Effectiveness of Guided Imagery on Level of Blood Pressure among PIH Mothers in Selected Hospital at Trichy

 

V. Komathi

Lecturer, Joitiba College of Nursing, Bhandu, Gujarat

 

ABSTRACT:

INTRODUCTION: Pregnancy can be one of life's most exciting and fulfilling adventures. A healthy mom and healthy baby--that's the goal for every pregnancy. Sometimes this is easy, sometimes it requires intensive efforts by the mother, her physicians, her nurses, other health care givers, family members and newborn child's physicians. OBJECTIVE: To evaluate the effectiveness of Guided Imagery on level of blood pressure among PIH mothers. DESIGN: A quantitative approach using quasi experimental pre-test post-test design with control group. PARTICIPANTS: 60 PIH mothers were selected using Non-probability purposive sampling technique in Pankajam Sitharam Hospital at Trichy District, Tamilnadu. INTERVENTIONS: Guided Imagery was given to the mothers in experimental group for 10 minutes duration twice a day for 3 days. TOOL: Sphygmomanometer was used to assess the level of blood pressure. RESULTS: Analysis using paired ‘t’ test was found to be significant. CONCLUSION: The findings of the study revealed that Guided Imagery helps in reducing blood pressure among PIH mothers.

 

 

 

INTRODUCTION:

“Mothers reflect God’s loving presence on earth”

                                                        William R. Webb

 

Maternity is a strange yet breathtaking experience in a woman’s life. A clear joy that comes in her life is overwhelming, when she becomes aware of new life growing inside of body. Every woman wants to have the best possible pregnancy in terms of experience as well as outcomeN2. Some of the medical and obstetric complications during pregnancy may affect the joy of motherhood, imposing threat on physical and psychological well being.

 

Every minute of every day, somewhere in the world, a woman dies from complications related to pregnancy or childbirth. That is, 3,58,000 women, at a minimum, dying every year worldwide. 99% of these deaths occur in developing countries, making maternal mortality the health statistic with the largest disparity between developed and developing countries. In India, one woman dies in every 5 minutes from a pregnancy related causeN19.

 

Hypertensive disorders are one among the common medical complications reported during pregnancy. Pregnancy induced hypertension (PIH) is a form of high blood pressure which develops at the time of pregnancy, usually after 20 weeks in a previously normotensive women. Generally PIH is defined by systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg, in 4 hours or more apart intervalsB4. However a rise in systolic blood pressure of 20-30 mmHg or 10-15 mmHg of diastolic blood pressure or both from pre pregnant baseline value on two or more occasions, 4 hours or more apart is also diagnostic B5. If PIH is left untreated, it may lead to severe complications including eclampsia, shock and hemorrhage for the mother. The risk for fetus due to PIH includes intrauterine death, intrauterine growth retardation, asphyxia and prematurityB5.

 

The conventional treatment modalities of PIH include the use of anti- hypertensive drugs, diuretics, protein rich diet and quiet rest. There is a lot of interest in alternative and complementary therapies for high blood pressure nowadays. This is understandable, since most regular medicines for high blood pressure have undesirable side effects. These side effects often include drowsiness, impaired judgment (sometimes leading to serious accidents), nausea and allergic reactions. Most alternative and complementary medicines for high blood pressure offer relief from the problem without these unwanted effectsN9.

 

Mind – body interventions, particularly biofeedback, Guided Imagery and yoga, have been found to modestly reduce high blood pressure compared with placebo. Guided Imagery is the conscious use of imagination and the mind to create positive images or a setting in order to bring about healthful changes in the body and mind. Guided Imagery was defined by Bresler and Rossman (2003), co founders of the academy for Guided Imagery as “a range of techniques from simple visualization and direct imagery based suggestion through metaphor and story telling”. Guided Imagery is basically used to learn and rehearse skills, more effectively problem solving through visualizing possible outcomes of different alternatives and increase creativity and imaginationN15.

 

One of the most appealing and forgiving features about imagery is that almost anyone can use it. Imagery skips across the barriers of education, class, race, gender and age – a truly equal opportunity intervention. People can invent their own imagery (mental imagery) or they can listen to imagery that has been created for them (Guided Imagery). Thus, Guided Imagery is a simple and convenient relaxation techniqueN15.

 

NEED FOR THE STUDY:

Any medical complication during pregnancy is a threat for two lives – the mother and the fetus. This demand for utmost and efficient care of a woman during pregnancy.

India is among the countries which have a very high maternal mortality ratio. The MMR in India is about 230/1, 00,000 live births for the year 2008. India has set the target of achieving MMR of 109/1, 00,000 live births by the year 2015N19. The problem of PIH is like an iceberg interestingly and it has been one of the major causes of mortality in some countries during last two decades. PIH occurs in about 5% to 8% of all pregnancies globally. Pre eclampsia and eclampsia accounts for more than 50,000 maternal deaths each year. PIH is also associated with fivefold increase in perinatal mortality. Globally, 12% of all maternal deaths are caused by eclampsia. Women younger than 20 or older than 35 have significantly higher morbidity rates. Hypertension in pregnancy also increases the woman’s risk for a caesarean birth. Thus, PIH is a dangerous disorder which can affect the well being of both mother and fetusN8.

 

Imagery is the center of all relaxation techniques designed to release brain chemicals that act as the body’s natural brain tranquilizers, which helps in lowering blood pressure, reducing heart rate, decreasing pain perception, decreasing stress and anxiety. Advocates of imagery contend that the imagination is a potent healer that has long been overlooked by practitioners of western medicine. Imagery can relieve pain, speed healing and help the body subdue hundreds of ailments including depression, impotence, allergies and asthma. The power of mind to influence the body is quite remarkable. Although it is n’t always curative, imagery can be helpful in 90% of problems that people bring to the attention of their primary care physiciansN12.

 

Diane L Tusek., (2006) in his article had reviewed various clinical studies to show that stress during pregnancy and labour can have a negative effect on the health of the mother and baby. Stress during pregnancy can lead to complications during pregnancy and labour, more lower back pain, anxiety, low birth weight, increased risk of miscarriage, premature delivery and soon. Guided meditation and imagery are relaxation techniques clinically proven to help manage pregnancy stress, ease labour pain, improve sleep and reduce complication during pregnancy, labour and DeliveryN6.

 

Zablocki., (2009) in his article “pathways to healing” had reviewed about the various complementary therapies which can be used as pathways to healing. In this article, the author had quoted that Guided Imagery can help to relax and elevate mood, lower blood pressure, reduce painN6. Guided Imagery can be integrated into the current nursing practice which will help to reduce blood pressure of mothers who were diagnosed to have PIH. The researcher wants to try a non pharmacological method for reducing blood pressure among mothers with PIH. So the researcher had selected the topic.

 

STATEMENT OF THE PROBLEM:

 Effectiveness of Guided Imagery on Level of Blood Pressure among PIH Mothers in Selected Hospital at Trichy.

 

OBJECTIVES:

1.      To evaluate the effectiveness of Guided Imagery on level of blood pressure among PIH mothers.

2.      To determine the association between the level of blood pressure among PIH mothers with their selected demographic variables.

 

HYPOTHESIS:

H1: Guided Imagery is effective in reducing blood pressure among PIH mothers.

H2: There is a significant association between the level of blood pressure among PIH mothers with their selected demographic variables (Age, Educational qualification, Occupation, Monthly income, Duration of sleep at night, Family history of PIH, Family history of HT, Body mass index)

 

OPERATIONAL DEFINITIONS:

Effectiveness:

It refers to the outcome of Guided Imagery in terms of reducing blood pressure among PIH mothers.

 

Guided Imagery:

A technique that involves using the imagination and mental images with the help of a picture of natural scenery and related audio script to promote relaxation, thereby bringing about change in level of blood pressure.

 

Blood Pressure:

The term blood pressure refers to the systolic and diastolic pressure measured at a person’s upper arm using sphygmomanometer.

 

PIH:

PIH is raised blood pressure (> 140/90 mm of Hg) developing in a woman during the second and third trimester of pregnancy.

 

ASSUMPTIONS:

·        Guided Imagery is a simple and convenient relaxation technique.

·        Guided Imagery has positive impact on health.

·        Guided Imagery lowers level of anxiety and stress.

·        Guided Imagery is useful for conditions that are made worse by stress such as high blood pressure, pain and headache.

·        Guided Imagery promotes relaxation and improves quality of life.

·        Guided Imagery has no side effects on PIH mothers.

·        Guided Imagery promotes overall well being of PIH mothers.

 

DELIMITATIONS

·        The study is limited to the mothers who are diagnosed to have PIH in Pankajam Sitharam Hospital, Trichy.

·        The study is limited to the data collection period of six weeks.

 

PROJECTED OUTCOME:

·        The study will help the nurses to identify the effectiveness of Guided Imagery on level of blood pressure among PIH mothers.

·        The study will help the nurses to incorporate Guided Imagery in routine nursing care while caring for a woman with PIH.

 

REVIEW OF LITERATURE:

Lylaine Gavette, Joyce Roberts., (2006) conducted a retrospective study among pregnant adolescents to justify the use of mean arterial pressure to predict pregnancy induced hypertension. Using retrospective chart review, data were gathered from 84 nulliparous adolescents, 27 of whom developed PIH and 57 who did not. Second trimester MAP values proved significantly higher for the group with PIH (M=82.2) than for those who remained normotensive (M=71.3) [t (82) =5.74, p=0.000] It was revealed that the mean arterial pressure values proved significantly higher for the group with PIH than for those who remained normotensive. Sandhya Sivakumar., B Vishnu Bhat., Bhawana Ashok Badhe., (2000) conducted an experimental study to evaluate the effect of pregnancy induced hypertension on mothers and their babies. The effects of maternal hypertension on the hematological profiles of neonates were studied in 50 cases comparing the values with that of infants born to normotensive mothers. It was found that there was a higher number of pre term, intra uterine growth retardation and small for gestational age babies among infants born to hypertensive mothers.

 

Emily A. Holmes., Andrew Mathews., (2010) in his article had reviewed the evidences on Guided Imagery and concluded that imagery can evoke emotion in at least three ways: direct influence on emotional systems in the brain, overlap between processes involved in mental imagery and perception which can lead to responding as if to real emotion arousing events and the capacity of images to make contact with memories for emotional episodes in the past. Thus, imagery will be useful in managing emotional disorders and psychological disorders. The authors have also stressed the role of imagery in maintaining emotional disorders and its uses in psychological treatment. Janet.A.Dipietro et.al., (2007) conducted an experimental study at Baltimore, United states among pregnant women to assess the fetal responses to induced maternal relaxation through Guided Imagery. A pre test post test control group design was used. The18 minute Guided Imagery relaxation generated significant changes in maternal heart rate, skin conductance and respiration period. Significant alterations in fetal neurobehaviour were observed, including decreased fetal heart rate, increased FHR variability and suppression of fetal motor activity. Evaluation of correspondence between changes within individual maternal fetal pairs revealed significant associations between maternal autonomic measures and fetal cardiac patterns. Ackerman et.al., (2000) had reviewed that Guided Imagery is a therapeutic technique that allows a person to use his or her own imagination to connect their body and mind to achieve desirable outcomes such as decreased pain and reduced anxiety.

 

Wight Moffatt, Faith. C., (2006) conducted a randomized control trial at Toronto among hypertensive pregnant women regarding the effects of Guided Imagery on blood pressure. They had selected 66 samples who were diagnosed to have PIH, and were allotted to either 15 minute period of Guided Imagery or of quiet rest. Intervention was given twice daily for 4 weeks or until delivery whichever came first. Women allocated to Guided Imagery had significantly lower average daytime ambulatory mean MAP when compared with women allocated quiet rest (GI: M = 1.58 mmHg, SD = 7.63; QR : M = 5.93 mmHg, SD = 6.55; t = 2.36, p = 0.02). It was concluded that guided imagery is easy to use, low cost, acceptable to women, has no risks and it is effective in reducing level of blood pressure among hypertensive pregnant women.

 

Baha Sibai., (2008) in his article in Science Direct reviews that Guided Imagery is a learning process to listen to someone’s voice, relax the breathing and consciously direct the ability to imagine. The effect of vivid imagery sends a message to the emotional control center of the brain. From there the message is passed along to the body’s endocrine, immune & autonomic nervous systems. These systems influence a wide range of bodily functions including heart & breathing rates and blood pressure.

 

CONCEPTUAL FRAMEWORK:

Conceptual framework of this present study was developed based on modified “Ela Joy Lehrmann and Mortens Framework of Midwifery Care”. Lehrman has identified the concepts underlying antenatal care being provided. The author says that there is significant association between the quantitative extent to which midwives are able to put the concepts of midwifery care into practice and the qualitative difference in the care experienced by the woman.

 

 

METHODOLOGY:

 

Description of Guided Imagery Procedure:

The script for Guided Imagery was selected after consulting with a psychologist. The script was translated in Tamil language with the help of language experts. The contents of the script was spoken with soft and clear voice, with correct pronunciation and pacing and recorded in an audio tape. The colour photograph to be used for the specific Guided Imagery script was downloaded from the internet.

 

Pre interventional level of blood pressure was checked for the participants. The researcher asked the participant to wear comfortable and loose clothing. She asked the participant to sit comfortably in a chair. The researcher explained about the scene to be imagined and asked the mother to relax. The theme picture was then handed over to the mother, and the recorded audio was played with the help of a headphone. Other environmental stimuli were kept to the minimum as much as possible in the room. Blood pressure was checked 10 minutes after administering Guided Imagery.

 

Data Collection Procedure:

Prior permission was sought from the selected hospital and obtained. Mothers were informed about the package and procedure of intervention. Informed consent was obtained. The demographic and obstetric data was collected using structured interview questionnaire. Mothers were assigned to experimental and control group, with careful matching of selected demographic variables and pre test MAP level on day 1 of the two groups. Intervention of Guided Imagery was given to the mothers in experimental group using photo and audio CD for 10 minutes, twice a day at 8 am and 8 pm. Blood pressure was checked 10 minutes before and after intervention in experimental group. For control group, blood pressure was checked in the morning and evening at the same time as that of the experimental group.

 

DATA ANALYSIS AND INTERPRETATION

Table 1: Frequency and Percentage Distribution of Mean Arterial Pressure Among Clients with PIH in Experimental Group  N = 30

 

Table 2: Frequency and Percentage Distribution of Mean Arterial Pressure among Clients with PIH in Control Group     N =30

 

TABLE 3. - Paired T Test of Level of Blood Pressure among PIH Mothers In Experimental and Control Group. N = 60

      P< 0.05

 

Table 4: Mean, standard deviation, mean deviation and independent t test on level of blood pressure among PIH mothers    N = 60

P< 0.05 level  ; * - significant, NS – non significant

 

MAJOR FINDINGS OF THE STUDY:

Major study findings include:

With regard to effectiveness of guided imagery on level of blood pressure, the obtained t value for level of blood pressure in  control group was 0.84 which is not significant at p<0.05. For experimental group, the t value obtained was 22.52, which is highly significant at p<0.05 level.

 

With regard to the association between the level of blood pressure with their selected demographic variables such as age, education, occupation, income, duration of sleep at night, family history of PIH, family history of HT and body mass index; there were significant association found with occupation, duration of sleep at night, family history of PIH, family history of HT and body mass index. Other variables like age, education, income were not found to have any significant association with the level of blood pressure.

 

IMPLICATIONS OF THE STUDY:

Nursing practice

The findings of the study clearly point out that guided imagery intervention is effective in reduction of blood pressure of PIH mothers.

The reduction of level of blood pressure of PIH mothers has an important role to play in enabling effectiveness of guided imagery intervention as an independent nursing intervention. This can be facilitated by motivating nurses to:

·        Learn accurate assessment of level of blood pressure with sphygmo manometer

·        Develop sensitivity to the effects of guided imagery on reduction of blood pressure among PIH mothers.

·        Understand the importance of guided imagery intervention as an adjunct to pharmacological therapy.

·        Encourage peer use of guided imagery intervention as a form of relaxation among PIH mothers.

·        Encourage the use of guided imagery intervention in reduction of blood pressure to minimize the requirement of other non - pharmacological management.

Nursing education:

Health personnel may separate the theory and practice while treating the PIH mothers and tend to reduce the level of blood pressure, which cannot be beneficial for the mothers. So nursing educators should motivate students to:

·        Provide adequate clinical exposure to students where guided imagery is used in reduction of blood pressure.

·        Arrange for participation in demonstrating guided imagery techniques by audio visual aids, group conference and bedside clinics.

·        Conduct competitions in developing the best script and audio CD for relaxation through guided imagery.

·        Make available literature related to guided imagery techniques in reduction of blood pressure in the library, for student reference.

 

Nursing administration:

·        Collaborate with the hospital authorities in formulating policies to employ the specially qualified nurses in antenatal ward and periodically supervise their application of guided imagery intervention.

·        Collaborate with hospital authorities in allocating a small budget for purchase of guided imagery pictures, audio CD, CD player, head phones and video projector.

·        Conduct inservice education program on guided imagery and its application in various fields.

·        Provide opportunity for nurses to attend training program on guided imagery techniques while handling the PIH mothers.

 

Nursing research

·        Encourage further research studies on the effectiveness of guided imagery intervention in reduction of blood pressure among PIH mothers.

·        As is evident from the review of literature, more research needs to be conducted on the effectiveness of guided imagery intervention along with other routine procedure in reduction of blood pressure, pain, anxiety, stress, insomnia etc.

·        Disseminate the findings through conferences, seminar publication in professional national and international journals and world wide web.

 

RECOMMENDATIONS:

·        The study can be replicated with a large sample size.

·        The study can be conducted on patients with high blood pressure due to reasons other than PIH.

·        The intervention guided imagery have good effects and can be taught to all the care givers including family members.

·        A study can be conducted to assess the attitude and practice of guided imagery among nurses posted in antenatal ward.

·        The study can be conducted using time series design to evaluate the duration of effectiveness of each guided imagery intervention.

·        A comparative study can be conducted between guided imagery with any other relaxation therapies.

 

CONCLUSION:

The main conclusion from this present study is that most of the PIH mothers in experimental group had severe and moderate level of elevation of mean arterial pressure in pre test and mild and moderate elevation of mean arterial pressure in post test. This shows the imperative need to understand the utilities of guided imagery techniques in reduction of blood pressure among PIH mothers and it will improve the quality of life by preventing the complications of high blood pressure which includes the stability in physiological, psychological, vocational and lifestyle aspects.

 

REFERENCES:

BOOK REFERENCES:

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J5      Lylaine Gavette., Joyce Roberts., (2006). “Use Of Mean Arterial Pressure To Predict Pregnancy Induced Hypertension In Adolescents”, Journal of Nurse-Midwifery, V(32), I(6):357-364.

J6      Mounira Habli et al., (2007)., “Neonatal Outcomes In Pregnancies With Pre Eclampsia Or Gestational Ht And In Normotensive Pregnancies”., AJOG, V(197), I(4): 406e1-406ef.

J7      Prakash J. et al., (2006)., “Hypertension In Pregnancy: Hospital Base Study”, Journal of Association of Physicians in India, V(54): 273-278.

J8      Xu Xiong et al., (2007)., “Impact Of Pregnancy Induced Hypertension On Fetal Growth”., AJOG, V(180), I(1): 207-213.

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N14   Immune Responses to Guided Imagery during Breast Cancer Treatment, www.ncbi.nlm.nih.gov/pubmed Dated on 01-02-2008.

N15   In Search of Inner Wisdom: Guided Mindfulness Meditation in the Context of Suicide,  http://www.soulfulconnections.org/giudedimagery.htm Dated on 05-03-2008.

N16   Lack of Sleep During Pregnancy Up Risk of High Blood Pressure, http://www.businessweek.com/healthday/html Dated on 01-10-10.

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Received on 04.06.2015           Modified on 26.06.2015

Accepted on 27.07.2015           © A&V Publication all right reserved