ABSTRACT
Background
Dysmenorrhoea is a very painful menstruation,
without any abnormality on pelvis. Several theories suggest dysmenorrhoea can
be overcome using the application of warm compress or effleurage technique. The
Objective of this research is to identify
the effectiveness between warm compress and effleurage technique in the
reduction of dysmenorrhoea. Method
Pre experimental design was conducted to 15 female student of which received
warm compress and 15 female student of which received effleurage technique.
Samples were recruited using random sampling. Data were collected using
questionnaire. A Paired Sample T-test and Independent Sample T-test was used to
examine the difference between the two groups.
Result findings There is no significant differences between warm
compress and effleurage technique in the reduction of dysmenorrhoea intensity
(p = 0,310). Both intervention group had significant to reduced dysmenorrhoea intensity (p = 0,00). Conclusion
Warm compress and effleurage technique can be equally used to reduced
dysmenorrhoea intensity.
Keywords : Dysmenorrhoea, Pain
Management, Pain Intensity
A.
Background
Menstruation comonly
may caused the emerge of pain or sickness in abdomen area. This pain
absolutelly disturb if it is not be cured. There are many ways to reduce the
pain for example : through pharmacologics; by using analgesic medicine or anti inflamation
nonsteroid medicine ( NSAID), or
reducing the pain with the intervention or nursing care without using
pharmacologics medicine because nonpharmacologics treatment is safer than
consuming pharmacologics medicine. Pain management by using non pharmacologics
is safer because it is not arising the side effect and using physiological
process. For reducing the pain intensity, it is suggested to use non
pharmacologics pain management, such as : massage, ice therapy, warm compress,
relaxation therapy and hypnosis ( Bare and Smeltzer, 2002 )
Based on the experimental
which is conducted, in Indonesia the rate of Dysmenorhea up to 64.25% which
consist of 54. 89% for primary dysmenorrhea and 9.36% secondary dysmenorrhea ( Info sehat, 2008 ).
Moreover, the research to 89 the students of Nurshing Program of Sriwijaya
University, it is found that 64% of the students get dysmenorrhea and 36% not
get dysmenorrhea. Most of the students
do not try anything to reduce the intensity of the pain and only little part of
them who finding solution to reduce the pain of dysmenorrhea by using cajuput
oil, warm compress and analgesic medicine. Unfortunatelly, the effectiveness of
both treatments are not evaluated yet, and it is necesarry to examine and
compare which one is more effective to reduce or to prevent dysmenorrhea.
B.
Objective
The objective of this
research is to identify the effectiveness between warm compress and effleurage
technique in reducing dysmenorrhea.
C.
Hypothesis
There are differences
between warm compress and effleurage technique through the intensity of
menstruation pain ( Dysmenorrhea ).
D.
Method
Pre experimental design
was conducted to 15 female students of which received warm compress and 15
female students of which received effleurage technique. Samples were recruited
using random sampling with inclution criteria getting primary Dysmenorrhoea,
the average rate of less than 20 years old, and based on the criteria of those
female students do not smoking or having diet, event getting depressed.
Data were
collected by using quetionaire through
two group of samplings. Meanwhile, to measure the intensity of dysmenorrhea
pain is using Mankoski classification. The first group is exemined by taking
warm compress which lies under the stomach for ten minutes at the first day of
getting menstruation. Then, the second group is examine with efflurage by
giving soft touch to the stomache used circle movement ( one direction) and
giving soft pressure for ten minutes at the first day of getting menstruation.
A Paired Sample T- test
and Independentsample T- test was used to examined the difference between two
groups.
E.
The
Analysis
- The
intensity of Menstruation Pain before and after Giving Warm Compress
The sampling which is
taken from 15 respondens, before treating
by warm compress, it is gained that the highest intensity of the pain is 7 and
the lowest intensity of the pain is 3 and the rate of SD is 1.20. After giving
treatment with warm compress, there is 5 for the highest intensity of the pain
and the lowest intensity of the pain is 1, while the rate of intensity of the
pain is 3.13 and the rate of SD is 1.30. The whole respondens having
decreassion after giving treatment with warm compress for ten minutes. The
decreassion of the higest intensity of the pain is 4 and the decreassion of the
lowest intensity of the pain is 1. And the rate for the decreassion of the
intensity of the pain is 2.06 with the rate of SD is 0.961
The painfull of
menstruation of the subjects is caused by the overload prostaglandin secretion in
endometrial area when the subjects get their menstruation. The increassion of
prostagladin number may caused over contraction of uterus, the decreassion of
blood stream to uterus, vasospasme arteriolar, and ischemics of uterus muscle.
The previous research
which is conducted by Akin et all ( 2001) which compared the effectiveness of
giving warm compress intensivelly and
the effectiveness of ibuprofen in reducing of primary dysmenorrhea, it is shown
that warm compress therapy is reducing the
intensity of the pain if it is comparing with the member group of
control who do not get the treatment.
According to Bobak (
2005 ), warm compress is functioned for reducing or preventing the pain of
which the heat from the compress is able to reduce the ischemics because it is
declining the contraction of uterus and defusing blood vessel, so, it may
reduce the suspense and the pain, increase blood steam, and reduce vasocongesti
pelvics. The therapy of heat i s used to cure the pain and it is influenced in
four difference levels;may use local warming to reduce the stimulus or
nociceptor perifer respons around it. Local warming influenced in changing
blood vessel to be vasodilatation; reducing a dismissal from bradikinin,
prostaglandin, and another alogogenics substance ( Thomas, 2006 ).
- The
Intensity of the Pain before and after Effleurage Technique
Before giving treatment
by using Effleurage technique, it is found that the highest intensity of the
pain is 7 and the lowest intensity of the pain is 2 with the rate of mean the pain intensity is 4.8 and the total SD 1.
56. After receiving Effleurage technique, the highest intensity of the pain is
6 and the lowest intensity of the pain is 1, with the rate of the pain
intensity is 3. 06 and the total SD 1. 48.
The sampling from 14 respondens having decreation of the pain intensity
and only one responden who is not responsif after receiving Effleurage
technique for ten minutes. The decreation of the highest intensity of the pain
is 3 levels and the lowest decreation of the pain intensity is 0 level or we
may say that it is not decreased. The rate of mean decreassion of the pain
intensity is 1. 73 with the total SD is 0.798.
The result of this
research is supported Ekowati’s research, Ekowati et all ( 2010 ), it is stated
that massage effleurage technique to abdomen has an effect for the decreassion
of the intensity of the pain for dysmenorrhea. The decreassion of menstruation
pain is occured after giving massage effleurage technique. It stimulates the
tactile fiber of the skin, so, the
signal of the pain can be blocked (Bobak, 2005). According to Meek (1993), soft touch and massage are the integration of
sensory technique which is influenced the activity of otonomous nerve system.
If we perceive a touch as stimulus for relaxing, so, it will arise the respons
of relaxation ( Perry and Potter 2005)
- The Analysis of Influence of Warm Compress
in the Reduction of Dysmenorrhea
Table 1
The Influence of Warm Compress in the
reduction of dysmenorrhea
|
Paired
Differences
|
|||||||
|
|
95% Confidence
Interval
of the Difference
|
|
|||||
|
Mean
|
Std. Deviation
|
Std. Error Mean
|
Lower
|
Upper
|
t
|
Df
|
Sig. (2-tailed)
|
|
2.06667
|
.96115
|
.24817
|
1.53440
|
2.59893
|
8.328
|
14
|
.000
|
b.
The Analysis of Influence of Effleurage technique in the reduction of Dysmenorrhea
Tabel 2
The
Influence of Effleurage technique in the Reduction of Dysmenorrhea
|
Paired
Differences
|
|||||||
|
|
95% Confidence
Interval
of the Difference
|
|
|||||
|
Mean
|
Std. Deviation
|
Std. Error Mean
|
Lower
|
Upper
|
t
|
Df
|
Sig. (2-tailed)
|
|
1.73333
|
.79881
|
.20625
|
1.29097
|
2.17570
|
8.404
|
14
|
.000
|
- The analysis of Effectiveness between Warm
Compress and Effleurage Technique
in the Reduction of Dysmenorrhea
Tabel 3
Perbedaaan Perubahan Tingkat Intensitas Nyeri
Menstruasi Antara Kelompok Kompres Hangat dan Kelompok Teknik Effleurage
|
t-test
for Equality of Means
|
||||||
|
|
95% Confidence
Interval
of the Difference
|
|
||||
|
Mean Difference
|
Std. Error
Difference
|
Lower
|
Upper
|
t
|
Df
|
Sig. (2-tailed)
|
|
.33333
|
.32269
|
-.32766
|
.99433
|
1.033
|
28
|
.310
|
From the table 3, it is shown that
the two treatments; warm compress and
effleurage technique may reduce the pain intensity in menstruation (
dysmenorrhea ). But if we see the differences of the changing of the intensity
the pain, there is no significant differences, p value = 0. 310. It can be concluded
that there is no differences effectiveness between the use of warm compress and
effleurage technique in the reduction dysmenorrhea.
According to Perry and Potter (
2005 ), warm compress and effleurage technique is nonpharmacologics therapy; cutaneus
stimulus, in which skin stimulus is used for reducing the pain. The method of cutaneus
stimulus is not really clear. One of theory stated that this way will stimulate
a dismissal of endorfin which is blocking the transmission of pain stimulation.
Gate – Control Theory stated that cutaneus stimulus activated the fiber of
sensory nerve A – Beta and make it bigger and faster. This proccess is reducing
the transmission of the pain through the fiber C and Delta- A with small
diameter. It will caused the gate sinaps closing the transmission of pain
stimulus.
F.
Conclussion
- The
intensity of the pain of the responden before receiving warm compress, for
the highest intensity of the pain is 7, and the lowest intensity of the
pain is 3, with the rate of mean is 5.2 and total SD is 1. 20
- The
intensity of the pain of the responden after receiving warm compress with
the highest intensity of the pain is 5, and the lowest intensity of the
pain is 1, with the mean rate is 3. 13 and total SD is 1.30.
- The
intensity of the pain of the respondens before effleurage technique with
the highest intensity of the pain 7 and the lowest intensity of the pain
2,and the rate mean is 3. 06 and SD 1. 48.
- The
intensity of the pain of responden after receiving effleurage with the
highest intensity of the pain is 3. 06 and total SD 1. 48.
- From
15 respondens who receive warm compress, it is getting the decreassion of
the mean rate 2.06 and 15 respondens who receive effleurage technique get
decreassion for 1.73. It is shown that warm compress and effleurage
technique is effective in the reduction of the pain intensity of
menstruation. The result of the data to the effectiveness between warm
compress and effleurage technique through the intensity of dysmenorrhea
using independent sample T- test with α = 0, 05 is gained the P value =
0.310, it means that the hyipothesis is not valid or in another word there
is no significant differences between warm compress and effleurage
technique againts dysmenorrhea.
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