Guided Imagery on Bio Physiological Parameters among Patients receiving Chemotherapy
T. Angel Priya1, Dr. N. Ganapathy2, Dr. P. Padmavathi3
1Principal, The Salvation Army Catherine Booth College of Nursing, Nagercoil.
2Chairman, Dhanvantri College of Nursing, Namakkal.
3Principal, Dhanvantri College of Nursing, Namakkal.
*Corresponding Author Email: priyabangel@gmail.com
ABSTRACT:
Cancer is a group of diseases characterized by uncontrolled and unregulated growth of cells. Chemotherapy is used to treat cancer which has many adverse effects that can be reduced by mind-body medicine. One amongst which is Guided Imagery that uses mental imagery to focus and direct the users’ imagination. So the researcher decided to create awareness about guided imagery and make them to practice the same to bring a reduction in their bio-physiological parameters. This study evaluates the effectiveness of guided imagery on selected bio physiological parameters among patients receiving chemotherapy in selected hospitals at Kanyakumari district, Tamilnadu. Evaluative research approach, quasi experimental time series research design was used for this study. It was conducted in Holy Cross Hospital, Nagercoil, Kanyakumari District among 20 samples selected by purposive sampling technique. After obtaining permission from the hospital and informed consent from the samples, demographic variables and clinical variables were collected. Pretest was conducted immediately after chemotherapy by using Observation tool which consisted of measurement of heart rate and blood pressure. Guided imagery was administered to them and post test was conducted for all the cycles (1st to 5th cycles). Majority of the samples belongs to the age group of 50-59 years, have an educational status of degree and above, were homemakers, belongs to nuclear family, reside in urban area with more than two children and have no social habits. 50% of them were males and 50% of them were females. All of them had identified their disease through biopsy and were with Cancer stomach with the duration of 12-120 months using adplatin as the chemotherapeutic drug have not undergone surgical treatment and taken ayurvedic treatment too. Half of them were in 2nd and 3rd stages of cancer respectively. 40% of them have not taken antiemetic drugs and 40% of them had taken antiemetic drugs for less than 12 months. It was also found that there was a move of samples from abnormal to normal heart rate and blood pressure after guided imagery. The pre test to final post test improvement of heart rate was statistically very highly significant (P<0.001). The pretest mean systolic blood pressure was 139.0±8.8mm/Hg. The pretest mean systolic blood pressure was 139.0±8.8mm/Hg. The post-5 tests mean systolic blood pressure was 123.0±4.8mm/Hg. The improvement of systolic blood pressure was statistically very highly significant (P<0.001). The pre test means diastolic blood pressure was 91.0±5.7mm/Hg. The post-5 tests mean diastolic blood pressure was 77.0±8.2mm/Hg. The improvement of diastolic blood pressure was statistically highly significant (P<0.01). Thus it was proved that guided imagery can effectively reduce the bio-physiological parameters that rise due to chemotherapy.
KEYWORDS: Cancer, chemotherapy, bio-physiological parameters, guided imagery.
INTRODUCTION:
Cancer is a group of more than 200 diseases characterized by uncontrolled and unregulated growth of cells. It is a major health problem that occurs in all people of all ethnicities. The most commonly diagnosed cancer worldwide was those of the lung (1.8 million, 13% of the total) and breast (1.4 million, 9.7%). The most common causes of cancer death were concerns of the lung (1.6 million, 19.4% of the total), liver (0.8 million, 9.1%) and stomach (0.7 million, 8.8%)1.
There are many types of treatment for cancer. The types of treatment will depend on the type of cancer. Most people will have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. Chemotherapy is used to treat many types of cancer. Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Damage to healthy cells may cause side effects, such as fatigue, mouth sores, nausea and hair loss2.
A variety of changes occurs in the bio-physiologic parameters also which cannot be relieved by drugs. So it requires some sort of mind-body medicine. Mind-body medicine uses methods as calming the mind, relaxing the body, expressing emotions, changing negative thoughts and controlling physical functions. The method of mind-body medicine includes meditation, bio feedback, guided imagery, hypnosis, acupressure, group therapy, behavior therapy, cognitive restructuring and individual psychotherapy. Guided Imagery is also called “visualization therapy”. This method uses mental imagery to focus and direct the users’ imagination to affect their actions. This is an alternative therapy of holistic healing3.
Guided Imagery uses the power of thought to influence psychological and physiological states4. Lewis emphasized the uses of guided imagery in health care. He discusses how it can significantly reduce stress, pain, side effects of treatments, blood pressure, headaches and strength immune functioning. Patients are encouraged to be active participants in their care. Patients, family members and staff have demonstrated positive benefits5.
The researcher found from her clinical experience that most of the cancer patients are vulnerable to severe fatigue and changes in bio-physiological parameters like blood pressure and heart rate during and after chemotherapy which cannot be relieved by drugs.
Hence, the researcher felt that there is a need to reduce the bio-physiological parameters like blood pressure and heart rate. So the researcher decided to create awareness among oncologic patients about guided imagery, make them to practice the same and find out the extent of successive reduction in bio-physiological parameters among those patients.
STATEMENT OF THE PROBLEM:
A study to evaluate the effectiveness of Guided Imagery on selected bio physiological parameters among patients receiving chemotherapy in selected hospitals at Kanyakumari district, Tamilnadu.
OBJECTIVES:
· To assess the bio physiological parameters before and after Guided Imagery among patients receiving chemotherapy.
· To find out the effectiveness of Guided Imagery among patients receiving chemotherapy.
Operational Definitions:
Guided imagery
It refers to administration of combination of music with words for a period of 18 minutes in each cycle after chemotherapy with the help of an audio recorded CD.
Bio-physiological parameters:
It includes blood pressure and heart rate assessed by digital BP apparatus.
Chemotherapy:
Patients in 2nd and 3rd stage of cancer receiving chemotherapy (1st to 5th cycle).
HYPOTHESIS:
H1 There is a significant difference between pre test and post test scores of guided imagery on selected bio physiological parameters among patients receiving chemotherapy.
MATERIALS AND METHODS:
Evaluative research approach, quasi experimental time series research design was used for the study.
The study was conducted in Holy Cross Hospital, Nagercoil at Kanyakumari District among 20 samples selected by purposive sampling technique.
After obtaining permission from the hospital and informed consent form the samples, demographic variables such as age, gender, educational status, occupation, type of family, residence, number of children, habits and clinical variables such as disease identification, duration of illness, type of cancer, stage of cancer, type of chemotherapeutic drug, mode of chemotherapy, history of intake of anti emetic medication, course of chemotherapy, type of surgery and any other treatment were collected.
Pretest was conducted among them immediately after chemotherapy by using Observation tool which consisted of measurement of heart rate and blood pressure. Guided imagery was administered to them and post test was conducted for all the cycles (1st to 5th cycles).
The bio-physiological parameters among patients receiving chemotherapy before and after guided imagery were analyzed by using frequency and percentage. To find out the effectiveness of guided imagery among patients receiving chemotherapy, paired ‘t’ test was used.
RESULTS AND DISCUSSION:
The findings showed that majority of the samples belongs to the age group of 50-59 years, have an educational status of degree and above, were homemakers, belongs to nuclear family, reside in urban area with more than two children and have no social habits. 50% of them were males and 50% of them were females. All of them had identified their disease through biopsy and using chemotherapeutic drug through IV mode. Majority of them were with Cancer stomach with the duration of 12-120 months using adplatin as the chemotherapeutic drug and has not undergone any other treatment. Half of them were in 2nd and 3rd stages of cancer respectively. 40% of them have not taken antiemetic drugs and 40% of them had taken antiemetic drugs for less than 12 months.
Table-1: Assessment of study samples’ Heart Rate, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) before and after undergoing guided imagery. N=20
|
Test |
Heart Rates |
Systolic Blood Pressure (SBP) |
Diastolic Blood Pressure (DBP) |
|||||||||
|
Abnormal |
Normal |
Abnormal |
Normal |
Abnormal |
Normal |
|||||||
|
No |
% |
No |
% |
No |
% |
No |
% |
No |
% |
No |
% |
|
|
Pre test |
12 |
60 |
8 |
40 |
20 |
100 |
0 |
0 |
18 |
90 |
2 |
10 |
|
Post test-1 |
4 |
20 |
16 |
80 |
18 |
90 |
2 |
10 |
12 |
60 |
8 |
40 |
|
Post test-2 |
2 |
10 |
18 |
90 |
18 |
90 |
2 |
10 |
10 |
50 |
10 |
50 |
|
Post test-3 |
0 |
0 |
20 |
100 |
14 |
100 |
6 |
30 |
6 |
30 |
14 |
70 |
|
Post test-4 |
0 |
0 |
20 |
100 |
10 |
50 |
10 |
50 |
4 |
20 |
16 |
80 |
|
Post test-5 |
0 |
0 |
20 |
100 |
6 |
30 |
14 |
70 |
4 |
20 |
16 |
80 |
Table-2: Effectiveness of guided imagery in the improvements of heart rate, systolic blood pressure and diastolic blood pressure. N=20
|
Test |
Improvement in Heart Rate |
Improvement in Systolic Blood Pressure |
Improvement in Diastolic Blood Pressure |
df |
||||||
|
Mean |
SD |
t |
Mean |
SD |
t |
Mean |
SD |
t |
||
|
Pre-Post-1 |
2.4 |
3.0 |
2.571* |
9.0 |
7.4 |
3.857** |
7.0 |
6.7 |
3.280** |
9 |
|
Post-1-Post-2 |
0.2 |
1.8 |
0.361 |
0.0 |
0.0 |
0.0 |
0.0 |
4.7 |
0.0 |
9 |
|
Post-2-Post-3 |
1.6 |
1.8 |
2.753 |
3.0 |
4.8 |
1.964 |
2.0 |
6.3 |
1.000 |
9 |
|
Post-3-Post-4 |
0.6 |
1.6 |
1.152 |
2.0 |
4.2 |
1.500 |
4.0 |
7.0 |
1.809 |
9 |
|
Post-4-Post-5 |
1.2 |
1.0 |
3.674** |
2.0 |
4.2 |
1.500 |
1.0 |
5.7 |
0.557 |
9 |
|
Pre-Post-5 |
6.0 |
2.8 |
6.708*** |
16.0 |
7.0 |
7.236*** |
14.0 |
8.4 |
5.250** |
9 |
*** P<0.001; ** P<0.01; *P<0.05
The above table shows that in the pretest, 60% of samples had abnormal heart rate before undergoing guided imagery. After guided imagery, 60% was reduced to 20% at first post test and at post-2, it was further reduced to 10%. After that all the study samples (100%) were normal in post tests 3, 4 and 5. Similarly, 100% of samples had abnormal SBP before undergoing guided imagery. After undergoing guided imagery, the above abnormal samples were reduced to 90% at first post test and post-2. At post test-3, 70% were abnormal. At the 4th and 5th post test, 50% of samples had abnormal and normal SBP respectively. 90% of samples had abnormal DBP before undergoing the intervention. After undergoing the intervention, the abnormality was reduced as 60%. Successively, the abnormalities of DBP were reduced to 50% and 30% in post-2 and 3 tests. Subsequently, in post 4 and 5 tests the abnormality was reduced as 20% each.
The above table shows that heart rates and blood pressure were improving from pre test to post-1, 2, 3, 4 and 5. The pre test to final post test improvement of heart rate was statistically very highly significant (P<0.001). The pretest mean SBP was 139.0±8.8mm/Hg. The post-5 test mean SBP was 123.0±4.8mm/Hg. The improvement of SBP was statistically very highly significant (P<0.001). The pre test mean DBP was 91.0±5.7mm/Hg. The post-5 test mean DBP was 77.0±8.2mm/Hg. The improvement of DBP was statistically highly significant (P<0.01).
REFERENCES:
1 Lewis. (2011). Medical Surgical Nursing. New Delhi. Chintamani publications.
2 National Cancer Institute. (2015). Retrieved from https://www.cancer.gov/about-cancer/treatment/types.
3 Dreber T. Mind, Body and Medicine. The Use of Guided Imagery with Stress. Home Health Care Nurse, 1998; 14 (16): 878-888.
4 Baider L, Uziely B, De Nour AK. Progressive Muscle Relaxation and Guided Imagery in Patient’s with Stress. General Hospital Psychiatry, 1997; 16: 340-347.
5 Lewis H. Uses of Guided Imagery in Health Care. The Journal of Invasive Cardiology, 1999; 17 (4): 75-79.
Received on 08.02.2018 Modified on 28.03.2018
Accepted on 08.04.2018 ©AandV Publications All right reserved
Asian J. Nursing Education and Research. 2018; 8(3):437-439.
DOI: 10.5958/2349-2996.2018.00089.7