JOURNAL READINGEFFECT OF FOOT REFLEX MASSAGE ON STERNOTOMY PAIN AFTER CORONARY ARTERY BYPASS GRAFT SURGERY

Disusun untuk memenuhi tugas Profesi Ners Keperawatan Gawat Darurat Pembimbing Akademik : Ns. Ahmad Pujianto., S.Kep.,M.Kep.Pembimbing Klinik : Suryani, S.Kep.,Ns.

Disusun oleh:Gigih Sanjaya Putra22020114210033

PROGRAM PROFESI NERS ANGKATAN XXIVJURUSAN KEPERAWATAN FAKULTAS KEDOKTERANUNIVERSITAS DIPONEGORO2015

JOURNAL READING

Tanggal : 19 April 2015Nama Mahasiswa : Gigih Sanjaya PutraMetodologi PenelitianLokasi Penelitian : Tehran, IranKarakteristik Responden : a. Age less than 70 yearsb. History of diabetes less than 15 yearsc. Non-addictiond. Connection time to pump less than 4 hourse. Healthy feetf. Full consciousness and absence of mental problemsg. Passing 48 hours from surgery without receiving any narcotic medication Jumlah responden : 90 respondenTeknik Sampling : Purposive Sampling an random samplingVariable yang diukur/diteliti : Variabel bebas :foot reflexology. Variabel terikat : pain after sternotomy Prosedur penelitian : 1. Acquiring the research morality committees agreement2. The researcher acquired the informed satisfaction of patients 3. Registering demographic information of patients in the questionnaire through interviewMetode Pengumpulan Data : 1. This research is a quasi experimental study2. McGill visual pain scale was used for measurement of pain intensity3. Data were divided into three test, control and placebo groups by purposive sampling method and with random sampling.4. Quantitative variables were studied by Smirnov Kolmogorov5. Data were analyzed with parametric tests who used SPSS 15 software.Reliabilitas dan Validitas instrumen yang digunakan : -Uji statistik yang digunakan : Chi square test, ANOVA statistical, Paired t-test

Informasi CitasiPengarang : Sadegih Shermeh, Bozorgzad, P., Ghafourian, A, R., Ebadi, A. Razmjoei, N., Afzali, M., Azizi, A.Tahun : 2009Judul artikel : Effect Of Foot Reflex Massage On Sternotomy Pain After Coronary Artery Bypass Graft SurgeryPenerbit/Nama Jurnal : Iranian Journal of Critical Care NursingVolume : 2Issue/No : 2Halaman : 51-54

Latar BelakangReflex massage is used as a useful treatment method in China, Egypt and India for the hundreds of years. Dr Fitz Jerald introduced some parts of body such as ear, nose and throat as treatment points for the first time in early 1900 in south of America. According to this, the energy is following through vertical pathways all over the body from foot to head. So, pressure on a reflex point can effect on the whole body such as glands, bones and muscles. This idea was completed with a physiologist`s view called Eunice Ingham who presented the sensitive points map of the body. After centuries, there is not still a certain agreement among reflexologists about the effect mechanism of this method. One of the proposed theories is that there are canals in the body, which the life power or the vital energy follows through themfrom feet to whole organs of the body and any barrier in this flow would finally cause disease. In recent years, use of treatment methods of the alternative medicine such as massage is increased in medical units. The soft tissue touching used in the treatment massage, would cause pain decrease and ease increase in patients and would consequently increase patients adjustment power against occurred conditions. Nowadays, the relationship between heart disease and mental situation is proved. Because of this, use of the alternative medicine for these people causes health promotion and comfort increase that is very effective on treatment procedure. Coronary diseases are the most common heart disease which in spite of recent effective medical methods of treatment, many patients may require vessel graft. Coronary artery bypass graft (CABG) is an effective method for decrease or removal of cardiac angina. Chest pain in sternum is one of the most common complications after CABG. The pain after sternotomy is probably because of the nervous fibers cut in scar and is described as a vague pain around surgery area and in the cut area. Pain can last for 3 months as a chronic pain that starts in first hours after surgery and would get better usually with narcotic medications until 48 hours after the surgery. The pain causes activation ofthe nervous system and then the cardiovascular system and the created cycle would increase cardiovascular performance. The heart rate and the blood pressure increase, increases myocardium demand for oxygen and this would hinder the recovery procedure after surgery. The pain also affects the activity rate of patients and increases the surgery complications.Because of this, the effective pain control would lead to decrease of cardio-pulmonary complications after open-heart surgery. Massage is one of the oldtechniques used in pain treatment and has been considered in recent studies very much. Anderson studied massage effect on shoulder and neck pain in patients after CABG in year 2007. Findings of this study demonstrated the massage positive effect on pain relief of patients. Gunnarsdottir has recommended foot massage on pain relief of CABG patients. Reflex massage is a simple and none invasive method that can be taken into account as a part of nursing care in intensive units. Because of this, an interventional study was performed with the goal of evaluating the effect of foot reflex massage on chest pain decrease in CABG patients after surgery.Hasil Penelitian/StudiQuantitative variables were studied by Smirnov- Kolmogorov test and the results showed normal distribution with p>0/05. Then, the data were analyzedwith parametric tests. The obtained results are: 7 questions were about the demographic information and all of the 3 groups were compared. The age average and age standard deviation of the studied units in the 3 groups of test, control and placebo were 57/4(7/7), 60/27(8/1) and 56/6(2/6) respectively.The number of men and women were the same in the 3 groups. Most of study units were married and illiterate. Most of the men were retired and most of the women were housekeepers and they were undergoing open-heart surgery for the first time.The pump time average (minutes) was 66/95(30/3) in test group, 78/7(43/20) in control group and 86/3(40) in placebo group. The data analysis with Chi square test, one-direct variance analysis and repeated measures variance analysis demonstrated that there is no significant difference in demographic characteristic of the three groups (p>0/05).With regard to the research goals, the pain intensity average was 4/6(1/2) in test group, 5/1(1/7) in control group and 5/6(1/9) in placebo group.ANOVA statistical test showed no difference between 3 groups about the pain intensity before the intervention (p>0/05). The pain intensity in the 3 groups were 3/34(1/5), 5(1/9) and 5/46(1/9) after intervention, respectively. Paired t-test showed significant statistical difference between the average scores in test group before and after the intervention; but there was no significant difference in other groups. Statistical studies showed that the foot reflex massage had no significant effect on vital signs of the patients and the findings did not have significant difference in the three groups (p>0.05). According to the findings of repeated measures variance analysis test, the painvariation process had no significant difference in the test group and the placebo group (p>0.05).

Tujuan Penelitian/StudiThis study was performed to investigate the effect of foot reflex massage on sternotomy pain of patients after coronary artery by pass graft surgeryImplikasi Hasil PenelitianThis research is effective on patients sternotomy pain after CABG surgery. Beside that, this method is so simple and cheap. So, it can be used as suitable supplement for medical therapies and analgesics in future.

Pertanyaan PenelitianHow does the effect of foot reflex massage on sternotomy pain of patients after coronary artery by pass graft surgery ? Kekuatan Penelitian/StudiFoot reflex is effective to decrease pain scale after CABG surgery. Babajani, et.all, studied the effect of foot reflexology massage on the level pain during chest tube removal after open heart surgery. They states the foot massages has no significant effect to increase of the level pain during chest tube removal after open heart surgery. Grealish et.al studied the use of foot massage as a nursing intervention in patients admitted with cancer. The results showed that the reflexology has a significant and immediate effect on the pain, nausea, and relaxation, when it was measured with a visual analog scale. Stephenson et.al studied the effectiveness of foot reflexology on pain and anxiety in patients admitted with breast and lung cancer. The results showed the foot reflexology intervention in patients with breast and lung cancer experienced has a significant reduction in anxiety and pain.

Desain Penelitian/StudiQuasi experimental studyKeterbatasan Penelitian/Studi-

KESIMPULAN1. There is no difference between 3 groups about the pain intensity before the intervention (p>0/05), measurement by ANOVA statistical.2. Paired t-test showed significant statistical difference between the average scores in test group before and after the intervention; but there was no significant difference in other groups.3. Statistical studies showed that the foot reflex massage had no significant effect on vital signs of the patients and the findings did not have significant difference in the three groups (p>0.05). 4. According to the findings of repeated measures variance analysis test, the pain variation process had no significant difference in the test group and the placebo group (p>0.05).

DAFTAR PUSTAKA

1. Babajani, S., Babatabar, H, D., Ebadi, A., Mahmoudi, H., Nasiri, E. (2014). The Effect of Foot Reflexology Massage on The Level of Pain During Chest Tube Removal After Open Heart Surgery. Iran Journal Critical Care Nurse : Iran. 7(1) : 15-22. 2. Grealish L,Lomasney A,Whiteman B. (2000). Foot Massage. A Nursing Intervention To Modify The Distressing Symptoms Of Pain And Nausea InpatientsHospitalized With Cancer. School of Nursing, Division of Science and Design, University of Canberra, Australia. 23(3):237-43, http://www.ncbi.nlm.nih.gov/pubmed/108517753. Stephenson NL,Weinrich SP,Tavakoli AS.(2000). The Effects Of Foot Reflexology On Anxiety And Pain In Patients With Breast And Lung Cance., School of Nursing, East Carolina University, Greenville, NC, USA. 27(1):67-72. http://www.ncbi.nlm.nih.gov/pubmed/10660924