AROMATHERAPY HAND MASSAGE Aromatherapy - Gradworks

171 Pages·2013·6.83 MB·English

Running Head: AROMATHERAPY HAND MASSAGE
Aromatherapy Hand Massage
for Older Adults with Chronic Pain
Living in Long-Term Care
Kathleen Cino, MS, RN
Submitted in Partial fulfillment
of the Requirements for the Degree
Doctor of Philosophy in Nursing
March 21, 2013
Dissertation Committee
Ann Peirce PhD, RN, Chair
Yiyuan Sun DNSc, RN
Steven Baumann PhD, RN
UMI Number: 3571080
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ADELPHI UNIVERSITY
School of Nursing
Garden City, New York 11530
Approval of Dissertation
Dissertation Title: Aromatherapy Hand Massage for Older Adults Living in Long Term Care
Kathleen Cino
This dissertation was approved by Dr. Anne G. Peirce as Chair, and Drs. Yiyuan Sun and Steven
Baumann as Committee Members
In partial fulfillment for the degree
Doctor of Philosophy in Nursing
Jz/Aaz.
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Arrrfe jG. Peirce PhDjA), RRN
Yiyuan Sun DNSc, RN
--------
Steven Baumann PhD, RN
a.i. xo\b
Date''—
AROMATHERAPY HAND MASSAGE 3
Acknowledgements
Developing this study has been a journey. Along the journey, I have worked with
many nurse scholars. To one in particular I dedicate this work. Dr Anne Peirce, the
chairperson of the dissertation committee has mentored each phase of the growth and
development necessary to accomplish this study. She has provided the necessary support,
criticism, and grounding to keep moving ahead toward the goal. Over the course of many
semesters, she encouraged the best I had to give and never let me settle for less.
I thank Dr Yiyuan Sun, member of the dissertation committee whose expertise in
statistical analysis supported a large part of the development of this document. I thank Dr
Steven Baumann, member of the dissertation committee for using his expertise in the care
of older adults to question, suggest, and encourage changes in this document that
strengthen the case for alternative methods of chronic pain management.
Many hours of PhD course work underscore this document. Dr Jane White
helped to begin this journey of scholarship in the courses, writing, and dialogues we
shared with my cohort colleagues. In addition, I want to thank Dr Donohue-Porter for
her work as administrator of the doctoral program.
This study would not have been possible without the cooperation of
administrators, nursing directors, nursing supervisors, and medical directors as well as
many unit nurses and social workers. The residents of the long-term care facilities who
participated in the project are forever in my heart. I thank Dr Sharon Henle, Dr Virginia
Peterson, and Dr Kathleen Walsh for their expertise, time, and presence during data
collection.
I thank the American Holistic Nurses Association and the Alpha Omega Chapter
of Sigma Theta Tau International for grant support on this project. Additionally, I thank
the graduate faculty of Adelphi University for the Noah Tubbs Family Scholarship.
I thank my family and friends for their concern and kindness when I needed it.
Finally, I thank my husband John for his support and encouragement along this journey.
I would not have been able to complete this journey without his help.
AROMATHERAPY HAND MASSAGE 4
TABLE OF CONTENTS
Title...............................................................................................................................................1
Committee signatures...................................................................................................................2
Acknowledgements......................................................................................................................3
Table of Contents..........................................................................................................................4
List of Tables.................................................................................................................................8
List of Figures................................................................................................................................9
Abstract........................................................................................................................................10
Chapter 1: Problem Identification............................................................................................11
Background...................................................................................................................11
Theoretical Model for Study.......................................................................................18
Significance of the Study.............................................................................................23
Purpose..........................................................................................................................24
Research Questions.......................................................................................................24
Summary........................................................................................................................24
Chapter 2: Review of the Literature.......................................................................................26
Chronic Pain...................................................................................................................26
Older Adults and Chronic Pain.................................................................................28
Chronic Pain Coping......................................................................................................31
Older Adults’ Chronic Pain Coping.........................................................................34
Assessment of Chronic Pain and Long-Term Care....................................................36
Management of Chronic Pain and Long-Term Care.................................................40
Chronic Pain Protocols.................................................................................42
AROMATHERAPY HAND MASSAGE 5
Complementary and Alternative Medicine...............................................................44
CAM in Nursing............................................................................................45
CAM and Older Adults.................................................................................47
CAM in Long-Term Care............................................................................48
Aromatherapy................................................................................................................49
Massage........................................................................................................................53
Nurse Presence............................................................................................................56
Summary......................................................................................................................59
Chapter 3 Methodology...........................................................................................................62
Design..........................................................................................................................62
Methods/Sample.........................................................................................................62
Theoretical and Operational Definitions of Study Variables...............................64
Research Hypothesis/Questions...............................................................................65
Instruments.................................................................................................................66
Demographic Data Instrument....................................................................66
The Iowa Pain Thermometer.......................................................................67
Geriatric Multidimensional Pain and Illness Inventory...........................67
Procedure for Data Collection...................................................................................69
Protection of Human Subjects.....................................................................................75
Data Analysis..............................................................................................................76
Chapter 4 Presentation of Results.........................................................................................77
Overview of Data Collection and Analysis............................................................77
Recruitment of Participants and Resulting Sample...............................................77
AROMATHERAPY HAND MASSAGE 6
Instruments..................................................................................................................78
Geriatric Multidimensional Pain and Illness Inventory........................................79
Interrater Reliability Testing of Geriatric Multidimensional Pain Illness Inventory
80
The Iowa Pain Thermometer.....................................................................................80
Data Analysis Procedure...........................................................................................81
Description of Sample Characteristics....................................................................82
Outcome variables......................................................................................................93
Inferential Statistics....................................................................................................93
Research Question 1 Analysis...................................................................................93
Data cleaning....................................................................................................93
Tests of normality............................................................................................94
Homogeneity of variance and variance-covariance matrices.....................97
Multicollinearity...............................................................................................98
Results of analysis..........................................................................................98
Research Question 2 Analysis...................................................................................101
Repeated Measure ANOVA for Mixed Design.......................................102
Tests of normality...............................................................................102
Homogeneity of variance/covariance.............................................103
Sphericity............................................................................................104
Results of analysis.........................................................................................104
Weekly difference analysis............................................................................105
Results of analysis for week two..................................................................107
AROMATHERAPY HAND MASSAGE 7
Results of analysis for week three.............................................................107
Results of analysis for week four..............................................................108
Results of analysis for week five...............................................................108
Exploratory Analysis for Research Question 2 .......................................109
Summary......................................................................................................112
Chapter 5 Summary, Discussion, Limitations, Implications, Recommendations, and
Conclusions...........................................................................................................................113
Summary...................................................................................................................113
Limitations.................................................................................................................114
Discussion..................................................................................................................116
Implications................................................................................................................120
Recommendations for Further Research................................................................121
Conclusions................................................................................................................121
References...............................................................................................................................123
Appendices.............................................................................................................................142
A: Histograms...........................................................................................................142
B: Hand M technique.................................................................................................146
C: The Iowa Pain Thermometer..............................................................................147
D: The Geriatric Multidimensional Pain and Illness Inventory............................148
E: Informed Consent..................................................................................................150
F: Adverse Event Protocol.........................................................................................153
G: Demographic Data Form.......................................................................................154
H: Study Flyer............................................................................................................156
AROMATHERAPY HAND MASSAGE 8
I: IRB Approval- Adelphi University...................................................................157
J: Letters of Agreement............................................................................................164
List of Tables
Table 1: Classification of CAM Modalities.............................................................15
Table 3.1:Timeline for Data Collection.....................................................................74
Table 4.1: Descriptive Statistics for Demographic Data.........................................83
Table 4.2: Descriptive Statistics for Minimum Data Set.........................................85
Table 4.3: Descriptive Statistics for Group Demographic Data.............................86
Table 4.4: Pain Medications........................................................................................89
Table 4.5: Antidepressants and Other Psychiatric Medications..............................90
Table 4.6: Sleeping and Antianxiety Medications.....................................................91
Table 4.7: Frequency of Medical Diagnosis..............................................................92
Table 4.8: Descriptive Statistics of Dependent Variables......................................96
Table 4.9: Levene’s Test of Equality of Error Variances on Six Dependent
Variables........................................................................................................................97
Table 4.10: Test of Between Subjects Effects Derived From MANOVA Analysis
...........................................................................................................................................99
Table 4.11: Descriptive Statistics for Pain and Suffering......................................100
Table 4.12: Model Summary Generated from ANOVA Analysis of Pain and
Suffering......................................................................................................................101
Table 4.13: Descriptive Statistics for Iowa Pain Thermometer.............................102
Table 4.14: Model Summary Generated from Repeated Measures Analysis of
Research Question 2 ................................................................................................105
AROMATHERAPY HAND MASSAGE 9
Table 4.15: Model Summary Generated from Repeated Measures Analysis of IPT
Scores at Week 2 .........................................................................................................107
Table 4.16: Model Summary Generated from Repeated Measures Analysis of IPT
Scores at Week 3 108
Table 4.17: Model Summary Generated from Repeated Measures Analysis of IPT
Scores at Week 4 .........................................................................................................108
Table 4.18: Model Summary Generated from Repeated Measures Analysis of IPT
Scores at Week 5..........................................................................................................109
Table 4.19: Tests of Within Subjects Effects Derived From Profile Analysis... 109
List of Figures
Figure 1 :Model of Aromatherapy Hand Massage Effect on Chronic Pain..........19
Figure 2: The Body-Self Neuromatrix.......................................................................21
Figure 3: Profiles of treatment groups indicating change in IPT score across time
.........................................................................................................................................Ill
Figure 4: Histogram for Pain and Suffering............................................................142
Figure 5: Histogram for Life Interference...............................................................143
Figure 6: Histogram for Emotional Distress...........................................................144
Figure 7: Histogram for the Iowa Pain Thermometer Posttest Scores.................145