Graduate capstone project presenting preliminary data on showering hydrotherapy. Measurement validation and analysis of vital signs in small group of subjects.

1. Jeanne C. Chilla, BSN, RNC
Western Michigan University
Kalamazoo, Michigan

2. • Original question:
How do women use showers as a pain
management method in labor?
Physiological and Psychological
Responses to Therapeutic
Showering

3. BackgroundBackground
 57% Americans shower daily57% Americans shower daily
 Suggested therapeutic effectsSuggested therapeutic effects
 Humidified airHumidified air
 WarmthWarmth
 MassageMassage
 MovementMovement
 RelaxationRelaxation
 RevitalizationRevitalization
 Pain reliefPain relief

4. Literature ReviewLiterature Review
 Intervention strategyIntervention strategy
 Pain managementPain management
 ElderlyElderly
 Rheumatoid ArthritisRheumatoid Arthritis
 Childbirth/laborChildbirth/labor
 Pre-operative disinfectionPre-operative disinfection

5.  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

6.  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).

7. Research QuestionsResearch Questions
Are there physiologic changes in normal healthyAre there physiologic changes in normal healthy
women of childbearing age after 30 minutes ofwomen of childbearing age after 30 minutes of
showering?showering?
Do normal healthy women of childbearing ageDo normal healthy women of childbearing age
experience psychological changes after 30 minutesexperience psychological changes after 30 minutes
of showering?of showering?

8. MethodMethod
 DesignDesign
 Quasi-experimentalQuasi-experimental
 Repeated measuresRepeated measures
Benfield, Herman, Katz, Wilson, & Davis (2001)Benfield, Herman, Katz, Wilson, & Davis (2001)

9. 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

10. Sample DescriptionSample Description
(N = 10)(N = 10)
 DemographicsDemographics
 CaucasianCaucasian
 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

11.  Visual analogue scaleVisual analogue scale
 Numerical rating scaleNumerical rating scale
 Lee Fatigue Scale (VAS-F)Lee Fatigue Scale (VAS-F)
 Cronbach’sCronbach’s αα internal reliability VAS-Finternal reliability VAS-F
 Pretest/posttest subscalePretest/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

12. 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

13. 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

14. ResultsResults
SPSS 15.0SPSS 15.0
 Physiological changesPhysiological changes
↓↓ Mean pulse rateMean pulse rate ((tt = 3.25= 3.25,df= 8, p = 0.12),df= 8, p = 0.12)
↑↑ Mean HCTMean HCT ((tt = -2.66,= -2.66, dfdf = 9,= 9, pp = .026)= .026)
↓↓ BP (MAP) decreasedBP (MAP) decreased
↑↑ Core temp. increased slightlyCore temp. increased slightly

15. ResultsResults
 Psychological changes (pairedPsychological changes (paired tt-test)-test)
 Tension per VAS (Tension per VAS (tt = 2.54,= 2.54, df =df = 9,9, p = .049).p = .049).
 No other variables showed statisticallyNo other variables showed statistically
significant changes from pretest to posttestsignificant changes from pretest to posttest

16. DiscussionDiscussion
 Lack of variationLack of variation
 Stable hemodynamic and thermodynamicStable 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

17. 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

18. RecommendationsRecommendations
 Larger sample size withLarger sample size with
randomizationrandomization
 Different populations with moreDifferent populations with more
significant health complaintssignificant health complaints
 Observational studiesObservational studies
 Easily reproducible procedure andEasily reproducible procedure and
methodsmethods

19. Nursing ImplicatonsNursing Implicatons
 Establish therapeutic interventionEstablish therapeutic intervention
 Coordinate with therapiesCoordinate with therapies
 Environmental adaptationsEnvironmental adaptations
 Partnering with patientsPartnering with patients

20. ConclusionConclusion
 Unique research opportunityUnique research opportunity
 Opportunity for healingOpportunity for healing
 Evidence based practiceEvidence based practice
 Simple, inexpensive, accessibleSimple, inexpensive, accessible

21. AcknowledgmentsAcknowledgments
Dr. Mary Ann StarkDr. Mary Ann Stark
Dr. Michael MillerDr. Michael Miller
Elizabeth Brand, SNElizabeth Brand, SN

22. 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 thermalGagge, A. P., Stolwijk, A. J., & Hardy, J. D. (1967). Comfort and thermal
sensations associated with physiological responses and various ambientsensations 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 subjectiveGift, 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 aLee, 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

23. QuestionsQuestions ?