The aim of this study was to test the hypothesis that the practical application of reflexology in nursing students for 5 weeks, causing a wide range of bodily behaviors and improved quality of life.

1. SYMPOSIUM 2015
REFLEXOLOGY AND HEALTH EDUCATION IN NURSING STUDENTS
Quality of life, perceived manifestations
and
emerging meanings of an educational experience
UNIVERSITY ROVIRA I VIRGILI, TARRAGONA (CATALONIA) (SPAIN)
SCHOOL OF NURSING
I INTEGRATIVE NURSING SYMPOSIUM
Reykjavik 2015
Esmel-Esmel Neus
Ricomà Muntané Roser
Moreno Sànchez Montserrat
Jimenez-Herrera Maria

2. INTEGRATIVE MEDICINE
 Combining communication technology and less aggressive methods, less invasive, less toxic
to facilitate integrating health different modalities
 Importance of the relationship as central
 Physical emotional balance spiritual
REFLEXOLOGY
 It’s a non invasive technique in relation to that person has a key role
 It reflects a comprehensive view of the person
 Integration information, communication and presence
 Alleviate suffering, accompany, releases stress, causes relaxation
PREVENTION INTEGRATION COMUNICACION FUTURE
SYMPOSIUM 2015
INTEGRATIVE MEDICINE AND REFLEXOLOGY

3. INTRODUCTION: Reflexology
 In our Nursing school students can learn:
Complementary nursing techniques
 3 Credits ECTS optional yearlong
 This subject is taught for two years
 The first year they learn: Reflexology and Relaxation
The second year we deepen reflexology
and introduce: Sound Therapy with Tibetan bowls
Musictherapy
Flower remedies
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4. DEVELOPMENT OF CLASSES
 Theoretical classroom sessions
 Practical classes in the laboratory
 Creative work
 Final evaluation
LEARNING OBJECTIVES
 The current state of affairs and scientific evidence
 The treatment technique and application
 Perception, presence, touch, contact
 Observation of the process and personal experience
INTRODUCTION: Reflexology

5.  Draw in the foot anatomy and reflex areas.
 Practicing including stroke technique
 Observe the bodily manifestations during
and between sessions
 Create a mold of the foot itself and draw in
the reflex zones
 We applied H. Marquardt reflexology map
INTRODUCTION:Reflexology
The interest in offering an integrative, innovative and
creative learning, has led us to create a
METHODOLOGY OWN

6. SYMPOSIUM 2015
 It’s a therapeutic modality frequently used in various
countries of Europe and America (Mc Cullough 2014,
Muñoz Selles, 2013, Bordes, 2013, Launso, 1999).
IT HAS BEEN SHOWN TO BE EFFECTIVE IN IMPROVING THE
QUALITY OF LIFE
Of cancer patients (Hughes, 2011). Help in coping with
the pain of fibromyalgia (Lu Wa, 2011, Gunnarsdottir, 2010).
Improve the quality of sleep in women after giving
birth (Chia- Yen Li, 2011) and many other health
problems (Mc Cullough 2014,Vicar, 2007, Launso, 1999)
INTRODUCTION: Reflexology

7.  It is known that in some cases applying
reflexology promotes the appearance of
different physical manifestations during the
session (Bordes, 2013, Gunnarsdottir 2010)
 These manifestations provide information
about the progress of the session and allow
the therapist to adapt the treatment to the
needs that arise (Marquart, 2003, Lett, 2000,
Dougans I. 2006)
SYMPOSIUM 2015
Reflexology: Manifestations

8.  In the days following or between sessions, other types of
“unpleasant” manifestations can appear before
improvement, (Gunardotsit 2010, Marquartd, 2003, Lett
2000)
 Some of these manifestations can be unpleasant and
various authors have defined them as curative crises
due to a detoxification effect or catharsis in which the
emotional overflow is part of the healing process
(Mackereth 2006).
 However, we know little about the physical behaviours
associated with reflexology or what they express
(Gunasdotir 2010).
SYMPOSIUM 2015
Reflexology: Manifestations

9. THE STUDY: Aim
The aim of this study is to test the hypothesis that the practical
application of reflexology in nursing students for 5 weeks, causing
a wide range of bodily behaviors and improved quality of life.
This is the first part of a larger study involving 100 nursing students
allocated into 4 groups involved.
In this symposium results are presented:
 GROUP A: The preview of the results of bodily behaviors
perceived by the first group of students (33 participants).
 GROUP B: The results of the first two groups(62 participants) in
reference to the relationship between quality of life and the
application of reflexology.
Learning from the experience.
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10. OBJECTIVES
a) To describe the physical and emotional
manifestations that nursing students perceived
during and between sessions
b) To analyze the effect of reflexology regarding
quality of life of nursing students who received this
training
c) To know the level of understanding acquired and
determine the value attributed to the practical
training and creative sessions.
d) To discover the essence and meaning of the
process through experiential narratives.
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11. PARTICIPANTS
Group A: 25 sophomores nursing 22 female 3 male
Group B: 62 sophomores nursing 54 female 8 male
 Data collection Set a Dec 2014
 Intervention: 1 weekly session of 40 minutes / 5 weeks
MEASURES
 Inventory ad hoc perceived manifestations during and
between sessions.
 SF12 quality of life questionnaire
 Write stories about their teaching experience
 Questionnaire with closed questions about awareness of
complementary therapies
METODOLOGY: Descriptive observational study
with a quantitative and a qualitative methodology.
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12. RESULTS
Perceived manifestations during sessions
THE MOST SIGNIFICANT
OTHER: Crying. Lacrimation. Sweat. Diuresis. Itching. Chills
Asleep during the session. Restlessness
INFERENTIAL REGARDING AGE (ANOVA)
 No statistically significant differences on the influence of age
 No significant differences between zone reflex systems.
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RELAXATION WELLNESS BOWEL
MOVEMENTS
Relaxation was identified by all participants in all sessions

13. RESULTS
Perceived manifestations between sessions
THE MOST SIGNIFICANT
DIURESIS DEPOSITION MUCUS DREAMS
OTHER:
SALIVATION FATIGUE VAGINAL
/URETHRAL
DISCHARGE
ITCHING IRRITATED
SKIN
SKIN
IMPURITIES

14. Table 1 Values of p. according to test ranges Friedman
D. VARIABLE N CHI.
SQUA
RE
g.
l.
P<
FRAME OF MIND 25 16,88 4 0.0
02
QUALITY SLEEP 25 18.57 4 0.0
01
VITALITY 25 13.29 4 0.0
09
WELLNESS 25 23,36
4
4 0.0
01
FLEXIBILITY OF THE SKIN 25 56,66 4 0.0
01
MOISTURE SKIN 25 42,09 4 0.0
01
CONCENTRATION 25 36,18
3
4 0.0
01
MOTIVATION 25 18,05 4 0.0
01
RESULTS: Perceived improvements
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DEPENDENT VARIABLES IN ALL REVIEW (P <0.01)
The statistically significant values were achieved in the last session

15. RESULTS: Quality of life
SYMPOSIUM 2015
Statistical analysis was
performed using SPSS
(version. 15.0).
The level of significance
was 0.05.
The respective values of the
probabilities under the null
hypothesis of no difference
between pretest and posttest
are: Item 4 (p = 0.312); item 5
(p = 0.024); item 6 (p = 0.01)
Item 7 (p = 0.296).
Average N
Standard
deviation
p<
(P. Wilcoxon)
Par 1 ITEM 1 PRE 2,42 64 ,708
ITEM 1 2,25 64 2,42 0.115
Par 2 ITEM2 PRE 2,88 64 2,25
ITEM 2 2,97 64 2,88 0.058
Par 3 ITEM 3 PRE 2,77 64 2,97
ITEM 3 2,77 64 2,77 1
Par 4 ITEM8 PRE 1,70 64 2,77
ITEM 8 1,42 64 1,70 0.103
Par 5 ITEM 9 PRE 3,09 64 1,42
ITEM 9 2,83 64 3,09 0.096
Par 6 ITEM10 PRE 3,03 64 2,83
ITEM 10 2,75 64 3,03 0.147
Par 7 ITEM 11 PRE 4,34 64 2,75
ITEM 11 4,64 64 4,34 0.033
Par 8 ITEM 12 PRE 4,27 63 4,64
ITEM 12 4,43 63 4,27 0.306

16. RESULTS: Quality of life
Therefore, we can say that the evaluated intervention
between pretest and posttest improves task
performance of subjects and mood through , reflected
in: Items 5, Item 6, item 11.
“He had to stop doing certain tasks at work or in their daily activities"
"made less than I wanted to do"
"Have you felt downhearted and blue?"

17. SYMPOSIUM 2015
A new way of body awareness
“Good opportunity to create closer links with the patient, and
also give confidence”
I think it is not only a technical, but a means to meet a person,
know your well being, your confidence, your mode”
A new way of body awareness
Discovering a new form of treatment
RESULTS:Understanding
acquired

18.  “It has shocked me a lot”. “ Surreal”
 “A different feeling, I've never made an anatomic
foot segment so deeply”
 “Some skepticism”
 “Surprised and perplexed to see the close
relationship between the feet and body”
 “Rewarding and surprising”
 “The synchronization of movements relaxation
occurring at that time did not think about
anything, just looked and felt”
 “I could escape from Reality”
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RESULTS: Experience of the first lesson

19.  “At first I had many doubts and fears, I can say that I have gained
security”
 “I started very lost without finding much sense as the subject and
have in mind biomedicine, really cost me believe. The classes
have helped me take off a bandage eyes and to know another
reality”
 “I started very skeptically and despite my ignorance on the
subject I am eager to implement acquired knowledge. It has
been very positive, I have experienced on my own body
sensations of wellness and relaxation”
 “This course quite surprised me, I did not expect to come to
understand things that I could not imagine they existed”
 “I just think this is the essence of nursing care”
RESULTS: Reflections of the last lesson

20. RESULTS:
Practical training and
creative sessions
 “I think that drawing the foot reflex zone and then
practice it is a good learning technique”
 “Very nice and fun, good way to learn a lot”
 “I could not even imagine the detail with which the
organs are reflected in the foot”
 “Practice has allowed me to understand far beyond
the theory”
 “When we were asked to make a foot print i thought
this was not a class of crafts, experience but was
making art therapy”

21. RESULTS: Emerging
values
“ A trust relationship is established without knowing how…” Confidence
“I get laughter at seeing the fellow next door…” The silence in the
following sessions allows me to discover the intimate moment that was
produced and respect that he deserved “ Respect
“My thoughts and my hands were there, at present, it was surprising,
even meditating had got so real presence in the moment” Presence
“It is a creative therapy, the information you receive will indicate the
needs of the person and becomes a co-creation in motion”
Co creativity

22. CONCLUSIONS
 The application of reflexology leads to a wide range of clear
secondary reactions that are expressed through different
physical behaviours.
 In the characterization of the dimensions of quality of life
improved physical and emotional rol.
 There may be a relationship between the application of
reflexology and mechanisms that promote wellness and
comfort.
 Our methodology has proven effective in the health
education of students by promoting an approach to the
essence of nursing, discovering its values and showing essential
holistic understanding of the body. All this leads us to
recognize the importance of this modality in the field of
Integrative Medicine.
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23.  Some limitations of this study were that the participants did
not send their observations and reflections or did so late,
which created difficulties in data analysis. Moreover it comes
to nursing students who did not know the practice of
reflexology in the majority, whereby the movement
technique was not as accurate as when applied by a
trained professional, despite which the results confirm the
high potential of this therapy for nursing professionals.
 The need to investigate the matter with a broader mind to
demonstrate objectively yet unobserved effects that may
corroborate the positive perception that reflect different
studies show that students perceived.
Limitations of this study

24. Bibliography
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physiological and biochemical outcomes associated with a
reflexology treatment: A systematic review. Evidence-based
Complementary and Alternative Medicine 2014.
 2.Bordes M. “Esto no es una mancia”. Un análisis de las formas de
diagnóstico y tratamiento en las medicinas alternativas. Ciencias
sociales y religión 2013;19:49-71.
 3.Muñoz-Sellés E, Goberna-Tricas J. Oferta formativa en terapias
alternativas y complementarias para la asistencia al parto. Matronas
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 4.Launsø L, Brendstrup E, Arnberg S. An exploratory study of
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 5.Hughes CM, Krirsnakriengkrai S, Kumar S, McDonough SM. The effect
of reflexology on the autonomic nervous system in healthy adults: a
feasibility study. Altern Ther Health Med [Internet] 2011;17:32–7. Online
document at: http://www.ncbi.nlm.nih.gov/pubmed/22164810
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25.  6.Lu WA, Chen GY, Kuo CD. Foot reflexology can increase vagal modulation,
decrease sympathetic modulation, and lower blood pressure in healthy subjects
and patients with coronary artery disease. Alternative Therapies in Health and
Medicine 2011;17: 8–14.
 7.Gunnarsdottir TJ, Peden-McAlpine C. Effects of reflexology on fibromyalgia
symptoms: A multiple case study. Complement Ther Clin Pract 2010;16:167–72.
 8.Li CY, Chen SC, Li CY, Gau ML, Huang CM. Randomised controlled trial of the
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 Vicar 2007
 9.Marquardt H. Manual práctico de la terapia de las zonas relfejas de los pies.
Barcelona: Urano, 2003.
 10. Lett A. The future of reflexology. Complementary therapies in nursing &
midwifery 2002;8:84–90.
 Mackereth PA. An introduction to catharsis and the healing crisis in reflexology.
Complementary therapies in nursing & midwifery 1999;67–74.
 Dougans I. The new reflexology: A unique blend of traditional Chinese medicine
andWestern reflexology practice for better health and healing. NY:
Marlowe&Co.; 2006
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26. SYMPOSIUM 2015
INTEGRATIVE NURSING
Reykjavik 2015
Thanks for your atention
www.neusesmel.com