physiological and psychological responses
DESCRIPTION
Graduate capstone project presenting preliminary data on showering hydrotherapy. Measurement validation and analysis of vital signs in small group of subjects.TRANSCRIPT
Jeanne C. Chilla, BSN, RNCWestern Michigan University
Kalamazoo, Michigan
• Original question:
How do women use showers as a pain management method in labor?
Physiological and Psychological Responses to Therapeutic
Showering
BackgroundBackground
57% Americans shower daily57% Americans shower daily Suggested therapeutic effectsSuggested therapeutic effects
Humidified airHumidified air WarmthWarmth MassageMassage MovementMovement RelaxationRelaxation RevitalizationRevitalization Pain reliefPain relief
Literature ReviewLiterature Review
Intervention strategyIntervention strategy Pain management Pain management
ElderlyElderly Rheumatoid ArthritisRheumatoid Arthritis Childbirth/laborChildbirth/labor
Pre-operative disinfectionPre-operative disinfection
Water quality & Environmental exposureWater quality & Environmental exposure Chemical inhalant—THM, ManganeseChemical inhalant—THM, Manganese PathogensPathogens ScaldingScalding
Literature ReviewLiterature Review
Non-scientific methodsNon-scientific methods
Therapeutic benefits are not reflected in current literature
Japanese studiesJapanese studies Bathing stylesBathing styles Physiological responsesPhysiological responses
PulsePulse BPBP Hct/HgbHct/Hgb
Room temperatureRoom temperature Thermal comfortThermal comfort
Literature ReviewLiterature Review
Hashiguchi, N., Ni, F., & Tochihara, Y. (2002). Kanda, K., Ohnaka, T., Tochihara, Y., Tsukuzi, K., Shodai, Y., & Nakamura, K. (1996).Ohnaka, T., Tochihara, Y., Kubo, M., & Yamaguchi, C. (1995).
Research QuestionsResearch Questions
Are there physiologic changes in normal healthy Are there physiologic changes in normal healthy women of childbearing age after 30 minutes of women of childbearing age after 30 minutes of showering?showering?
Do normal healthy women of childbearing age Do normal healthy women of childbearing age experience psychological changes after 30 minutes experience psychological changes after 30 minutes of showering?of showering?
MethodMethod
DesignDesign Quasi-experimentalQuasi-experimental Repeated measuresRepeated measures
Benfield, Herman, Katz, Wilson, & Davis (2001)Benfield, Herman, Katz, Wilson, & Davis (2001)
SettingSetting
HPER labHPER lab Full bath with single shower stallFull bath with single shower stall Shower seatShower seat Single shower headSingle shower head Subject controlsSubject controls 16 oz water16 oz water
Sample Description Sample Description (N = 10)(N = 10)
DemographicsDemographics Caucasian Caucasian 21-39 years old (21-39 years old (XX = 27.0; = 27.0; SD =SD =7.7)7.7) Single (60%); Married (30%); Divorced (10%)Single (60%); Married (30%); Divorced (10%) Educational levelEducational level
Visual analogue scaleVisual analogue scale Numerical rating scaleNumerical rating scale
Lee Fatigue Scale (VAS-F)Lee Fatigue Scale (VAS-F) Cronbach’s Cronbach’s αα internal reliability VAS-F internal reliability VAS-F
Pretest/posttest subscale Pretest/posttest subscale .96 & .98 fatigue.96 & .98 fatigue
.89 & .92 energy.89 & .92 energy
Gagge Thermal comfort scaleGagge Thermal comfort scale
Measurement ToolsMeasurement Tools
Alpha .05 a prioriAlpha .05 a priori
ProcedureProcedure
HSIRBHSIRB Informed consentInformed consent
Pencil & paper VAS-FPencil & paper VAS-F Numerical rating (0-10) and 100mm VASNumerical rating (0-10) and 100mm VAS
Pain, anxiety, tension, relaxationPain, anxiety, tension, relaxation Gagge Thermal scaleGagge Thermal scale
Pencil and Paper posttests
ProcedureProcedure
Interval measurements (single rater)Interval measurements (single rater) Water & Room temperaturesWater & Room temperatures Core temperatureCore temperature Pulse & BPPulse & BP Lancet hematocritLancet hematocrit Gagge scaleGagge scale
ResultsResultsSPSS 15.0SPSS 15.0
Physiological changesPhysiological changes
↓↓ Mean pulse rate Mean pulse rate ((t t = 3.25= 3.25,df= 8, p = 0.12),df= 8, p = 0.12)
↑↑ Mean HCT Mean HCT ((tt = -2.66, = -2.66, dfdf = 9, = 9, pp = .026) = .026)
↓ ↓ BP (MAP) decreasedBP (MAP) decreased↑ ↑ Core temp. increased slightlyCore temp. increased slightly
ResultsResults
Psychological changes (paired Psychological changes (paired tt-test)-test) Tension per VAS (Tension per VAS (t t = 2.54, = 2.54, df = df = 9, 9, p = .049).p = .049).
No other variables showed statistically No other variables showed statistically significant changes from pretest to posttest significant changes from pretest to posttest
DiscussionDiscussion
Lack of variation Lack of variation Stable hemodynamic and thermodynamic Stable hemodynamic and thermodynamic
statusstatus Subjects at rest vs. ↑activitySubjects at rest vs. ↑activity 30 minutes showering is safe30 minutes showering is safe
Is 30 minutes long enough?Is 30 minutes long enough? Underpowered sampleUnderpowered sample
LimitationsLimitations
Small, homogenous sampleSmall, homogenous sample Data collection errorsData collection errors Palpation & auscultation techniquesPalpation & auscultation techniques Capillary v. serum samplingCapillary v. serum sampling VAS critiqueVAS critique VAS-F instabilityVAS-F instability
RecommendationsRecommendations
Larger sample size with Larger sample size with randomizationrandomization
Different populations with more Different populations with more significant health complaintssignificant health complaints
Observational studiesObservational studies
Easily reproducible procedure and Easily reproducible procedure and methodsmethods
Nursing ImplicatonsNursing Implicatons
Establish therapeutic interventionEstablish therapeutic intervention Coordinate with therapiesCoordinate with therapies Environmental adaptationsEnvironmental adaptations Partnering with patientsPartnering with patients
ConclusionConclusion
Unique research opportunityUnique research opportunity
Opportunity for healingOpportunity for healing Evidence based practiceEvidence based practice Simple, inexpensive, accessibleSimple, inexpensive, accessible
Acknowledgments Acknowledgments
Dr. Mary Ann StarkDr. Mary Ann Stark
Dr. Michael MillerDr. Michael Miller
Elizabeth Brand, SNElizabeth Brand, SN
ReferencesReferences
Benfield, R.D., Herman, J., Katz, V.E., Wilson, S.P., & Davis, J.M. (2001). Benfield, R.D., Herman, J., Katz, V.E., Wilson, S.P., & Davis, J.M. (2001). Hydrotherapy in labor, Hydrotherapy in labor, Research in Nursing & Health, 24, Research in Nursing & Health, 24, 57-67.57-67.
Gagge, A. P., Stolwijk, A. J., & Hardy, J. D. (1967). Comfort and thermal Gagge, A. P., Stolwijk, A. J., & Hardy, J. D. (1967). Comfort and thermal sensations associated with physiological responses and various ambient sensations associated with physiological responses and various ambient temperatures. temperatures. Environmental Research, 1Environmental Research, 1, 1-20. , 1-20.
Gift, A. G. (1989). Visual analogue scales: Measurement of subjective Gift, A. G. (1989). Visual analogue scales: Measurement of subjective phenomena. phenomena. Nursing Research, 38Nursing Research, 38, 5, 286-288. Lee, K. A., Hicks, G., and , 5, 286-288. Lee, K. A., Hicks, G., and Nino-Murcia, G. (1991). Validity and reliability of a scale to assess fatigue. Nino-Murcia, G. (1991). Validity and reliability of a scale to assess fatigue. Psychiatry ResearchPsychiatry Research, 36, 291-298. , 36, 291-298.
Lee, K. A., Hicks, G., and Nino-Murcia, G. (1991). Validity and reliability of a Lee, K. A., Hicks, G., and Nino-Murcia, G. (1991). Validity and reliability of a scale to assess fatigue. scale to assess fatigue. Psychiatry ResearchPsychiatry Research, 36, 291-298. , 36, 291-298.
Complete reference list available by contacting Jeanne C. Chilla, BSN, RNc [email protected]
QuestionsQuestions ?