Articles

Complementary Nursing Care Pursuing Alternatives in the Medical Field By Shirley Vanderbilt
Originally published in Massage & Bodywork magazine, December/January 2003. Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.

Two years ago, researchers Patricia Sohn and Cynthia Loveland Cook surveyed nurse practitioners (NPs) in Missouri and Oregon to assess their knowledge and use of complementary and alternative medicine (CAM). The results of their study, published in a 2002 Journal of Advanced Nursing, revealed that while respondents appeared to embrace CAM on a large scale, a much smaller number actually based that acceptance on formal education. Of 151 NPs completing the survey, 83 percent said they had recommended CAM to their patients, with 50 percent of those referrals being for massage. In contrast, only 24 percent of the study sample noted formal nursing education as the source of their knowledge for recommending CAM. Sixty-seven percent reported personal experience as a primary source of information, with professional journals, seminars and continuing education following behind. Authors stated, "In response to the first two research questions on the level and source of knowledge about CAM therapy, NPs reported minimal knowledge and did not rely on scientific evidence as their primary source of knowledge when incorporating these modalities into practice." As noted by the authors, these findings confirm results of past studies in the nursing field in which CAM referrals were high, but formal knowledge was lacking.
1

Substantial acceptance of CAM treatments by the general public has been documented in several studies conducted by David Eisenberg, M.D., director of the Consortial Center for Chiropractic Research, and colleagues. For example, their 1997 survey showed a 47 percent increase from 1990 in the number of people seeking treatment from CAM practitioners. These results were corroborated with a study researching long-term trends, which indicate that of those reporting CAM use at the beginning of the study, "nearly half continued to use them many years later." The study concludes, "Use of CAM therapies by a large proportion of the study sample is the result of a secular trend that began at least a half century ago. This trend suggests a continuing demand for CAM therapies that will affect health care delivery for the foreseeable future."
2 3

Massage in Hospitals Massage has been the focus of several recent studies conducted in hospital settings. A large teaching hospital in England was the site for investigation of foot massage and guided relaxation to promote psychological well-being in patients recovering from cardiac surgery. The study, published in the Journal of Advanced Nursing (Jan. 2002), sought to establish these modalities as effective, noninvasive techniques easily implemented by nursing staff for post-operative care. The small sample size (n=25)*, short time scale and nonblinding of the evaluator leave questions regarding methodological strength of this trial, but authors noted the results are promising.

Overall, results in experimental groups did not reach statistical significance. However, foot massage produced statistically significant improvement in subjects' calm scores on the VAS, and ratings for other psychological measurements (pain, tension, relaxation and rest) showed a larger improvement than for either the guided relaxation or control groups.7 In another hospital setting in South Korea, researchers tested the power of hand massage to decrease anxiety in patients having cataract surgery under local anesthesia. In addition to assessing anxiety by VAS, the study team also included physiological measurements. The experimental group (n=29) received hand massage five minutes prior to surgery and exhibited significant positive changes in anxiety, blood pressure and pulse rate after massage treatment and before the end of surgery. This group also had significantly decreased norepinephrine and epinephrine levels, while the control group (n=30) showed an increase in these and cortisol levels.
8

A study team from New York Presbyterian Hospital's integrative medicine program investigated the use of a 10-minute massage to decrease anxiety in patients undergoing cardiac catheterization (Alternative Therapies in Health and Medicine, 2002). In the experimental group (n=43), subjects were given an upper-body massage by a licensed massage therapist just prior to the medical procedure. Control subjects (n=35) were instructed to remain quietly at rest for 10 minutes in the presence of the therapist during pre-procedure waiting, in an environment that duplicated that of the massage group. While researchers claimed success in the feasibility of incorporating a brief massage into this pre-procedure time period and its acceptance by patients (the study's primary purpose), outcome measures failed to show any significant statistical difference between the two groups regarding self-reported anxiety and pain, or in clinical measures of vital signs, cortisol levels and medication usage. These negative findings do not necessarily diminish the possibility of success in some future research effort. Massage was of short duration, and external factors -- such as interruptions by medical staff -- may have affected the results. Although the pilot was fraught with limitations, it does open the door for more thoughtfully-executed inquiry.
9

In a somewhat limited trial from North Carolina, nursing researchers used slow stroke back massage on patients undergoing general, orthopedic and stroke rehabilitation. Publishing their results in Rehabilitation Nursing (Sept./Oct. 2001), the team stated the study's positive results have "implications for improving nursing care in a rehabilitation setting." Back rubs, they noted, were once an integral part of nursing care but have been displaced, in part, by time constraints on staff. Limitations in this quasi-experimental design included small sample size (n=24), lack of randomization, lack of gender or race mix, short time scale and use of the experimental group as their own controls. Despite these drawbacks, the positive responses from patients point to the value of inclusion of massage in nursing care. "On all occasions," said the authors, "responses indicated that the intervention left (patients) feeling cared for, happy, physically relaxed, less anxious, closer to the nurse, calm and restful."

Summary: http://www.massagetherapy.com/articles/index.php/article_id/404/ComplementaryNursing-CareThe article talks about how massage can help people to release their stress and anxiety that can lead them to their wellness. Touch is a very important part of human contact. It helps us feel connected and loved by those around us. Massage uses touch through rubbing or kneading of parts of the body to aid circulation, relax the muscles, or provide sensual stimulation. There are a lot of health benefits massage therapy can offer, one of which and the most important is, it can relieve stress. By this, it can encourage the relaxation of the body and improves the circulation of the blood in the body. Studies also show that massage can help people to promote their psychological well-being especially those patients who are recovering from a surgery. In parts of South Korea, this article also shows that massage can help to decrease the anxiety of the patients having cataract surgery under local anesthesia. To sum it all, massage, as simple as it may seem, has contributed a lot in terms of making the patient feel at ease and comfortable. And we all know that being comfortable is a good sign of wellness.

Reaction: Massage is indeed a very special procedure to do for the wellness of the patient. It is being passed on for generations and it seems to give an amazing result year after year. I am glad that I was able to read about this article for me to know the benefits of back massage to the patients. This can help me improve my skills in handling my patient when the time comes when I needed to provide this type of care. Different cases have different type of comfort to be given for the wellness of the patient. In terms of relieving the stress of the patient, massage is one of the best nursing tools we have. It not only helps releasing the stress, it can also help the breathing capacity of the patient. It also helps decrease the depression. These are just few of the benefits of back massage. As a student nurse, I am now armed and equipped to do my duty not only to give what is enough but give what it is best for our patient. I can give proper massaging technique that can help improve his/her condition. This article is helpful to us, student nurses, for us to be oriented on the different simple ways on giving proper care. Indeed, great things come in small packages, even this simple procedure can be a big help in the medical field.