INTRODUCTION:

The maintenance and promotion of health is achieved through different combination of physical, mental and social well being. Health is a positive quality of life which helps us to live to in fullest and serve our fellowmen to the best of our ability. Health is an elusive word. Most people who consider themselves healthy are not actually healthy.

And many people, who are suffering from some known disease, may be relatively healthy. Health is a concept which does not merely related to absence of disease, of healthy working of organs, or having good thoughts. Health is a holistic concept. It relates to a person as a whole. The state of one’s health is reflective of an individual’s ability to meet life’s challenges and maintain his or her capacity for optimal functioning. This requires the various aspects of one’s makeup i.e. mental, physical and biochemical, to maintain a level of functioning that has a positive influence and support for one another. (WHO 2011).

The first recording of human blood pressure came in 1847 when Carl Ludwig inserted a catheter in patient’s artery and hooked the catheter to an invention called kymograph. Identifying diagnosing treating and controlling hypertension at an early stage can significantly reduce the risk of developing heart attacks kidney failure or strokes.

Hypertension is often called the “silent killer” because it is frequentely asymptomatic until it becomes severe and target organ disease has occurred. A patient with severe hypertension may experience a variety of symptoms secondary to effects on blood vessels in the various organs and tissues or to the increased workload of the heart. These secondary symptoms include fatigue, reduced activity tolerance, dizziness, palpitations, angina and dyspnea. (Lewis, 2011)

According to medical massage expert, Boris Prilutsky, (2009) massage’s mobilization of skin, connective tissue, muscle tissue and the periosteum, stimulates receptors that send messages of relaxation to the central nervous system. These reflexes cause vasodilation, resulting in decreased blood pressure and heart rate. Characterized by long strokes applied of venous and lymphatic flow. It is a painless, gentle and non forceful technique that is not associated with any serious adverse effects. Massage therapy has been shown to decrease sympathetic activity and increase parasympathetic activity. Therefore, this therapy is able to decrease anxiety and stress. In addition, massage therapy is able to reduce blood pressure (BP) and heart rate (HR) in hypertensive individuals. It also increases skin blood flow and suppleness and induces tissue relaxation.

NEED OF THE STUDY:

Hypertension is a major public health problem due to its high prevalence all around the globe. Around 7.5 million deaths or 12.8% of the total of all annual deaths worldwide occur due to high blood pressure. It is predicted to be increased to 1.56 billion adults with hypertension in 2025.

The Global health statistics 2012, 63% of deaths were due to non-communicable diseases (NCD) and cardio vascular disease (CVD) was the most predominant (48%). 13% of global deaths are attributable for raised blood pressure which is a leading behavioural and physiological risk factor. High blood pressure is the third most important risk factor for an attributable burden of NCD in South Asia. Hypertension is responsible for 57% of stroke deaths and 24% of coronary heart disease deaths in India.

In India with a population estimation of 1.1 billion, the prevalence of HTN has been estimated to be 3% to 34.5% in males and 5.8% to 33.5% in females. By the end of 2025 the projected prevalence of HTN in Indian men and women are 22.9% and 23.6%.6 As per the statistics of Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, the overall prevalence of hypertension in India by 2020 will be 159.46/1000 population. The prevalence of HTN has increased in urban communities as well as rural people. The prevalence of hypertension in the last six decades has increased from 2% to 25% among urban residents and from 2% to 15% among the rural residents in India.

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of Swedish massage on blood pressure among patients with hypertension in selected hospitals at Kanyakumari district.

OBJECTIVES OF THE STUDY:

· To assess the pre and post test level of blood pressure among patients with hypertension in experimental and control group.

· To find out the effectiveness of Swedish massage on blood pressure among patients with hypertension in experimental group.

· To determine the association between pre test level of blood pressure with demographic variable such as age, gender, religion, habits injurious to health, occupation, food habits, socio-economic background, duration of hospitalization, duration of illness, co-morbidities, body mass index.

HYPOTHESES:

· H1: The mean post test score of blood pressure among patients with hypertension will be less than the mean pre test score of blood pressure in experimental group who had Swedish massage.

· H2: The mean post test score of blood pressure among patients with hypertension in the experimental group will be lower than the mean post test score of blood pressure among the patients with hypertension in the control group.

· H3: There will be significant association between pre test score blood pressure among patients with hypertension and selected demographic variables such as age, gender, habits injurious in health, occupation, food habits, and socio-economic background, duration of hospitalization, duration of illness, co-morbidities, and body mass index.

MATERIAL AND METHODS:

In this study, accessible population was patients with hypertension in selected hospital, Nagorcoil. Purposive sampling technique was used. The content validity of the tool was established on the basis of the opinion of 5 experts. The reliability of accuracy of sphygmomanometer was ensured by obtaining a certificate from biomedical department. The pilot study was conducted at Jaya raj hospital, Marthandam 6 samples were selected. 3 samples as experimental group and 3 samples as control group. In this study, the sample was clients with hypertension who full fill the sampling criteria in Morris Mathias hospital Nagarcoil. the sample size was 60 patients with hypertension who satisfied the inclusion criteria. Among them 30 patients were as experimental group and 30 patients were as control group. Swedish massage was given patients with hypertension for 20 minutes twice a day at 9am and 4pm twice a day for 5 days. The post-test level of blood pressure was evaluated on the 5^th day for both groups using sphygmomanometer.

Research design:

Quasi-experimental pre-test and post-test control group research design was adopted in this study.

Table A: Diagramatic Representation of Research Design group

	Pre-test	Intervention	Post-test
Experimental group	O1	X1,X2	O2
Control group	O1	X1	O2

Keys:

O1 - Pre- test assessment of blood pressure in the experimental and control group.

O2 - Post-test assessment of level of blood pressure in experimental and control group.

X1 - Hospital routine.

X2 - Swedish massage.

Variables:

Independent variables: In this study the independent variable is “Swedish massage”.

Dependent variable: In this study, the dependent variable is “blood pressure”.

Extraneous variable: In this research study, it refers to demographic profile which consist variables such as age, gender, religion, socio-economic background, occupation, habits injuries in health, food habits, duration of hospitalization, duration of illness, co- morbidities and body mass index.

Research settings: Morris Mathias Hospital is a General Hospital it has 250 beds which is, 40-45 kms away from Thasiah College of nursing. Various specialities and treatments offered at Morris Mathias Hospital. The hospital is equipped with ENT, general surgery, gynecology and obstetrics, medical care, orthopedic surgery, plastic surgery, intensive care unit, emergency department and dialysis unit ect. Each department has 20 – 25 beds are available. The setting was chosen based on the feasibility and availability of clients.

Population:

Target population:

In this study, the target population was patients with hypertension.

Accessible population:

In this study, accessible population was patients with hypertension in selected hospital, Nagorcoil.

Sample:

Sample is defined as “the subset of a population comprising those selected to participate in study”. (Denise F. polit, 2011)

In this study, the sample was patients with hypertension who full fill the sampling criteria in Morris Mathias hospital Nagarcoil.

Sample size: In this study, the sample size was 60 patients with hypertension who satisfied the inclusion criteria. Among them 30 patients were as experimental group and 30 patients were as control group.

Sampling technique: Purposive sampling technique was used to select the sample for the study.

Description of tool: The tool was developed after excessive review of literature, internet search and expert opinion. It helped the investigator to selected most suitable scale. The tool consists of two sections:

Section A: Demographic variables consist of age, gender, religion, socio-economic background, habits injurious in health, food habits, duration of hospitalization, duration of illness, co- morbidities and body mass index.

Section B: Blood pressure diary.

Method of data collection:

Step 1: Selection of patients with hypertension

Step 2: Pre-assessing patients with hypertension.

Step 3: Intervention

Step 4: Post assessment of patients with hypertension

RESULTS AND DISCUSSION:

Frequency and percentage distribution of the level of blood pressure among patients with hypertension according to demographic variables in experimental and control group: depicts that in experimental group majority of clients 43.3% belonged to the age group of 61 and above years. 40% were in the age group of 51-60 years and 16.7% were in the age group of 41-50 years. In the control group most of the clients 43.3% were in the age group 51-60 years, 40% belongs to the age group of above 60 years and 16.7%were in the age group of 41-50 years.

According to sex, majority of the clients both in experimental group and control group were male, ie 60% and 53.3% respectively. According to religion, majority of the clients both in experimental group and control group were Christians ie 53.3% and 60% respectively. Related to dietary pattern, majority of the clients both in experimental group and control group were in non-vegetarian ie 90% and 93.3% respectively. Based on occupation, majority of the clients both in experimental group and control group were in moderate worker ie 60% and 53.3% respectively.

According to unhealthy habits in experimental group majority of them 40% were in nil, 33.3% were smoking and 26.7% were alcoholism. In control group majority of clients 46.7% were nil, 30% were smoking and 23.3% were alcoholism. Related to education, majority of the clients both in experimental group and control group were in formal education ie 83.3% and 80% respectively. According to type of family in experimental group majority of them 60% were joint family and 40% were nuclear family. In control group 53.3% were joint family and 46.7% were nuclear family.

According to monthly income in experimental group majority of them 60% were Rs.10001-20000, 16.7% were both below Rs.10000 and above Rs. 30001. In control group 53.3% were in Rs. 10001- 20000, 23.3% were below Rs.10000, 13.3% were above Rs.30001 and 10% were Rs. 20001-30000.

The mean post test score of systolic blood pressure in experimental group was 145.93 which was less than mean pre test systolic blood pressure score 171.00. The obtained paired ‘t’ value is 23.79 was highly significant at o.ooo level. The mean difference 25.07 is a true difference and it has not occurred by chance.

The mean post test score of diastolic blood pressure in experimental group was 91.10 which was less than mean pre test diastolic blood pressure score 105.26. The obtained paired ‘t’ value is 15.68 was highly significant at 0.000 level. The mean difference 14.16 is a true difference which has not occurred by chance.

The above finding fail to support the null hypothesis. Hence the researcher rejects the null hypothesis and accepts the research hypothesis. This proves that due to the effect of Swedish massage, the mean post test blood pressure score of patients in experimental group had marked reduction.

Depicts that in the experimental group the mean post test systolic blood pressure 145.93 were lesser than the post test systolic blood pressure score of the control group 165.66. The obtained ‘t’ value 5.23 was statistically highly significant at 0.000 level. This indicates the mean difference of 19.73 was true difference and has not occurred by chance.

In the experimental group the mean post test diastolic blood pressure score 91.10 were lesser than the post test diastolic blood pressure score of the control group on 97.93. The obtained ‘t’ value 2.61 was statistically significant at 0.031 level. This indicates the mean difference of 6.83 was true difference and has not occurred by chance. The above findings of systolic and diastolic blood pressure fail to support the null hypothesis. Hence the researcher rejects the null hypothesis and accepts the research hypothesis.

Figure 2: Comparison of post test levels of systolic and diastolic blood pressure among patients with hypertension experimental and control group

CONCLUSION:

The following conclusions were drawn from the study:

· The blood pressure among patients with hypertension in experimental group was significantly reduced after Swedish massage.

· The study proved that Swedish massage was very effective in reducing the blood pressure

· Blood pressure score among patients with hypertension in control group had small changes in post test

· There was association between blood pressure score and selected demographic variables among patients with hypertension

NURSING IMPLICATIONS:

The researcher has derived the following implications from the study result. Blood pressure is one of the most disturbing symptoms. Now a days, so many conventional management modalities are available. Use of drugs can lead to many side effects. This often requires a nursing intervention which has no side effects.

Nursing practice:

· The result of the study encourages the nurse to conduct in service education programs on various types of massages in reducing blood pressure

· In the field of nursing practice the nurse should develop indepth knowledge about Swedish massage among patients with hypertension.

· Nurses should have knowledge regarding the benefits of Swedish massage on patients with hypertension.

· The findings of the study enlighten the fact that Swedish massage can be used to decreased blood pressure among hypertension.

Nursing education:

· Nurse educator can train and encourage the student nurses to implement Swedish massage as a complementary and alternative therapy

· The study motivates student nurses to explore new strategies for reducing the blood pressure

· The nursing curriculum can be updated with the inclusion of Swedish massage as complementary therapies for under graduate.

Nursing administration:

· The study helps the nurse administrator to assess the knowledge of nurses regarding complementary and alternative therapies

· The result of the study encourages the nurse administrator to conduct in service education programs on various types of Swedish massage in reducing blood pressure

· Nurse administrator can prepare the protocol regarding each Swedish massage sessions and provide time schedule in the wards for Swedish massage.

· Nurse administrators can create awareness among nurses by arranging continue nursing education on Swedish massage which is a very good cost- effective nursing intervention to reducing blood pressure

Nursing Research:

· The findings of the study would help to expand the scientific body of professional knowledge upon which their research can be conducted. Large scale study can be conducted on the effectiveness of Swedish massage on blood pressure among patients with hypertension and disseminate the findings through conferences, seminars publishing in nursing journals.

REFERENCES:

1. Brunner and Suddarth’s. (2008). Text book of Medical-Surgic Nursing. (13^th edition). New Delhi; Wolters kluwer publications.

2. Brinda Nochols. (2008). Text book of Medical-Surgical Nursing. (7^th edition). Lippincott Williams and Wilkins publication.

3. Izreen Supa’at. (2012). Effects of Swedish massage therapy on blood pressure in hypertensive women. Volume 13. ID171852.

4. Hena.(2017). Effectiveness of Swedish massage therapy on blood pressure among patients with hypertension. International Journal of development research. Volume 7. Page no 14133- 14136. ISSN 2230-9926.

Received on 27.05.2024 Modified on 11.07.2024

A and V Pub J. of Nursing and Medical Res. 2024; 3(3):104-108.

DOI: 10.52711/jnmr.2024.24

	Blood pressure type	Test	Mean	SD	Mean difference	Paired ‘t’ test	P value
Experimental group	Systolic blood pressure	Pre test	171.00	15.31	25.07	23.79	.000 **
		Post test	145.93	14.48
	Diastolic blood pressure	Pre test	105.26	9.16	14.16	15.68	.000 **
		Post test	91.10	8.22

	Blood pressure type	Mean	SD	Mean difference	‘t’ test	P value
Experimental group	Systolic	145.93	14.48	19.73	5.23	.000**
Control group	Systolic	165.66	14.91
Experimental group	Diastolic	91.10	8.22
Control group	Diastolic	97.93	12.19	6.83	2.61	0.031*