- Email: [email protected]
Physiological and psychological effects of back rubs
Research Briefs Physiological and Psychological Effects of Back Rubs
Mary C. Corley, Joan Ferriter, Joy Zeh, and Cynthia Gifford
LTHOUGH numerous nursing texts expound on the benefits of back rubs, including improved circulation, pain relief, relaxation, and increased sense of worth, few studies have substantiated these outcomes. The findings are sometimes conflicting and often confusing, with researchers reporting (a) no change in blood pressure or heart rate (Kaufmann, 1964; Longworth, 1982), (b) a decrease in heart rate in elderly women (Madison, 1973), (c) and increase in heart rate and a decrease in oxygen saturation (Tyler, Winslow, Clark, & White, 1990), (d) a decrease in frontalis electromyographic activity (Longworth, 1982), (e) decreases in blood pressure and heart rate and an increase in skin temperature (Fakouri & Jones, 1987, (f) an increase in salivary immunoglobulin A concentration (Gr6er et al., 1994), and (g) an improvement in mood (Sims, 1986). Because findings on back rubs are not conclusive enough to guide nursing practice, and because of the need to address different populations, the research question addressed was as follows: are the physiological and psychological responses different between a 3-minute back rub and a 3-minute control period of undisturbed rest in the institutionalized elderly?
A
METHODS
This study was designed to include 84 participants. However, only 19 residents (8 men and 11 women from a private institution and a federal long-term care facility) agreed to participate. The Short Portable Mental Status Questionnaire (Pfieffer, 1985) and staff evaluations were used to assess ability to give informed consent. The experimental group of 12 included 6 male and 6 female residents randomly assigned using a random number table. The control group consisted of 2 men Applied Nursing Research, Vol. 8, No. 1 (February), 1995: pp. 39-43
and 5 women. Their average age was 78 years; the length of stay in the nursing home ranged from 1 to 84 months. Marital status, religion, and race did not significantly differ between the experimental and control groups using Fisher's Exact Test. The back rubs were administered to the experimental group by the same investigator during the early evening hours in the resident's own room. After 15 minutes of bed rest and before and after the back rub, a second investigator recorded physiological baseline measurements in the same order. The two investigators were in the patient's room throughout the whole period but did not encourage conversation. The control group rested an addition 3 min after the baseline 15-min rest; other steps were the same for the control group.
Physiological Measurements Heart rate was measured by auscultation of the apical pulse. Systolic and diastolic blood pressure values were measured with a mercury column spygmomanometer and a Littman stethoscope (Carolina Biological Supply Company, Burlington, NC) in accordance with the procedures recommended by the American Heart Association for blood pressure determination. Respiratory rate was directly observed by the investigator. Electromyographic (EMG) activity of the masseter and trapezius muscle groups was recorded unilaterally to assess electric potential created by muscle contraction with the J & J EMG (model M-57) (J&J Enterprises, Poulsbo, WA) using noninvasive adhesive electrodes, which were attached to the area over the muscle groups. Before data collection, EMG equipment was tested to assure adequate battery power, and a dummy electrode plate was used to screen the environment for any extraneous electrical noise that might yield artifacts similar to muscle electrical activity. Skin temperature was assessed using a Yellow Springs Instrument Company (Yellow Springs, OH) banjo-style skin thermister taped to the lower back.
Psychological Evaluations Tactual aversion/sensitivity reactions to the back rub and mood were the psychological variables 39
40
RESEARCH BRIEFS
FINDINGS
measured. The Tactual Minimizing Scale, a fiveitem subscale measuring tactile aversion, from the Spiegel Personality Inventory (SPI) (Spiegel, 1969), was adapted by the investigator by making separate items from two multiple variable items, yielding a 10-item scale. The original Tactual Minimizing Scale had a test-retest reliability of .79 with a group of college students and criterion validity with a sample of normal and mentally ill subjects (Spiegel, 1969). Six of the items measured tactile aversion and four measured tactile sensitivity. Participants completed the Tactual Minimizing Scale at baseline only. Mood measurement consisted of three pairs of adjectives (tense/ peaceful, tired/full of vitality, worried/hopeful), reflecting a subjective state of mind associated with high levels of physiological arousal (Sims, 1986). Upon completion of the back rub, the experimental group completed Lane's (1989) questionnaire on their reaction to the back rub (five items: comfortable/uncomfortable, relaxed/tense, annoyed/ pleased, agreeable/disagreeable, calm/nervous) from the Territorial Intrusions and Personal Space Scale, and both groups completed the mood measurement instrument a second time. Lane's entire instrument had a Cronbach's alpha of .85. The reliability of these instruments was not assessed in this sample.
Physiological Variables Baseline physiological variables differed significantly between the two groups only on skin temperature and trapezins EMG. Data analysis using the Wilcoxon test (small sample did not meet assumptions of t test) revealed that men in the experimental group showed a significant increase in skin temperature (M = - 1.08; SD = .97), as did the women in the control group. Mean heart rate, systolic pressure, and diastolic pressure declined slightly from baseline in both the experimental and control groups, but this difference was not significant. The systolic pressure did not differ significantly in the experimental group; however, men showed a decrease in systolic blood pressure (M = 8.3; SD = 11.1) and women showed an increase (M = 3.7; SD = 9.2) The systolic difference range in the experimental group after the back rub was from a decrease of 24 to an increase of 22 mm Hg. (Table 1). Psychological Variables Mood ratings improved for both groups after the back rub or rest period; however, the mood of the experimental group (M = .92; SD = .79) was not significantly better than that of the control group
Table 1. Changes in Physiological and Psychological Variables in Back Rub or Rest Groups (PreIntervention Minus Post-Intervention) Back rub group (n = 12) Female (n = 6) Differences Heart rate (beats/rain) Respiratory rate (breaths/min)* Systolic blood pressure (mm Hg)t Diastolic blood pressure (mm Hg) Skin temperature (°C) Masseter EMG (N,V) Trapezius EMG (I~V) Tactile aversiont'§'** Tactile sensitivity IL,~,**
Rest group (n = 7)
Male (n = 6)
Both
M
SD
M
SD
-1.0 -2.7
7.1 4.1
2.3 1,0
5.1 3.0
-3.7
9.2
8.3
4.7 -0.6 0.3 1.2 3.2 2.3
7,0 0.7 2.3 3.1 0.8 1,5
1.0 -1.1 2.0 -0.5 2.8 0.2
NOTE *p = .02 All Males vs. All Females. 1-p = .04 Experimental Group. Males vs. Females. t p = .05 Experimental vs. Control Group. §p = .01 Experimental vs. Control Group at Baseline, lip = .02 Experimental vs. Control Group Post-Intervention. ~p = ,01 All Males vs. Females. **Baseline measurement only.
Female (n = 5)
M
Male (n = 2)
Both
SD
M
SD
M
SD
M
SD
.7 .8
6.2 3.9
2.6 -2.4
21.3 2.2
-2.0 1.0
5,7 1.4
1.3 1.4
17.7 2.5
11.1
2.3
11.5
0.8
16.7
4.0
16.9
1.7
15.4
3.7 0.9 4.6 1,2 0.8 0.4
2.8 -0.8 1.2 -0.3 5.5 1.3
5.6 .8 3.5 2.4 1.9 1.5
-3.2 -0.5 1.8 -1.0 1.4 3.0
11.7 0.4 2.8 2.5 0.9 0.7
4.0 -1.3 1.5 4.0 3.0 1.0
2.8 0.4 0.7 2.8 1.4 0.0
1.1 0.7 1.7 0.4 5.6 1.3
10.3 0.5 2.3 3.4 1.4 0.8
RESEARCH BRIEFS
41
(M = 1.42; SD = .79) (a lower score reflected improvement). In addition, women in the experimental group showed a significant improvement in mood (M = 1; SD = .89) from the baseline (M = 2.3; SD = .8) assessment. Women in both experimental and control groups scored significantly higher on tactile reactions, particularly tactile sensitivity (M = 1.9; SD = 1.3), than did men (M = .4; SD = .5). W o m e n ' i n the experimental group had significantly greater tactile sensitivity than males in the experimental group. Most residents rated the back rub positively: 83% said they were comfortable, 67% were pleased and calm and found it agreeable, and 58% were relaxed. Correlations Significant correlations were found between a number of variables: (a) greater heart rate differences were correlated with low tactile reaction (r = - . 5 7 ; p ~ .05) and low tactile aversion (r = - .49; p ~< .05); (b) greater respiratory rate differences were correlated with greater skin temperature differences (r = - .61; p = .01), low tactile reaction (r = - . 6 1 ; p < .01), low tactile sensitivity (r = - . 6 2 ; p = .01), and better mood at baseline (r = - .48; p = .05); (c) greater differences in masseter EMG activities were correlated with more negative responses to the back rub (r = .64; p < .05); (d) greater differences in skin temperature were associated with more negative mood changes after the back rub (r = .59; p < .01); (e) greater tactile reaction was associated with poor mood at baseline (r = .59; p < .01); and (f) greater aversion to touch was correlated with poorer mood at baseline (r = .52; p = .05). IMPLICATIONS The significant difference in mood after a back rub has implications for nursing care. Mood improved for both groups, but the improvement was significantly greater for the experimental group. Back rubs may be administered to improve resi-
dents' moods. Although physiological measures did not change significantly, back rubs should be given with caution to a resident whose blood pressure is too low or too high and who shows a decrease or increase of these values. Further research is necessary to determine the effects of back rubs in relation to the medications the patient may be taking. The similarity in the changes in heart rate, diastolic blood pressure, respirations, and EMG readings between the randomly assigned experimental and control groups was not expected. In their exploratory study, Fakouri and Jones (1987) found a significant decrease in heart rate and systolic pressure (4 men and 14 women) with a 3-minute slow-stroke back massage. The study reported here showed no similar effect. The results of the current study also differ from Longworth's (1982), who found a decrease in frontalis EMG activity. However, the correlation between response to back rub and masseter EMG activity may reflect a similar response. Sex differences need further explanation, because they conflict with the findings on blood pressure and heart rate as reported by Kaufman (1964) and Madison (1973). Spiegel (1969) also reported greater tactile sensitivity and aversion in women versus men. More than half of the residents felt relaxed after the back rub, which is important if a back rub is given to relax the subject. On the whole, the effect of the back rub was more positive in the present study than in that of Madison (1973) (54% positive). These findings underscore the need for clinicians to carefully assess the long-term resident's response to back rubs. However, the variation in residents' responses to back rubs points to the need to elicit individual patients' preferences as part of an admissions assessment. ACKNOWLEDGEMENT The authors thank Barbara Mark, Phi), RN, and Jean Wyman, PhD, FAAN, for their valuable assistance in the preparation of the manuscript.
REFERENCES Fakouri, C., & Jones, P. (1987). RelaxationRX: Slow stroke back rub. Journal of Gerontological Nursing, 13(2), 32-35. Grber, M., Mozingo, J., Droppleman, P., Davis, M., Jolly, M., Boyuton, M., Davis, K., & Kay, S. (1994). Measures of salivary secretory immunoglobulin A and State Anxiety after a nursing back rub. Applied Nursing Research, 7, 2-13. Kaufman, M.A. (1964). Autonomic responses as related to nursing comfort measures. Nursing Research, 13, 45-55.
Lane, P. (1989). Nurse-client perceptions: The double standard of touch. Issues in Mental Health Nursing, 10, 1-13. Longworth, J. (1982). Psychophysiologicaleffects of slow stroke back massage in normotensive females. Advances in Nursing Science, 4(4), 44-61. Madison, A.S. (1973). Psychophysiologicalresponses of female nursing home residents to backmassage: An investigation of the effect of one type of touch. (Doctoraldissertation, Uni-
RESEARCH BRIEFS
42
versity of Maryland, 1973), Dissertation Abstracts International, 35, 914B. Pfieffer, E. (1985). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of American Geriatric Society, 24, 433-441. Sims, S. (1986). Slow stroke back massage for cancer patients. Nursing Times, 82(13) 47-50. Spiegel, D. (1969). SPI discriminators among four psychological health-sickness levels. Journal of Consulting and Clinical Psychology, 33, 750-756. Tyler, D., Winslow, E., Clark, A., & White, K. (1990). Effects of a 1-minute back rub on mixed venous oxygen saturation and heart rate in critically ill patients. Heart & Lung, 19, 562-565.
From the Nursing Administration, Virginia Commonwealth University H1V-AIDS Center, Virginia Commonwealth University, Richmond, VA, and H.H. McGuire Veterans Administration Medical Center, Richmond, VA. Mary C. Cofley, PhD, RN; Associate Professor, Nursing Administration and Information Systems; Joan Ferdter, BSN, RN: Virginia Commonwealth University; Joy Zeh, MS, RN, FNP: Virginia Commonwealth University HIV-AIDS Center; Cynthia Gifford, MS, RNC: Clinical Specialist, H.H. McGuire Veterans Administration Medical Center. Research supported by an intramural Geriatric Leadership Academic Award 1KO7AGO0404from the National Institute on Aging, Bethesda, MD. Address reprint requests to Mary C. Corley, PhD, RN, Associate Professor, Nursing Administration and Information Systems, Virginia Commonwealth University, Box 980567, Richmond, VA 23298-0567. Copyright © 1995 by W.B. Saunders Company 0897-1897/95/0801-000855.00/0
E f f e c t i v e n e s s of a T e l e p h o n e I n t e r v e n t i o n in R e d u c i n g Anxiety of F a m i l i e s of P a t i e n t s in an I n t e n s i v e Care Unit
Marcy J. Johnson and Deborah I. Frank
HE ADMISSION OF a patient to an intensive care unit (ICU) can be a great stress to the family (O'Malley et al., 1991). The family of the patient has many needs, one of which is the need to receive information about the patient's status (Molter, 1979). Hodovanic, Reardon, Reese, and Hedges (1984) described a comprehensive family crisis intervention program to meet family needs.
T
This program incorporated a systematic telephoning of family members to apprise them of the patient's status. Although this clinical program was deemed to be effective, further empirical investigation is warranted. The purpose of this study was to investigate the effectiveness of a similar telephone intervention strategy in reducing the anxiety of family members of patients admitted to an ICU. METHODS
The study used a quasi-experimental, pretest/ posttest control group design. After receiving approval from the appropriate Institutional Review Boards for Protection of Human Subjects, the nursing staff at a cardiac ICU in a medium-sized hospital was oriented to participate in the data collection. On admission of a patient to ICU, family members were approached and asked to participate in the study. The families who agreed to participate (71% of 59 approached) were assigned to the control group or experimental group on an alternate basis. Twenty subjects were in each of the control and experimental groups. Those who agreed to participate immediately completed the State Anxiety portion of the Spielberger State-Trait Anxiety Inventory (STAI) (Spielberger, Gorsuch, & Luschene, 1970). This instrument was selected for its reported validity and reliability as a measure of state anxiety: the transitory emotional response to a stressful situation (Spielberger, 1983). The STAI was administered again 48 hours after the first-testing. Between the time of initial testing and posttesting, the control group received the routine information from the nursing staff about the patient's status. Within the experimental group, a designated family member received a telephone call twice daily to inform them of the status of the patient. The primary care nurse for the patient was designated to call the family at a prearranged time in the morning and evening. The nurse used a protocol checklist to provide the status report that included information about any new treatments, stability of vital signs, level of pain, test reports, or other changes in the patient's condition since the previous call. This checklist was then placed on the patient's chart. RESULTS
There were no significant differences between the experimental and control groups on demo-
Mary C. Corley, Joan Ferriter, Joy Zeh, and Cynthia Gifford
LTHOUGH numerous nursing texts expound on the benefits of back rubs, including improved circulation, pain relief, relaxation, and increased sense of worth, few studies have substantiated these outcomes. The findings are sometimes conflicting and often confusing, with researchers reporting (a) no change in blood pressure or heart rate (Kaufmann, 1964; Longworth, 1982), (b) a decrease in heart rate in elderly women (Madison, 1973), (c) and increase in heart rate and a decrease in oxygen saturation (Tyler, Winslow, Clark, & White, 1990), (d) a decrease in frontalis electromyographic activity (Longworth, 1982), (e) decreases in blood pressure and heart rate and an increase in skin temperature (Fakouri & Jones, 1987, (f) an increase in salivary immunoglobulin A concentration (Gr6er et al., 1994), and (g) an improvement in mood (Sims, 1986). Because findings on back rubs are not conclusive enough to guide nursing practice, and because of the need to address different populations, the research question addressed was as follows: are the physiological and psychological responses different between a 3-minute back rub and a 3-minute control period of undisturbed rest in the institutionalized elderly?
A
METHODS
This study was designed to include 84 participants. However, only 19 residents (8 men and 11 women from a private institution and a federal long-term care facility) agreed to participate. The Short Portable Mental Status Questionnaire (Pfieffer, 1985) and staff evaluations were used to assess ability to give informed consent. The experimental group of 12 included 6 male and 6 female residents randomly assigned using a random number table. The control group consisted of 2 men Applied Nursing Research, Vol. 8, No. 1 (February), 1995: pp. 39-43
and 5 women. Their average age was 78 years; the length of stay in the nursing home ranged from 1 to 84 months. Marital status, religion, and race did not significantly differ between the experimental and control groups using Fisher's Exact Test. The back rubs were administered to the experimental group by the same investigator during the early evening hours in the resident's own room. After 15 minutes of bed rest and before and after the back rub, a second investigator recorded physiological baseline measurements in the same order. The two investigators were in the patient's room throughout the whole period but did not encourage conversation. The control group rested an addition 3 min after the baseline 15-min rest; other steps were the same for the control group.
Physiological Measurements Heart rate was measured by auscultation of the apical pulse. Systolic and diastolic blood pressure values were measured with a mercury column spygmomanometer and a Littman stethoscope (Carolina Biological Supply Company, Burlington, NC) in accordance with the procedures recommended by the American Heart Association for blood pressure determination. Respiratory rate was directly observed by the investigator. Electromyographic (EMG) activity of the masseter and trapezius muscle groups was recorded unilaterally to assess electric potential created by muscle contraction with the J & J EMG (model M-57) (J&J Enterprises, Poulsbo, WA) using noninvasive adhesive electrodes, which were attached to the area over the muscle groups. Before data collection, EMG equipment was tested to assure adequate battery power, and a dummy electrode plate was used to screen the environment for any extraneous electrical noise that might yield artifacts similar to muscle electrical activity. Skin temperature was assessed using a Yellow Springs Instrument Company (Yellow Springs, OH) banjo-style skin thermister taped to the lower back.
Psychological Evaluations Tactual aversion/sensitivity reactions to the back rub and mood were the psychological variables 39
40
RESEARCH BRIEFS
FINDINGS
measured. The Tactual Minimizing Scale, a fiveitem subscale measuring tactile aversion, from the Spiegel Personality Inventory (SPI) (Spiegel, 1969), was adapted by the investigator by making separate items from two multiple variable items, yielding a 10-item scale. The original Tactual Minimizing Scale had a test-retest reliability of .79 with a group of college students and criterion validity with a sample of normal and mentally ill subjects (Spiegel, 1969). Six of the items measured tactile aversion and four measured tactile sensitivity. Participants completed the Tactual Minimizing Scale at baseline only. Mood measurement consisted of three pairs of adjectives (tense/ peaceful, tired/full of vitality, worried/hopeful), reflecting a subjective state of mind associated with high levels of physiological arousal (Sims, 1986). Upon completion of the back rub, the experimental group completed Lane's (1989) questionnaire on their reaction to the back rub (five items: comfortable/uncomfortable, relaxed/tense, annoyed/ pleased, agreeable/disagreeable, calm/nervous) from the Territorial Intrusions and Personal Space Scale, and both groups completed the mood measurement instrument a second time. Lane's entire instrument had a Cronbach's alpha of .85. The reliability of these instruments was not assessed in this sample.
Physiological Variables Baseline physiological variables differed significantly between the two groups only on skin temperature and trapezins EMG. Data analysis using the Wilcoxon test (small sample did not meet assumptions of t test) revealed that men in the experimental group showed a significant increase in skin temperature (M = - 1.08; SD = .97), as did the women in the control group. Mean heart rate, systolic pressure, and diastolic pressure declined slightly from baseline in both the experimental and control groups, but this difference was not significant. The systolic pressure did not differ significantly in the experimental group; however, men showed a decrease in systolic blood pressure (M = 8.3; SD = 11.1) and women showed an increase (M = 3.7; SD = 9.2) The systolic difference range in the experimental group after the back rub was from a decrease of 24 to an increase of 22 mm Hg. (Table 1). Psychological Variables Mood ratings improved for both groups after the back rub or rest period; however, the mood of the experimental group (M = .92; SD = .79) was not significantly better than that of the control group
Table 1. Changes in Physiological and Psychological Variables in Back Rub or Rest Groups (PreIntervention Minus Post-Intervention) Back rub group (n = 12) Female (n = 6) Differences Heart rate (beats/rain) Respiratory rate (breaths/min)* Systolic blood pressure (mm Hg)t Diastolic blood pressure (mm Hg) Skin temperature (°C) Masseter EMG (N,V) Trapezius EMG (I~V) Tactile aversiont'§'** Tactile sensitivity IL,~,**
Rest group (n = 7)
Male (n = 6)
Both
M
SD
M
SD
-1.0 -2.7
7.1 4.1
2.3 1,0
5.1 3.0
-3.7
9.2
8.3
4.7 -0.6 0.3 1.2 3.2 2.3
7,0 0.7 2.3 3.1 0.8 1,5
1.0 -1.1 2.0 -0.5 2.8 0.2
NOTE *p = .02 All Males vs. All Females. 1-p = .04 Experimental Group. Males vs. Females. t p = .05 Experimental vs. Control Group. §p = .01 Experimental vs. Control Group at Baseline, lip = .02 Experimental vs. Control Group Post-Intervention. ~p = ,01 All Males vs. Females. **Baseline measurement only.
Female (n = 5)
M
Male (n = 2)
Both
SD
M
SD
M
SD
M
SD
.7 .8
6.2 3.9
2.6 -2.4
21.3 2.2
-2.0 1.0
5,7 1.4
1.3 1.4
17.7 2.5
11.1
2.3
11.5
0.8
16.7
4.0
16.9
1.7
15.4
3.7 0.9 4.6 1,2 0.8 0.4
2.8 -0.8 1.2 -0.3 5.5 1.3
5.6 .8 3.5 2.4 1.9 1.5
-3.2 -0.5 1.8 -1.0 1.4 3.0
11.7 0.4 2.8 2.5 0.9 0.7
4.0 -1.3 1.5 4.0 3.0 1.0
2.8 0.4 0.7 2.8 1.4 0.0
1.1 0.7 1.7 0.4 5.6 1.3
10.3 0.5 2.3 3.4 1.4 0.8
RESEARCH BRIEFS
41
(M = 1.42; SD = .79) (a lower score reflected improvement). In addition, women in the experimental group showed a significant improvement in mood (M = 1; SD = .89) from the baseline (M = 2.3; SD = .8) assessment. Women in both experimental and control groups scored significantly higher on tactile reactions, particularly tactile sensitivity (M = 1.9; SD = 1.3), than did men (M = .4; SD = .5). W o m e n ' i n the experimental group had significantly greater tactile sensitivity than males in the experimental group. Most residents rated the back rub positively: 83% said they were comfortable, 67% were pleased and calm and found it agreeable, and 58% were relaxed. Correlations Significant correlations were found between a number of variables: (a) greater heart rate differences were correlated with low tactile reaction (r = - . 5 7 ; p ~ .05) and low tactile aversion (r = - .49; p ~< .05); (b) greater respiratory rate differences were correlated with greater skin temperature differences (r = - .61; p = .01), low tactile reaction (r = - . 6 1 ; p < .01), low tactile sensitivity (r = - . 6 2 ; p = .01), and better mood at baseline (r = - .48; p = .05); (c) greater differences in masseter EMG activities were correlated with more negative responses to the back rub (r = .64; p < .05); (d) greater differences in skin temperature were associated with more negative mood changes after the back rub (r = .59; p < .01); (e) greater tactile reaction was associated with poor mood at baseline (r = .59; p < .01); and (f) greater aversion to touch was correlated with poorer mood at baseline (r = .52; p = .05). IMPLICATIONS The significant difference in mood after a back rub has implications for nursing care. Mood improved for both groups, but the improvement was significantly greater for the experimental group. Back rubs may be administered to improve resi-
dents' moods. Although physiological measures did not change significantly, back rubs should be given with caution to a resident whose blood pressure is too low or too high and who shows a decrease or increase of these values. Further research is necessary to determine the effects of back rubs in relation to the medications the patient may be taking. The similarity in the changes in heart rate, diastolic blood pressure, respirations, and EMG readings between the randomly assigned experimental and control groups was not expected. In their exploratory study, Fakouri and Jones (1987) found a significant decrease in heart rate and systolic pressure (4 men and 14 women) with a 3-minute slow-stroke back massage. The study reported here showed no similar effect. The results of the current study also differ from Longworth's (1982), who found a decrease in frontalis EMG activity. However, the correlation between response to back rub and masseter EMG activity may reflect a similar response. Sex differences need further explanation, because they conflict with the findings on blood pressure and heart rate as reported by Kaufman (1964) and Madison (1973). Spiegel (1969) also reported greater tactile sensitivity and aversion in women versus men. More than half of the residents felt relaxed after the back rub, which is important if a back rub is given to relax the subject. On the whole, the effect of the back rub was more positive in the present study than in that of Madison (1973) (54% positive). These findings underscore the need for clinicians to carefully assess the long-term resident's response to back rubs. However, the variation in residents' responses to back rubs points to the need to elicit individual patients' preferences as part of an admissions assessment. ACKNOWLEDGEMENT The authors thank Barbara Mark, Phi), RN, and Jean Wyman, PhD, FAAN, for their valuable assistance in the preparation of the manuscript.
REFERENCES Fakouri, C., & Jones, P. (1987). RelaxationRX: Slow stroke back rub. Journal of Gerontological Nursing, 13(2), 32-35. Grber, M., Mozingo, J., Droppleman, P., Davis, M., Jolly, M., Boyuton, M., Davis, K., & Kay, S. (1994). Measures of salivary secretory immunoglobulin A and State Anxiety after a nursing back rub. Applied Nursing Research, 7, 2-13. Kaufman, M.A. (1964). Autonomic responses as related to nursing comfort measures. Nursing Research, 13, 45-55.
Lane, P. (1989). Nurse-client perceptions: The double standard of touch. Issues in Mental Health Nursing, 10, 1-13. Longworth, J. (1982). Psychophysiologicaleffects of slow stroke back massage in normotensive females. Advances in Nursing Science, 4(4), 44-61. Madison, A.S. (1973). Psychophysiologicalresponses of female nursing home residents to backmassage: An investigation of the effect of one type of touch. (Doctoraldissertation, Uni-
RESEARCH BRIEFS
42
versity of Maryland, 1973), Dissertation Abstracts International, 35, 914B. Pfieffer, E. (1985). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of American Geriatric Society, 24, 433-441. Sims, S. (1986). Slow stroke back massage for cancer patients. Nursing Times, 82(13) 47-50. Spiegel, D. (1969). SPI discriminators among four psychological health-sickness levels. Journal of Consulting and Clinical Psychology, 33, 750-756. Tyler, D., Winslow, E., Clark, A., & White, K. (1990). Effects of a 1-minute back rub on mixed venous oxygen saturation and heart rate in critically ill patients. Heart & Lung, 19, 562-565.
From the Nursing Administration, Virginia Commonwealth University H1V-AIDS Center, Virginia Commonwealth University, Richmond, VA, and H.H. McGuire Veterans Administration Medical Center, Richmond, VA. Mary C. Cofley, PhD, RN; Associate Professor, Nursing Administration and Information Systems; Joan Ferdter, BSN, RN: Virginia Commonwealth University; Joy Zeh, MS, RN, FNP: Virginia Commonwealth University HIV-AIDS Center; Cynthia Gifford, MS, RNC: Clinical Specialist, H.H. McGuire Veterans Administration Medical Center. Research supported by an intramural Geriatric Leadership Academic Award 1KO7AGO0404from the National Institute on Aging, Bethesda, MD. Address reprint requests to Mary C. Corley, PhD, RN, Associate Professor, Nursing Administration and Information Systems, Virginia Commonwealth University, Box 980567, Richmond, VA 23298-0567. Copyright © 1995 by W.B. Saunders Company 0897-1897/95/0801-000855.00/0
E f f e c t i v e n e s s of a T e l e p h o n e I n t e r v e n t i o n in R e d u c i n g Anxiety of F a m i l i e s of P a t i e n t s in an I n t e n s i v e Care Unit
Marcy J. Johnson and Deborah I. Frank
HE ADMISSION OF a patient to an intensive care unit (ICU) can be a great stress to the family (O'Malley et al., 1991). The family of the patient has many needs, one of which is the need to receive information about the patient's status (Molter, 1979). Hodovanic, Reardon, Reese, and Hedges (1984) described a comprehensive family crisis intervention program to meet family needs.
T
This program incorporated a systematic telephoning of family members to apprise them of the patient's status. Although this clinical program was deemed to be effective, further empirical investigation is warranted. The purpose of this study was to investigate the effectiveness of a similar telephone intervention strategy in reducing the anxiety of family members of patients admitted to an ICU. METHODS
The study used a quasi-experimental, pretest/ posttest control group design. After receiving approval from the appropriate Institutional Review Boards for Protection of Human Subjects, the nursing staff at a cardiac ICU in a medium-sized hospital was oriented to participate in the data collection. On admission of a patient to ICU, family members were approached and asked to participate in the study. The families who agreed to participate (71% of 59 approached) were assigned to the control group or experimental group on an alternate basis. Twenty subjects were in each of the control and experimental groups. Those who agreed to participate immediately completed the State Anxiety portion of the Spielberger State-Trait Anxiety Inventory (STAI) (Spielberger, Gorsuch, & Luschene, 1970). This instrument was selected for its reported validity and reliability as a measure of state anxiety: the transitory emotional response to a stressful situation (Spielberger, 1983). The STAI was administered again 48 hours after the first-testing. Between the time of initial testing and posttesting, the control group received the routine information from the nursing staff about the patient's status. Within the experimental group, a designated family member received a telephone call twice daily to inform them of the status of the patient. The primary care nurse for the patient was designated to call the family at a prearranged time in the morning and evening. The nurse used a protocol checklist to provide the status report that included information about any new treatments, stability of vital signs, level of pain, test reports, or other changes in the patient's condition since the previous call. This checklist was then placed on the patient's chart. RESULTS
There were no significant differences between the experimental and control groups on demo-