Slow Stroke Back Massage

Slow-stroke back massage,or effleurage, is a technique taught in nursing schools. See exhibit
16.1 for a description of how to perfom slow-stroke back massage

Hand Massage

Techniques for performing hand massage are outlined in exhibit 16.2. The techniques are
easy to use with many populations, including older adults (Kolcaba, Schirm & Streiner,
2006;Snyder, Eagan & Burns,1995) as well as infants and children (Field,2002). A suggested
period for administering massage is 21/2 minutes per hand. The length of time is
individualized for each patient, based on response

Exhibit 16.1 Tehnique for Slow-Stroke Back Massage

1. Environment
 The room should be at comfortable temperatur
 The lights should be dimmed
 Noise should be eliminated
 The nurse should keep talking at a minimum
2. The Patient
 Ask the patient whether there is a need to use the bathroom or whether there is
any way the nurse can assist to promote relaxation before beginning the
massage
 The patient should be assisted to a comfortable position
 Clothing should be removed to the back is exposed
 Modesty should be respected
3. The Slow-Stroke Back Massage
 Palms of the hands and fingers are used (effleurage)
 The nurse warms her hands
 The nurse applies nonallergenic lotion to her hands
 Palms of the hands are placed in the sacral area on each side of the spine
 Gentle pressure is applied
 Long, slow, rhythmic, circular strokes are used to move upward on each side
of the spine toward the base of the neck.
 The long, slow, rhythmic, circular strokes are used to move downward on each
side of the spine toward the sacral area
 intervention

Various strokes are used to produce friction and pressure on cutaneous and subcutaneous tissues.
the type of stroke and the amount of pressure chosen depend on the desired outcomes and the
body part being massaged.

There are a number of types of massage: swedish (a massage using long, flowing strokes),
esalen (a meditative massage using light touch), deep tissue or neuromuscular (an intense kneading
of the body). The different types of massage incorporate a variety of strokes, varying levels of
pressure, and a multitude of procedures. Massage strokes can be administered to the entire body or
to specific areas of the body, such as the back, feet, or hands.

The environment in which massage is administered is important. The room must be warm
enough for the person to be comfortable because shivering could negate the effects of the massage.
In addition, privacy needs to be ensured. Adding music and aromatherapy to massage sessions has
been thought to increase the effectiveness of massage. Before administering massage, the nurse
should explain the intervention, obtain a history, and secure the permission of the patient.

MEASUREMENT OF OUTCOMES
Both physiological and psychological outcomes have been used to measure the effectiveness
of massage. Indices of relaxation heart rate, blood pressure, respiration rate, skin temperature,
cortisol level, and muscle tension have been measured in many studies. Anxiety inventories
and scales to determine pain level and quality of sleep as well as quality of life indices have
been used to determine the efficacy of massage. Protocols for the duration of massage are
needed. Typically, massage is dosed at 30 minuter or 60 minute intervals because this is the
duration of time used by massage therapists. The result of a randomized controlled trial (n=
125) used a 60 minute, once weekly dose of massage in an 8 week protocol for osteoarthritis
of the knee (Perlman et al, 2012 ,p. e30248). This was an optimal standard for future dose
finding studies. More research is needed to guide implementation and standardize massage
protocols for other conditions. It is important that short and long term effects of massage be
measured.

Cultursl ASPECTS
Shiatsu, a pressure point type of massage, is popular in japan and other asian countries. Its
underdlying purpose is to rebalance the energy system in the body through pressure on
specific points. Although shiatsu may not be comforting during administration, relaxation is
often felt at the conclusion. Shiatsu may be used to help alleviate other conditions. Taniguki
(2008) found shiatsu therapy to be highly efficacious in managing constipation in six elderly
patients (from 81 years old to 93 years old) who were on bed rest and receiving home care.
 In countries such as japan, acupuncture and moxibustion are often used in addition
to massage therapists who also often have a license to practice acupunture and moxibustion
(hirakawa et al 2005).
In a multicultural qualitative study (kilstoff & Chenoweth, 1998), hand massage
was conducted on Chinese, Italian, Vietnamese, arab, French, and English speaking
participants (n= 39 ; 16 yads of persons with dementia and caregivers; 7 day care staff ) in a
dementia care patient setting. The results showed reduction in stress, decreased agitation,
increased alertness, improved self hygiene, and improved sleep. Family caregivers also
reported less distress, improved sleep, and feelings of calm.
Massage is widely used around the world as illustrated in the accounts of nursing
students (see Sidebar 16.1)

Pain

Reduction of pain is another condition for which massage is often used numerous studies
have found that massage resulted in a reduction of pain. In a reviemw of esearch on the use of
massage and aromatherapy in person with cancer, Wang and keck ( 2004 ) reported a
lessening of pain in posteporative patients, and mok and woo (2004) found that massage
lessened pain in patient with strokes.

Sleep

The from with a study by Richards (1998) using polysomnography as an objective measure
for sleep in hospitalized men (n=69) compared a slow stroke back massage intervention
group between participants using relaxing music and control group. The data did not show
statistically significant result; however, a power analysis indicated a large sample size was
needed. A randomized controlled trial of massage on participant ( n = 57 ) after coronary
artery bypass graft surgery showed decreased fatigue and more effective sleep ( nerbass,
feltrim, de souza, Ykeda, & lorenzi – filho, 2010). Another randomized controlled pilot study
(Haris at al ., 2012) with person with dementia in the nursing home (n=40) used actigraphy to
objectively measure sleep in participants receiving a 3 minute, slow-stroke back massage
compared with a usual-care control condition. There no statisticaly significant differences
between participants in the slow-stroke back massage intervention group and control group.
Although a large sample size was needed, paticipants provided evidence in subjective
comments for clinical significane for the use of slow-stroke back massage for relaxation and
sleep in this population.
 Relaxation

Nurses use massage as an intervention to relieve physiological and psychological stress and
promote relaxation (Harris & Richards, 2010). In a review of 22 studies in which massage
had been used, Richards, Gibsand Overton-McCoy (2000) found that the most commonly
reported out- come was a reduction in anxiety Mok and Woo (2004) collected data on
psychological indicators for decreased anxiety after a 10-minute slow-stroke back massage
on hospi- talized Chinese older patients diagnosed with stroke (n=102, The results showed
statistically significant results at the p = 0.05 level for relaxation using the Spielberger Self-
Evaluation Questionnaire to provide evidence for the decrease in psychological indicators for
stress. Another study (Chen et al, 2012) revealed statistically significant decreases-after bad

massage--in systolic blood pressure (p <0.01), diastolic blood pressue (p <001) pulse (p
<0.01), and respiratory rates (p <0.01), as well as a tistically significant difference in anxiety
(p 0.02) in participants (n=64) with severe congestive heart failure. Several studies using
hand massage reported a decrease in ps ical indicators for stress (Hickes-Moore & Robinson,
2008; Kolcaba ea 2006, Remington, 2002). Two randomized controlled trials on hand sage
(tlickes-Moore & Robinson, 2008, Remington, 2002) use Mansfield Agitation Index (CMAI)
to test the effects of hand reducing agitation. Hickes-Moore and Robinson (2008) and after
(202) reported statistically significant decreases in agitation massage on 1 hour after

Precautions

Ernst (2003) reviewed the literature to determine adverse reations to massage. Although a
numberof negative reactions were noted, the major ity of these were associated with exotic
types of massage and not with the Swedish massage technique. Another review of the
literature ( Batavia, 2004) indicated the following contraindications to performing massage.

III. MANIPULATIVE AND BODY-BASED THERAPIES

Including: arteritis, esophageal varicies, unstable hypotension, advanced respiratory failure,

postmyocardial infraction, aneurysm, emboli, arrhyth-mia, anticoagulant therapy/disease,
herst failure, phelebitas, varicose veins, deep vein thrombosis, tumor and cancer.

The patient’s history of massage gathered by the nurse prior to the intervention provides
information about past use of massage and any adverse responses. It is also important to find
out the person’s overallresponses to touch. Some people may be averse to being touched
because of past negative experiences. Others my be hypersensitive to touch. One method for
evercoming this sensitivity this beginning with ligh touch and slowly increasing the pressure.
The area to be massaged is assessed for rednes, bruises, edema, or rashes prior to performing
massage.

Age-related changes are important considerations for massage. Older adu Age-related
changes are important considerations for massage. Older adults experience more fragile skin
and may take anticoagulants, which could cause bruising with massage. Osteoporosis and
corticosteroids also place the older adult at risk for fracture. Arthritis, Parkinson's disease,
and stroke may limit mobilily, The nurse may need modify massage tech- niques positioning,
and pratocols when considering age-related changes and comorbidities (Rose, 2010)
Massage therapists and nurses have been reluctant to use massage with cancer patients
(Gecsedi, 2002) because of the beliel that the therapy may ini tiate or accelerate metastases.
Guidelines are being developed to govern the use of massage with perions with cancer. A
physician's order is neede body region and technique to be used. Factors considered are the
location othe tumer, the stage of the cancer, and the location of any metastatic lesions.
Pressure in the immrtiat, arra of the cancer isfto be avoided. A pilot study ( n =12) comparing
reflexolugy and Swedish massage to reduce physiologi-cal stress and pain and improve nod
was conducted on nursing home residents with cancer lodgson & Lafferty, 2012). The results
revealed tha both techniques were feasible and produced measurable improvements on
cortisol leves, pain, and mood. The study supports the need to dievelop guidelines for older
adults with cancer in the nursing home.
Because blood pressure my belowered during massage, monitoring for light-headedness Is
suggested following the initial massage session, par-ticularly in older adult If light-
headedness does occur, allowing the person may help to decrease the likelihoad of
hypotension and falls. Monitoring of blood pressure and pulse rate are required in persons
with cardiac conditions, to determine whether adverse effecls are being experienced.

Massage Strokes in Nursing

In 1895, Dr. J. H. Kellog from Battle Creek, Michigan, wrote The Art of Massage to teach
nurses and other practitioners how to use massage tech-niques (Calvert, 2002; Kellog, 1895).
Although early in nursing history massage was prescribed by physicians, nurses responded by
showing leadership to specialize in massage.

Commonly used strokes in administering massage include effleurage, friction, pressure,

petrissage, vibration, and percussion.
 Effleurage

Effleurage is a slow, rhythmic stroking, with light skin contact. Effleurage may be applied
with varying degrees of pressure, depending on the part of the body being massaged and the
outcome desired. The palmar surface of the hands is used for larger surfaces, the thumbs and fingers
for smaller

areas. On large surfaces, long, gliding strokes about 10 inches to 20 inches in length are applied.

Friction Movements

In friction movements, moderate, constant pressure to one area is made with the thumbs or fingers.
The fingers may be held in one place or moved in a small circumscribed area.

Pressure Stroke Stroke

The pressure stroke is similar to the friction stroke, except pressure strokes are made with the whole
hand.

Petrissage

Petrissage, or kneading, involves lifting a large fold of skin and the underlying muscle and holding the
tissue between the thumb and fingers. The tissues are pushed against the bone, then raised and
squeezed in circular movements. The grasp on the tissues is alternately loosened and
tightened.Tissues are supported by one hand while being kneaded with the other Variations include
pinching, rolling, wringing, and kneading with fists or fingers Petrissage is limited to tissues having a
significant muscle mass

Vibration Strokes

Vibation strokes can be administered with either the entire hand or with the fingers, Rapid,
continuous strokes are used. Because administering vibration strokes requires a significant amount
of energy, mechanical vibrators are sometimes used.

Percussion Strokes

For percusion strokes, the wrist acts as a fulcrum for the hand, with the hand hitting the tissue.
Strokes are made with a rapid tempo over a large body area. Tapping and clapping are variants of
percussion strokes.
 Sidebar 16.1. Accounts of Massage of International Nursing

Studens at Carr Collage of Nursing, Harding University,

Searcy, Arkansas

Larissa Pinczuk, Canada

As a missionary who lived in [the] Ukraine, I have travelled a lot and learned about many cultural
practices and traditions. Among numerous home remedies and treatments that I have seen, the use of
massagge therapy seemed quite common, especially in care for the elderly. Some older people who
cannot afford, or are afraid to seek, health care [often] turn to less-costly options, such as using
massagge as a meathod for pain relief. In everyday living, it is also used in the home to relieve anxiety
and correct bad posture. Some people even attend extracurricular massage courses to gain the
professional skills that could better help their sick loved ones at home.

Esi Fosua Yeboah, Ghana

The us of massage therapy in Ghana and the United states is similiar. In Ghana, it is us for relaxation,
increasing circulation, decreasing pain, and inducing sleep. It is also used for treatment of
fibromyalgia and depression. The following comment was writen in 2011 in a blog
(www.massageprofessionals.com/profiles/blogs/initiating-our-association-in-africa) by Yaw Bateng,
who has established a massage theraphy school in Ghana:”the professional of massage has not been
given attention in africa, most especially in Ghana.’’
 III. MANIPULATIVE AND BODY-BASED THERAPIES

Sidebar 16. 1. Accounts of Massage of International Nursing

Student at Carr Collage of Nursing, Harding University,

Searcy, Arkansas ( continud)

Azel Peralta, Philippines

In the Southeast Asian island of the Philippines, one massage technique is called “hilot.” This
means healer or to rub. “Manghihilots,” those who practise the hilot technique, usually learn
their art throught teachings and praktices that have been passed down throught the
generations. Hilot is not something learned through scholling. People in the Philippinie
villages visit Manghihilots to look for a cure instead of traveling many miles to the cities to
see a doctor. Hilot is a holistic art of healing and is used to correct imbalance in the body
such us fluid, energy, fractures, sprains, and dislocations. Hilot is also used used for inducing
labor of pregnant woman. Natural banana leaves and coconut oil, which are staples of these
islands, are used in the proces of locating the problem areas and diagnosing health problems.
Technique can range from a combination of a deep-tissue massage to manipulate muscle
tissue, bones, and joints to using only a stroking or rubbing motion of the fingers.

Sivchhun Hun, Cambodia

Massage therapy is a big part of the lives of Cambodian people. It is used here for various
reasons, including the benefits of relaxation. My parent havea massage thepist visit them at
home daily around evening time. They believe that by receiving massage theraphy before
their bedtime it helps them to relax, to sleep better a night, and to feel better when they wake
up in the morning.
Savira

Massage is a widely used complementary therapy that has been employed by nurses
since the time of florence nigtingale. Early nurse specialisits in massage traced the history of
massage in textbooks such as the theory and practice of massage (goodall –copestake,1919);
massage :An elementary text book for nurses (macafee,1917);fundamental of massage for
students of nursing (jansen,1932) ; and textbook of massage for nurse and beginner
(rawlins,1933). The outhors devoted extensive histories of massage to teach the students
appreciation for the subject ( jensen,1932,p,v). Macafee (1917) wrote “the history of massage
is as old as that of man ...”(p.5). both eastern and western cultures are a part of the history of
the traditionalnursing practice of massage.

In 3000 BCE,the chunese documented the use of massage in cong fau of tao-tse.
There is evidence in sa-tsai-tou-hoei, written in 1000 BCE and published in the 16Th century,
that the japanese also used massage ( calvert,2002;jensen,1932). Goodall-copestake (1919)
record how massage is associated with ancient hindu writings. The japanese translated
massage or shampooing as amma. Natives from the sandwich island used lomi-lomi; the
moris of new zealand used the term romi-romi; and the natives of tong island used toogi-
toogi to mean massage ( kellog,1895,p.12) the french word masser or to shampoo was
applied to massage (goodall-copestake,1919,p.1;jensen,1932,p.20).

The greeks and hippocrates, the father of medicine, incoporated massage into the
practice of medicine. In 380 BEC hippocrates wrote, “A physician must be experiented in ...
rubbing ” (goodall-copestake,1919,p.2). galen used massage principles with gladiator student
in pergamos (jensen,1932; Rawlins,1933). In 1813 ,per. Henrik ling of sweden developed
swedish massage movement at the royal central institute of stockholm. In 1860, Dr johan
mezger of amsterdam used massage on king frederick VII( then crown prince ) of denmark,
and his success promoted the popularity of massage across scandinavia, the netherlands, and
germany ( jensen, 1932).

Although throughout history it has been known as an art and a complementary/

alternative therapy, the practice of massage continouse to build on a robust foundation, and
evidance –based practices related to massage are evolving. In the western world,massage may
be used to treat a disease or syndrome diagnosed by eastern or asian massage is recomended
by eastern medical providers to treat disharmony and imbalance in the human body ( massage
therapy body of knowledge [MTBOK], 2010 ; wieting &cugalj, 2011). Western massage may
use affleurage,patrissage, tapotement, or deep friction ( wieting & cugalj,2011). Eastern
massage practices include shiatsu and may combine several tecniques ( wieting&
cugalj,2011). Today, across all cultures, massage is a holistic intervention that uses the
natural healing process to connect the body, mind,and spirit.
FUTURE RESEARCH

There is lack of rigous research on complementery therapies such as massage. Specific

technique, questions relate to who should administer the massage, spesific protocols, dose-
finding studies, qualitative research, and studies to support the clinical significance of
massage are all areas for futher investigation to build the nursing science in massage. One
challenge in conducting research on massage is having a comparable control group.
McNamara, Burnham, Smith, and Carroll(2003) comparable controlsage and standartdcare in
patients undergoing a diagnostic test.

Reflexology and Swedish massage (Hodgson & Lafferty, 2012) were compared on nursing
hoame residents with cancer. A randomized controlled trial (N= 125) that compared
structural and relaxation massage for low back pain used blinding to test the effectiveness of
treatment for low back pain (Cherkin et al, 2012). More studies are needed that sompare
massage techniques for develloping evidence-based practices. The results of a randomized
controlled trial (n=125;Perlman et al, 2012) showed that a 60-minute, once-weekly dose of
massage was an optimal standard for future dose-finding studies in persons with osteoarthritis
of the knee. The following are suggestion for reasrch that is needed so that practitioners may
have more directionin using massage in clinical settings

 Well-designed studies using blinding, randomization, and attetion control groups with
large sample sizes are needed.
 Few investigators have explored the impact massage has on
psychoneuroimmunological indices. Studies on the use of massage with patients
having HIV infection and cancer would guid nurses in its use with the groups.
 Dose-finding studies for administering massage and the number of sessions that
produce the best results need to be established studies. Because of time constraints in
practice settings, this information would be very helpful to busy practitioners.
 What, if any, is the effect of the gender of the therapist administering massage on the
outcomes obtained ? few studies have reported on the significance of the therapist in
realation to that of the the patient

Penemuan Masa Depan

Kurangnya penelitian yang ketat pada terapi komplementer seperti pijat. Teknik spesifik,
pertanyaan yang berakaitan dengan siapa yaang harus mengola pijat, protokol spesifik, studi
penemuan dosis, penelitian kualitatif dan studi untuk mendukung signifikansi klinis dari pijat
adalah semua area untuk penyelidikan lebih lanjut untuk membangun ilmu keperawatan di
pijat. Salah satu tantangan dalam melakukan penelitian tentang pijat adalah memiliki
kelompok kontrol yang sebanding. McNamara, Burnham, Smith, dan Carroll (2003)
perawatan yang sebanding dan perawatan standar pada pasien yang menjalani tes diagnostik.
Pijat refleksi dan Swedia (Hodgson & Lafferty, 2012) dibandingkan pada penghuni panti
jompo dengan kanker. Sebuah uji coba terkontrol secara acak (N = 125) yang
membandingkan pijat struktural dan relaksasi untuk nyeri punggung yang digunakan
membutakan untuk menguji efektivitas pengobatan untuk nyeri pinggang (Cherkin et al,
2012). Diperlukan lebih banyak lagi studi yang membesarkan teknik-teknik massege untuk
mengembangkan praktik-praktik berbasis bukti. Hasil dari uji coba terkontrol secara acak (n
= 125; Perlman et al, 2012) menunjukkan bahwa 60 menit, pijatan sekali seminggu
merupakan standar optimal untuk penelitian penemuan dosis masa depan pada orang dengan
osteoartritis lutut. Berikut ini adalah saran untuk reasrch yang diperlukan sehingga praktisi
mungkin memiliki lebih banyak arah dalam menggunakan pijat dalam pengaturan klinis.

 Penelitian yang dirancng dengan baik menggunakan kelompok penyamaran,

pengacakan, dan kontrol perhatian dengan ukuran sampel yang besar diperlukan.
 Beberapa peneliti telah menyelidiki dampak pijat pada indeks psikoneuroimunologi.
Pembelajaran tentang penggunaan pijat dengan pasien yang terinfeksi HIV dan kanker
akan memandu perawat dalam penggunaanya dengan kelompok.
 Studi pencarian dosis untuk pemberian pijatan dan jumlah sesi yang menghasilkan
hasil terbaik perlu dilakukan penelitian. Karena keterbatasan waktu dalam pengaturan
latihan, informasi ini akan sangat membantu para praktisi yang sibuk.
 Apa, jika ada, apakah efek gender dari terapis yang memberikan pijatan pada hasil
yang diperoleh? beberapa penelitian telah melaporkan pentingnya terapis dalam
kenyataan dengan pasien
Yoga

SCINTIFIC BASIS

Although massage is both an art and a science, the early nurse mas-sage specialists
recognized massage as a science. Rawlins (1933) stated,"Massage is a science, not a fad of the times"
(p. 19) Jensen (1932) defined massage as "the scientific manipulation of body tissue as a therapeutic
measure" (p. 2).

Florence Nightingale based the use of nonpharmacological inter-ventions such as massage on

the Environmental Adaptation Theory Nightingale believed that nurses should promote the best
possible envi-ronment that would allow natural laws to improve the healing process (Dossey,
Selanders, Beck, & Attewel, 2005).

Today, perhaps due to the relative lack of its study by rigorous research methods, massage is
often thought of as more of an art than a sci-ence. Nurse researcher Dr. Tiffany Fields established the
first center in the world devoted to the science of touch and massage. The Touch Research Institute
was established in 1992 at the University of Miami School of Medicine (Touch Research Institute, n
d). Dr. Field was one of the first to study the effects of massage on weight gain in preterm infants
(Field,2002) and build the capacity for nursing science on massage.

Massage is used by nurses to promote health and wellness. It is used to increase circulation,
relieve pain, induce sleep, reduce anxiety or depression, and improve quality of life (Rose, 2010).
Massage produces therapeutic effects on multiple body systems: integumentary, musculo-skeletal,
cardiovascular, lymph, and nervous. Manipulating the skin and underlying muscle makes the skin
supple. Massage increases or enhances movement in the musculoskeletal system by reducing
swelling, looser and stretching contracted tendons, and aiding in the reduction of soft-tissue
adhesions. Friction to the cutancous and subcutaneous tissues releases histamines that in turn produce
vasodilation of vessels and enhance venous return (Snyder& Taniguki, 2010)

Massage is a proposed mechanism for relaxation to reduce psychological and physiological

stress (Harris & Richards, 2010). Stress is also an individual subjective experience. When the body
interprets a psysiological or psychological response as stressful, the sympathetic nervous system
stimulates the hypothalamic-pituitary-adrenal (HPA) axis in the brain. There is a realese of stress
hormones such as cortisol and epinephrine. Tactile stimulation in the body tissues causes
neurohormonal responses hroughout the nervous system. Mechanoreceptors cause impulses to travel
from the peripheral nervous systen, up the ascending spinal cord to the neuro cortex. The stimulus is
then interpreted in the higher brain resulting in a neurological or biochemical response (Lawton,
2003). Massage activates the parasympathetic nervous system to decrease heart rate, blood pleasure,
and respirations that resutl in relaxation (Maroska, Pollini. Boulanger, Brooks, & Teitlebaum, 2010)

Studies show that massage produces physiological and psychological indicators for the
relaxation responsc (Clarris & Richards, 2010). Using foot massage with cardinc patients, Hattan,
King, and Griffiths (2002) found that subjects receiving this therapy reported feeling much calmer. ln
a quasi-experimental study (n = 24) klolland and Pokorny (2001) showed a statistically significant
difference (p =0.05) in vital signs before and after the slow-stroke massage intervention. The decrease
in vital signs indicates that massage may mediate the stress response (Harris & Richards, 2010)

Reduction of pain, a frequent desired outcome of massage, is closely related to the relaxation
response. Through the relaxation response, massage relieves pain by stimulating the large diameter
nerve fibers that have an inhibitory input on T-cells (Furlan, Imamura, Dryden & Irvin, 2008).
according to Wang and Keck, "massaging the hands and feet stimulates the mechanoreceptors that
activate the nonpainful nerve fibers, preventing pain transmission from reaching consciousness"
(2004, p.59) studies have validated that patients were mare comfortable after the administration of
massage (Frey Law et al, 2008: Wang & Keck, 2004)

In addition, research is emerging on how massage impacts the psycho-neuroimmunological

functions of the body and mind. There was higher natural killer (NK) cytotoxicity and higher daily
weight in preterm infants who received massage in a randomized placebo-controlled trial (Ang et al.,
2012). Billhult, Lindholm, Gunnarsson, and Stener-Victoria (2008) explored the effect of massage on
CD4 + and CD8+ T-cells in women with cancer. Findings revealed that massage had no effect on
these indices. Massage is a holistic therapy that promotes overall health, including emotional well-
being (Currin & Meister, 2008); decreases pain and anxiety during labor (Chang, Wang, & Chen,
2002); and increases quality of life (Williams et al, 2005).

INTERVENTION

Various strokes are used to produce friction and pressure on cutaneous and subcutaneous
tissues. The type of stroke and the amount of pres-sure chosen depend on the desired outcomes and
the body part being massaged There are a number of types of massage: Swedish (a massage using
long,flowing strokes), Esalen (a meditative massage using light touch), dee tissue or neuromuscular
(an intense kneading of the body), sports massage (a vigorous massage to loosen and ease sore
muscles). Shiatsu (a Japanese pressure-point technique to relieve stress), and reflexology (a deep foot
massage that relates to parts of the body). The different types of massage incorporate a variety of
strokes, varying levels of pressure, and a multi-tude of procedures. Massage strokes can be
administered to the entiro body or to specific areas of the body, such as the back, feet, or hands The
environment in which massage is administered is important The room must be warm enough for the
person to be comfortable because shivering could negate the effects of the massage. In addition,
privacy needs to be ensured. Adding music and aromatherapy to massage sessions has been thought to
increase the effectiveness of massage. Before administering massage, the nurse should explain the
intervention, obtain and secure the permission of the patient.