الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Patients suffering from congestive heart failure (CHF) frequently feel physical suffering and anxiety (Chen, Clark, Tai and Lin, 2010).Massage is a systematic form of touch that manipulates soft tissues of the body to promote comfort and healing. Massage seems to relax the muscles and decreases norepinephrine that consequently will result in reduced anxiety (Buttagat, Eungpinichpong, Chatchawan, & Kharmwan,2011). Massage can reduce pain, BP, heart rate, cortisol, and promote sleep and immune function. (Harris and Richards, 2010; Richards, 1998;Goodfellow, 2003).Aim of the study The aim of the present study was to examine the effect of back massage on anxiety and physiologic responses in patients with heart failure.Setting and population A quasi experimental design (pretest and posttest) was utilized. The study was carried out at the coronary care unit, at Shebin El-Kom, Menoufia University Hospital, Menoufia Governorate, Egypt. A convenient sample of eighty four patients of both sexes, aged from 19 to 65 years old was selected.To achieve the aim of the current study the following instruments were used: I- A Semi Structured Demographic Questionnaire.II- State Anxiety Inventory Scale (SAI): Anxiety was measured using the Spielberger’s State Anxiety Inventory (SAI) (Spielberger and Effect of Back Massage on Anxiety and Physiologic Responses among Patient with Heart Failure- 72 -Sydeman, 1994). The State Anxiety Inventory is a self-reported scale that consists of 20 statements that measure how respondents feel at the time of assessment. Half of the items were worded negatively, and half were worded positively. The State Anxiety Inventory scale evaluates feeling of apprehension, tension, nervousness, and worry. Subjects respond to the items on the scale by rating their responses on a four-point likert-type scale, from 1 (not at all) to 4 (very much so). Total scores can range from 20 to 80. Higher scores indicate a higher level of anxiety. A cut off point of 39 – 40 has been suggested to detect
clinically significant symptoms for the S-Anxiety scale (Addolorato et al., 1999). III- New York Heart Association Classification of Heart failure : Cardiac Function Status was measured using the New York Heart Association (NYHA) Classification (The Criteria Committee of the New York Heart Association, 1973). The NYHA Classification measures the patient’s perception of symptoms occurring during different levels of activity by assigning subjects to one of four cardiac functional classes (I –IV) based on subjects’ responses to questions about the amount of fatigue, dyspnea or pain they experience at different levels of physical activity prior to the cardiac event. This classification reflects physical disabilities related specifically to the cardiac event. The instrument consists of four categories and participants were asked to classify themselves in one of the four categories to reflect their cardiac functional status prior to the cardiac event. The categories reflect the ability to perform daily physical activities and the accompanying symptoms. The classes (I-IV) are:- Class I: no limitation of physical activity. Ordinary activity does not cause undue fatigue, palpitation, or dyspnea. Effect of Back Massage on Anxiety and Physiologic Responses among Patient with Heart Failure- 73 -Class II: slight, mild limitation of physical activity. Comfortable at rest but ordinary activity causes fatigue, palpitation, or dyspnea. Class III: marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes fatigue, palpitation, or dyspnea.Class IV: unable to carry out any physical activity without discomfort and symptoms occur at rest.IV- Biophysiological Parameters Sheet: Cardiorespiratory Parameters Questionnaire: It was developed by Holzheimer (2001) to assess physiological parameters: such as; Hart Rate (HR), Respiratory Rate (RR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) via the monitor (Nihon Kohden Life Scope Bsm-3500) which was calibrated automatically. Oxygen saturation (SaO2) was measured by the pulse oximerty.The study revealed the following findings: The mean age of the participant was (52.38±4.8) years old among the study group and (52.62± 4.8) years old among the control group, belonging to the sex; half of the study group (52.4%) were male and (47.6%) were female. There was a highly statistically significant difference in the total anxiety score pre and post intervention in the study group. There was a statistically significant difference in the physiological parameters pre and post intervention in the study group. There was a relationship between total anxiety score and gender and occupation among the study group post intervention.Effect of Back Massage on Anxiety and Physiologic Responses among Patient with Heart Failure- 74 -Conclusions Based on findings of the current study, it can be concluded that back massage can help patients with heart failure to be less anxious and more comfortable. After back massage for 3 consecutive days, the participants’ systolic and diastolic BP, HR, and breathing rates were significantly lower than before, while their oxygen saturation levels significantly increased. Recommendations Based on the study findings, it can recommended that: The change in the vital signs is an important finding of this study because these changes would reduce the myocardial oxygen demand. Thus it can be recommended that massage therapy be used to balance the vital signs of patients with heart failure admitted in CCU. Nursing currently emphasizes caring and humanity and, in
that light, the back massage protocol and the results of this
study might be used to improve nursing education. It can be
promoted in clinical practice, and carried out as part of nursing continuous education so as to enhance nursing quality and patient comfort.Future Research Recommendations This study design needs to be expanded to a larger more heterogeneous population. This study did not analyze gender effects. However comparing gender effects would be interesting particularly because there are studies reporting differences among gender.