Obstetrical patients' anxiety during transition of labor and the Nursing intervention of touch
This experimental investigation tested the relationship between the nursing intervention of reassuring touch and selected psycho-physiological manifestations of anxiety in the obstetrical patient during the transitional phase of labor. The study population consisted of ninety obstetrical subjects randomly assigned to one of two groups by a list of random numbers. The control group composed of forty-five (45) subjects received routine nursing care as established by the department of obstetrics of the participating hospital. The experimental group, composed of forty-five (45) subjects, received the same type of care as the control group and received the additional nursing intervention of reassuring touch. These subjects received a five to ten second physical hand contract by the nurse on the subject’s hand, arm or head in response to each verbal expression of anxiety (i.e. “I’m afraid, anxious, going to die, do something, can’t stand it anymore”) during the first thirty minutes of the transitional phase of labor . The study period lasted twenty-one days. The conceptual framework for this study included: touch (Sullivan’s Interpersonal Theory) and stress (Selye’s Adaptation Theory). The independent variable was reassuring touch, and the dependent variable was anxiety as measured by blood pressure levels, by verbal expressions, of subjects during the transition of labor and a self-report of subjects regarding their perception of anxiety. A classification of low, moderate, severe, panic anxiety established from three previous pilot studies was utilized in this investigation. A two-tailed two sample t-test was the statistical method of choice to analyze the relationship between reassuring touch and blood pressure, verbal expressions and self-report. The null hypothesis was rejected in each case at the .05 level of significance. The means of the sample differed significantly. The analysis of variance and a Pairwise Tukey Analysis tested the relationship between reassuring touch and blood pressure, verbal expression and self-report. The null hypothesis was rejected at the .05 level of significance. On the basis of the data collected and analysis of the results, it can be concluded that: The nursing intervention of reassuring touch is effective in significantly reducing the level of anxiety as expressed in blood pressure readings during the subject’s transition phase of labor. The nursing intervention of reassuring touch is effective in the number of verbal expressions of anxiety stated by the subject during the first 30 minutes of the transition phase of labor. The nursing intervention of reassuring touch is effective as expressed by the subject on a self-report questionnaire one to four hours post-delivery regarding the subject’s perception of anxiety expressed during the transition phase of labor. Essential components of nursing practice are: assessment, diagnosis, intervention, and evaluation. These are reflected in the implications as stated below: The effectiveness of the nurse in dealing with the obstetrical patient’s anxiety is contingent upon how accurately she assesses the patient’s responses to impending labor and its meaning for her on the application of nursing intervention arising from sound theoretical base. As a result of this study, it appears that the nursing intervention of reassuring touch can be used as a means to handle the obstetrical patient’s physiological manifestations of anxiety measured by blood pressure and psychological manifestations of anxiety as measured by the subject’s verbal expressions during the transition phase of labor. Among the affects of a diagnostic classification of nursing practice, the most significant should be the providing of nursing care and focus on the patient’s needs and the application of specific nursing intervention. Three pilot studies conducted prior to this investigation identified specific parameters of anxiety which provided a diagnostic classification of anxiety experienced by the woman in the transition phase of labor. This investigation supported reassuring touch as a significant intervention for the woman in the transition phase of labor. The evaluation of nursing practice is facilitated when there is a framework for empirically teaching the effects of an action for a specific diagnosis for a specific diagnosis for which it is prescribed. It was concluded by this study that reassuring touch can be empirically tested in relation to the nursing diagnosis of anxiety as experienced by the woman in the transition phase of labor.