Abdominal histerektomi sonrası refleksolojinin iyilik haline etkisi
Küçük Resim Yok
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Araştırma, abdominal histerektomi ameliyatı sonrası uygulanan refleksolojinin, ağrı, anksiyete, yaşam bulguları, yorgunluk, kas gerginliği, gevşeme ve memnuniyet düzeyleri üzerine etkisini belirlemek amacı ile randomize kontrollü deneysel olarak yapılmıştır. Araştırma, Eylül 2013–Eylül 2014 tarihleri arasında, Ege Üniversitesi Hastanesi, Kadın Hastalıkları ve Doğum Anabilim Dalı yoğun bakım ünitesi ve jinekoloji servisinde yatmakta olan, abdominal histerektomi operasyonu geçirmiş kadınlara uygulanmıştır. Araştırmanın örneklemini, seçim kriterlerine uyan 32'i uygulama, 31'i kontrol olmak üzere toplam 63 kadın oluşturmuştur. Araştırma verilerinin toplanmasında; hasta tanıtım formu, post operatif günlük izlem formu, durumluluk ve sürekli kaygı envanteri (Spielberger State- Trait Anxiety Inventory-STAI), ağrı, yorgunluk şiddetinin, kas gerginliği, gevşeme ve memnuniyet düzeylerinin değerlendirilmesinde "visiual analog skalası" kullanılmıştır. Uygulama ve kontrol grubundaki kadınlar, postoperatif dönemde üç gün boyunca takip edilmiştir. Uygulama ve kontrol grupları geldikleri haftaya göre refleksoloji ve kontrol gruplarına ayrılarak randomize edilmiştir. Bir hafta kontrol grubu, bir hafta uygulama grubu seçilmiştir. Aynı zamanda, uygulama ve kontrol grubundaki kadınlar, Ramsey sedasyon skalasına ve hasta bağımlılık düzeylerine göre seçilerek randomizasyon sağlanmıştır. Ameliyat sonrası kontrol grubundaki kadınlar, sadece hasta kontrollü analjezik tedavisi (HKA) alırken, uygulama grubundaki kadınlara HKA tedavisine ek olarak ayak refleksolojisi uygulanmıştır. Refleksoloji ameliyat sonrası yoğun bakım ünitesinde bulunan, Ramsay sedasyon skalası 2 puan olan her bir hasta için, günde bir defa olmak üzere uygulanmış, ameliyat sonrası 2. ve 3. günde aynı saatte, servise geçen hastalara aynı işlemler tekrar edilmiştir. Refleksoloji uygulama grubundaki kadınlara, her bir ayağa 10'ar dakika olmak üzere, belirlenmiş alanlara toplam 20 dakika olacak şekilde uygulanmıştır. Kadınlara uygulama öncesi (0.dakika), uygulamadan hemen sonra (30. dakika) ve uygulamadan yarım saat sonra değerlendirme ölçekleri uygulanarak (60.dakika), ağrı, durumluluk anksiyete, yorgunluk, kas gerginliği, gevşeme ve memnuniyet düzeyleri değerlendirilmiştir. Ayrıca, sempatik aktivitenin değerlendirilmesi için kan basıncı, nabız ve solunum düzeyleri ölçülmüştür. Herhangi bir girişim de bulunulmayan kontrol grubundaki kadınların, ameliyat sonrası 1., 2. ve 3.günde uygulama grubunda belirtilen şekilde aynı saatlerde, tansiyon, nabız, solunum sayısı, ağrı, anksiyete, yorgunluk, kas gerginliği, gevşeme ve memnuniyet düzeyleri değerlendirilmiştir. Araştırmada verilerin analizinde; frekans, yüzde, pearson kikare ve fisher'ın kesin ki-kare testi, tekrarlayan ölçümlerde varyans analizi, Bonferroni düzeltmeli t testi, Friedman Varyans Analizi, Bonferroni düzeltmeli wilcoxon işaretli sıralar testi, bağımsız gruplarda t testi, Mann Whitney U Testi kullanılmıştır. Kadınların sosyo-demografik özelliklerine göre dağılımı incelendiğinde; kadınların yaş ortalamasının 47.23±4.71 yaş olduğu, uygulama grubunda yer alan kadınların %31.2'sinin ortaokul/ lise mezunu olduğu, %78.1'inin evli olduğu, kontrol grubundaki kadınların %38.7'sinin ortaokul/ lise mezunu olduğu, %77.4'ünün evli olduğu saptanmıştır. Uygulama grubundaki kadınların %59.4'ünün "Myom+Menoraji" tanısı aldığı ve %81.3'üne "TAH+BSO" yapıldığı, kontrol grubundaki kadınların %51.6'sının "Myom+Menoraji" tanısı aldığı ve %80.6'ına "TAH+BSO" yapıldığı saptanmıştır. Araştırma sonucunda, uygulama ve kontrol grubu arasında, sistolik kan basıncı, diastolik kan basıncı, nabız ve solunum ortalamalarında, belli zamanlarda anlamlı farklılıklar olduğu saptanmıştır (p<0.05). Üç günlük izlem sonucunda, refleksoloji uygulamasından hemen sonra (30.dakika) ve refleksolojiden uygulamasından yarım saat sonrasında (60.dakika), ağrı, yorgunluk, kas gerginliği, durumluluk anksiyete puan ortalamalarında, uygulama ve kontrol grubu arasında anlamlı farklılık olduğu ve uygulama grubunda kontrol grubuna göre anlamlı ölçüde azalma olduğu saptanmıştır (p<0.05). Belirtilen sürelerde, gevşeme ve memnuniyet puan ortalamalarında da, uygulama ve kontrol grubu arasında anlamlı fark olduğu, uygulama grubunun gevşeme ve memnuniyet düzeylerinin kontrol grubunda göre anlamlı ölçüde arttığı saptanmıştır (p<0.05). Sonuç olarak, ayak refleksolojisinin, abdominal histerektomi olmuş kadınlarda, ağrı, anksiyete, yorgunluk, kas gerginliği düzeylerinde azalmaya, gevşeme, memnuniyet düzeylerinde artmaya yol açtığı ve bu farkın istatistiksel olarak anlamlı olduğu saptanmıştır (p<0.05). Dolayısıyla, abdominal histerektomi sonrası uygulanan, ayak refleksolojisinin yoğun bakım ve jinekoloji servislerinde yatan kadınların, ameliyat sonrası iyilik halini artıran etkili bir hemşirelik girişimi olduğu saptanmıştır
The research was conducted randomized controlled trial and experimentally in order to determine the effects of postoperative pain, anxiety, vital signs, fatigue, muscle tension, relaxation and satisfaction was carried out reflexology after abdominal hysterectomy. Research, has been applied to women who had undergone abdominal hysterectomy and lying in the intensive care unit and gynecology service in Ege University Hospital, Department of Obstetrics and Gynecology, between September 2013-September 2014. The sample of the study, has a total of 63 women, which including the application meets the selection criteria sample of 32 survey and 31 control. Patient identification form, post-operative day follow-up form, State-Trate Anxiety Inventory (STAI), the evaluation of pain, fatigue severity, muscle tension, relaxation and satisfaction "visiual analog scale" were used as data collection tool. Women in the treated and control groups were followed for three days post-operative period. The treated and control group were randomized as reflexology and control groups are divided by the week they come. One week control group, a week reflexology group is selected. At the same time, women in the treatment and control groups, randomization according to their level of women dependency and Ramsey sedation scale has been selected. While postoperative women in the control group took only patient-controlled analgesic therapy (PCA), foot reflexology has been applied in addition to analgesic therapy to women in the treatment groups. Reflexology administered once a day for each woman in postoperative intensive care unit which Ramsay Sedation Scale was 2 points. Postoperative day 2 and 3 at the same time, the same procedures were repeated when patient transfers to service. Women in the experimental group, including reflexology 10 minutes to each foot was applied the designated area so that total of 20 minutes. Assessment scales applied before practice to women (0.minutes), immediately after practice (30 minutes) and after half an hour of practice (after 60 minutes), that are evaluated pain levels, anxiety, fatigue, muscle tension, relaxation and satisfaction levels. In addition, the blood pressure, heart rate and respiration levels were measured for assessing the sympathetic activity. Not made any attempt of women in the control group, postoperative 1st, 2nd and 3rd day as specified in the application group at the same time were evaluated blood pressure, pulse, respiratory rate, level of pain, anxiety, fatigue, muscle tension, relaxation and satisfaction levels. The analyses of the research data was used number, percentage, Pearson's chi-square and Fisher's exact chi-square test, analysis of variance for repeated measures, Bonferroni correction t-test, Friedman ANOVA, Bonferroni correction Wilcoxon signed rank test, independent samples t test, Mann-Whitney U test. The distribution of women by socio-demographic characteristics is examined; the mean age of the women was 47.23±4.71 years, The women in the treatment group were 31.2% of middle school / high school that graduates, 78.1% were married, women in the control group was 38.7% of of middle school/high school that graduates, 77.4% were found to be married. Women in the experimental group was as a diagnosis 59.4% of "Fibroids + menorrhagia" and 81.3% of women undergo "TAH+BSO" operation, 51.6% of women in the control group diagnosed as "Fibroids + menorrhagia" and 80.6% of women undergo "TAH+BSO" operation. As a result, between the application and the control group, diastolic blood pressure, pulse and respiratory average was found that significant differences at certain times during the three-day measurements (p<0.05). As a result of the three-day follow-up, immediately after application of reflexology and after half an hour after application of reflexology treatments, pain, fatigue, muscle tension, trait anxiety scores in the average, statistically significant differences between treatment and control groups and was found to be significantly decreased compared to the control group (p<0.05). In the specified period, the average score in relaxation and satisfaction, which is a significant difference between treatment and control group, relaxation and satisfaction level of the treatment groups was found to increase significantly compared to the control group (p<0.05). As a result, the foot reflexology, women had abdominal hysterectomy, leads to decreased pain, anxiety, fatigue, muscle tone, increased the level of relaxation and satisfaction and it was found to be statistically significant difference (p<0.05). Thus, applied after abdominal hysterectomy, women hospitalized in intensive care and gynecology service of foot reflexology, after surgery was found to be an effective nursing interventions that improve the wellbeing.
The research was conducted randomized controlled trial and experimentally in order to determine the effects of postoperative pain, anxiety, vital signs, fatigue, muscle tension, relaxation and satisfaction was carried out reflexology after abdominal hysterectomy. Research, has been applied to women who had undergone abdominal hysterectomy and lying in the intensive care unit and gynecology service in Ege University Hospital, Department of Obstetrics and Gynecology, between September 2013-September 2014. The sample of the study, has a total of 63 women, which including the application meets the selection criteria sample of 32 survey and 31 control. Patient identification form, post-operative day follow-up form, State-Trate Anxiety Inventory (STAI), the evaluation of pain, fatigue severity, muscle tension, relaxation and satisfaction "visiual analog scale" were used as data collection tool. Women in the treated and control groups were followed for three days post-operative period. The treated and control group were randomized as reflexology and control groups are divided by the week they come. One week control group, a week reflexology group is selected. At the same time, women in the treatment and control groups, randomization according to their level of women dependency and Ramsey sedation scale has been selected. While postoperative women in the control group took only patient-controlled analgesic therapy (PCA), foot reflexology has been applied in addition to analgesic therapy to women in the treatment groups. Reflexology administered once a day for each woman in postoperative intensive care unit which Ramsay Sedation Scale was 2 points. Postoperative day 2 and 3 at the same time, the same procedures were repeated when patient transfers to service. Women in the experimental group, including reflexology 10 minutes to each foot was applied the designated area so that total of 20 minutes. Assessment scales applied before practice to women (0.minutes), immediately after practice (30 minutes) and after half an hour of practice (after 60 minutes), that are evaluated pain levels, anxiety, fatigue, muscle tension, relaxation and satisfaction levels. In addition, the blood pressure, heart rate and respiration levels were measured for assessing the sympathetic activity. Not made any attempt of women in the control group, postoperative 1st, 2nd and 3rd day as specified in the application group at the same time were evaluated blood pressure, pulse, respiratory rate, level of pain, anxiety, fatigue, muscle tension, relaxation and satisfaction levels. The analyses of the research data was used number, percentage, Pearson's chi-square and Fisher's exact chi-square test, analysis of variance for repeated measures, Bonferroni correction t-test, Friedman ANOVA, Bonferroni correction Wilcoxon signed rank test, independent samples t test, Mann-Whitney U test. The distribution of women by socio-demographic characteristics is examined; the mean age of the women was 47.23±4.71 years, The women in the treatment group were 31.2% of middle school / high school that graduates, 78.1% were married, women in the control group was 38.7% of of middle school/high school that graduates, 77.4% were found to be married. Women in the experimental group was as a diagnosis 59.4% of "Fibroids + menorrhagia" and 81.3% of women undergo "TAH+BSO" operation, 51.6% of women in the control group diagnosed as "Fibroids + menorrhagia" and 80.6% of women undergo "TAH+BSO" operation. As a result, between the application and the control group, diastolic blood pressure, pulse and respiratory average was found that significant differences at certain times during the three-day measurements (p<0.05). As a result of the three-day follow-up, immediately after application of reflexology and after half an hour after application of reflexology treatments, pain, fatigue, muscle tension, trait anxiety scores in the average, statistically significant differences between treatment and control groups and was found to be significantly decreased compared to the control group (p<0.05). In the specified period, the average score in relaxation and satisfaction, which is a significant difference between treatment and control group, relaxation and satisfaction level of the treatment groups was found to increase significantly compared to the control group (p<0.05). As a result, the foot reflexology, women had abdominal hysterectomy, leads to decreased pain, anxiety, fatigue, muscle tone, increased the level of relaxation and satisfaction and it was found to be statistically significant difference (p<0.05). Thus, applied after abdominal hysterectomy, women hospitalized in intensive care and gynecology service of foot reflexology, after surgery was found to be an effective nursing interventions that improve the wellbeing.
Açıklama
Anahtar Kelimeler
Hemşirelik, Nursing, Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology
