Jeanne C. Chilla, BSN, RNCWestern Michigan University

Kalamazoo, Michigan

• Original question:

How do women use showers as a pain management method in labor?

Physiological and Psychological Responses to Therapeutic

Showering

BackgroundBackground

57% Americans shower daily57% Americans shower daily Suggested therapeutic effectsSuggested therapeutic effects

Humidified airHumidified air WarmthWarmth MassageMassage MovementMovement RelaxationRelaxation RevitalizationRevitalization Pain reliefPain relief

Literature ReviewLiterature Review

Intervention strategyIntervention strategy Pain management Pain management

ElderlyElderly Rheumatoid ArthritisRheumatoid Arthritis Childbirth/laborChildbirth/labor

Pre-operative disinfectionPre-operative disinfection

Water quality & Environmental exposureWater quality & Environmental exposure Chemical inhalant—THM, ManganeseChemical inhalant—THM, Manganese PathogensPathogens ScaldingScalding

Literature ReviewLiterature Review

Non-scientific methodsNon-scientific methods

Therapeutic benefits are not reflected in current literature

Japanese studiesJapanese studies Bathing stylesBathing styles Physiological responsesPhysiological responses

PulsePulse BPBP Hct/HgbHct/Hgb

Room temperatureRoom temperature Thermal comfortThermal comfort

Literature ReviewLiterature Review

Hashiguchi, N., Ni, F., & Tochihara, Y. (2002). Kanda, K., Ohnaka, T., Tochihara, Y., Tsukuzi, K., Shodai, Y., & Nakamura, K. (1996).Ohnaka, T., Tochihara, Y., Kubo, M., & Yamaguchi, C. (1995).

Research QuestionsResearch Questions

Are there physiologic changes in normal healthy Are there physiologic changes in normal healthy women of childbearing age after 30 minutes of women of childbearing age after 30 minutes of showering?showering?

Do normal healthy women of childbearing age Do normal healthy women of childbearing age experience psychological changes after 30 minutes experience psychological changes after 30 minutes of showering?of showering?

MethodMethod

DesignDesign Quasi-experimentalQuasi-experimental Repeated measuresRepeated measures

Benfield, Herman, Katz, Wilson, & Davis (2001)Benfield, Herman, Katz, Wilson, & Davis (2001)

SettingSetting

HPER labHPER lab Full bath with single shower stallFull bath with single shower stall Shower seatShower seat Single shower headSingle shower head Subject controlsSubject controls 16 oz water16 oz water

Sample Description Sample Description (N = 10)(N = 10)

DemographicsDemographics Caucasian Caucasian 21-39 years old (21-39 years old (XX = 27.0; = 27.0; SD =SD =7.7)7.7) Single (60%); Married (30%); Divorced (10%)Single (60%); Married (30%); Divorced (10%) Educational levelEducational level

Visual analogue scaleVisual analogue scale Numerical rating scaleNumerical rating scale

Lee Fatigue Scale (VAS-F)Lee Fatigue Scale (VAS-F) Cronbach’s Cronbach’s αα internal reliability VAS-F internal reliability VAS-F

Pretest/posttest subscale Pretest/posttest subscale .96 & .98 fatigue.96 & .98 fatigue

.89 & .92 energy.89 & .92 energy

Gagge Thermal comfort scaleGagge Thermal comfort scale

Measurement ToolsMeasurement Tools

Alpha .05 a prioriAlpha .05 a priori

ProcedureProcedure

HSIRBHSIRB Informed consentInformed consent

Pencil & paper VAS-FPencil & paper VAS-F Numerical rating (0-10) and 100mm VASNumerical rating (0-10) and 100mm VAS

Pain, anxiety, tension, relaxationPain, anxiety, tension, relaxation Gagge Thermal scaleGagge Thermal scale

Pencil and Paper posttests

ProcedureProcedure

Interval measurements (single rater)Interval measurements (single rater) Water & Room temperaturesWater & Room temperatures Core temperatureCore temperature Pulse & BPPulse & BP Lancet hematocritLancet hematocrit Gagge scaleGagge scale

ResultsResultsSPSS 15.0SPSS 15.0

Physiological changesPhysiological changes

↓↓ Mean pulse rate Mean pulse rate ((t t = 3.25= 3.25,df= 8, p = 0.12),df= 8, p = 0.12)

↑↑ Mean HCT Mean HCT ((tt = -2.66, = -2.66, dfdf = 9, = 9, pp = .026) = .026)

↓ ↓ BP (MAP) decreasedBP (MAP) decreased↑ ↑ Core temp. increased slightlyCore temp. increased slightly

ResultsResults

Psychological changes (paired Psychological changes (paired tt-test)-test) Tension per VAS (Tension per VAS (t t = 2.54, = 2.54, df = df = 9, 9, p = .049).p = .049).

No other variables showed statistically No other variables showed statistically significant changes from pretest to posttest significant changes from pretest to posttest

DiscussionDiscussion

Lack of variation Lack of variation Stable hemodynamic and thermodynamic Stable hemodynamic and thermodynamic

statusstatus Subjects at rest vs. ↑activitySubjects at rest vs. ↑activity 30 minutes showering is safe30 minutes showering is safe

Is 30 minutes long enough?Is 30 minutes long enough? Underpowered sampleUnderpowered sample

LimitationsLimitations

Small, homogenous sampleSmall, homogenous sample Data collection errorsData collection errors Palpation & auscultation techniquesPalpation & auscultation techniques Capillary v. serum samplingCapillary v. serum sampling VAS critiqueVAS critique VAS-F instabilityVAS-F instability

RecommendationsRecommendations

Larger sample size with Larger sample size with randomizationrandomization

Different populations with more Different populations with more significant health complaintssignificant health complaints

Observational studiesObservational studies

Easily reproducible procedure and Easily reproducible procedure and methodsmethods

Nursing ImplicatonsNursing Implicatons

Establish therapeutic interventionEstablish therapeutic intervention Coordinate with therapiesCoordinate with therapies Environmental adaptationsEnvironmental adaptations Partnering with patientsPartnering with patients

ConclusionConclusion

Unique research opportunityUnique research opportunity

Opportunity for healingOpportunity for healing Evidence based practiceEvidence based practice Simple, inexpensive, accessibleSimple, inexpensive, accessible

Acknowledgments Acknowledgments

Dr. Mary Ann StarkDr. Mary Ann Stark

Dr. Michael MillerDr. Michael Miller

Elizabeth Brand, SNElizabeth Brand, SN

ReferencesReferences

Benfield, R.D., Herman, J., Katz, V.E., Wilson, S.P., & Davis, J.M. (2001). Benfield, R.D., Herman, J., Katz, V.E., Wilson, S.P., & Davis, J.M. (2001). Hydrotherapy in labor, Hydrotherapy in labor, Research in Nursing & Health, 24, Research in Nursing & Health, 24, 57-67.57-67.

Gagge, A. P., Stolwijk, A. J., & Hardy, J. D. (1967). Comfort and thermal Gagge, A. P., Stolwijk, A. J., & Hardy, J. D. (1967). Comfort and thermal sensations associated with physiological responses and various ambient sensations associated with physiological responses and various ambient temperatures. temperatures. Environmental Research, 1Environmental Research, 1, 1-20. , 1-20.

Gift, A. G. (1989). Visual analogue scales: Measurement of subjective Gift, A. G. (1989). Visual analogue scales: Measurement of subjective phenomena. phenomena. Nursing Research, 38Nursing Research, 38, 5, 286-288. Lee, K. A., Hicks, G., and , 5, 286-288. Lee, K. A., Hicks, G., and Nino-Murcia, G. (1991). Validity and reliability of a scale to assess fatigue. Nino-Murcia, G. (1991). Validity and reliability of a scale to assess fatigue. Psychiatry ResearchPsychiatry Research, 36, 291-298. , 36, 291-298.

Lee, K. A., Hicks, G., and Nino-Murcia, G. (1991). Validity and reliability of a Lee, K. A., Hicks, G., and Nino-Murcia, G. (1991). Validity and reliability of a scale to assess fatigue. scale to assess fatigue. Psychiatry ResearchPsychiatry Research, 36, 291-298. , 36, 291-298.

Complete reference list available by contacting Jeanne C. Chilla, BSN, RNc chillaob@hotmail.com

QuestionsQuestions ?