Effect of Foot Bath and Massage on Insomnia in Patients with Liver Cirrhosis and Investigation of Nursing Satisfaction

Clinic of Digestive Internal Medicine, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China

CLINICAL STUDY

Effect of Foot Bath and Massage on Insomnia in Patients with Liver Cirrhosis and Investigation of Nursing Satisfaction

Li Min-fen

Clinic of Digestive Internal Medicine, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China

Author: Li Min-fen, bachelor, nurse in charge.

E-mail: sxykdxyl@163.com

Objective: To observe the effect of foot bath and massage on insomnia in patients with liver cirrhosis.

Methods: By control design of retrospective nonconcurrent cohort study, 100 insomnia patients with liver cirrhosis admitted and treated in our clinic between October 2011 and September 2012, were recruited in the control group and given routine nursing of internal medicine. A total of 105 insomnia patients with liver cirrhosis, admitted and treated between October 2012 and September 2013, were recruited in the intervention group and given foot bath and massage on the basis of routine nursing of internal medicine. After continuous intervention for 14 d, the clinical effects and the nursing satisfaction were evaluated.

Results: There were statistically significant differences in clinical effects and sleeping quality between the two groups (P＜0.05,P＜0.01). The therapeutic effect was better in the intervention group than in the control group, and the nursing satisfaction was remarkably higher in the intervention group than in the control group (P＜0.05).

Conclusion: Foot bath and massage can obviously reduce insomnia in the patients with liver cirrhosis, improve the sleeping quality, and effectively elevate the nursing satisfaction of the patients, and are worthy of clinical popularization and application.

Foot Bath; Tuina; Massage; Liver Cirrhosis; Complications; Insomnia; Nursing

Sleep is a very important physiological process of the human body. Sleep disorders not only can influence the health independently and also are closely related to some chronic diseases, such as liver cirrhosis[1]. Studies have proven that insomnia is a commonly encountered sleep disorder in patients with liver cirrhosis, leading to poor control of the pathological situation and also causing complications of anxiety and depression in the patients, and thus affecting rehabilitation of the patients[2]. Studies have also suggested that foot bath and massage are remarkably effective for insomnia induced by chronic diseases[3-4]. The investigation of the patient’s satisfaction is the most objective and most impartial evaluation of nursing quality, as it really reflects the experience of the patients through a series of nursing services[5]. In order to understand the clinical effect of foot bath and massage for cirrhotic patients with insomnia and their satisfaction with nursing, I conducted the relevant study. Now, the results are given as follows.

1 Research Subjects

1.1 Diagnostic criteria

Those in conformity with the diagnostic criteria of liver cirrhosis inDiagnostic and Therapeutic Program of Liver Cirrhosis by Integration of Chinese Medicine and Western Medicinestipulated by Professional Committee of Digestive Diseases, China Society of Integrated Traditional Chinese and Western Medicine[6]. The diagnosis of insomnia was assessed by the internationally-acknowledged SPIEGEL scale (the score ≥12 points was regarded as insomnia)[7].

1.2 Inclusion criteria

In conformity with the aforementioned diagnostic criteria of liver cirrhosis and insomnia, normal thinking ability and able to communicate effectively; without limitation in age and gender; willing to participate in the study and signed the informed consent.

1.3 Exclusion criteria

Not in conformity with the above diagnostic and inclusion criteria; with oral administration of medications for insomnia in the past seven days; with insomnia influenced by surgery, cough and pain; those in the acute stage of severe complications and with mental disorders.

1.4 General data

One hundred insomnia patients with liver cirrhosis, admitted and treated in our clinic between October 2011 and September 2012, were recruited in the control group and given routine nursing of internal medicine. One hundred and five insomnia patients with liver cirrhosis, admitted and treated between October 2012 and September 2013, were recruited in the intervention group and given foot bath and massage on the basis of routine nursing of internal medicine. In comparisons of gender, age, insomnia duration, and scores of Pittsburgh sleep quality index (PSQI) between the two groups, there were not statistically significant differences (allP＞0.05), indicating that the two groups were comparable (Table 1).

Table 1. Comparison of general data between the two groups

2 Intervention Methods

The patients in the two groups were treated with conventional anti-cirrhosis drugs and sleeping pills.

2.1 Intervention group

2.1.1 Routine nursing of internal medicine

After admission, the nurses cordially greeted the patients and arranged the medical beds, and kept the wards clean, tidy, quiet and comfortable. The patients with a severe condition and needed to follow special examinations were told to confine to the bed absolutely, by the proper sleeping position in accordance with the pathological situation. The newly admitted patients were immediately checked by measuring the body temperature, pulse, respiration, blood pressure and evaluating the vital signs. The nurse in charge collected the subjective and objective information of the patients, wrote the nursing chart and offered the advice of admission and discharge. During hospitalization, the routine nursing was given in accordance with the pathological situation and nursing grades. The nurses paid attention to the vital signs and secreta, excreta, and the therapeutic effects, and observed and managed the adverse reaction of drugs. In accordance with the actual situation, the dietary advice, rehabilitation training, psychological intervention, drug advice and sleeping intervention were well processed. Before hospital discharge, the detailed health education and follow-up guidance were given.

2.1.2 Foot bath and massage

Foot bath: The patients were guided to soak the feet in warm water before going to bed every night, water temperature at 38-45℃, and rub two feet. When water temperature dropped down, hot water was added. The feet were soaked for 15-20 min till the whole body was slightly warm. Then, two feet were cleaned dry.

Massage: Foot massage was given by the trained professional nurses. Sanyinjiao (SP 6), Zusanli (ST 36), Yongquan (KI 1), Taichong (LR 3), Taixi (KI 3), and Shenmai (BL 62) were massaged with one-thumb Tui-pushing method. Massage was given for 10 min each session, continuously for 14 d.

2.2 Control group

Only the same routine nursing of internal medicine was given as the intervention group, without foot bath and massage.

3 Observation of Therapeutic Effects

3.1 Assessment indexes

Before and after intervention, the sleeping quality was assessed by PSQI scale[7]respectively, and the clinical effects were analyzed after intervention. The satisfaction with nursing service was evaluated at the discharge, based upon the nursing satisfaction questionnaire designed by our hospital.

3.1.1 PSQI scale

The self-assessment items were composed of seven factors, including sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, administration of sleeping pills, and daytime dysfunction. Every factor was scored by 0-3 grades. The accumulated points of various factors were the total score of PSQI scale. The range of total scores was 0-21 points. The higher the sores were, the poorer the sleep quality was[7].

3.1.2 Evaluation of therapeutic effects

The criteria of the therapeutic effects were stipulated according to the therapeutic effect criteria of insomnia inEvaluating Criteria of Therapeutic Effects in the Treatment of Mental Disorders(revised draft)[8].

Cure: After treatment, the sleep time was restored to normal level or was above 6 h, and the patients felt sound in sleep and vigorous after waking up.

Remarkable effect: The sleep was obviously improved, and the sleep time was increased by over 3 h.

Effect: The sleep time was increased than before the treatment, but the sleep time was increased by less than 3 h.

Failure: No improvement or the condition was even aggravated after treatment.

3.2 Statistical methods

The SPSS 17.0 version statistical software was used for statistical analysis. The measurement data were expressed by mean ± standard deviationand processed by usingt-test. The rank test was used for comparison of the grading data.

3.3 Results

3.3.1 Comparison of PSQI score

Before intervention, the difference in PSQI score between the two groups were not statically significant (P＞0.05). After intervention, the PSQI score was obviously lower in the intervention group than that in the control group (P＜0.05). The difference value of PSQI score before and after intervention in the intervention group was remarkably higher than that in the control group (Table 2).

3.3.2 Comparison of insomnia effect

The total effective rate was 89.5% in the intervention group versus 66.0% in the control group. The difference in the total effective rate between the two groups was statistically significant (P＜0.01), (Table 3).

3.3.3 Comparison of nursing satisfaction

At the time of discharge, 38 cases were very satisfied, and 48 cases were fairly satisfied and 14 cases were not satisfied in the control group; as well as 66 cases were very satisfied, and 39 cases were fairly satisfied, and zero was unsatisfied in the intervention group. The difference in the nursing satisfaction was statistically significant between the two groups (P＜0.01), (Table 4).

Table 2. Comparison of PSQI scores before and after intervention between the two groups (point)

Table 2. Comparison of PSQI scores before and after intervention between the two groups (point)

Note: Compared with the same group before intervention, P＜0.05; compared with the control group, 2) P＜0.05

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Table 3. Comparison of insomnia effect between the two groups (case)

Table 4. Comparison of nursing satisfaction between the two groups (case)

4 Discussion

Foot bath and massage are originated in China. InHuang Di Nei Jing(Yellow Emperor’s Classic of Internal Medicine), the oldest classic book of traditional Chinese medicine, massage for treatment of diseases was mentioned in many places and many foot acupoints were also recorded. Judged from the meridian theory of Chinese medicine and holographic theory, the functions of five Zang and six Fu organs have corresponding acupoints or reflex zones on the foot. To stimulate the acupoints or reflex zones on the foot by massage can excite the meridian qi, dredge the meridians and promote the circulation of qi and blood, so as to improve the sleep quality of the patients with insomnia[3]. The foot is the starting site of the Three Yin Meridians of Foot and also the ending site of Three Yang Meridians of Foot. There are up to 66 acupoints on both feet, accounting for 10% of the acupoints of the whole body[4]. When Sanyinjiao (SP 6), Zusanli (ST 36), Yongquan (KI 1), Taichong (LR 3) are stimulated by foot bath and massage, at the time while the foot muscles are relaxed, the brain receives the stimulating signals and releases the order to inhibit the cerebral cortex, so as to enable people to feel relaxed in the brain and to fall into asleep quickly and sleep soundly. It is clear that foot bath and massage have the effects to calm the mind and assist sleep[9].

It has been proven by this study that foot bath and massage can remarkably improve the sleep quality in the cirrhotic patients with insomnia, better than routine nursing of internal medicine. Zong LC, et al[4]analyzed the clinical effect of foot bath and massage in treatment of insomnia patients with type II diabetes, and the results showed that foot bath and massage are remarkably effective in treatment of insomnia in diabetes, and can help to reduce blood sugar. The results of this study are as same as those in the study of Zong LC, et al.

The nursing satisfaction is the most objective and most impartial evaluation of the nursing quality[5]. The enhancement of the patient’s satisfaction reduces the conflict between the nurses and patients and is very significant for building up a harmonious nurse-patient relationship[10]. It has been proven by statistical analysis of the nursing satisfaction survey conducted in the two groups at the discharge that foot bath and massage can significantly improve patient’s nursing satisfaction.

In summary, foot bath and massage can significantly reduce insomnia degree in the cirrhotic patients with insomnia, improve sleep quality, and improve the patient’s nursing satisfaction effectively, and are safe, reliable, and effective. As an effective intervention mode for cirrhotic insomnia, foot bath and massage have a certain value in application and need to be further perfected and popularized.

Conflict of Interest

There is no conflict of interest in this article.

Acknowledgments

This work was supported by Tongde Hospital of Zhejiang Province.

Statement of Informed Consent

All the patients signed the informed consent.

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Translator: Huang Guo-qi

R244.1

: A

Date:December 20, 2013