The Effect of Caring Touch on Stress and Immune Response of Patients undergoing Open Heart Surgery

Kim, Hae Soon

Abstract

Open heart surgery is itself a difficult and risky procedure, so patients who receive surgery experiences severe stress and anxiety from physiological and psychological sources. These stresses increase workload of heart and oxigen consumption so that increased pulse rate, blood pressure, arithmia can being a harmful effect to the patients. Thus, nursing intervention should be given in order to reduce these stresses. The purpose of this study was to define "caring touch" which could relieve a patient's anxiety and reinforce his immune reactions. This study examined how "caring touch" could be a easy and useful way of nursing care. Finally, this research attempted to find out when it is appropriate to begin this caring touch compared effect of caring touch given before and after operation. This study was designed using a quasi-experimental approach with non-equivalent control groups and non-synchronized design. The study subjects consisted of 65 adult patients who have undertaken open heart surgery in the two general hospitals of K. and S. located in Inchon and Buchon from the 4th of Jannuary to the 28th of May in 1998. Group A was a study group consisting of 22 patients who were given caring touch twice a day from the day before the operation untill the 7th day after the operation. Group B was a study group consisting of 20 patients who received the care from the 1st day after the operation to the 7th day in the same manner as Group A. The control group consisted of 23 patients who were not given this care. This study used two measuring instrument: Visual Analogue Scale Anxiety which was developed by Cline(1922), and Trait and State Anxiety by Spielberger(1970). Measuring items were blood pressure, pulse rate, cortisol level, percentages of T-lymphocyte, and natural killer cell in the blood. Data collected were analyzed by SAS program for x2 test, ANOVA, Repeated measures of ANOVA, Pearson-correlation, Scheffe multiple comparison, and Profile multiple comparison methods. The results of the study are as follows: 1. Emotional stress reaction Level of VAS anxiety and State anxiety of group A and B showed a significant decline compared to the control group(P<.o5). The anxiety of group A and B showed significant lower level on the 1st day after operation than the day before operation, and the anxiety level was also lower on the 7th day after operation than 1st day after operation(P<.001). 2. Physiological stress reaction Systolic BP measured in groups A and B showed significant higher difference between before and after receiving caring touch compared to control group(P<.05). Systolic BP measured on the 1st day after the operation was lower than the day before and the 7th day after operation(P<.01). The control group however, showed no difference. Diastolic BP measured in group A showed signigicant higher difference between before and after receiving caring touch than control group(P<.05). However, there was no significant difference in it on the three points of measurings. Pulse rate measured in group A showed significant higher difference between before and after receiving caring touch than control group(P<.05), and the pulse rates measured on the 1st day after operation were significantly lower than the day before operation and the 7th day after operation(P<.01). But these was no difference in the control group. The cortisol level of all three groups showed no significant difference, and the level of cortisol measured on 1st day after operation was significantly higher than the day before operation and 7th day after operation(P<.01). 3. Immune reactions T-lymphocyte of group B was found higher rates than the control group(P<.05), and the T-lymphocyte measured on the day befor operation and 7th day after operation were significantly higher than the 1st day after operation(P<.001). NK-cell rate of all three groups revealed no significant difference and NK-cell measured on the 1st day after operation showed higher rates than the 7th day after operation(P<.001). Based on above mentioned results, it is found that emotional and physiological stress of open heart surgery patients can be relieved by giving caring and which was identified on the measured items of VAS Anxiety, State anxiety, BP, and pulse rate. And those measurings were markedly decreased on the 1st day after opertion. Especially group A, which began caring touch before undergoing operation showed less anxiety compared to group B, which received caring touch from the 1st day after operation. Thus, the most appropriate time for giving caring touch was a day before the operation. And also it was found that caring touch increased the T-lymphocyte rate, and immune reactions when anxiety level decreased. Therefore caring touch was proved to be a way of emotional nursing intervention to relieve anxiety and increse immune reaction.