Annexure II - Rajiv Gandhi University of Health Sciences



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

| |Name of the candidate and address |SOUMYA SUSAN SAM |

| |(in block letters) |I YEAR M. Sc. NURSING |

| | |LAXMI MEMORIAL COLLEGE OF NURSING |

| | |BALMATTA |

| | |MANGALORE |

| |Name of the Institution |LAXMI MEMORIAL COLLEGE OF NURSING |

| | |BALMATTA |

| | |MANGALORE |

| |Course of Study and Subject |M. Sc. NURSING |

| | |MEDICAL SURGICAL NURSING |

| |Date of Admission to the course |23.06.2012 |

| |Title of the Topic |

| | |

| |EFFECTIVENESS OF FOOTBATH THERAPY ON FATIGUE AMONG PATIENTS WITH CHRONIC RENAL FAILURE IN SELECTED HOSPITAL AT MANGALORE|

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| |Brief resume of the intended work |

| |6.1 Need for the study |

| |Excretory system is a passive biological system that removes waste products from the body and helps to maintain |

| |homeostasis. As most healthy functioning organs produce metabolic and other wastes, the entire health of human being |

| |depends on function of excretory system. Kidneys are the primary excretory organs.1 Kidneys regulates the body’s fluid, |

| |electrolytes, and acid base balances while removing toxic substances from blood and excreting them in urine. When |

| |kidneys are not functioning, the waste products and excess fluids build up in blood causing oedema, uraemia and |

| |anaemia.2 |

| |Chronic renal failure is defined as progressive, irreversible loss of functioning renal tissue such that remaining |

| |kidney mass can no longer maintain the body’s internal environment.2 It is defined as either the presence of kidney |

| |damage or glomerular filtration rate less than 60 ml/mt for 3 months or longer.3 Chronic renal failure can develop |

| |insidiously over many years, or it may result from episode of acute renal failure from which client has not recovered.2 |

| |As renal function progressively deteriorates, every body system becomes affected.3 Fatigue is a highly prevalent symptom|

| |experienced by persons who live with chronic illness, including those with renal failure. A number of physiological |

| |disorders are associated with fatigue including malnutrition, anaemia, and uraemia4. Over 50% of end stage renal disease|

| |patients complained of persistent fatigue been the initiation of dialysis therapy and continued to experience while on |

| |dialysis and which persisted nearly all the time. Fatigue has been identified by end stage renal disease patients who |

| |are under haemodialysis treatment as a distressing and disabling symptom that interferes their ability to enjoy life and|

| |to take care of themselves.5 |

| |End stage renal disease represents a major problem for public health and it brings about complex implications to social |

| |and economic structures of every nation in world. Kidneys Wales foundation in UK shows that more than 500 |

| |million people in worldwide approximately one in ten adults have some forms of kidney damage.6 According to the survey |

| |conducted by National kidney foundation in India, states that kidney diseases rank third amongst life threatening |

| |diseases and estimates approximately 2, 00,000 people in India go into terminal kidney failure annually and millions |

| |more suffer lesser forms of kidney disease. Only 22.5% of patients receive dialysis treatment.7 |

| |A systematic review was done to describe the prevalence of symptoms in end- stage renal disease to better understand the|

| |total symptom burden. Extensive database and hand searches were undertaken, by predefined protocol, for studies |

| |reporting symptom prevalence in ESRD population in dialysis, discontinuing dialysis or without dialysis. Prevalence data|

| |were extracted, study quality assessed by use of established criteria and studies combined to show mean prevalence and |

| |range. Fifty nine studies in dialysis patients, one in patients discontinuing dialysis met inclusion criteria. For |

| |following symptoms weighted mean prevalence (and range) were fatigue 71 %( 12%-97%), pruritis 55 %( 10%-77%), |

| |constipation 55% (8%-57%), anorexia 19 %( 25-61%), sleep disturbance 44 %( 20-83%).8 Anecdotally, fatigue is viewed by |

| |nurses as something that cannot be changed as it is part of disease process. Many use complementary therapies to reduce |

| |fatigue and other associated symptoms.4 |

| |Complementary medicine is growing in popularly all the time, and is becoming a significant part of modern- day health |

| |care, with millions of treatments taking place each year. It reaches back into the distant past, drawing on health |

| |wisdom from ancient cultures such as Greeks, Egyptians and Chinese and yet is also bang up- to- date with new health |

| |innovations and latest technological advance. The most used such therapies are biofeedback, aromatherapy, relaxation |

| |technique, massage, acupuncture, hydrotherapy.9 |

| |Hydrotherapy is the use of water to relieve discomfort and promote physical well being. A warm foot bath warms the skin,|

| |which causes vessel dilation and induces heat dissipation. Foot bath is an effective method of relaxation, since it |

| |induces both significant increases in sympathetic activity. In |

| |addition, foot bath increases white blood cells and natural killer cells cytotoxicity. When warm water foot bath therapy|

| |is applied at a high temperature to the body the capillary vessels dilate, become flaccid and exhibit signs of loss of |

| |tension.10 |

| |The investigator during her clinical experiences has come across chronic renal failure patients with fatigue and muscle |

| |weakness. Untreated fatigue may impact greatly on quality of life, leading to increased dependence on others, weakness, |

| |increased physical and mental energy, social withdrawal and depression. From findings of literature, researcher realized|

| |importance of reducing fatigue by nursing interventions and designed a study on effect of footbath on fatigue in |

| |patients with chronic renal failure in selected hospital at Mangalore. |

| |6.2 Review of literature |

| |A longitudinal study was conducted to assess the effectiveness of warm water foot bath therapy on relieving fatigue and |

| |insomnia problems in clients undergoing chemotherapy. There were 25 and 18 participants in comparison and experimental |

| |groups who completed the study. Adults diagnosed with gynaecologic cancer and receiving 4- series platinum chemotherapy |

| |regimen were recruited and then followed up for six months. The fatigue levels and sleep quality were assessed by Brief |

| |Fatigue Inventory-Taiwan Form and Verran and Snyder- Halpern (VSH) sleep scale. They completed fatigue and insomnia |

| |items on 1st, 2nd, 4th, 7th and 14 days after each scheduled chemotherapy. Participants in the experimental group |

| |soaked their feet in 41.C to 42.C warm water for 20 minutes every evening, starting eve of receiving the first |

| |chemotherapy. The study results indicated that there was significant reduction in fatigue and improvement in sleep |

| |quality from second session of chemotherapy and continued to improve during the study period.11 |

| |A study was conducted to assess the effect of foot bathing on distal- proximal skin temperature gradient in elders in |

| |Taiwan. Six older adults, under a cross- over design, were randomised to the sequence of water bah temperatures. |

| |Each subject’s feet and legs were immersed in a temperature controlled water tub to 20 cm above the ankles for one hour |

| |in each of two water temperatures (40.C and 41.C). Oral, abdominal and foot- bathing temperatures were taken during and |

| |after foot- bathing. Distal- proximal skin temperature gradient was calculated by subtracting abdominal temperature from|

| |foot temperature. Results showed that value of distal proximal temperature gradient was increased in 10th minute bathing|

| |at both water temperatures and maintained above 0ºC. The value of distal proximal temperature gradient with 41.C water |

| |was slightly higher than 40.C (t= 0.04-1.48, all p->0.05).Both 40.C and 41.C foot bathing for one hour thus increases |

| |distal proximal gradient and is an effective way to affect whole body skin blood flow and trigger heat dissipation.12 |

| |A study was conducted on physiological effects of mild foot bath at Graduate School of Health and Welfare, Yamaguchi |

| |Prefectural University. They examined on 31 subjects before, during and 10 minutes foot bath at 41.C. Weakly alkaline |

| |hot water supplied by the administration of Yuda- Hot Spring was used for this study. Body temperature and blood flow |

| |were measured at leg and arm by a laser Doppler blood flow meter. Electrocardiogram was recorded from leg and arm and |

| |electroencephalogram was lead from FZ, CZ and PZ on the mid sagittal plane of the head. Analogue signals of ECG and EEG |

| |were digitalized and recorded for 30 min before, during and after the foot bath, then analyzed by means of a |

| |conventional spectral analysis protocol. No obvious change was observed in body temperature, while subcutaneous blood |

| |flow increased in the lower limb during the foot bath. Relative content of high frequency component in the heart rate |

| |variability and of the alpha rhythm in EEG were increased in 69% subjects during the foot bath. This observation |

| |suggests that about two- thirds of subjects experienced a true rest as well as mental relaxation during the foot bath. |

| |In addition, this study recommended for further research to find out “relax” effect of foot bath.13 |

| |A study was conducted to investigate the effects of foot bathing on autonomic nerve and immune function. Eleven |

| |healthy female volunteers (aged 22-24 years) undertook footbath at 42.C for 10 minutes, with or without |

| |additional mechanical stimulation (air bubbles and vibration). Autonomic responses were evaluated by electrocardiography|

| |and spectral analysis of heart rate variability and by measurement `of blood flow. White blood cell counts, ratios of |

| |lymphocyte subsets, and natural killer (NK) cell cytotoxicity were used as indicators of immune function. Foot bathing |

| |with mechanic stimulation produced significant changes in measured autoimmune responses, indicating shift to increased |

| |para sympathetic and decreased sympathetic activity and significant increases in WBC count and NK cell cytotoxicity, |

| |suggesting an improved immune status.14 |

| |A study was conducted to investigate relaxation response of subjects to footbath, foot massage and foot massage combined|

| |with foot bath compared with that of control group at Japan. Ten subjects (mean age 72.0, SD-2.2), physiological data |

| |(heart rate, foot skin temperature) were continuously measured and subjective data were obtained before care, |

| |immediately after care and 120 minutes after care. The comparisons were performed with one way ANOVA, Tukey’s test and |

| |Friedman test. Immediately after care, foot massage resulted in significant decrease in heart rate in comparison with |

| |control (p ................
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