"Special foot massage" as a complimentary therapy in palliative care
Terminal illness often throws up challenges that conventional treatments fail to address satisfactorily. Complimentary therapies such as foot massages are being rediscovered for their particular benefits in palliative care. This article includes a brief description of the process and discusses the author's experience with it's use.
Keywords: Anxiety, complementary therapy, depression and quality of life, palliative, relaxation, special foot massages
Many people with cancer experience pain, anxiety and mood disturbance. Conventional treatments do not always satisfactorily relieve these symptoms and some patients may not be able to tolerate their side effects. Complementary therapies such as acupuncture, mind -body techniques, massage and other methods can help relieve symptoms and improve physical and mental well being.
Complementary therapies are central to the 'caring' paradigm and it is these therapies that offer nurses the opportunity to enhance nursing care for patients. Hence, it is to this area rather than to the medical tasks that nurses should look in developing their scope of professional practice. A large number of complementary therapies involve touch and aim to improve mood and general well being. A variety of behavioural techniques have been developed and tested for managing the psychological and physical reactions associated with cancer, its management and to improve quality of life. When cure is no longer possible and the emphasis of treatment shifts to comfort, care and symptom control, complementary therapies may be particularly beneficial.
Patients with cancer often use massage therapy as an adjunct treatment. Grealish et al , studied the effectiveness of a 10 minute foot massage (5 minute per foot) on 87 subjects and found it to have a significant immediate effect on the perception of pain, nausea and relaxation when measured with a visual analog scale. They recommended the use of foot massage as a complementary therapy and as a relatively simple nursing intervention for patients experiencing nausea or pain related to the cancer experience.
Massage is a systematic and rhythmic form of touch, using certain manipulations of the soft tissues of the body to restore metabolic balance to the same. It is a way of being nurtured, it is relaxing and can help to reduce muscle tension.
The author underwent a specialized training programme in palliative care in UK in 1993 under the late Ms Helen Passant -who had significant experience in the use of massage therapy in palliative care.
An extensive review of related literature was used to develop the 'special foot massage' technique.,,,,,,,,, The steps and the techniques were adapted and the special massage technique was developed and rigorously scrutinized for content validity, inter-rater reliability was established by demonstrating the techniques to five experts from USA, UK, UAE and India. This massage technique was used for her PhD dissertation by the author.
Foot massage is a specific form of massaging which is described in more detail below:
This technique was tried in a group of breast cancer patients undergoing radiation to chest wall and associated drainage areas to test its effectiveness on anxiety, depression and quality of life. It was found to cause a significant reduction in anxiety and depression with significant increases in the quality of life. Foot massage is an important and much neglected aspect of nursing care. Foot massage has physical and psychological benefits for the whole person.
The feet are easily accessible and require no repositioning. While massaging, the nurse can assess the feet, stimulate circulation, decrease edema and provide a local form of passive exercise. Through this therapy patients receive attention and touch, which are vital elements of care that promote comfort and well-being.
Foot massage is a technique by which both the feet of the recipient are held at various positions, stroked gently and rhythmically to attain a relaxation response.
Preparation of environment
Equipments and supplies
Preparation of the patient
Wash your hands with warm water, as a cold touch is not relaxing. Put the patient on the bed or couch with the head on a soft pillow and the feet raised over a hard pillow allowing the heels to hang loose at the foot end of the bed. Put on the audiocassette with the soft, background music. Center oneself, taking a moment to block out all external distractions and try to achieve a state of calmness by focusing on the well being of the patient in an act of unconditional love and caring. Throughout the procedure, one may send vibrations of peace, love and joy to the patient.
First, make a general assessment of both the feet. Look for contraindications such as cuts/wounds/ulcerations/swelling/fractures/toe deformities/ extreme arthritic pain. Examine the feet for color, crease indicating pressure, cleanliness and condition of nails and skin. Take a little 'oil' in your hand and apply it gently to both feet of the patient spreading it evenly.
To relax the foot and to check for flexibility/tension, do each exercise given below, to both the feet, start with the right foot first and cover the left with a towel. Hold the right foot gently but firmly (15 sec) to let the patient feel your presence and touch before you begin.
Now soothe the dorsum and the lateral sides of the foot with gentle strokes (15 secs) using both of one's hands. Cover the right foot and repeat the above steps (A-F) on the left foot: ending by covering the left foot as well (total 2 minutes). If one needs more oil, help oneself to the oil with one hand only, leaving the other hand on the foot; never take off both one's hands from the foot at once, thus, disrupting the contact one has established.
Once again, begin by exposing the right foot, brush and stroke the same from above the ankle to the toes three times and squeeze along both sides of the foot from ankle to toes (15 sec.). Gently rest both your hands one by one at various places on the foot by holding and grasping, providing 'warmth' using the following steps: Stretch the sole, soothe the dorsum from ankle to toes medially, laterally and down towards the heel. Then reverse the movements (15 secs.). Massage smoothly and evenly. All movements have to be soft, with very gentle pressure. Now keep the right foot covered and repeat A-F on the left foot (2 minutes).
Expose both feet now and gently rest both one's hands simultaneously at various places on the feet by holding and grasping, providing 'warmth' using the following steps. Make sure that the time allotted for both feet together must be more than that allotted for each foot seperately.
Repeat the above steps using a massage-rest-massage sequence. Follow this up by stroking both the feet with progressively lighter movements (3 minutes) allowing the patient to go into a deeply relaxed state.
Finish the procedure by quietly covering both feet with the towel. Allow the patient to remain in the relaxed position for 2 minutes.
Total duration of procedure: 20 minutes
Frequency: Daily for 7 consecutive days
Termination: The instructor may stay with the patient until she becomes awake.
Following foot massage, the instructor may observe and record the patient's response, any remarks or reactions of the patient and the general effect of the intervention on the patient as observed and as narrated by the patient.
The elements of massage are both simple and profound. In its essence it is touch. Touch is a vital and basic form of communication, conveying nuances of feeling more expressively and effectively than verbal communication. In depressive states, the caring touch can increase self esteem and encourage verbalization of feelings. For the terminally ill, touch affords comfort and support.
Foot massage is a very effective means of communicating. It provides physical contact in a very acceptable way within the Indian culture. It can be particularly valuable for those who receive little human touch. To be touched in a gentle and unembarrassed way can be very comforting. It is also a good way of getting to know someone well by developing a relationship based on honesty and trust.
[Figure - 1], [Figure - 2], [Figure - 3]