Professional Documents
Culture Documents
Foot Massage Dissertation
Foot Massage Dissertation
2
= 3.84, P<0.05 NS = Not significant
Table 8 shows that there was no association between pre-foot massage pain
score, age (
2
= 0.109, P = 0.0742), and type of surgery (
2
= 0.670,
P = 0.336) at 0.05 level of significance. There fore null hypothesis was accepted and
the research hypothesis rejected.
55
Summary
This chapter dealt with the results of the data collected from 30 subjects
(postoperative abdominal surgery patients in a selected hospital in Mangalore).
Descriptive and inferential statistics were used to analyse the data based on the
objectives and hypotheses of the study. The findings revealed that foot massage had
impact on the level of pain, heart rate and blood pressure among postoperative
abdominal surgery patients.
DISCUSSION
56
6.DISCUSSION
Thischapterpresentsthemajorfindingsofthestudyanddiscussesthemwith
referencetotheobjectivesandhypothesesstatedandinrelationtothefindingsofsi
milarstudies.
M ajorfindingofthestudy
SectionIsam plecharacteristics
Fortythreepercentofthesubjectbelongedtotheagegroupof21-31
yrs.Findingsregardingagewasconsistentwiththeexperimentalstudytoseethesh
orttermeffectsofmyofacialtriggerpointmassagetherapy(aged32.41.55yrs)
31
an
dthefindingswereinconsistentwithothersimilarstudies.Acomparativestudycon
ductedinOsakatofindouteffectoffootmassageonrelaxation(meanage72,SD2.
2)
32
andexperimentalstudyconductedinJapantofindouttheeffectsofbiofeedback
usingfootmassage(agerange61-69yrs).
Fortypercentofthesubjectshadsecondaryeducationand60% were
unemployed.53% ofthesubjectshadcaesareansectionand37% hadhysterectomy.
Twointerventionalstudiesoffootreflexologytotestthewellbeing,voiding,bowel
movements,painandsleepinwomenunderwentabdominaloperationssupportedsi
milarfindings
38,39
56.7% subjectshadnopreviousexperienceofsurgery.M ajorityo
57
fthesubjects(63.3% )hadnoexperienceinnonpharmacologicalpainreliefmethods
SectionIIAssessm entoflevelofpainheartrateandbloodpressureofpostoper
ativeabdom inalsurgerypatientsbeforeim plem entationoffootm assage.
Thefindingsofthestudyshowedthatthemeanpretestpainlevel(X=10.67,
7.47)higherthanthemeanposttestpainlevelandthemeanpretestSBP(X=125)
washigherthanmeanposttestSBP.Themeanpre-testDBP
(X=82.80)washigherthanthemeanpost-testDBP.Thefindingswereconsistentw
iththatofothersimilarstudies.Anexperimentalstudyconductedin
Japantoinvestigatetheeffectofbiofeedbackusingfootmassageshowedtheaverag
ePR,respiratoryrateandBPwerehigherbeforefootmassage
(p<0.01)
33
.Aquasiexperimentalstudyconductedtofindouttheimmediate
effectofa5minutefootmassageonpatientsincriticalcareshowedhigherlevelsof
HR,BPandrespiratoryrate(p<0.01,p=0.02,p<0.038)respectively
34
.Twointervent
ionalstudiesonfootreflexologyinTaiwanintwodifferentsettingsalsosupportedt
hesamefindings
38,39
.
58
SectionIIIAssessm entofpainlevel,heartrateandbloodpressureaftertheim
plem entationoffootm assage.
Themeanpainlevelimmediatelyafter(x=85.70)and10minute
safter(x=4.77,4.53)footmassagewaslowerthanthemeanpre-testresults.Theme
anpost-test(footmassage)heartrates(76.47,75.40),SBP(120.53,116.27)andDB
P(79.13,76.07)immediatelyandtenminutesafter.Thefindingswereconsistentwit
hthefindingsofothersimilarstudies
31-37
.
SectionIVSignificanceofdifferencebetweenthem eanpre-testandpost-testpa
inlevel,H eartrateandBloodpressuream ongpostoperativeabdom inalsurge
rypatients.
Thefindingsofthestudydemonstratedsignificantdecreaseinp
osttestpainlevel[t
29
=12.041(O
1
-O
2
),t
29
=22.710(O
1
-O
3
),t
29
=12.590(O
2
-O
3
),p<0.0
5]fortheobjectiveassessment,and(t
29
=17.026,t
29
=23.230,t
29
=9.860)respectivelyf
ornumericalpainscale.Significantreductioninpost-testheartrate[t
29
=6.630(O
1
-O
2
),t
29
=7.577(O
1
-O
3
),t
29
=2.442(O
2
-O
3
)],SBP[t
29
=11.403(O
1
-O
2
),t
29
=18.793(O
1
-O
3
),t
2
9
=9.133(O
2
-O
3
)]andDBP[t
29
=9.845(O
1
-O
2
),t
29
=11.469(O
1
-O
3
),t
29
=7.388(O
2
-O
3
)].Fi
ndingsweresupportedbyothersimilarstudies.AcomparativestudyconductedinO
sakaJapantofindouttheeffectoffootmassageonrelaxationshowedsignificantre
ductioninHR(p=0.01)
32
.AnexperimentalstudyconductedinJapantoinvestigatet
59
heeffectofbiofeedbackusingfootmassageshowedtheaveragePR,respiratoryrate
,Bpwerelesser(p<0.01)afterfootmassage
33
.AstudyconductedinJapantofindou
ttheimmediateeffectofafiveminutefootmassageonpatientsoncriticalcaresho
wedsignificantdecreaseinHR(p<0.01),BP(p=0.02)andrespiration(p<0.038)
34
.An
on-equivalentpre-testpost-testcontrolgroupstudyconductedinKoreatoinvestigat
etheeffectsoffootmassageonpaininpostabdominaloperativepatientsshowedsi
gnificantreductioninpainfollowingfootmassage(t=-3.37,p=0.002),decreaseinPR
(F=7.73,p=0008)anddecreasedSBP(F=25.75,p=0.002)
35
.Aquasi-experimentalst
udyconductedincardiothoracichospital,Kolkatatodeterminetheeffectof10min
utefootmassageonCABGpatientspain,BP,PRandrespirationshowedsignifican
treduction(p<0.001)
36
.ArandomizedcontrolstudyconductedinEnglandtoexamin
etheeffectoffootmassageonpatientsperceptionofcarereceivedfollowinglaprosc
opicsterilizationshowedsignificantreductioninpain(p<0.001)
37
.SectionVAssociationbetweenprefootm assagepainscoreandthesele
ctedvariablessuchasage,andtypeofsurgery.
Findingsofthestudyshowednoassociationbetweenprefootmassagepa
inscore,age(
2
=0.109,p=0.0742)andtypeofsurgery(
2
=0.670,p=0.336)at0.05l
evelofsignificance.
60
Sum m ary
Thefindingsofthepresentstudywereanalysedanddiscussedwiththefindi
ngsofsimilarstudiesconductedinthepast.Thishelpedtheinvestigatortoprovetha
tthefindingsaretrueandfootmassagewaseffectiveinreducingpaininpatientswit
habdominalsurgery.
CONCLUSION
61
7. CONCLUSION
The chapter presents the conclusions drawn based on the present study. This
study attempted to find out the impact of foot massage on the level pain, heart rate,
and blood pressure of postoperative patients with abdominal surgery.
The pre-foot massage pain level was significantly higher than the post-foot
massage pain level.
The highest significance of difference in pain level was found between pre-
foot massage and 10 minutes after foot massage.
There was significant difference between pre-foot massage heart rate and
post-foot massage heart rate.
There was significant difference between pre-foot massage blood pressure
and post-foot massage blood pressure.
There was no significant association between pre-foot massage pain score,
age, and type of surgery.
62
Nursing Implications
The findings of this study have brought out certain facts that have far-
reaching implication for nursing in the area of practice, education, administration
and research.
Nursing Practice
Today, more than ever, healthcare reform calls nursing to provide cost
effective care. Concern about possible side effects of drug treatment and heavy
expenses on medical care are the reasons why people seek complimentary and
alternative medicine, because the dimensions of pain involve physical,
psychological, social and spiritual health. There will be a potential reduction in the
quality of life. Pain related anxiety, and sleeplessness release stress hormones, which
have deleterious effects upon post-surgical outcome.
Using the current research findings nurses can use foot massage as an
effective intervention in their practice. Foot massage is cost effective, easy to learn,
and has no adverse effects. It does not require additional equipment, extra
preparation, or expenditure. Foot massage as a means of touch can be used by the
nurses to communicate care and concern for the patients.
The findings of this study can be incorporated in the training of other
healthcare personnel and family members in providing healthcare.
Nursing Education
Alternative and complementary therapies are increasing in popularity
(British Medical Association, 1993). Nurses seem to be equipped to act as advocates
63
with regard to pain management in order to assess and alleviate pain of the patients.
The use of non-pharmacological measures like foot massage can be easily
incorporated in nursing education along with other complementary therapies. To
equip nurses to provide holistic care the nursing curriculum needs to cover non-
pharmacological measures such as foot massage for pain management. Nurse
educators need to highlight the non-pharmacological pain relief measures like foot
massage in the curriculum of basic nursing education as part of pain assessment and
management. Ongoing education can be planned for graduate students. Students can
be given a project work to experiment the need for foot massage in pain
management. Foot message as a non-pharmacological pain management method can
be highlighted as a part of in-service education programme. Family members should
also be educated on foot massage techniques which will enable them to help and
care for the individual who is in pain and thereby making these measures beneficial
to common people.
Nursing Administration
Today, there is an increasing need for quality and holistic care. The findings
of this study could be made use of by nursing and non-nursing personnel. Nursing
administrators are in the key position to formulate policies and the execution of
quality nursing based on research findings with necessary changes in nursing
education and practice. They should develop nursing practice standards, protocols,
and manuals for pain assessment and management. Awareness programmes could be
organised and information could be disseminated through media, like newspapers,
magazines, television and internet. In-service education for the staff nurses could be
64
provided with special emphasis on the use of foot massage to relieve pain in
postoperative patients.
Nursing Research
A profession seeking to improve the practice of its members and to enhance
its professional stature strives for the continuous development of a relevant body of
knowledge. It is apparent that there are significant gaps in research with regard to
foot massage and pain management. It is also observed that the published research
studies and trials on foot massage in the Indian setting are very limited.
Nurse researchers should be aware of the new trends in the existing
healthcare system. Emphasis should be laid on research in the area of non-
pharmacological measures of pain management in postoperative patients. The
findings of the research need to be disseminated through publications so that the
utilization of such research findings is encouraged.
Limitation
Since the study was confined to the postoperative patients with abdominal
surgery in the OBG unit of one hospital, generalisation of the study is limited.
Intervention was limited only for 10 minutes.
65
Recommendations
1. The study can be replicated on a larger sample with general surgery to have
generalisation.
2. A similar study can be replicated on a larger sample having a control group.
3. The study could be undertaken during chronic painful experience like cancer
pain.
4. Study could be conducted with a control group to assess the effect of other
complimentary therapies such as acupressure, progressive muscle relaxation,
and guided imagery.
5. A comparative study can be conducted with more than one intervention.
Suggestions
1. Complementary therapy cell could be arranged in the institution and
multidisciplinary team could be introduced.
2. Pain assessment and management should be given emphasis in postoperative
nursing care practices
3. Non-pharmacological methods of pain management should be emphasised in
nursing curriculum.
4. Nurses can be given training programmes on non-pharmacological pain
management.
66
5. Findings of this study can be utilised to educate family members and non-
nursing personnel to provide quality services in hospitals.
Summary
On the whole, conducting this study was a learning experience for the
investigator. The result of this study shows that foot massage is an effective non-
pharmacologic measure in reducing postoperative pain. Foot massage is an effective,
simple, non-invasive, cost-effective method that can be used easily without any side
effects or extra efforts from the part of practitioners.
SUMMARY
67
8. SUMMARY
Pain is an expected outcome postoperatively. The inadequacy of
postoperative pain management was shown in many studies and the pain is often
underestimated and untreated. Routinely postoperative pain is poorly controlled by
pharmacological means alone and the patients report mild to moderate pain even
though pain medications have been administered.
Effective postoperative pain control can be achieved through combination of
both pharmacological and non-pharmacological therapies. Massage is one of the
most widely used complimentary therapies in nursing practice. In spite of all the
advancement in the knowledge and complexes of techniques massage therapy
retains its usefulness and significance even in the steps for saving life from
immediate death as in cardiopulmonary arrest.
Throughout history, caregivers have used massage techniques to soothe a
painful body part. However, scientific evidence for the effectiveness of massage as a
non-pharmacological method of pain relief is recent. Foot massage can certainly
reduce pain because cutaneous stimulation stimulates nerve fibres which encourage
the release of endorphins that have analgesic properties and produces relaxation.
Relaxation may increase pain threshold and modify an individuals pain perception.
Foot massage reduces pain based on Gate Control Theory also.
Foot massage as a non-pharmacological pain relief measure is safe, easy to
administer, cost effective and simple.
68
The objectives of the study
1. To determine the level of pain of postoperative abdominal surgery patients
before implementation of foot massage as measured by a numerical pain
scale and observation checklist.
2. To determine the blood pressure and heart rate of postoperative abdominal
surgery patients before implementation of foot massage as measured by
sphygmomanometer and stethoscope.
3. To find out the impact of foot massage on the level of pain, heart rate and
blood pressure in terms of reduction in pain, change in blood pressure and
heart rate.
Assumptions
1. All postoperative patients will have some amount of pain.
2. Pain is multifactorial.
3. Pain is an individual unique experience.
4. Postoperative pain is poorly controlled by pharmacological means alone.
5. Foot massage is one of the effective non-pharmacological methods of pain
relief.
6. Foot massage is one of the best methods for relaxation.
69
Hypotheses
Hypotheses will be tested at 0.05 level of significance.
H
1
: The post-foot massage pain score will be significantly lower than the pre-
foot massage pain score.
H
2
: There will be a significant difference in the heart rate and blood pressure
measured between pre and post-foot care massage sessions.
H
3
: There will be significant association between pre-foot massage pain score
and selected variables such as age and type of surgery.
The conceptual framework used for the present study was based on Roys
Adaptation Model. The focus of this theory is the adaptation of the individual to
various stimui both from the environment and from within.
The variables of the present study were: independent variable foot
massage, and dependent variable heart rate and blood pressure.
The investigator used an evaluatory research approach to assess the impact of
foot massage on level of pain, heart rate and blood pressure among postoperative
patients with abdominal surgery. The research design selected was pre-experimental
(one group pre-test post-test) design.
The study was conducted at The Father Muller Medical College Hospital,
Mangalore. The population of the study included postoperative patients with
abdominal surgery. Purposive sampling technique was used to select 30 subjects
with pre determined criteria from the population
70
Tools for data collection were:
Tool I: Baseline proforma.
Tool II: Observation checklist to assess pain.
Tool III: Numerical pain scale to assess pain.
Tool IV: Sphygmomanometer and stethoscope to check blood pressure and heart
rate.
The content validity of the tool was established with the help of 11 experts
and reliability was established using inter-rater reliability for observation checklist.
Spearman Rank Correlation was used to test the reliability and the tool was found to
be reliable (r=0.95). Since numerical pain scale, sphygmomanometer and
stethoscope are already standardised tools; reliability test was not established for the
same. A pilot study was conducted to confirm the feasibility for conducting the main
study.
The main study was conducted between August 3, 2007 and August 29,
2007. The data obtained were analysed using both descriptive and inferential
statistics. The level of significance for testing hypotheses was set at 0.05.
The findings of the study showed significant difference in pain between the
pre- and post-foot massage pain score immediately, and after 10 minutes of foot
massage (t
29
= 12.041, t
29
= 22.71, t
29
= 12.59, p<0.05) for the observation checklist,
and (t
29
= 17.02, t
29
= 23.234, t
29
=9.865, p<0.05) for the numerical pain scale.
71
There was significant difference in the heart rate measured between pre- and
post-foot massage immediately and after 10 minutes after massage (t= 6.630,
t
29
= 7.577, t
29
= 2.442, p<0.05).
There was significant difference in the systolic blood pressure measured
between pre- and post-foot massage immediately and 10 minutes after foot massage
(t
29
= 11.403, t
29
= 18.793, t
29
= 9.133, p < 0.05).
Diastolic blood pressure has significant difference between pre-and post-foot
massage sessions immediately and 10 minutes after foot massage (t=9.845,
t
29
= 11.469, t
29
= 7.388, p <0.05).
There was no significant association between pre foot massage pain and
selected variables such as age (
2
= 0.109, p > 0.05) and type of surgery (
2
= 0.670,
p > 0.05).
On the whole, carrying out present study was really an enriching experience
to the investigator. The constant encouragement and guidance by the guide,
cooperation and interest of respondents to participate in the study contributed to the
fruitful completion of the study.
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ANNEXURES
78
Annexure 1
Letter requesting permission to conduct research study
From,
Laly Chacko.
II year M. Sc. Nursing
Father Muller College of Nursing
Kankanady, Mangalore.
To,
The Director
Father Muller College of Nursing and Medical College
Mangalore 575 002.
Respected Reverend Father
I have selected the below mentioned topic for my dissertation to be
submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka,
as a requirement for the award of Masters Degree in Nursing.
Topic: Impact of foot massage on the level of pain, Heart rate and Blood
pressure among patient with abdominal surgery in a selected
hospital at Mangalore
I am interested in conducting this study in your esteemed institution. I assure
that this study will not cause any inconvenience to the normal routine of the wards.
Kindly permit me to conduct the proposed study and do the needful.
Thanking you.
Yours sincerely,
Place: Mangalore
Date:
Laly Chacko.
79
Annexure 2
Letter granting permission to conduct the study
80
Annexure 3
Certificate of attending foot massage training
81
Annexure 4
Letter requesting opinion and suggestion of experts to validate the tool
From,
Laly Chacko
I Year M. Sc. Nursing
Father Muller College of Nursing
Kankanady
Mangalore-575002.
To,
Respected Sir/Madam/Sister,
Subject: Request for expert opinion and suggestions to establish content
validity of the research tool.
I, Laly Chacko, I Year M. Sc. Nursing student at Father Muller College
of Nursing have selected the following topic for my dissertation to be
submitted to Rajiv Gandhi University of Health Sciences in partial fulfilment
for the requirement for award of Master of Science in Nursing.
Topic: Impact of foot massage on the level of pain, heart rate and
blood pressure among patients with abdominal surgery in OBG
unit in a selected hospital at Mangalore.
Herewith I have enclosed
1. Objectives of the study, operational definitions and hypotheses
2. Baseline proforma
3. Blueprint of the observation checklist
4. Observation checklist for pain
5. Criteria checklist
6. Numerical pain scale
7. Vital parameter monitoring chart
I request you to go through the items and give your valuable
suggestions and opinions to develop the content validity of the tool. Kindly
suggest modifications, additions and deletions, if any, in the Remark column.
Thanking you.
Yours sincerely
Place: Mangalore
Date:
Laly Chacko
82
Annexure 5
Acceptance form for tool validation
Name: ________________________________
Designation: ________________________________
Name of the college/ hospital: ________________________________
Statement of acceptance or non acceptance
I give my acceptance/non-acceptance to validate the tool.
Topic: Impact of foot massage on the level of pain, heart rate and
blood pressure among patients with abdominal surgery in OBG
unit in a selected hospital at Mangalore
Place:
Date:
Signature
83
Annexure 6
Content Validation Certificate
I hereby certify that I have validated the tool of Laly Chacko, I Year
M. Sc. Nursing student, Father Muller College of Nursing who is undertaking
the following study:
Impact of foot massage on the level of pain, heart rate and blood
pressure among patients with abdominal surgery in OBG unit in a
selected hospital at Mangalore
Place: Signature of the expert
Date:
Designation and address
84
Annexure 7
Consent form (English)
Dear respondent,
I am a final year M. Sc. Nursing student of Father Muller College of
Nursing. As a partial fulfilment of the course, I am conducting a research
study on the following topic:
Impact of foot massage on the level of pain, heart rate and blood
pressure among patients with abdominal surgery in OBG unit in a
selected hospital at Mangalore
As part of the study, I would like to ask you a few questions. I assure
you that the information obtained from you will be kept strictly confidential
and will be used for the study purpose.
I expect your whole-hearted cooperation and will be grateful to you for
the same.
Yours sincerely,
Signature of the participant Laly Chacko
85
Annexure 8
Consent form of subjects (Kannada)
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86
Annexure 9
Blueprint of the Observation Checklist for the Objective Assessment of
Pain among Postoperative Abdominal Surgery Patients
Sl.
No. Content Items Total Percentage
1. Physical domain 3, 9, 13, 14 4 26.67
2. Psychological
domain
2, 4, 5, 7, 8, 11, 15 7 46.66
3. Physiological
domain
1, 6, 10, 12 4 26.67
Total 15 100.00
Scoring key
Score
Items Yes No
Positive score 1, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13,
14, 15
1 0
Negative score 2, 3 0 1
87
Annexure 10
Tool
Baseline Proforma
Instruction: The investigator places a tick mark () in the space provided
against the relevant answer.
1. Age (in years)
1.1 21 30 [ ]
1.2 31 40 [ ]
1.3 41 50 [ ]
1.4 51 60 [ ]
1.5 > 60 [ ]
2. Educational qualification
2.1 Illiterate [ ]
2.2 Primary education [ ]
2.3 Secondary education [ ]
2.4 Graduate [ ]
2.5 Postgraduate [ ]
2.6 Professional [ ]
3. Occupation
3.1 Unemployed [ ]
3.2 Employed [ ]
3.3 Professional [ ]
3.4 Self-employed [ ]
4. Surgical procedure done
4.1 Laparotomy [ ]
4.2 Hysterectomy [ ]
4.3 Caesarean section [ ]
4.4 Any other [ ]
5. Have you undergone any surgery in the past?
5.1 Yes [ ]
5.2 No [ ]
88
6. Have you received any type of analgesia or anaesthesia in the past?
6.1 Yes [ ]
6.2 No [ ]
7. Have you had any pain relief method other than medications for pain in
the past?
7.1 Yes [ ]
7.2 No [ ]
8. If yes, type of therapy
8.1 Acupuncture [ ]
8.2 Traditional massage [ ]
8.3 Aroma therapy [ ]
8.4 Acupressure [ ]
8.5 Yoga [ ]
8.6 Music therapy [ ]
89
Numerical Rating Scale for Pain
Instruction
Please place a tick mark according to the level of your pain on the
scale given below.
XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX
0 1 2 3 4 5 6 7 8 9 10
0 No pain
1 3 Mild pain
4 6 Moderate pain
7 9 Severe pain
10 Worst pain possible
90
Chart to Monitor Vital Parameters
Blood pressure Pulse
No.
Before foot
massage
Immediately
after foot
massage
10 minutes
after foot
massage
Before foot
massage
Immediately
after foot
massage
10 minutes
after foot
massage
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
91
Observation Checklist for Objective Assessment of Pain among
Postoperative Abdominal Surgery Patients
The investigator observes the behaviour responses of the client and
places a tick mark () in the appropriate column.
Sl.
No. Behaviour response Yes No
1. Remains restless in bed
2. Sleeps
3. Awake and relaxed
4. Expresses pain verbally
5. Holds breath/shallow breath
6. Groans with pain
7. Guards operated site
8. Holds cough
9. Shows painful facial expression
10. Unwilling to change position
11. Frowns
12. Clenches the fist
13. Expresses irritation and intolerance
14. Sheds tears
15. Asks for analgesics
Maximum score = 15; Minimum score = 0
Grading
Score Level of pain
0 3 Mild
4 7 Moderate
8 11 Severe
12 15 Unbearable
92
Annexure 11
Criteria Checklist for Validation of the Tools
Instructions: Please review the items in the tool and give your suggestions
regarding accuracy, relevance and appropriateness of the content. Kindly
place a tick mark () in the appropriate column. If there are any suggestions
or comments please mention in the Remarks column.
Q. No. Agree Disagree Remarks
Baseline Proforma
1.
2.
3.
4.
5.
6.
7.
8.
Observation Checklist for Objective Assessment of Pain among Postoperative
Abdominal Surgery Patients
1.
2.
3.
4.
5.
93
Q. No. Agree Disagree Remarks
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
94
Annexure 12
List of validators
1. Mrs. Ratna Prakash
Principal
Manipal College of Nursing
2. Rev. Sr. Rubeena, SD
Principal
Samaritan College of Nursing
Aluva, Ernakulam
3. Mrs. Elsa Sanatombi Devi
Associate Professor
Manipal College of Nursing
4. Sr. Lucy Rodrigues
Principal
St. Anns College of Nursing
5. Sr. Ann Rose DAlmeida
Principal
Athena College of Nursing
6. Mrs. Asha DSa
Lecturer
St. Anns College of Nursing
7. Mrs. Larissa Martha Sams
Principal
Laxmi College of Nursing
8. Mrs. Diana Lobo
Lecturer
Laxmi College of Nursing
9. Mrs. B. V. Kathyayani
Principal
M. V. Shetty IHS
10. Mrs. Molly Pinto
Assistant Professor
Nitte Usha Institute of Nursing
Sciences
11. Mr. Kanagaraj
HOD, Dept. of Physiotherapy
Father Muller Medical College
Hospital
95
Annexure 13
Photographs
Preparation of patient
Observational assessment of pain
96
Patient recording pain level on a numerical pain scale
Foot massage Step 1 Low stroke friction movement
97
Foot massage Step 2 Effleurage
Foot massage Step 3 Low stroke manipulation below the toes
98
Foot massage Step 4 Thumb rotation
99
Annexure 14
Statistical formulae used in the analysis of data
1. Spearman Rank Correlation Coefficient
=
) 1 (
6
1
2
2
n n
d
2. Chi square with Yates correction
2
=
) )( )( )( (
)
2
| (|
2
d b c a d c b a
N
bc ab N
+ + + +
3. Paired t test
t=
n
d
d
2
n
d
d
=
n
d d
d
=
2
) (
4. Standard deviation
SD =
n
x x
2
) (
100