candidate

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Remarks of Guide Name and Designation of (in block letters) 11. 1 11. 2 11. 3 11. 4 11. 5 11. 6 12. 1 12. 2

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Remarks of the Principal

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